# 292 Are you getting hungry?
Have you noticed whether the eating facility where you work tends to run out of food? Does it have much storage space? Just how many days of food does it have stockpiled? Does it rely on a logistical plan of "Just-in-time" deliveries? Is roadway access such that it might be disrupted during unusual weather or community emergency?
Answers may not be revealed outside of some 'small meeting rooms'. Frankly, if there is a disaster, demands for food may go way-y-y up! Staff will hold over. Off-duty staff and neighbors may volunteer. Patients may not be easily be discharged if there is road or outside facilities disruption. Displaced families of patients and volunteers may camp in the hospital and need food. When neighborhood supplies are consumed (two days), the public will line up hoping for a soup kitchen. Their estimates of how much food is stored may not accord with realitiy.
Unfortunately, running a good emergency facility necessitates butting our noses into the planning of other departments and administrators who want to tell us that "we've got it covered." But, hard questions must be asked by those on the "tip of the spear" or the "bleeding edge." Yes, other departments must execute, but they need to have the same sense of urgency as we. It is likely that they expect to get extra deliveries from their regular suppliers under good conditions, and are unlikely to have considered broken roadways, electrical lines down, water contamination, and gas leaks. If the kitchen is unserviceable, do they have a satellite location prepped to pick up the slack? Will it keep crowds away from functioning buildings? Are there long-storage foodstuffs laid away to last for a week or two with a feeding population thrice normal capacity?
California Wildfires. Earthquakes. Hurricanes (e.g., Katrina or Sandy). Floods & landslides (may follow fires or earthquakes). Large explosions. Terrorist attacks. In the Tokyo Sarin Release, one hospital received 600 patients in the first hour.
We have to think big. We have to be clever. With increasing urbanization, the populace are unaccustomed to "laying up supplies for the winter." Supply and service shortfalls are expected to be made up by the government, which does not have a good track record of prompt response. Needs unmet, lead to looting and disorder, compounding other problems.
How many of your department's people will serve on the needed committees and press for ample and urgent preparation?
# 291 My finger snaps and gets stuck!
A patient may say to you: "Sometimes, when I'm asleep or waking up, or my hand is overtired, this finger may just snap into a locked position. It hurts, and it hurts at the base of the finger when I touch it." You do a short confirmatory exam. You tell the patient: "This is Trigger Finger Syndrome" (sometimes called 'stenosing tenosynovitis'). The diagnosis is clinical, not usually needing X-Rays.
Inflammation of the tendon and its sheath leads to a 'catching' sensation and a painful snapping as it is released from flexion. A nodule may form on the tendon which is palpable and tender at the base of the finger. Commonly females>males, ring finger (but others may be involved), may be associated with diabetes, RA, gout, which can affect prognosis. Age is commonly in 50s and 60s. ~200,000 cases per annum in the USA.
You ask how it's been affecting him/her and give several options and assurances. Most conservative course is rest/splinting/NSAIDs. Steroid injection into the tendon sheath, sometimes repeated after three months, gives excellent results. Difficult cases (especially of the thumb) progress to one of several operative release procedures.
Clifford R. Wheeless, III, MD. Trigger Finger / Tenosynovitis. Wheeless" Textbook of Orthopaedics. Last updated June 9, 2016.b
Satishchandra Kale, MD, MBBS, MBA, MCh(Orth), FRCS(Edin), FRCS(Tr&Orth). Trigger Finger. Emedicine.medscape.com. Updated: August 27th, 2018.
All Tips: 2013 2014 2015 2016 2017 2018 - Updated! (11/04/2018)