http://insidesurgery.com/ Inside Surgery en-us Nucleus CMS v3.22 © Weblog http://backend.userland.com/rss http://insidesurgery.com//nucleus/nucleus2.gif http://insidesurgery.com/ http://insidesurgery.com/index.php?itemid=1102 Pennsylvania Plastic Surgeon Being Investigated For Possible Bribery

Dr. Richard Glunk is being investigated by Pennsylvania authorities for allegedly attempting to bribe a member of the Pennsylvania State Board of Medicine. Glunk, a plastic surgeon who practices in King of Prussia, Pennsylvania received a solicitation for and gave a campaign donation from Board Member Rabbi Solomon Isaacson for recent Philadelphia mayoral candidate and current congressman Bob Brady. Glunk has at this time not been formally charged with any crime.

Plastic Surgeons Launch Program To Help Wounded Soldiers

Dr. Donn Chatham, who heads the American Academy of Facial, Plastic, and Reconstructive Surgery, has announced a new program to help soldiers who sustain serious facial wounds. The program, called Faces of Honor, aims to provide more expert care in surgically repairing soldiers and veterans who may not have access to cutting edge treatments in their veterans administration hospitals.]]> Medical News Wire http://insidesurgery.com/index.php?itemid=1102 Sat, 3 Oct 2009 07:48:35 -0700 http://insidesurgery.com/index.php?itemid=1101 HIV Vaccine Trial Shows Partial Effectiveness

A HIV vaccine trial partially sponsored by the United States Army has shown statistical significance in reducing HIV infection in young adults.]]> Medical News Wire http://insidesurgery.com/index.php?itemid=1101 Mon, 28 Sep 2009 17:56:14 -0700 http://insidesurgery.com/index.php?itemid=1099 Woman Dies After Catching Fire During Surgery

Patient Janice McCall of Illinois has died at Vanderbilt Medical Center after suffering burn wounds while she was being operated on at Heartland Regional Medical Center in Marion, Illinois.
]]> Medical News Wire http://insidesurgery.com/index.php?itemid=1099 Fri, 18 Sep 2009 15:30:35 -0700 http://insidesurgery.com/index.php?itemid=1098
Restricted Work Hours For Residents Associated With Increased Complications

A new study has shown that the resident work hour restrictions adopted in 2003 actually leads to an increase in perioperative complications by orthopedic residents. The lead author on the study is orthopedic surgeon Dr. James M. Browne.



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]]> Medical News Wire http://insidesurgery.com/index.php?itemid=1098 Wed, 2 Sep 2009 19:19:42 -0700 http://insidesurgery.com/index.php?itemid=1097
Head of Orthopedic Surgery Society Responds To Obama Inaccuracies

Dr. Joseph D. Zuckerman, President of the American Academy of Orthopaedic Surgeons, responds to statements made by President Barack Obama that he feels unfairly characterize the role of orthopedic surgeons.

Massachusetts Governor Undergoes Successful Hip Replacement Surgery

Dr. Harry Rubash has announced that Governor Deval Patrick has undergone successful hip replacement surgery and is resting comfortably at the Massachusetts General Hospital in Boston, Massachusetts.

Donor Details Selling His Kidney For Cash

Israeli patient Nick Rosen describes selling one of his kidneys four years ago for $20,000.



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]]> Medical News Wire http://insidesurgery.com/index.php?itemid=1097 Tue, 1 Sep 2009 19:13:58 -0700 http://insidesurgery.com/index.php?itemid=1096 Court Reinstates Indictments In Medical Malpractice Conspiracy Case

The United States Court of Appeals for the Ninth Circuit has reinstated in the indictments in the notorious Las Vegas, Nevada "Medical Mafia" case. The medical and legal professionals involved in the case are attorney Noel Gage, former US Army medic Howard Awand, and orthopedic surgeons Dr. John Thalgott and Dr. Mark Kabins.]]> Medical News Wire http://insidesurgery.com/index.php?itemid=1096 Fri, 28 Aug 2009 11:08:57 -0700 http://insidesurgery.com/index.php?itemid=1095
Major news organizations are now reporting that the coroner is likely to rule Jackson's death a homicide. The reported exact doses and schedule of the powerful sedatives prescribed to Jackson are being detailed.

The author of this post is a critical care physician who has wide experience with administering Valium, Ativan, and propofol to patients and who has received propofol as a patient. Some thoughts on the use of these drugs and the care that Jackson reportedly received is below:

Propofol

First and foremost, propofol (Diprivan) should never be given in a home setting: this is grossly outside of the scope of acceptable practice. This drug is a cardiac and respiratory depressant and should only be given by anesthesia and intensive care physicians with wide experience.

Propofol has a relatively short onset of duration and a short duration of effect - if the patient is drug naieve to it. That is, if you only see the drug when you have your colonscopy every five years, it works within seconds of onset and "goes away when it is turned off."

However, it can and will build up in the tissues in patients who have received long infusions of it or shorter, frequent exposure to it and can potentiate additional doses.

Jackson's doctor reportedly said that he injected Jackson and then left the room for a few minutes and when he returned, Jackson had stopped breathing. Patients should NEVER be left alone after being administered propofol, even for a few seconds.

Patients being given this drug must be placed on a heart monitor that detects heart rate and a blood pressure monitor of some type. It is not clear from reports if this was done by Dr. Murray

Jackson's doctor claims he placed an oxygen saturation monitor on the patient. This device is a measure of oxygenation or "O2 saturation" only.

This type of monitor does not measure the respiratory status of a patient or how deeply and how fast a patient is breathing. It does not measure the patients partial pressure of carbon dioxide or PCO2, which is the important respiratory fvalue to monitor when giving propofol and "benzo's".

For example, it is possible to be dead and have a normal oxygen saturation for several minutes.

A physician who does not understand the above described limitations of monitoring is by definition not qualified to administer the drug.

When giving propofol to a non-intubated patient (i.e., without the breathing tube), the maximum initial dose I will use is 10 mgs. Dr. Murray administered 25 mgs after several doses of benzodiazepines (Ativan, Valium, and Versed), which will increase the heart and lung depression effect of propofol.

Patients sedated with propofol are not asleep (as Michael Jackson wished to be) and the use of propofol as a sleep inducer in the United States is outside the scope of standard care.

There is no reversal drug or antidote available to treat a propofol overdose, unlike Ativan, Valium, and Versed (which can be treated with the drug flumazenil.)

Patients who have respiratory depression with propofol need artificially controlled respirations by one of several methods.

A bag mask can be placed over the mouth and nose with air or oxygen forced into the lungs by squeezing it. Alternately, an endotracheal tube (breathing tube) or laryneal mask airway can be placed into the pharynx with air or oxygen delivered to the lungs.

It is not clear from reports if Dr. Murray had these items available when he administered the propofol, but if he did not it would be grossly negligent.

Benzodiazepines (Valium, Ativan, Versed)

Unlike propofol, these drugs are used as sleep inducers, but they are also strong sedatives that have the same respiratory and cardiac depressant effects as propofol.

Reports claim that Jackson was injected with these drugs. It is not clear if the injection was into a vein (intravenously) or into the muscle (intramuscularly or IM.)

Almost universally in the United States, benzodiazepines administered at home are given orally in pill form.

After Jackson was found to be in arrest, it is not clear if he was given flumazenil to reverse the effect of the Valium, Ativan, or Versed or if this was even available.

In medical settings, this reversal drug is typically available in case of overdose.

The dose and timing of the benzo's given to Jackson is not inordinately high for an intensive care setting for a patient on a ventilator, but it is more than would be considered prudent in an outpatient, home setting.

Criminal Charges/Medical Malpractice

If accurate as reported, the administration of these drugs in this manner to Michael Jackson by Dr. Murray is widely deviant from standard of care. It may even be criminally negligent. However, although I am not an attorney or judge, it seems difficult to see how this would fit the charge of murder. It seems unlikely that Murray was intentionally giving Jackson these drugs to harm him.







]]> Musings http://insidesurgery.com/index.php?itemid=1095 Mon, 24 Aug 2009 21:06:32 -0700 http://insidesurgery.com/index.php?itemid=1094 Brain Surgeon Under Investigation For Giving Free Care At Disney Hotel

Neurosurgeon Dr. Paolo Bolognese is under investigation by medical authorities for doing free consultations in the lobby of Disney World's Grand Floridian Resort in Orlando, Florida. Dr. Bolognese does not have a license to practice medicine in Florida and is under investigation in New York for performing unneeded surgeries.]]> Medical News Wire http://insidesurgery.com/index.php?itemid=1094 Mon, 24 Aug 2009 12:16:41 -0700 http://insidesurgery.com/index.php?itemid=1093 Stages of Wound Healing - Stage 1

Healing of wounded tissue is generally considered to occur in four phases. In order, these are coagulation, inflammation, proliferation, and remodeling.

The first coagulation phase of wound healing occurs seconds to one hour after injury. Platelets are the first cellular components to move to the wounded tissue. After platelets aggregate, clot formation occurs with release of the inflammatory mediators platelet-derived growth factor (PDGF) and tissue growth factor. PDGF causes neutrophils, fibroblasts, and macrophages to enter the wound.]]> Tip of the Day http://insidesurgery.com/index.php?itemid=1093 Sun, 23 Aug 2009 06:10:58 -0700 http://insidesurgery.com/index.php?itemid=1092 Steve Jobs Liver Transplant Surgeon Denies Special Treatment

Dr. James Eason denies that Apple CEO and founder bypassed other patients on the waiting list when he received a liver transplant earlier this year for a metastatic neuroendocrine tumor to the liver.

Korean Surgeons Use Robot To Remove Thyroid Cancers

Dr. Woong Youn Chung and his colleagues at Yonsei University College of Medicine have successfully removed over thirty cancerous thyroids using a robot that allows for precise control of the surgical instruments and small incisions.]]> Tip of the Day http://insidesurgery.com/index.php?itemid=1092 Sat, 22 Aug 2009 21:24:04 -0700