Less Laborious Labor with Handheld Stirrups

This newly launched device calls back to my residency days when I delivered babies. I would have had my nurses help birthing moms by supporting their legs by pulling their knees up and to the side of their bellies. Moms could increase their effort in bearing down by pulling on a rolled up towel. PushPal combines these two motions into one that the mother themselves can do:

by pulling on these handheld stirrups:


via MedGadget

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Gracefully Good Doctor

It's been a week since I've been back, but my return from Singapore is still fresh in mind:

I had the severe misfortune of continuing the fevers and chills while en route, here on the ground as well. In fact, after a fitful night, I went to work, looked miserable so Charlie Weiss insisted that I check in as a patient. Sure enough, I had a 102 degree fever, and he suspected influenza. I thought the severity of my fever, chills, green sputum i coughed up and muscle aches would buy me antibiotics, but I was wrong. Charlie sent me home with Tamiflu.

Thank God! I was feeling better the next day, but spent it in bed resting. I didn't think I was up to running around the clinic seeing patients just yet.

Sure enough, the next day, the test results were released: I had influenza A. But this was June friends asked quizzically? Ah, but I just came back from the equator where they have the good fortune of getting flu from both hemispheres equally, all year round. At least I wasn't around any flocks of chickens ;)

This is a shoutout to my buddy Charlie: Thanks for being a gracefully good doctor. You took care of me and sent me home, which means more work for you that day and the next, since I wasn't working along side you! Thanks for seeing my patients!

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Fevers, Chills, 5 Blankets, Oh My!

20 hours on a plane is no fun. 20 hours of fevers & chills on a plane squished into economy class is even less fun. Thank goodness I had a narcotic cough suppressant to keep from hacking on my fellow sufferers, but the fever made me delirious. I had strange dreams of Korean investments in airplane seat layout -- don't ask, it doesn't make sense to me either. Funny thing was, taking a gram of tylenol made me sweat even more. Under 5 blankets, and the stewardesses asking if I was ok. Pretty weird.

No AEDs (Automated External Defibrillators) displayed in Hong Kong, but arriving back in San Francisco I was not only relieved to be home, but also see the AEDs just next to the bathrooms. Way to go, Mayor Brown! Or at least I think that's whose administration the new international wing was built under.

You know what really sucks? We got in 1 hour early, but the bags took an hour to come out. You never win. Really.

The only bright point in the trip was when I got carded by a stewardess when I asked for some german reisling. Yeah, I look that young. That gave me a good laugh, but not for long since laughing made me cough more ;(

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Singapore Changi Terminal 2

I've walked all the way to my departure terminal here in Singapore's beautiful Changi Terminal 2, and no AED (automated electronic defibrillator) in sight. I'm suprised. I'm going to ask the staff what's the deal. I see them all over convention centers and hotels, and suprised they're not more prominently displayed here.

Time is myocardium. Shocking someone out of a non-perfusing rhythm is one of the most effective emergency procedures available.

(image courtesy of sfllaw)

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Medical In-Flight Technology Amenities

The recent scare with my father in law reminds me to do something I haven't for the last few transpacific flights. I usually let the stewardesses know I'm a physician. I've had to come to a half dozen folks' aid over the years, but none of them critically ill, thank goodness.

This time, I'm curious. Not to wish harm on anyone, but I read that Singapore Air has a telemedicine hookup which transmits vitals, oximetry and rhythm strips to MDs on the ground. The MDs then advise the stewardesses how critical the passenger is, and whether or not to attempt an emergency landing. Or God forbid, start resuscitation in-flight. I wonder if they have been instructed in the updated increased compressions-to-breaths ratio that ACLS just changed.

I think the telemedicine device probably works via the satellite internet hookup. It's a bit exorbitant for casual users at $$$ per minute, but for business travellers it probably makes sense for them to pay $40 for 20 hours of broadband connectivity in the air.

We'll see if it has to be used for telemedicine. Hope not, but I'm curious.

I just hope I don't pass this nasty cold to anyone I'd have to take care of on board. Man, just as my vacation ends, I get sick. Isn't that how it always is? I need a vacation from my vacation!

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Mission Impossible: treating chest pain in a third world setting

I recently had the misfortune of assisting my father-in-law get care for chest pain -- in the arrival hall of a foreign airport. Bottomline: don't get sick in a 3rd world country.

When he mentioned it had been there since waking up, varied with twisting his torso, and wasn't worse with lugging the suitcases around, i felt more assured. But what scared me was the increase in pain from walking up the tarmac, and his lightheadedness, as if he'd pass out. I asked the stewardess to call for an ambulance, laid him down on the floor, raised his feet and prayed for the best. They were a bit reluctant until i emphasized i was a doc and showed them my license -- as if they knew what our licences look like!

Fortunately, the ambulance came quickly, but when we loaded him into the rig, i was suprised. No quick check on rhythm -- no defibrillator. No IV to try and improve his hypotension from 80/40. No nitro, but thank goodness we had some on hand. Just some oxygen (or at least some gas coming out of a bubbling tubing), and a bumpy 30 minute ride to the hospital.

Once there, everyone sprang to action, starting IVs, giving the rest of the aspirin he needed, getting an EKG and comparing it to the old one faxed to the ER, and fortunately ruling out for a heart attack with negative test results.

If I were to have to do it over, I think I would have rolled back into the plane, where they had an AED which i could have checked his rhythm with, and had some more basic equipment to stabilize him for transport.

[roll Mission Impossible music]

This mission if you choose to accept it, will include diagnosing a patient with chest pain in a foreign country.

Dream devices for this mission include:

Mobile phone review of his electronic medical record (locked up in Singapore) of past workup of chest pain
PDA aquired EKG (they have these available for palm)
Fax reception via the windows CE HP smartphone we were carrying (to recieve the old ekg)
IV catheters, tubing, and Normal Saline solution
Aspirin, Sublingual nitroglycerin and nitropaste
Portable Oxygen
Medivac by helicopter to the nearest cardiac catheterization lab (if necessary)

Is this too much to ask for? Yeah, probably, but it was what I was wanting 1 week ago...

Don't expect as many firsthand accounts of the need for medical devices in the coming months, but tune in regularly for just as exciting reviews of technologies that are emerging, and available now.

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Welcome to Techmedicine

Hi! I'm Enoch, and I've been an enthusiast of using technology in medicine ever since as a kid, my dad risked the workings of his allergy practice to the shenanigans of my brothers and I jerry-rigging practice management and electronic medical record (EMR) software. I was smitten both with my dad's healing of his patients, as well as the crazy idea that the medieval practice of medicine could benefit from technologic automation. All along undergrad & med school at Brown University as well as Family Practice Residency at UC Davis Modesto, I explored different aspects of Medical Informatics. Fresh out of residency I took a road less traveled, joining an EMR internet startup, Medicalogic/Medscape. It was thrilling to be part of developing and marketing an EMR, participate in an IPO, only to see how difficult it is to entice physicians to change their behavior, resulting in bankrupcy and sale. Since then I've practiced Urgent Care medicine full time at Palo Alto Medical Foundation, while consulting for Epic (our EMR), Healthline, Google, MedGadget.com and Menlo Park Presbyterian Church Medical Missions Board. My interests have trended away from my primary care training towards acute care, disaster relief, and emergency preparedness. Mobile tools have been invaluable in my experiences in Katrina relief, and I'll share my passion for those with you as well.

Blogging has not only given me three years of an expressive outlet for my enthusiasm - it's also let me engage with similarly passionate people through ongoing discussions by linking to and commenting on their blogs. Seeing memes trickle throughout the medical blogosphere has given me hope that this honest & personal form of writing really makes a difference in influencing readers. I'm hoping you'll join me here in a similar fashion, letting me know if i'm all wet, or if i'm on target. I'll point you to the most promising technologies on the horizon, and current technologies that can help you now. How this is different from your favorite medical journal is that I'm interested in engaging in continuing dialogue about what I write about. I hope you are too!

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