Monday, February 09, 2009

Hot Weekend

Like many others, we sweltered over the weekend. But that was nothing - to hear that over 100 people have lost their lives in bushfires in Victoria is devastating. We are yet to hear from all our friends, but we hope that no-one has been injured. At the end of the day, property is replaceable but people aren't.

Maybe it is a reflection of how close we choose to court danger, or how deceptive the risk can be. In any case it is a demonstration of the power of natural events. Sadly this is not the first time, nor will it be the last time - but that should not stop us from picking ourselves off the ground, dusting off the ashes, and building anew. The trees, grasslands, scrub and fauna all do it, and so should we.

It is still disturbing to think about how serious these bushfires have been, I can only divert my ponderings with some clinical content.

Tips for dealing with major burns
Rule of Nines
When assessing the area of burns, a handy rule is that of the nines. Not very precise, but quick and dirty does the job. I have heard this rule attributed to multiple people - so I guess it doesn't matter so much. The palm is around 1% and can be used to estimate smaller burns.

  • Head & Neck - 9%
  • Chest (Front) - 9%
  • Chest (Back) - 9%
  • Abdomen (Front) - 9%
  • Lumbar Region & Buttocks - 9%
  • Each Arm - 9%
  • Each Leg (Front) - 9%
  • Each Leg (Back) - 9%
  • Miscellaneous (Groin / Perineum) - 1%

Adjust in children because the head is bigger (18% instead of 9%) and legs are smaller. Generally I send anything approaching 10% or affecting a critical region (head & neck, perineum, skin flexures or joint lines) to a specialised burns centre.

Burns Thickness
We used to be taught to classify burns as first, second and third degree. It doesn't really matter - either the dermis is intact and a burn is capable of epithelialising on its own (partial thickness) or it cannot (full thickness). Note that whether or not it requires skin grafting does not define the burn thickness - this is based on a multitude of other clinical factors.

If a patient has more than partial thickness burns, do not understimate the depth of the burn. Eschars need debridement firstly to assess the depth of injury and secondly to reduce compartment syndromes and contractures. In burns of the chest and torso they may limit respiratory excursion.

Fluid Losses
Patients with significant burns will lose large amounts of fluid through exudative and transudative losses. Fluid replacement is frequently overlooked. This is most essential over the first 24 hours, but is ongoing until the wound is healed.

Hopefully that will be enough tidbits to keep you busy. And may you all stay safe.

Monday, February 02, 2009

I Don't Understand the NHS

This is probably the domain of Dr Crippen but the more I read about the NHS the worse it seems to be.

What does the NHS Centre for Involvement do?

And do they really really need a National Knowledge and Question Answering Service?. I thought that's what AskJeeves, Universities and libraries were for. Before you know it there will be a Ministry of Truth.

Too bad the NHS' Jargon Buster service doesn't explain what "Involvement" and "Question Answering Service" mean, because it sure as hell has redefined what a Spine is!

Perhaps it is a function of the fact that the NHS is one of the largest employers in the world (over 1.5 million) that they have to find pointless activities for people to do? I vote that they shut down one of these departments and hire more doctors and nurses.

Sunday, February 01, 2009

Happy New Year Blah Blah Blah

After a long break, I have decided to resume my intermittent blogging. I know that it has been some time, and that many of you may have moved on to more regular and more exciting blogs, but nevertheless, I still have the urge to vent.

So I hope that you have all had a good Christmas, Hannukah, New Year, and New Year.

Part of the reason that I have been quiet is that I now find myself on both sides of the fence. All of a sudden, I have been planted inside a palace of power, a domain of dominance... an institution of influence. But enough of the alliterations. I have frequently complained about the powers that be - now even though I may be a speck or a fly on the wall I can see some of the machinations that lead to my complaints, and I am not impressed.

Partly I am not impressed by how bureaucratic and slow large organisations work. Partly I am not impressed with my own lack of enthusiasm at changing any of this. Nominally I may attend a committee that can change things. But I realise now how competing interests dilute progress. And I also see how committees have to justify their own existence.

So I am conflicted - I have better things to do with my time, but I still want to be on the inside, looking for an opportunity to improve things, even a little. Perhaps I am merely a pawn being played by others, but it means that I must be even more careful about what I write and blog about, lest I inadvertently divulge state secrets, or even worse my identity.

And so I leave you with two little tidbits for today:

1. This blog has been nominated for the Inaugural Australian Medical Blog Awards set up by DrCris at AppleQuack and Scalpel's Edge. If you think I deserve it, vote for me. Otherwise feel free to nominate another Australian Medical Blogger, like The Girl.

2. A fascinating piece from The SMH on the fraudsters allegedly dodgy dealings at Advanced Medical Institute. You may recall that these are the group that run are associated with the Heart Check group from my post here and here:

  • Authorities launch investigations into sex ads company - The Sydney Morning Herald
    (Click to Expand)

  • Why erectile dysfunction client wanted his cash back - The Sydney Morning Herald
    (Click to Expand)

  • From Siberian gulag to 'this beautiful country' - The Sydney Morning Herald
    (Click to Expand)