Overdue update

Quick note: I'm well into my medical education at an osteopathic medical school, and I confess I have let this blog starve from neglect for almost 2 years now.

I plan to post more since I have a bit more time these days, and the problem with facebook is that it is facebook. Here, I may remain slightly more anonymous. At the very least, this page is unlikely to pop up from a google search of my name, and until I am at least in my residency, it's probably best to leave some of my thoughts and opinions separated from my identity. (Especially given the unusually strict nature of the school I currently attend.)

Ok, off to read some renal phys.

The start of the next 7-10 years...

I got into medical school the other day. Funny, but it doesn't seem real yet. I'm not into my first choice, but interview there this month.

I started this blog with the idea that I'd track the various way I prepared for medical school, then I ended up getting waitlisted. Disappointing, but oh well.

In the next 8 months, I need to finish my genetics, calculus, and world religions courses, take 3 more courses in public health (to get my grad certificate), fill out my fafsa... oh yeah, there's plenty left to do.

World Record BAC (as far as we know)

I've seen a few blood alcohols that have been out there. Like, 500 or so a few times, and maybe one that was around 600-something. But while looking at some news websites, I found one that really blew me away: 0.914. And the Bulgarian fellow in question was, apparently, conscious and talking to the medical staff. They repeated the test 5 times before they took the result seriously... I guess I can't blame them for that. One assumes they also checked a blank at some point. This result is yesterday's news, I realize, being 2 years old, but still impressive. Well, I'm teaching today, so I'd better get back to my keynote.

zaius

Meningitis and single-dose Cipro

As often happens, a half-hour of research answered my question. A number of studies listed at the end of this post show that one 500 mg dose of Ciprofloxacin eliminates N. meningitis from nasal passages of carriers somewhere upwards of 95% of the time. In a study of personnel at a naval training center in Britain (abstract, full text available as PDF on same page), researchers reduced prevalence of N. meningitis from 19% to 1.5% after handing out Cipro to 2100 people at the facility.

Grains of salt here: These studies were all done in the late 1980's. Cipro first hit the market in 1987. Reports of N. meningitis that doesn't respond as well to cipro have been found in Spain (free full text) as of 2004. I haven't dug into these articles very far, but thus far the 1099 Dworzack article I used as a source of references found negative nasal swabs 20 days post treatment. Given the presence of N. meningitis in the environment, I wonder if many of the subjects were reinfected at some point after treatment.

Eradication of microbes is not easy, and rarely if ever is achieved for long periods of time.

Meningitis is a hell of an infection, as my experience over the past week has shown me. Incidentally, my brother, who was 3 at the time, almost died of meningitis shortly before I came into the world. They cultured meningococcus from my sister's sputum shortly thereafter, though like most people, she had never been ill.

Someday, I imagine we'll be able to tell why some folks get sick and others don't.

This is giving me a headache. (No neck tenderness yet, though.) Time to give it a rest.

zaius

List of references from
Dworzack, D.L., C.C. Sanders, E.A. Horowitz, J.M. Allais, M. Sookpranee, W.E. Sanders, Jr., and F.M. Ferraro. 1988.Evaluation of Single-Dose Ciprofloxacin in the Eradication of Neisseria meningitidis from Nasopharyngeal Carriers. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 32:1740-1741.

Pugsley, M. P., D. L. Dworzack, E. A. Horowitz, T. A. Cuevas, W. E. Sanders, Jr., and C. C. Sanders. 1987. Efficacy of ciprofloxacin in the treatment of nasopharyngeal carriers of
Neisseria meningitidis. J. Infect. Dis. 156:211-213.

Pugsley, M. P., D. L. Dworzack, J. S. Roccaforte, C. C. Sanders, J. S. Bakken, and W. E. Sanders, Jr. 1988. An open study of the efficacy of a single dose of ciprofloxacin in eliminating the
chronic nasopharyngeal carriage of Neisseria meningitidis. J. Infect. Dis. 157:852-853.

Renkonen, 0. V., A. Sivonen, and R. Visakorpi. 1987. Effect of ciprofloxacin on carrier rate of Neisseria meningitidis in army recruits in Finland. Antimicrob. Agents Chemother. 31:962-
963.

Schwartz, B., A. Al-Ruwais, J. A'ashi, C. V. Broome, A. Al-Tobaiqi, R. F. Fontaine, A. W. Hightower, and S. I. Music. 1988. Comparative efficacy of ceftriaxone and rifampicin in
eradicating pharyngeal carriage of group A Neisseria meningitidis. Lancet i:1239-1242.

Ullman, U., W. Giebel, A. Dalhoff, and P. Koeppe. 1985. Penetration of ciprofloxacin into nasal secretions, p. 1583-1584. In J. Ishigami (ed.), Recent advances in chemotherapy. University
of Tokyo Press, Tokyo.

Eventful week

I never started a blog because I didn't think I had anything particularly interesting to say, but reading cut-to-cure changed my mind. I do not have that writer's experience, and I don't imagine that I ever will, but my collection of experiences might be of interest to a few. Consider this a view of EMS from the trenches.

The past week has been memorable. I needled a chest for the first time recently, and I also used the EZ-IO for the first time on the same patient. It was a traumatic arrest, so I don't count that case as one of my shining achievements. Survival from traumatic arrest being about zero, I guess I don't feel too bad about the outcome, either. The old figure of less than 0.5% is likely far too high, although there is some debate. Weird thing was, he had no obvious external signs of trauma apart from a small lac to the forehead. I guess his car was pretty much a crushed pop can, though. According to the autopsy, he had a transected spinal cord injury. Nothing anyone could do.

I also witnessed a septic patient becoming progressively more symptomatic from DIC until being called upstairs to the (terminal) code blue. (If you guessed gram-negative bacteria as the cause, you win!) In the course of CPR, bluid* shot out from her nose and mouth with each compression. Does it count as an exposure if some of that hit my arm? To make things better, there was an EKG lead in the center of the sternum in a rather unorthodox placement (even for the EASI-lead business) that led to a large bruise over the heel of my right hand until I tore the lead off and repositioned it.[*Bluid: (n.) Any of a dozen blood-tinged fluids encountered in health care. Think of Sangria and you're pretty close, although the slice of orange is optional.]

Prophylaxis after exposure to N. meningitis is administration of one 500 mg ciprofloxacin tablet. I need to look up some info on the rationale behind that, and whether it's actually effective. My uninformed impression is that you might as well give me a tic-tac.

I do hope to have better research, more research, and links to more than other blogs and wikipedia articles in the future, and I'll try to set out some observations about health care, EMS, etc.

For now, I need to sleep.

zaius