My blog cited in JAMA Surgery paper Progress for bloggers

About a year and a half ago, I blogged that a medical student on Twitter used a blog post of mine as evidence. In January, the Canadian Journal of Anesthesia published an article I wrote under my pseudonym called “Why I blog and tweet.”

Last month, medical blogging took another step toward legitimacy. A JAMA Surgery Viewpoint formally cited my post critiquing the Finnish randomized trial of antibiotics versus surgery for the treatment of acute appendicitis.

Here is the first page with the portion of the piece discussing what I had written in the blog post.

Click on figure to enlarge.

Here is how citation appears in the JAMA Surgery article.

If you havent read my entire post about the randomized trial, click here.

Last year I said this: “Journals may have to adapt and become more like blogs. In the future, medical information may be disseminated by blogs and comments rather than journal articles and letters to the editor.”

We have already seen prominent publications such as the New England Journal of Medicine starting online forums and the BMJ hosting blogs (at least 36 so far) and rapid responses to published papers.

The sea change in the way medical research is disseminated may be happening sooner than I thought.

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Code Black Part II It gets worse

Last week, I reviewed the premier of the new medical television series "Code Black" and pointed out several flawed or impossible scenarios. I didnt think Id watch another episode.

But I was alerted to a rather shocking error on last weeks installment. I had to see it for myself.

On this typically chaotic day in the emergency department, a young woman was brought in after a car crash which occurred while she was in her way to the ED because of abdominal pain. A CT scan of her abdomen and pelvis was negative, but her serum lactate level was elevated. They then decided to examine her abdomen and noted tenderness. A bedside ultrasound done in the ED revealed a left ovarian torsion (twisting of the blood supply to the ovary which if not rapidly corrected, could cause irreversible damage). The patient had already had her right ovary removed. Further heightening the drama was that her husband died of lymphoma but had banked his sperm, and the patient wanted to have his baby.

She needed immediate surgery, but all of the hospitals operating rooms were busy. As the window of opportunity to correct the problem was closing, an operating room opened up. But alas, there was not a single gynecologist or surgeon available to do the case. According to the back story about Dr. Neil Hudson, hes a fully trained surgeon who decided to work in emergency medicine. One of the new ED residents begged Dr. Hudson to do the case, and he resisted for a while until it was almost too late.

Despite admitting to having no operating room privileges and surely no malpractice insurance coverage for surgery, Dr. Hudson finally acquiesced. Just before beginning the case, he explained to the OR staff what he was going to do.

Then the egregious error occurred. While scrubbed in the OR and wearing a sterile gloves and gown, he calmly reached up to pull his unsterile mask over his nose and mouth. Thats a no-no.

PS: I could find no reference mentioning an elevated lactate associated with ovarian torsion. The organ is likely too small for ischemia to have any effect on the that lab value.

Some other highlights. For a patient with multiple facial lacerations, Dr. Hudson ligated the maxillary artery—quite a feat in an emergency room without an OR light or any retraction. As you can see from the figure below, the maxillary artery is deep to the jawbone. Not shown are branches of the facial nerve which lie above the artery.

Dr. Leanne Rorich, the all-knowing equivalent of Dr. House, stopped a nosebleed by inserting Foley catheters in each nostril, a well-known trick. However she inflated the balloons with the closest liquid she had on hand—coffee, and the patients blood pressure normalized within seconds.

If the convoluted story of the woman with the ovarian torsion wasnt enough, the patient with the nosebleed happened to be a 14-year-old blind boy on Coumadin who fell while rock climbing with his father.

Stay tuned for the next episode featuring a bus that tumbles off a narrow mountain road while carrying non-compliant hemophiliacs.

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