We were pretty slammed and didn't have a whole lot of room in the ER. A lot of people who needed complicated work ups or were waiting for a bed upstairs. I was really just hanging out at the beginning of my shift waiting for things to happen. And that's usually one of two times when badness happens in the ER. When you're sitting around not doing a damn thing or when you're so damn busy that you can't imagine being able to handle anything else. 

So of course that's when we get a call from an EMS crew that they have a guy found slumped in his car on the side of the road. Cardiac arrest. So we get the resuscitation room ready and everyone decides I should put in the central line. Now when you get a call from an ambulance you can never be sure that it'll be exactly what was reported over the EMS radio. Sometimes you're told the patient is in arrest, but they get to the ER and they're alert with a semisteady pulse. Other times you get exactly what you expect. This was one of the latter times.

Patient comes in with full arrest. I go to place the central line in the patient's L thigh after cutting off his clothes. The central line will allow us to dump a lot of fluid in very quickly (in case he's bleeding internally) and deliver heart stimulating drugs directly to his heart even faster than we could with an IV line in his arm. Unfortunately he has no pulse, so it's a bit of a crap shoot. You find the anatomical landmarks and aim for the big vein deep in the thigh. I wasn't doing it briskfully enough so one of the attendings grabbed my syringe and showed me what needed to be done. After you find the vein with the needle, you thread a wire through the syringe and into the vein. Then you make a small nick in the skin with a scalpel, twist in a dilator over the wire to open up the pathway from the skin to the vein, pull that out, and then put in the catheter over the wire, remove the wire, and then suture the catheter into place. 

It sounds a bit easier typing it out than it is in real life. Especially when real life involves people performing full on CPR right next to you. The patient is shaking with each chest compression. You're a bit shaky because you haven't done this before. And the person in front of you is dying. You start to think if you're really cut out for all this. All these people around you have been doing this rather expertly for at least 2 years more than you. They can do it in half the time, maybe less. But they walk you through it, alternating encouraging words with barking orders. 

Once I had the central line in, I went to the side of the bed to assist with chest compressions. It's one of my favorite things to do: it's been shown time and again to save lives, I know what I'm doing, and I'm pretty good at it. At least that's what I've been told. We continued our life-saving efforts for about 20 minutes in total before my attending called the time of death. He was down at least 30 minutes before he got to our ER with EMS. There truly wasn't much more we could do. He never had any electrical activity in his heart and his pupils were fixed and dilated, a sign of brain death. 

We waited for the family to gather and then told them what had happened. That's always the hardest part of any unexpected death. As you begin to talk to the family, they almost always know where you're going. You can see it in their eyes and you feel terrible. We're taught to be direct and stick to the story: what we know about how the patient came to our ER, what we did, and what the outcome was. The last part is always the same. And we're taught to always end with "And despite our best efforts, they died". You never say "they passed" or "there was nothing else we could do" or any other euphimism. It's best to be direct. 

Last night there were about 14 various family members. I'd been involved in talking to family members before after a patient's death. This wasn't the worst time or the best time. Actually, I don't think there's a best time. And maybe every time is the worst time. It doesn't seem like it ever gets easier.

A few hours later, we had to intubate an intoxicated gentleman. I've intubated a handful of people in the OR with anesthesia before surgery, but never someone having difficulty breathing. There's a lot that goes into it... I don't know that the details are very exciting. I made a couple solid attempts but I couldn't get the tube to pass properly into the trachea, so after a couple tries, my senior resident took over and was able to get it in properly. Both he and the attending admitted it was a bit more difficult than they first suspected. We went over my technique and what I could do differently next time. They complimented my effort and the fact that I never seemed rushed or frustrated. But in the end I failed. Which sucks. I'm glad someone got the tube in to help the guy breathe, because he wasn't doing so hot, but I wish I had been able to do it.

Everything that went down last night I had done before in one capacity or another. I've put in central lines in the thigh in the middle of traumas but it's been at least 10 months. And when you haven't done it much before it's easy for your skills to get rusty. I've talked to family's before after a patient's death, but as I said earlier, I don't think it ever gets easier. 

I guess at the end, there's going to more firsts and more 'failures' during first attempts... although I hope not too many. But there's also going to be a lot of second, thirds, fourths, etc. It's a learning process with a damn steep learning curve. Hopefully, I'm climbing well.

And I'm super upset about shallow things.  I mean, I look like hell.  I'm working my ass off in the gym and stuff to burn calories, but I keep gaining weight.  I haven't been eating too terribly, and I'm burning about 500 cals per day anyways...so I don't get it.  Ugh.  My legs are SO HUGE.  All my clothes are too tight.  I seriously don't have ANYTHING to wear.  No jeans that fit.  No shorts that fit.  Nothing.  What the hell?!  I was in a size 4 less than a month ago, and now all of a sudden I have to squeeze myself into an 8.  WHY?!  And I peed on a stick, I'm not pregnant.  So that's out.  I just want to give up.  But then my husband will be repulsed by me. 

By the way...the other day I was looking for my shoes that I had just put by the door to wear...he said he put them in the closet because "Somebody has to clean..."  That broke my heart.  Seriously, it felt like someone took a knife and cut my heart in half.  He never says stuff like that to me.  And then yesterday, I said "Honey, I'm sorry I'm not skinny and cute" he said, "You are cute honey".  *sigh*  So that's confirmation that he thinks I'm a fatass.

Tomorrow begins my diet of sugar free energy drinks, diet pills and depression meds.  I gotta get skinny again.

Anyway here is this weeks Random Wikipedia Page of the Week.

Resusci Anne

Resusci Anne, also known as Rescue Anne or CPR Annie, is a training mannequin used for teaching Cardiopulmonary resuscitation (CPR) to both emergency workers and members of the general public. Resusci Anne was developed by Norwegian toy maker Åsmund Laerdal, based on the research of Peter Safar and James Elam, and was first introduced in 1960. The mannequin is designed to accurately simulate the human respiratory system and external body landmarks in order to facilitate training.

I've actually seen one of these first hand, it breathes, talks and can be injected with needles and has the ability to name the drug and the dosage. It's actually pretty weird at first, the guy who was showing the model to me attempted to put the model in cardiac arrest but failed to do so because the batteries ran low...which caused much disappointment on my part and frustration on his.

Happy Camping!

It started innocently enough on Wednesday night. He didn’t finish his dinner which was extremely unusual. Then after I got the girls to bed, Max started throwing up. After the first time, I got him outside where he threw up again.

It’s not the first time he’s gotten sick and I just figured it wouldn’t be the last either. Thursday morning I found another pile of barf on the floor and noticed he was having a hard time walking.

I knew something was wrong and debated loading everyone up and heading to San Diego so I had family back-up if Max was truly sick and needed medication or constant monitoring. I decided it was way too much work to drive three and a half hours with both kids and potentially a puking dog. So instead I went next door and blurted out to the neighbors something about needing a vet for Max.

Susan, my neighbor told me she knew of one locally and volunteered her son Eddie to go with me. {Just a side note, the Husband is out of town for 30 days for training for work.} Eddie, bless his soul agreed to go with me, not knowing what was even going on.

So we took Max {we equals me, the Big One, the Little One and Eddie carrying the 70-pound terrier}. We were quite the sight bombarding the Vet’s office. We decide they will do some X-rays and blood work to try and figure out what was going on. It was obvious to everyone that my sweet, sweet Max was not feeling well.

After an agonizing four hours, I called the Vet for the verdict. He told me there was "nothing catastrophically wrong" with Max. His white blood cell counts were high, his liver enzymes were high and it looked as if there was a mass on his liver. He recommended bringing Max home with some antibiotics and see if he just had a weird infection. If in the morning he wasn’t well, the Vet recommended either sedating Max and getting another X-ray or doing an ultra sound to determine the problems.

On Thursday night, Max was immobile. He wouldn’t move from the spot he was in. I stayed with him until about 11 p.m. and then went up top bed. I slept off an on and finally came down at 5 a.m. to check on him. He was in the exact same spot I had left him in. I patted him, told him I loved him and left him alone. When I came back downstairs at 7 a.m. Max was in the play room. I had left him in the living room. There was a small glimmer of hope that he was feeling better.

Then I saw it. There was a trail of black sludgy poop from the living room to the play room, but at least I knew he could walk. I called the Vet and told them I wanted an ultrasound. My fabulous friend, Karen, pointed out that what would probably happen if we did the X-ray was that it would be inconclusive and we’d have to do the ultrasound anyway. She was right.

I went next door to summon Eddie again and beg him to come with me. My 70-pound lump of love was too much for me to handle with both kids. He graciously agreed, canceling an appointment he had.

We ended up having to wait at the Vet for an hour just to drop him off. Apparently everybody else’s dog got sick today too.

They explained that they would be starting the procedure in about 30 minutes and that it would take about 30 minutes to do the procedure. I assumed they would call me in about an hour or so.

My sister and mom made the drive up and had just gotten to the house when I noticed it had been almost two hours since we left him. I told them what was happening and then I said it had been two hours so I knew something was wrong. They tried to assure me that the Vet’s office was just running late or dealing with some other issues and not to worry. Not 10 minutes later, the phone rang.

I could tell immediately from the Vet’s tone that something terrible had happened. She was very hesitant and then finally said, “we lost him.”

I screamed and collapsed on the ground in tears which of course set my mom off and freaked the Big One out. She was very concerned and I was trying to be a good mom and not freak her out more. But I failed miserably. Max was my first baby. I had had him for 10 years.

At some point my sister took the phone and spoke to the Vet while I tried unsuccessfully to control my emotions.

After an hour or so, I was ready to go say good-bye. My sister drove me while my mom watched the girls. It was so heartbreaking to see my Max lying there. He looked very peaceful and calm. But he was gone and I am just so, so, so sad.

Apparently after the ultrasound was completed, he started throwing up and then according to the vet, he just “stopped.” Everything stopped. He went into cardiac arrest. She said they got his heart re-started two times, but just couldn’t get him back.

The ultrasound points to lymphoma. His heart, liver, kidneys and lymph nodes were all enlarged. That coupled with the elevated white blood cells indicate cancer. We saw the x-rays and were astonished at how big his heart was.

Well, I wasn’t really all that surprised he was the sweetest, most wonderful dog in the world. I love you Max. And miss you terribly.

This was out Christmas 2006 picture. You can't see the Little One because she was in my tummy. :-)

"Finally, for all those from other media outlets and newspapers who have sarcastically dismissed our initial web story about Sean Avery’s hospitalization since the Rangers refuted it Wednesday afternoon, I wonder:

Was your initial reaction that the story couldn’t have been correct or did you simply race up to the MSG Training Center to get player reaction? And, did you call the hospital and/or Avery’s representatives to get the real story or did your “reporting” simply consist of taking the team’s word for what happened?

Fortunately, the intrepid men an women of the press who have exposed baseball’s steroid problems didn’t similarly regurgitate what they were told by people who understandably want their businesses viewed as beyond reproach."

You can read that in 2 ways. Either he is saying the initial Daily News report was correct, that Avery did go into cardiac arrest, and the Rangers are covering up the truth of Avery's condition... or, Mr. Dellapina is chastising his colleagues at other papers for so quickly dismissing the Daily News reporting, without doing any investigative reporting of their own, simply because the Rangers' PR machine said so.

I think it is the latter, but I guess we will have to wait for the whole truth to come out.  At the very least, Dellapina makes a good point.  We should always question what we read and what we hear.

Avery will be out for the rest of this season, but is expected to make a full recovery.

You can read the SI article here.  ESPN article here.

---

Update, 3:00 PM: Initial reports from the Daily News that said Avery had gone into cardiac arrest and was unconscious are being denied by the Rangers, who say he "walked into the hospital" and was never in a life-threatening situation.

Personally, I want to add that we here at 5-hole.com wish Sean all the best in his recovery and we hope to see him in Broadway blue next year.

A review by The Food and Drug Administration of its databases found reports of 19 sudden deaths in children treated with ADHD drugs and 26 reports of other problems including strokes and fast heart rates between 1999 and 2003.

The American Heart Association (AHA) recommended this week that all children with ADHD, for whom drugs are necessary, should have their hearts checked before taking the drugs. Stimulant drugs can increase blood pressure and heart rate. For most children, that isn't a problem. But in those with heart conditions, it could make them more vulnerable to sudden cardiac arrest or other heart problems. So, the AHA is now recommending a thorough exam, including a family history and an EKG, before children are put on the drugs to make sure that they don't have any undiagnosed heart issues.

This doesn't just apply to children who are about to start taking ADHD drugs, but also those who are already taking them. With careful monitoring, even children with heart conditions can take the drugs.

A screening of 1,000 children at the Children's Hospital of Philadelphia showed that 2% of the children had some kind of heart problem. Whilst that may seem like a small percentage, it isn't small to the families concerned.

An ADHD advocacy group called CHADD said parents should monitor their child's reaction to all medications. EKG screening "will bring an even further measure of safety to what is already a safe clinical treatment approach," the group said. But the American Academy of Child and Adolescent Psychiatry recently updated its treatment guidelines for ADHD, and did not recommend routine EKGs. They worry that the added step in the process to get drugs for their children might deter people from seeking treatment because it's an added expense and hassle.

The AACAP noted that the heart association doesn't recommended EKG screening for young athletes to prevent sudden death. The group has said it wasn't feasible or cost-effective to screen all student athletes. Well, duh. There are a hell of a lot more student athletes than there are children with ADHD. What a stupid reason to argue about the necessity to keep children safe from potential harm from a PHARMACEUTICAL!!!

Personally, I would have thought that parents would want to do what's best for their child, not worry about the extra strain it might put on them?

A spokeswoman for Novartis Pharmaceuticals Corp., which makes Ritalin, said the company had not seen the latest heart association statement and could not comment, but she pointed out that the label does suggest patients be evaluated for heart problems.

Well, at least there's that.

CME providers clamor for needs assessment data to support education interventions. How does your hospital data compare with the national data? Take a look at your data with your QI department. See what you learn. If there appears to be room for improvement in your setting, perhaps the two departments can identify collaborative initiatives that will significantly change the numbers, reduce morbidity, and save some lives, especially on the weekends.

Just a thought.

Raleigh — Cardiac arrest presents more danger to people than heart attacks. Local county health systems, however, are using a special body cooling therapy has improved patient’s chances of survival.

With a heart attack, a person feels chest pain or other related systems but remains conscious. With cardiac arrest, the heart goes into sudden atrial fibrillation: The heart stops pumping blood to the brain, and the person is unconscious.

Time is of the essence for survival and to save the brain from injury.

Cecelia Barbee, 43, of Raleigh, only remembers a severe thunderstorm the night she went into cardiac arrest in August 2007. She woke up to the sound of thunder, then went back to sleep.

Eight-year-old Hydeah, who was sleeping next to her mom, though, noticed something wrong.

“That’s when Hydeah came in the room and said ‘Uncle Reed, Uncle Reed, Mama dead, Mama dead,’” said Willis Hilton, Barbee’s brother, with whom Barbee was staying with at the time.

When Wake EMS arrived, they shocked Barbee’s heart back into rhythm, although she remained in a coma.

That moment held the greatest risk for Barbee’s brain, as the low oxygen supply started brain injury. Medical workers also began the cooling therapy at that moment.

“What hypothermia does is it stops that process and prevents ongoing injury to the brain,” Dr. Paul Hinchey, with Emergency Medicine at WakeMed, said.

EMS workers began induced hypothermia with a cold saline IV and cooling body wraps. At WakeMed, staff inserted a special cold catheter inserted into a large vein in Barbee’s leg. That procedure helped bring Barbee’s body temperature down from a normal 98.6 degrees Fahrenheit to 89.6 degrees for 24 hours.

Wake EMS, WakeMed and Rex Health Care began using the therapy in the fall of 2006.

“We’ve seen a pretty significant improvement both in resuscitation rate, in terms of the number of people who survive,” Hinchey said. “Also we’re seeing and improvement in neurological outcomes.”

Barbee said she was confused and had trouble walking when she first came home.

However, she has recovered to point where she can walk normally. Although her memory sometimes falters, relatives said Barbee has greatly improved.

“There were a lot of good doctors at the hospital that worked really hard to help me get to where I was at,” said Barbee.

Wake County EMS, WakeMed and Rex Health Care were gathering data on the effectiveness of induced hypothermia. Although results will be released in a few months, early indications – including Barbee’s case – are proof that the therapy is helping, Hinchey said.

Wake County was among the first in the country to implement the protocol for certain cardiac arrest patients. UNC Hospitals had a strong role in developing the therapy, and Orange County has also implemented its use.

Additionally, Duke University Medical Center uses induced hypothermia for many cardiac arrest patients. Durham County EMS does not.

Reporter: Allen Mask, M.D.

Copyright 2008 by WRAL.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

While waiting for the ambulance to arrive, what can you do? Take an aspirin. This can help dissolve any blood clots while you are waiting for the professionals.

Finally, the American Heart Association says this:

"The best strategy is to be aware of the early warning signs for heart attack and cardiac arrest and respond to them by calling 9-1-1. If you're driving alone and you start having severe chest pain or discomfort that starts to spread into your arm and up into your jaw pull over and flag down another motorist for help or phone 9-1-1 on a cellular telephone."

Experts Now Recommend Hands-Only CPR
 
By STEPHANIE NANO
Associated Press Writer
 
NEW YORK (AP) -- You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.
 
Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.
 
"You only have to do two things. Call 911 and push hard and fast on the middle of the person's chest," said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.
 
Hands-only CPR calls for uninterrupted chest presses - 100 a minute - until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.
 
This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. The odds are that the person is having cardiac arrest - the heart suddenly stops - which can occur after a heart attack or be caused by other heart problems. In such a case, the victim still has ample air in the lungs and blood and compressions keep blood flowing to the brain, heart and other organs.
 
A child who collapses is more likely to primarily have breathing problems - and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.
 
But in either case, "Something is better than nothing," Sayre said.
 
The CPR guidelines had been inching toward compression-only. The last update, in 2005, put more emphasis on chest pushes by alternating 30 presses with two quick breaths; those "unable or unwilling" to do the breaths could do presses alone.
 
Now the heart association has given equal standing to hands-only CPR. Those who have been trained in traditional cardiopulmonary resuscitation can still opt to use it.
 
Sayre said the association took the unusual step of making the changes now - the next update wasn't due until 2010 - because three studies last year showed hands-only was as good as traditional CPR. Hands-only will be added to CPR training.
 
An estimated 310,000 Americans die each year of cardiac arrest outside hospitals or in emergency rooms. Only about 6 percent of those who are stricken outside a hospital survive, although rates vary by location. People who quickly get CPR while awaiting medical treatment have double or triple the chance of surviving. But less than a third of victims get this essential help.
 
Dr. Gordon Ewy, who's been pushing for hands-only CPR for 15 years, said he was "dancing in the streets" over the heart association's change even though he doesn't think it goes far enough. Ewy (pronounced AY-vee) is director of the University of Arizona Sarver Heart Center in Tucson, where the compression-only technique was pioneered.
 
Ewy said there's no point to giving early breaths in the case of sudden cardiac arrest, and it takes too long to stop compressions to give two breaths - 16 seconds for the average person. He noted that victims often gasp periodically anyway, drawing in a little air on their own.
 
Anonymous surveys show that people are reluctant to do mouth-to-mouth, Ewy said, partly because of fear of infections.
 
"When people are honest, they're not going to do it," he said. "It's not only the yuck factor."
 
In recent years, emergency service dispatchers have been coaching callers in hands-only CPR rather than telling them how to alternate breaths and compressions.
 
"They love it. It's less complicated and the outcomes are better," said Dallas emergency medical services chief Dr. Paul Pepe, who also chairs emergency medicine at the University of Texas Southwestern Medical Center.
 
One person who's been spreading the word about hands-only CPR is Temecula, Calif., chiropractor Jared Hjelmstad, who helped save the life of a fellow health club member in Southern California
 
Hjelmstad, 40, had read about it in a medical journal and used it on Garth Goodall, who collapsed while working out at their gym in February. Hjelmstad's 15-year-old son Josh called 911 in the meantime.
 
Hjelmstad said he pumped on Goodall's chest for more than 12 minutes - encouraged by Goodall's intermittent gasps - until paramedics arrived. He was thrilled to find out the next day that Goodall had survived.
 
On Sunday, he visited Goodall in the hospital where he is recovering from triple bypass surgery.
 
"After this whole thing happened, I was on cloud nine," said Hjelmstad. "I was just fortunate enough to be there."
 
Goodall, a 49-year-old construction contractor, said he had been healthy and fit before the collapse, and there'd been no hint that he had clogged heart arteries.
 
"I was lucky," he said. Had the situation been reversed, "I wouldn't have known what to do."
 
"It's a second lease on life," he added.
 
---
 
On the Net:
 
Heart Association: http://www.americanheart.org/handsonlycpr
 
Sarver Heart Center: http://www.heart.arizona.edu/
 
© 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Learn more about our Privacy Policy.

My thoughts revolved around my Mom and the months after her death in 2004. Sadly, it was only after she died and once we got the autopsy results back that we found out that she had coronary artery disease (CAD) and it was really bad. I don't even think she knew she had a ticking time bomb in her chest. The night she died, she didn't feel well and thought it was just indigestion and went to bed early. Because my Dad wanted her to rest, he slept on the sofa in the living room. Both were always early risers and so the next morning when 10 AM rolled around and my Mom still wasn't up, my Dad went to check on her... Her time of death was said to be around 12:30 AM. There were Tums all over the floor and on the nightstand. It would seem that right to the end, my Mom thought it was just indigestion until it was too late to do anything.

Did you know that Cardiovascular disease is the leading cause of death for Canadian and American women?

On the Canadian Heart And Stroke Foundation website, it lists 9 controllable factors associated to risks and heart disease. My Mom had 6 and only controlled 2.

• She had high blood pressure (took meds)
• She had high cholesterol (took meds)
• She was overweight
• She was physically inactive
• She smoked
• She was really stressed

My Mom also suffered from something that far too many women (Moms) suffer from, something I call "chronic suck-it-up-ism". When she was sick, nobody knew about it. If she was in pain, nobody knew about it. She never complained, not even to my Dad. She also avoided doctors like the plague. I think she preferred not knowing what was wrong with her. So the night she died, she thought she was under the weather. Heart failure is often confused for indigestion or acid reflux.

A couple of weeks later, my Sister and I went to see our doctors. Heart Disease is hereditary and neither of us wanted to suffer the same fate. When my tests came in, I was nervous as hell. I sat across from my doctor and he read me the results. I bust into tears. Everything was normal or better than average. He said to keep doing what I was doing and I wouldn't have any problems...

I continued to do my thing and was in the best shape of my life. I was geared up to run the Montreal Marathon in 2005 but then I had another setback: My ex and I broke-up 2 weeks before the race. I found myself moving that weekend instead of running. I'll spare you the details of the story but after that, I slowly stopped running and before long forgot everything I promised myself I would do but more importantly not do and I got lazy (I have to call it what it is).

What occurred to me this weekend is that I am dishonoring my Mom's memory and have forgotten everything that I learned from her death. I am doing myself a serious disservice at the same time that could lead to much bigger health problems than what I feel now. I used to always say that no matter what religion we believe in, in this lifetime, we are only given 1 body. We owe it to ourselves to treat it well and protect it... Needless to say, those words have now made their way onto my bulletin board. This weekend's epiphany was more powerful and meaningful than anything I could have read in a fitness magazine or website or could have heard from one of the contestants on The Biggest Loser, even though I love that show...

So I decided to start my Marathon training early take advantage of the lovely weather we had this weekend and I went running. I also decided that when I run the Montreal Marathon this year, I will run in honor of my mother - Mary Kilsdonk and raise money for the Heart and Stroke Foundation of Canada.

With all of the backlash that is coming from the Richard Zednik incident, one question that doesn't seem to want to go away, is whether a game should be called after incidents of this magnitude.

Most people remember what happened with Jiri Fischer on November 21, 2005. If you don't, well all you really need to know is that he collapsed while on the bench after his heart went into cardiac arrest. After he was resuscitated by the medical staff at Joe Louis Arena. The game was postponed, and when it was replayed at a later date, the Nashville Predators started the game with the 1-0 lead they held.

Last night, in the aftermath of the the gruesome incident, the game was allowed to carry on after Commissioner Gary Bettman, Director of Hockey Operations Colin Campbell, and both of the team's coaches were consulted. They reached an agreement to play out the remainding 10 minutes of the game when they got word that Zednik was in stable condition.

I strongly believe that the game should have been called, and postponed. I cannot fathom the thought of even trying to play hockey after a friend, teammate, and respected opponent endures a near death experience.

He could be experiencing cardiac arrest. He could be suffering from severe indigestion. He could be in the throes of a major panic attack.

Then again, he might just be trying to show what a manly man he is by grabbing big honkin' handfuls of chest hair through his sweatshirt and yanking at 'em like there's no tomorrow!

I couldn't do that, though, and I know this from experience. All it took was one little through-the-shirt tug from my two-year-old daughter as she tried to scale "Daddy Mountain" to make my eyeballs shoot out of their sockets like bloodshot tether balls and leave me in a quivering, fetal-position heap for about five minutes.

What can I say....I'm a wimp.

This is my 100^th post. If this was a sitcom, I'd be drooling over the possibilities of syndication! Woohoo! But it's a blog and it's been up for just over 6 months.

Also yesterday the blog hit 5000 views and it was the most viewed day ever for the blog. Thanks to everyone for stopping by. I know most of you are looking for monkeys. It's true. I get more hits for monkeys than anything else, but often the monkey seekers take a look around before running off to see other blogs about monkeys. (Psst. Go to Punkeys.com if you want your daily monkey fix.)

On to the post…

Today's centennial post is about an article on CNN.com regarding what not to do. This is a perfect example of how negative thinking can help you in a major situation, like going to the emergency room:

Mason and the emergency room doctors have this advice about what not to do while navigating the ER:

1. Don't forget to call your doctor on the way to the ER

When ER doctors hear from a fellow physician, they listen, says Beiser at the University of Chicago. "They'll talk to me professionally and put a bug in my ear," he says. "This guy will now be on my radar screen."

2. Don't use an ambulance unless you really need it

"There's a myth out there that if you arrive in an ambulance, you'll go straight back to the doctor," Mason says. "But it's not true. If we can see that you can walk, you may get asked to get off that gurney and go to the waiting room."

3. Don't be quiet

If the triage nurse -- that's who makes the decisions about who needs care first -- isn't helping you, don't stop there, says Sayah. "Speak up. Say, 'I need to see the person in charge,'" he says.

4. Don't get angry, and don't lie

While it's important to make yourself heard, it's also important to use basic etiquette.

"We're all human, and usually when people are nice to us, we're nicer back to them," Sayah says.

Lying about your symptoms -- making them seem worse than they really are in hopes of getting attention faster -- can backfire, says Dr. William Bozeman, an emergency room doctor at Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina.

"We have people saying they have crushing sub-sternal chest pain, that they're having a heart attack, when in reality they're trying to get Vicodin for chronic back pain," he says. When the staff figures it out, "They may not be very pleased at all and may not treat you nicely."

5. Don't forget the phone

If things get really bad, and no one is helping you, look for a house phone, dial zero, and ask for the hospital administrator on call, Sayah says. "Even the smallest hospitals have a hospital administrator or a patient advocate on call 24/7," he says. "Hospital administrators don't want to hear patients are unhappy. Their job is to break the hurdles and move forward."

Hopefully you never need to go to the emergency (positive thinking) but if you do, you're now better equipped to help yourself avoid trouble and situations where it could delay treatment (negative thinking). Planning ahead, thinking of the negatives (but not dwelling on them) can put you in a better position to succeed.

Heart disease in the US generally results in expensive care. Yet recent data indicate that we, Americans, are dying of preventable illness at a rate greater than citizens of other developed nations. So why is American healthcare so expensive- waste. It's simple. Everyone wants everything all the time. There is little attention given to actual therapeutic value.

Heart disease specifically suffers from this overuse. Coronary artery surgery, angioplasty, or stents offer little value beyond conservative medical therapy. Yet some of these therapies have as much as a 20% incidence of serious complications. With no demonstrable value.

You must ask your doctor about the benefit of treatment to you. No one else will.

The first case of coronary catheterization was serendipitous: Sones, a pediatric cardiologist at the Cleveland Clinic, accidentally injected radiocontrast in the coronary artery instead of the left ventricle. Although the patient had a reversible cardiac arrest, Sones and Shirey developed the procedure further, and are credited with the discovery.

Sure he caused a reversible cardiac arrest, who hasn't? But he learned from his mistake, saw something of value in his actions and it is now used to treat and diagnose heart issues. His one major mistake has probably saved thousands of lives.

So don't rake yourself over the coals when you do make a mistake, if you learn from them, they no longer become mistakes but opportunities to learn.

A man named Norman noticed an unfamiliar car parked in the company lot that Monday morning as he arrived for work around 8AM. The engine was idling and the windows were foggy. He went inside at first only to come outside again to take another look. When he finally approached the vehicle, he saw it - a black hose taped to the exhaust pipe trailing back into the trunk of the car. The police and paramedics arrived less than five minutes after the 911 call placed by Norman.

The bump, about half the size of a large orange, was first noticed by the paramedics when they pulled me from the reclined drivers' side seat. I was unconsious and unresponsive to pain. I was intubated and we began our ride to the Jersey City Medical Center just outside of Manhattan, where I had an apartment in the West Village at the time.

En route to the hospital, I stopped breathing - and then I came as close to death as one can and still live to tell about it. I was 27 and pulmonary and cardiac arrest were new things to me. To call the experience unique is a grand example of understatement, and looking back over the nine years since that day it seems to me that I had to almost die in order to really live.

Generally the week of nights was ok. Monday night was really hectic and i was busy till 3am. There were several cardiac arrests and i felt a bit of a loose end initially since it has been so long since i have attended an arrest. Unfortunately, on Tuesday I was part of the arrest team that failed to revive a 25 year girl who came in hypothermic and almost asystolic---was really sad! The rest of the week was fine, and eventually my body clock adjusted to my new hours, so now i know i am tired and yet i don't feel sleepy. Bizarrely in this job i will have random one day nights, so my next night on-call is next Tues. Plus i am working Xmas day and the NY weekend. Oh well! This is better than Psych!

Gotta go to bed. Footy tomorrow AM.