Be wise. Be brave. Be tricky. (slithytove) wrote,
Be wise. Be brave. Be tricky.

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Beldar has a heart attack.

Beldar is a fairly well-known law blogger. He's 47 years old. He ate a burrito and a jalapeño and had some indigestion. It returned the next day. Went to the ER. Oops. It wasn't indigestion. Now he has a stent, and a colorful groin hematoma at the cath site. He says:

The modest pain — a dull ache located not under my sternum, but high on my chest wall, almost over to my left shoulder joint — was not at all the "classical presentation" for heart trouble. I had some sweating, but no nausea or referred/radiated pain elsewhere, and no shortness of breath.

The idea that there is a 'classical presentation' for myocardial infarction—generally what people mean when they say, 'heart attack'—should probably be discarded. It's worthless. My boss, Jim Roberts, Chairman of my department and co-author of this highly-regarded Emergency Medicine textbook, says that when he graduated residency he thought he knew what an MI looked like. Today, thirty years later, he says he has no clue what an MI looks like.

It can look like anything. Pain anywhere between the navel and the eyes. Pain of any conceivable description. Pain like an ulcer. Pain like a gall bladder attack. Pain like shoulder bursitis. Pain like a slipped disk in the neck. Pain like a toothache. It doesn't have be severe pain. It usually isn't 'sharp' pain. The patient may even refuse to call it pain: "Doctor, why do you keep asking me about 'pain'? It isn't pain!" (I avoid even using the word 'pain' nowadays: I say 'discomfort' instead, because so many patients were refusing to say they had pain, when what they were experiencing was 'heaviness', or 'pressure', or 'ache', or 'cold'.) A substantial number of patients with MI have no pain of any kind: in one famous long-term study, a quarter of all patients shown later to have had MIs had no history of pain, or any other symptoms that they could recall.

Now that's scary. How is the patient supposed to know? How is the doctor supposed to know? No, EKGs on everyone aren't the answer. They are frequently falsely negative. Blood tests often aren't helpful. They are often falsely negative during the first six hours after the start of an MI, and may always be negative during 'unstable angina', which isn't an MI, but can turn into one at any moment.

There's no safe answer. I wind up admitting an awful lot of patients, most of whom turn out not to be having an MI, just to catch the few who do. Trying to diagnose MI is like looking for a single, very sharp needle in a very large haystack.

BTW, Beldar's symptoms don't sound anything like 'indigestion', which usually doesn't cause pain near the shoulder or sweating. If you're having chest discomfort and/or shortness of breath, call 911. (Do not drive. Do not let others drive you. Ask the dead people we pull out of private cars in the parking lot a couple of times a year. They'll tell you. In their own way.)

Beldar's blog has photos of posters on the wall of his hospital ward with cute pictures of little girls dressed in anachronistic nurses' uniforms, their index fingers over their lips in the 'Shush!' sign. "They're intended as gentle and humorous reminders to hold the noise levels down, I guess," he says. Actually, probably not. Hospitals have given up on noise control, I'm afraid. The posters are most likely reminders for staff to be mindful of patient privacy, and not discuss patient care in public places, such as elevators or the cafeteria. Patient privacy is currently a high-profile quality improvement issue in medicine.


meaning: dig

発掘== hakkutsu == (noun which can take する to act as a verb) excavation, exhumation
根掘り葉掘り == nehorihahori ==  (adverb, expression) thoroughly, persistently, through-and-through

Left radical is one of the radical forms of 'hand'. Right radical is 'crouch' (see yesterday's kanji). Here the right radical acts phonetically to express 'dig'. This character originally meant, 'crouch and dig by hand'. Henshall suggests as a mnemonic: 'Crouch and dig by hand.'

Info from Taka Kanji Database
List of compounds including this character from Risu Dictionary

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