From the monthly archives:

November 2008

When John Ritter died, the newspapers said he had a tear in his aorta. Is this common? How do you avoid it?
Fortunately this is not common. From the newspaper reports, it sounds like John Ritter died from an aortic dissection, which is when the largest artery in the body, the aorta, tears along its own vessel wall. Usually this happens to individuals that have high blood pressure, and the aorta wall becomes damaged over time. Then, the blood can start to separate the layers of the vessel wall. This can have catastrophic results. Patients often complain of chest pain and back pain, which is frequently described as “tearing” on the inside. However, it can easily be mistaken for other problems, such as a heart attack which is much more common. ER Stories  had a recent example of his own case of an aortic dissection case too.
Treatment may involve surgery to repair the blood vessel, and agressive blood pressure control.
However, this is a diagnosis you do not want, because it can often result in death. To avoid this and other cardiovascular diseases, focus on good blood pressure control, heart healthy diet, exercise, and no smoking. Also, be very careful when you choose your parents, they will determine your risk for just about everything.

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Here’s a hilarious photograph of a medical office in China  for a subject that is seldom a laughing matter.


There is currently a major national recall of window blinds due to several strangulation deaths of  children. Apparently many of these blinds were sold at IKEA.


I personally have never seen a child who was strangled on a window shade or blind before, but I have to say I am sensitive to the issue. 


As a resident, I was in the ER when a 3 year old girl was brought in with choking.  She had been eating a type of candy that was kind of like a big gummy bear.



Unfortunately, by the time she was brought in to the ER, she was unconscious, and had been without adequate air for about 20 minutes.  We were able to get a tube down her airway, and pull out the candy, but she was brain dead by that time. 


That case made me re-think my entire career. 


The look on her father’s face still haunts me.


I’m curious if anyone has any stories of other choking hazards, and specifically problems with window shades or blinds.



Just reading this from ER Stories makes my ulcer start acting up.  I hate when I’m stuck trying to transfer a patient who is critical and having logistical problems.  Expectations from patients and their families often exceed the reality of our medical system.


A colleague recently saw a newborn child brought in with trouble breathing. He seemed to be trying to cry, but no noise was coming out of his mouth. He was very “floppy”- just no muscular tone at all. Because he couldn’t breath well, he needed to be put on a ventilator to keep his oxygen up. All the tests in the ER came back normal, so there was no explanation for the child behaving this way. He didn’t seem to have any serious infection such as pneumonia, or sepsis. The brain scan was normal. It turned out that the child was from out of the country, and the parents had given him some honey that may have been contaminated.
Laboratory tests showed this child had infant botulism, which resulted in paralysis, to the point where he couldn’t breath on his own. He had to be kept on a mechanical ventilator and admitted to intensive care, until the infection could be treated fully, but he did well, and gradually regained his strength.