Meanwhile 2

Written by Tad. Posted in Kooks

Steven Colbert does a segment on his “A Late Show” that he calls “Meanwhile.” It is a collection of little news items, too small to stand alone as a story on his show. Here is another little “Bad Tad Meanwhile.” A little fact about a patient where there is no more information available or it doesn’t matter. Just weird encounters in the emergency department.

A 74-year-old man claimed he came in to be seen “sooner rather than later” because he didn’t want to be a “bad looking corpse.”

A young man fell on an arrow, which stabbed him up under the chin. It passed through his tongue, the roof of his mouth and into his nasal cavity.

A young woman came in complaining of a “bad infection in my grinder.” I had never heard a woman refer to her vagina as a “grinder” before and have not been able to find such a definition anywhere, even in the likes of Urban Dictionary. Maybe I am just not street wise.

I asked the son of an elderly man if his father had any medical problems. He said, “He has something wrong with his arm.” I pulled up the patient’s sleeve to reveal a dialysis shunt. So, chronic renal failure on dialysis turned into “something wrong with his arm.”

More Bad Tad Meanwhile next time!

Replacement “Mexican Bag”

Written by Tad. Posted in Trauma Strap Bags

Here is a departure from my usual bags. I started making bags to find a use for trauma straps that were otherwise ending up in the trash. Years later, we were eating lunch in a little South Asian grocery store with a little restaurant in it. They had big rolls of nylon straps for sale. I was unable to learn what Indians might use them for but I bought a roll to see what I could come up with.

Here is a picture of the bag I made. I modeled it after a shopping bag we bought when we were on vacation in Mexico in 1992. It has been such a great bag for us for all those years that I decided to recreate it. I have now made two of them and they are great for larger volumes like going the beach. No trauma straps but a fun bag.

Big Chewy Brownie Cookies with Dried Cherries and White Chocolate Chips

Written by Tad. Posted in Cookies

Recipe By: The Mom 100

Summary:

First made during Covid-19 shut down.

Ingredients:

½ cup unsalted butter
2 ounces unsweetened chocolate
12 ounces semisweet chocolate chips
1½ cups all-purpose flour
½ teaspoon baking powder
½ teaspoon salt
4 large eggs
1½ cups sugar, more for flattening
2 teaspoons pure vanilla extract
1 cup white chocolate chips
¾ cup roughly chopped dried cherries

Directions:

1. Heat oven to 350°F. Line baking sheets with parchment.

2. Over double boiler, melt butter, unsweetened and semisweet chocolates, stirring frequently, just until melted and smooth. Allow to cool slightly.

3. In small bowl, combine flour, baking powder, and salt. Set aside.

4. In large bowl, beat eggs, sugar and vanilla with an electric mixer until creamy and yellow, about 1 minute.

5. With mixer on low speed, blend in flour mixture, in a few batches, until just combined.

6. Beat in chocolate mixture until smooth. The batter will be very thick.

7. Stir in white chocolate chips and dried cherries.

8. Scoop out two-tablespoon balls of dough onto prepared baking sheet.

9. Butter the bottom of a drinking glass. Dip it in sugar. Flatten a dough ball. Re-dip glass before flattening each of the other balls.

10. Bake about 13 minutes until tops are crackly and edges are set.

11. Remove from oven and let sit for one minute on baking sheet (the cookies will sink slightly), then transfer to a wire rack.

Red and Silver Bag

Written by Tad. Posted in Trauma Strap Bags

I am coming down to the end of some the colored straps I have been holding on for some time. I had just enough red and silver straps to make this nice little bag.

Banana Chocolate Chip Cookies

Written by Tad. Posted in Cookies

banana chocolate chiip

This recipe was marked “vegan.” I changed oil to butter and threw in an egg. They also had to be cooked way longer than one would expect, maybe because of the water in the banana. I picked this recipe because I had one banana that I needed to use of put in the freezer for future use.

Recipe By:

Adapted from: NYT Cooking

Yield:

16

Ingredients:

1 very ripe medium banana
1/3 cup butter, softened
2/3 cup sugar
1 egg
1 teaspoon vanilla extract
3/4 cup plus 2 tablespoons all-purpose flour
1/2 teaspoon baking soda
1/4 teaspoon salt
1/4 teaspoon ground cinnamon
2 cups rolled oats
1/2 cup chopped walnuts (optional, of course)
1/2 cup chocolate chips

Directions:

1. Heat oven to 350 degrees. Cover 2 baking sheets with parchment.

2. In mixing bowl, mash banana well. Add butter, sugar, egg and vanilla. Mix well.

3. Stir in flour, baking soda, salt and cinnamon.

4. Stir in oatmeal, walnuts and chocolate chips. Mix well, making sure oats are well moistened.

5. Use cookie scoop to form into 2 tablespoon balls. Butter the bottom of a drinking glass. Dip buttered bottom into sugar. Flatten balls somewhat. Redip in sugar before each ball. Place 2 inches apart on a baking sheet.

6. Bake until lightly browned, about 18 minutes. Remove from heat and allow to cool for 2 minutes. Transfer to a rack to cool completely. Store in an airtight container.

 

 

 

 

 

 

Meanwhile

Written by Tad. Posted in Kooks

Steven Colbert does a segment on his “A Late Show” that he calls “Meanwhile.” It is a collection of little news items, too small to stand alone as a story on his show. I would like to do a little “Bad Tad Meanwhile.” A little fact about a patient where there is no more information available or it doesn’t matter. Just weird encounters in the emergency department.
Twice I have had to dig little beads out of the craters in teeth caused by severe cavities. One was in a child and one was a 22-year-old man.
A 20-year-old man came in with a complaint of uncontrollable farting when he gets nervous.
A 22-year-old female was hit in the thigh with a lime that was shot from a gun. I had heard of potato cannons before but never one that had been modified to shoot citrus.
A 38-year-old man came in with a heavy metal ring on penis, which was purple and markedly swollen. I was unable to cut it off (the ring) with anything we had in the hospital. Some passing paramedics saw what was going on. They left and came back with bolt cutters that did the job.
In one shift, I saw had 17-year-old patients who claimed that they couldn’t get pregnant because their husbands “always pull out in time.”
More Bad Tad Meanwhile next time!

Chocolate Chocolate Chip Cookies

Written by Tad. Posted in Cookies

 

How many variations on chocolate and chocolate chip can one cookie blog come up with? I made these during Covid-19 shutdown. They are really rich and chocolaty. Poking a few extra chocolate chips on them and a little sprinkle of sea salt made them beautiful!

Recipe By:

www.modernhoney.com

Yield:

24

Ingredients:

1 cup butter, softened
1 cup brown sugar
1 cup sugar
2 large eggs
1 teaspoon vanilla
⅔ cup cocoa
  cups flour
1 teaspoon baking soda
½ teaspoon salt
2 cups chocolate chips
sea salt flakes, optional

Directions:

1. Heat oven to 350 degrees.

2. In a large mixing bowl, cream together butter, brown sugar, and sugar until light and creamy.

3. Stir in eggs and vanilla. Scrape down sides of the bowl.

4. Stir in cocoa, flour, baking soda, and salt.

5. Fold in chocolate chips.

6. Roll into 2 tablespoon balls. Place on parchment-lined baking sheet. Press more chocolate chunks into the cookie balls, sprinkle with salt flakes, if so desired.

7. Bake about 11 minutes or until cookies begin to puff up and the sides begin to indent. Remove from oven and let sit for 5 minutes before removing from pan.

Cardiogenic Shock

Written by Tad. Posted in Kooks

I was called into the room to see a young, healthy woman who had abdominal pain, vomiting and diarrhea for several days. I found her to have abdominal tenderness and low blood pressure. She was clearly ill. Of specific concern was that her finger tips were blue, a clear sign something bad was keeping her blood from flowing well. It was not at all clear just what would be causing her illness. I told her, her mother and her boyfriend I was worried and I reviewed with them what I was going to do to get some answers and start treating her.

My first focus was on the abdominal pain, vomiting and diarrhea. I ordered pain medication, fluids and antibiotics in case she had an infection. I was thinking maybe her low blood pressure and the poor circulation to her fingers were just from being severely dehydrated. But, we are always thinking of more unusual, bad reasons our patients are sick, so I ordered more tests than I would normally have done. I also had the charge nurse move her to the room right next to my work area so I could keep a close eye on her.

Her lab tests confirmed she was sick but didn’t answer any questions as to why. I wanted to get a CT scan of her abdomen but because her blood pressure was so low, it was not safe to send her to the Radiology Department. Second best, we did an ultrasound at the bedside. It didn’t show anything in her abdomen but, very much to my surprise, it showed a huge pericardial effusion. That is a collection of fluid between the heart and the sack the heart sits in. It usually occurs because of inflammation and, if it is large enough or develops too quickly, it can press on the heart, keeping it from filling adequately with blood. This could cause low blood pressure and poor blood flow to the fingertips.

The treatment of a pericardial effusion is to pass a big, long needle through the skin in the upper abdomen. It is directed up under the ribs, into the heart sack. The hope is that sucking that fluid out will give the heart a better chance to fill with blood so it can pump more efficiently, raising the blood pressure and fixing the circulation.

Draining a pericardial effusion is done very rarely but, if done quickly and correctly, it can be life-saving. I spread antiseptic over her chest and abdomen. I passed the needle up under her ribs into her chest and was immediately able to start drawing fluid out with a syringe. With the ultrasound, I could see when I had removed it all. Unfortunately, I could also see that, even after the fluid was out, her heart was beating very weakly. Taking the fluid out didn’t help her at all.

Now, at least, I had my diagnosis. Cardiogenic shock. That means the heart is beating so weakly it is unable to keep blood moving well enough to get oxygen into all of the tissues. I then was able to concentrate on her heart as I continued treating her.

Unfortunately, she continued doing poorly. Her blood pressure got so low she went unconscious. I intubated her and ordered multiple medications to keep her blood pressure up enough to send her for the CT scan of her abdomen. I still didn’t understand what could cause vomiting, diarrhea, abdominal pain and cardiogenic shock.

He blood pressure improved just well enough for me to risk sending her to Radiology. The CT scan showed inflamed intestines. Nothing else. It looked like she was probably very ill with a virus. That would cause her intestines to be inflamed and give her pain, vomiting and diarrhea. A virus can also inflame the outside covering of the heart, causing the pericardial effusion. Worse, it can inflame the heart muscle itself, causing viral myocarditis, which can cause the heart to beat weakly. Though I had not found anything I could easily fix, at least I had a picture of what was going on. I didn’t feel like I was missing anything.

While all of this was going on, I had also been making phone calls to get her admitted to the hospital. I talked to our cardiologist who said the patient should go to the bigger hospital in the large city a few miles from us. When I contacted them, they said she was too sick and should go to a “university hospital.” The closest place like that to us had no beds and would not accept her. The next closest place was so busy, I could never even talk to a doctor. Finally, I got ahold of an intensive care doctor at a big university hospital about two hours’ driving time from us. He was very helpful, giving me recommendations on how to treat her as we got ready to fly her to where he was.

Unfortunately, I soon learned the helicopters were grounded because of weather. I knew if she went by ground she might die en route. I also knew if she stayed here, she was certainly going to die.

All this time, she just got worse and worse, eventually requiring CPR. I stood at the bedside with the ultrasound probe over her heart. When it stopped beating, we would do CPR for a while and give her adrenalin injections. This would keep her heart beating weakly but when the effect of the CPR and adrenalin wore off, her heart would stop and we could do it again.

Her mother was kneeling on the floor next to me, holding her daughter’s hand, and begging her to live. Her upset, but remarkably under control, boyfriend was by her head. At one point, the boyfriend’s mother came in as well. She put one hand on the patient and one on her son and prayed, asking God to intervene in the patient’s behalf. I stood there with them, feeling I had done everything possible but that she was certainly going to die.

For almost two hours we were there like that. The patient was too sick to be admitted to our hospital and too unstable to be transferred. She got everything I could possibly use to pull her through, but her heart just kept getting weaker and weaker. I was standing there, watching the family cry and pray as her heart slowly gave out. There was nothing I could do about it. Eventually, her heart stopped completely and she was pronounced dead.

I felt physically and emotionally spent. After the family had some time alone with her, I went in and talked with them. I explained what I thought had happened. I reviewed with them what I had tried to do for her. I cried and said I was so sorry for them.

By the time this was over, I could hardly do anything else. I had a hard time focusing my attention elsewhere because my mind would immediately circle back to this case. Though I am good at leaving my work at the hospital, I was not able to do so in this case and it took a long time for me to work through my feelings and get back to normal.

A measure of how difficult this case was is how it affected the emergency department staff. For a couple of weeks, people who were involved with her care were talking about how challenging it had been. For about that same time period, every time I would come in for a shift, the other doctor would say something like, “Hey, I heard about that case you had…” Everyone was talking about it.

So, a young lady that may have just had the stomach flu, died from cardiogenic shock. It could happen to anyone. Why did she have such bad luck? Why did I have the opportunity to be the one with her and her family while she died? Just my luck. Good or bad?

 

 

Michelle’s Chocolate Chip Cookies

Written by Tad. Posted in Cookies

My son-in-law’s mother sent me this recipe. For just a “plain” chocolate chip cookie recipe, I found this to be very easy and the cookies very satisfying for those who like soft cookies. After I tried them the first time, I baked them three more times in a row.

 

Recipe By:

Michelle Hyde

Ingredients:

1 cup butter
2 cups brown sugar
⅓ cup sugar
2 eggs
4 teaspoons vanilla
1 teaspoon baking soda
1 teaspoon baking powder
1 teaspoon salt
3 ½  cups flour
1 teaspoon instant coffee
12 ounces chocolate chips

Directions:

1. Heat oven to 375 degrees. Line baking sheets with parchment.

2. Cream together butter and sugars.

3. Mix in eggs and vanilla.

4. Combine all dry ingredients.

5. Stir dry ingredients into butter mixture.

6. Stir in chocolate chips.

7. Scoop 2-tablespoon balls onto prepared sheets. Bake 10 to 12 minutes. (Took longer than this in my oven to get the edges just a bit browned, my preferred level of doneness.)

Copyright © 2014 Bad Tad, MD