The Martlet; a newsletter where Surgery, Culture, Innovation, Finance and Informatics cohabitate
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What a year it's been for us (and everyone else)!
The surge of COVID requiring Critical Care has largely passed, being replaced by a surge in violence which has been overwhelming Trauma Centers throughout the US.
With penetrating trauma rates nearly double pre-pandemic levels, it's clear that our urban trauma centers are approaching levels seen during the 1980s when cities were plagued by crack cocaine associated crime. Further compounding this crime situation is the apparent increase in very high speed car crashes, unhelmeted motorcycle crashes and all the injuries associated with the electric scooters recently legalized in NY.
Whereas COVID testing consumed much of our entertainment division's time the last few months, this has transitioned into the new dilemma; verifying vaccination status. With no centralized database, and some states banning vaccine passports, it isn't clear how we will solve this last piece of the puzzle to getting back to normal.
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Trauma Surgery plays a leading role in Verdi's
La Forza Del Destino
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In Act I, Don Alvaro drops his pistol, which accidently goes off, fatally wounding the Marquis. The Marquis' son, Don Carlo, whose sister is coincidentally Don Alvaro's clandestine lover, swears to catch Don Alvaro and settle the score.
In Act III, several years later, Alvaro and Carlo are in a battle near Velletri Italy together under assumed names. Since they don't know who the other is, they pledge to be brothers in arm. In this battle, Don Alvaro is "gravely wounded" in the chest. The situation looks hopeless so he asks Don Carlo to burn his collection of love letters (unbeknownst to Carlo the letters are from his sister to Alvaro) should he die. Because Alvaro was unexpected to survive, Carlo reads the letters and realizes it was Alvaro who killed his father and stole his sister. However, the Surgeon is able to save Alvaro's life and he makes a full recovery. You can probably imagine how the rest of the story goes.....
We've all seen plenty of "trauma drama", but it's reassuring to know Surgeons were seeing it in 1862!
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Ever had a patient with actual horns?
The Pitfalls of Subdermal Implants
First introduced in 1994, subdermal implants have become increasingly popular in the body modification community. Unlike more traditional adornments like piercings and tattoos, subdermal implants require an actual surgical procedure, albeit a fairly simple one. An incision is made into the subcutaneous tissue, and a pocket is created using an elevator or other similar instrument. The implant is then inserted and the incision is sutured closed. The artist may apply a pressure bandage to keep the implant firmly in place for the first few days of healing.
While this seems like a straightforward procedure, it can be fraught with problems for the recipient. Since the artist isn’t a licensed medical professional, the entire procedure must be performed without any kind of anesthetic. In addition, most artists aren’t trained or equipped to provide the level of sterility found in the surgical theatre, so infection is a major concern. The implants themselves aren’t subject to the stringent regulations of medical implants, making negative reactions and rejection more likely. Perhaps the most common and least well-known complication is tissue resorption. With movement, the implant rubs against the tissue around it, wearing it away over time, causing permanent damage to muscles, nerves and even bone. The only remedy for any of these complications is to remove the implant. If you’re called upon to perform this procedure, you may want to use billing code T85.698A: Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter.
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Which apps are the most helpful when you're on call?
Part 1: Medical Calculators
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How do you calculate a FeNa? What's the Pediatric Glasgow Coma Score? Is a CT indicated in this infant that fell off the sofa?
These are questions that I'm pretty sure you run into if you take call. Thankfully, there's a myriad of medical calculators that can answer your questions.
The most practical one is "Calculate by QxMD". The nice thing is that you can set your favorites so you have the things you need as a homepage.
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Easy Money: Are you getting 100% of the professional fees when your APP does a note? |
You should be. If an attending merely co-signs the APP note, or places a boilerplate supervisory statement, then you're only getting 80%. To get 100%, the addendum must include a physical exam and some type of assessment.
An easy way to make technology work for you is to create a supervisory statement that either includes a single point of physical exam that could apply to most patients, and use dynamic fields to include an auto-populated assessment. For example, "abdomen was soft and non-tender" could apply to most patients, so hardwire that into a "dot phrase" or expandable acronym. Then use dynamic codes to pull in age, diagnosis and length of stay.
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