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When Clarence Thomas & John Roberts Defended The 7th Amendment

Andrew Cochran — Mon, 30 Jan 2012 08:12:07 GMT

The Seventh Amendment provides that " [i]n Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved... Accordingly, we must conclude that the Seventh Amendment provides a right to a jury trial where the copyright owner elects to recover statutory damages... The right to a jury trial includes the right to have a jury determine the amount of statutory damages, if any, awarded to the copyright owner. It has long been recognized that "by the law the jury are judges of the damages.'' Lord Townshend v. Hughes, 2 Mod. 150, 151, 86 Eng. Rep. 994, 994-995 (C.P. 1677). Thus in Dimick v. Schiedt, 293 U.S. 474, 55 S.Ct. 296, 79 L.Ed. 603 (1935), the Court stated that "the common law rule as it existed at the time of the adoption of the Constitution'' was that "in cases where the amount of damages was uncertain[,] their assessment was a matter so peculiarly within the province of the jury that the Court should not alter it.''

So wrote Justice Clarence Thomas in his opinion for a unanimous Supreme Court, when it ruled in a 1998 copyright infringement case that the Seventh Amendment requires the right to a jury trial where the copyright owner elects to recover statutory damages. InFeltner v. Columbia Pictures Television, Inc., the Court overruled the Ninth Circuit Court of Appeals, which had affirmed a district court's ruling denying Feltner's motion for a jury trial. Justice Thomas' opinion included a discussion of the applicability of the Seventh Amendment to copyright infringement cases and, in effect, a terrific defense of the right to a civil jury trial and the role of local juries. Justice Thomas noted that even before adoption of the Constitution, in England and in the American colonies, "copyright suits for monetary damages were tried in courts of law, and thus before juries." And he wrote that the Copyright Act of 1790 didn't change that practice.

Ironically, the attorney asserting Mr. Feltner's Seventh Amendment rights was John Roberts, now the Chief Justice of the Supreme Court, and during oral argument before the Court, he eloquently noted the historical role and significance of civil jury rights enumerated under the Seventh Amendment:

In light of clear historical practice on both sides of the Atlantic prior to 1971, Feltner had a right under the Seventh Amendment to have a jury make that finding and others on which the award was based and determine the amount of damages to be imposed within the statutory limits.

The idea that... when Congress fixes the amount of the penalty it can therefore delegate that task to judges ignores the whole purpose of the Seventh Amendment.

The Seventh Amendment is to protect against judicial bias and corruption and overreaching and, while that's not implicated when Congress fixes the amount because Congress is doing that, the judge is just applying it, when you give that task to the judge the whole reason for having the Seventh Amendment comes into play...

As someone who has criticized the Roberts Court for decisions denying civil jury trials in a number of preemption and arbitration cases, I was surprised to learn of this defense of the Seventh Amendment by Justice Thomas. My thanks to Bob Peck of the Center for Constitutional Litigation in Washington for pointing it out. Now if only the Roberts Court would only take a realistic view of the practical and harmful impacts of federal preemption and forced arbitration clauses on our right to a civil jury trial.

Originally posted at InjuryBoard by Andrew Cochran

The Dangers of Coumadin

Halli Brownfield — Mon, 05 Jan 2009 09:37:41 GMT

Spangenberg partners, Rhonda Baker Debevec and Stuart Scott, recently handled two separate malpractice cases for clients who suffered severe bleeding complications related to a commonly prescribed anti-coagulant or “blood-thinner” called Coumadin. This medication – also sometimes called Warfarin – is prescribed for medical conditions that increase the patient’s risk for forming potentially fatal blood clots like atrial fibrillation (an abnormal heart rhythm) and deep vein thrombosis (DVT). By inhibiting the blood’s complex clotting or coagulation mechanism, Coumadin prevents the formation of new clots and the growth or extension of old clots.

To test whether appropriate amounts of Coumadin have been prescribed, the prescribing physician must carefully and consistently monitor the patient’s blood for its anticoagulation or INR (International Normalized Ratio) level. If the level is too low, the patient is once again at risk for blood clot formation. If the level is too high, the patient’s risk for severe internal bleeding, hemorrhagic stroke, and death is increased. While Coumadin is an effective treatment, it can also be extremely dangerous for several reasons. First, the therapeutic range for this medication is quite narrow. In other words, the difference between a safe level of Coumadin and a dangerously high level is quite small. Second, several different factors can magnify the medication’s blood thinning properties including the patient’s liver and kidney function, diet, alcohol consumption, age, and prior medical history. As such to maximize patient safety, prescribing physicians must provide dietary guidance to their patients and properly educate them about this drug and its potentially dangerous side effects. Equally critical, physicians must be on the alert for signs and symptoms of excessive blood thinning and know how to appropriately manage it. If a patient’s blood test reveals an excessively high INR level and/or the patient has active bleeding, this is a medical emergency requiring immediate hospitalization and rapid reversal of the Coumadin’s anticoagulant effect with intravenous medication.

In the case handled by Mr. Scott, the patient’s blood-work revealed an abnormally high level of INR or in layman’s terms that the blood was too thin. Moreover, the patient also had blood in his urine which can be an indication of internal bleeding. Instead of informing his patient that he had a life-threatening overdose of Coumadin requiring immediate hospitalization, the Defendant doctor merely told the patient to stop taking Coumadin over the weekend and come into the office on Monday for a repeat test. Left untreated, the patient suffered a severe hemorrhagic or bleeding stroke on Saturday which left him permanently and functionally disabled. Had his physician appropriately provided immediate treatment, the patient’s stroke probably would have been averted. Unfortunately, this particular physician was unaware that rapid reversal treatment for Coumadin overdose existed until after the patient’s stroke. Through the efforts of Mr. Scott, the case was settled at a confidential mediation.

Similarly, in the case handled by Ms. Debevec, blood tests showed that the patient’s INR was exceedingly high and that the patient’s risk of suffering from spontaneous internal bleeding was likewise exceedingly high. Rather than treating the situation as a life-threatening medical emergency, the treating doctor instructed the patient to discontinue her Coumadin, failed to re-check her blood and did not administer the life-saving medication to counteract the Coumadin’s effects. As a result, she suffered internal bleeding and passed away in her home a few days later. This matter was also resolved in a confidential proceeding.

As both of these cases illustrate, the proper management of patients on Coumadin therapy is critically important to patient safety. While some bleeding complications from Coumadin therapy may be unavoidable, many are preventable with effective and competent management. If you or your loved one has been prescribed this medication, please take the medication exactly as prescribed and consult your medical professional to learn more about how to maximize your safety while taking this beneficial medication. If you or your loved one has suffered a bleeding complication from the improper administration and/or management of Coumadin (Warfarin), please contact us to learn whether you may have potential recourse against the prescribing physician.

Originally posted at InjuryBoard by Halli Brownfield

Signs And Symptoms Of Vp Shunt Malfunction

Stephen Pokiniewski — Mon, 29 Nov 2010 11:42:47 GMT

Over the 25 years I have represented patients injured by medical error at Anapol Schwartz, we have handle a number of cases involving injuries due to the failure to recognize, diagnosis and timely treat malfunctioning ventriculoperitoneal (VP) shunts. The “typical” care involves the surgical placement of a VP shunt in a child who has developed hydrocephalus (a build up of cerebrospinal (CSF) fluid in the skull which can cause pressure on the brain). Below is a link to a diagram of a shunt.

See: “Spina Bifida Shunt System” image as found at www.spinabifida.asn.au

After the placement of the shunt, the patient is closely monitored for signs and symptoms that the shunt is working properly. There are a number of signs of a malfunctioning shunt:

HEADACHE
VOMITING
FEVER
IRRITABILITY AND PERSONALITY CHANGES
DETERIORATION IN PERFORMANCE - school work, gait, balance, and concentration
LETHARGY AND DROWSINESS
DIZZINESS
VISION DISTURBANCES
SEIZURES

The most common symptom of shunt malfunction is recurrent headaches. However, any of the above symptoms should prompt evaluation by the treating physicians. In recent a case where there was a delay in treatment of a malfunctioning shunt, the patient’s healthcare providers recognized that her headaches and vomiting were signs of shunt malfunction, but delayed in having her seen by a neurosurgeon. The delay resulted in her developing seizures which caused her to suffer permanent brain injury.

Originally posted at InjuryBoard by Stephen Pokiniewski

Trauma 1 v. Trauma 2 Hospitals, What's the Difference to A Person Hurt In An Accident?

Shapiro, Lewis & Appleton — Tue, 29 Sep 2009 10:32:15 GMT

A trauma center is hospital capable of rendering medical care to patients suffering traumatic injuries. Yet, there are several different levels. A trauma center can be either a level one, two, three, or four. In order to qualify as a trauma center, a hospital is required to meet criteria set forth by the American College of Surgeons. There are a few factors that determine what level a center is classified as. These factors include the type of resources available at the particular center, as well as the amount of patients admitted annually. Each level classification must adhere to certain national standards.

A level one trauma hospital maintains a wide range of specialists and equipment, which are available 24-hours a day. These centers must also meet annual volume requirements for admitting severely injured persons. One criterion that places a level one center above others is that the center must have a program of research and be a leader in the field of trauma education/injury prevention.

A level two hospital works collaboratively with a level one hospital. This center provides care which supplements the medical expertise of the level one center. A level two center provides 24-hour services. However, the services only include the essential specialties, personnel, and equipment. Unlike level one centers, the minimum volume requirements for level two centers are dependent upon local conditions. Also, level two centers are not required to maintain a research or surgical residency program.

A level three trauma hospital maintains the basics. While they do not have the same amount of specialists as a level one or two, they are capable of meeting the needs for most trauma patients, including emergency resuscitation, surgery, and intensive care. These types of centers have a transfer agreement with either a level one or level two center so that back-up care may be provided in extreme situations.

A level four hospital provides essential care, such as stabilizations and treatment, where no alternatives exist. These centers are often located in remote areas. It’s important to understand the differences among trauma hospital classifications.

Even though all levels are capable of stabilizing patients, specialty care may only be available at certain hospitals and thus, may require you to transfer. Consider the following:

Sentara Virginia Beach General Hospital: Level Two trauma center
Sentara Norfolk General Hospital: Level One trauma center
Pitt County Memorial Hospital in Greenville, NC: Level One trauma center

As attorneys specializing in accident cases, our most seriously injured clients are often inpatients at one of these three facilities. People in car wrecks in South Hampton Roads and the Outer Banks are most likely to be treated at these Sentara centers. Pitt Memorial serves as the main trauma center for much of North-East North Carolina.

Level Four:

Level Three:

Level Two:

Level One:

Originally posted at InjuryBoard by Shapiro, Lewis & Appleton

Medication Error In Allentown Causes Tragic Death

Gregory Spizer — Mon, 30 Jan 2012 11:52:24 GMT

On Friday, the Allentown Morning Call addressed a Pennsylvania Department of Health report which indicated that on three separate occasions in 2010 and 2011, nurses at St. Luke's Hospital in Allentown improperly programmed patient-controlled pumps which delivered pain medication. As a result, 3 patients overdosed themselves.

One of the patients, a 38 year man who had undergone a hernia repair, received five times the amount of morphine prescribed to him. Tragically, this man died a day after surgery with what the Lehigh County Coroner's Office described as natural causes.

Unfortunately, medication errors in hospitals is not an unusual occurrence. A study by Dr. C.A. Bond was published in Pharmacotherapy in 2002. According to Dr. Bond, medication errors occurred in 5.22% of patients admitted to hospitals each year or a dispensing error took place every 22.04 hours.

With these alarming statistics, it is imperative that our hospital's pharmacies, nurses and other staff members are properly trained to avoid medication dispensing errors. It is also vitally important to make sure that quality control measures and safety nets are in place so when errors inevitably do occur, they will be caught before tragedy strikes.

Originally posted at InjuryBoard by Gregory Spizer

Bacterial Infections: Good, Bad, and Deadly

Michael Monheit — Fri, 04 Mar 2011 07:41:01 GMT

Bacterial infections can be deadly. Many bacterial infections are misdiagnosed which may be considered medical malpractice. The below bacterial infections are by no means a complete list of all the serious to life-threatening infections.

The vast majority of the bacteria in the body are harmless and protected by your immune system. Some bacteria are even beneficial but it’s the pathogenic bacteria that cause infectious diseases and critical bacterial infections that you have to worry about. Most bacterial infections can be prevented.

Let’s look at some dangerous bacterial infections for pregnant women:

A common bacterial infection is the bladder infection; its medical term is cystitis. For pregnant women who suffer from a bladder infection or urinary tract infection (UTI), complications may be deadly and require immediate medical treatment. When detected early, a bladder infection during pregnancy can be treated. When not treated, a bladder infection can lead to a kidney infection or get into the blood stream causing further complications for mother and baby.

Group B strep is so preventable. Unfortunately, the Group B strep test may not be covered by your health insurance provider and some doctors don’t consider it as part of the prenatal exam. One test could put pregnant women out of harm’s way. Group B strep is carried in the vagina and most of the time is not problematic but when it is – Group B strep can lead to meningitis and blood-borne infections.

Chorioamnionitis or amnionitis is a rare bacterial infection affecting the uterus, amniotic sac, and fetus. Infection of the uterus is caused by bacteria invading the uterine cavity through the mother's bloodstream or more commonly, the vagina and cervix. Preterm labor, a dilated cervix, and ruptured membranes (or water breaking before 37 weeks) are all risks for developing amnionitis. Pelvic examinations during the last three months of pregnancy contribute to premature rupture of membranes. Also past experiences of water breaking, chlamydia infections, and smoking put women at risk for premature rupture.

Unfortunately, this amnionitis infection cannot be treated without delivering the baby. Although a rare bacterial infection, 5 percent of pregnancies are affected.

Just say no to contaminated cheese and deli meats if you’re pregnant. Listeria bacteria move through the intestinal wall and spreads by way of the bloodstream to other organs, the brain, and placenta because pregnant women naturally have weakened immune systems. If infection spreads to the nervous system, symptoms such as headache and stiff neck happen. Infected pregnant women may experience mild, flu-like symptoms. Infections during pregnancy can lead to more serious problems for the fetus.

Bacterial meningitis exposure during pregnancy is dangerous to both mother and baby. Listeria may lead to bacterial meningitis.

Here are some bacterial infections that can affect all age groups but especially people with weakened immune systems:

Bacterial meningitis is the most common and the most life threatening unless treated promptly and correctly. Meningitis is an infection of the membranes surrounding the brain and spinal cord. Meningitis can be caused by a bacterial, fungal or viral infection. Infection may cause tissues around the brain to swell which interferes with blood flow resulting in paralysis or stroke.

Outbreaks of bacterial meningitis can happen in schools, dorms, and camps. Sometimes the cause is unknown, environmental, caused by a head injury, or from a weakened immune system. Children between the ages of one month and two years are the most susceptible to bacterial meningitis as well as college students and the elderly, people who have suffered from sickle cell anemia or take steroids.

Bacterial meningitis symptoms may be misdiagnosed as the flu. If not immediately treated with the right antibiotics, people can die or suffer paralysis within 24 hours.

Unfortunately, MRSA is resistant to many antibiotics. MRSA is often associated with high school students and hospital induced infections or HAIs. MRSA stands for methicillin-resistant staphylococcus aureus which are different strains of bacteria. MRSA can be spread easily enough from person to person contact and can enter the body through a wound or cut.

Staphylococcus aureus is a group of bacteria that live on the surface of people's skin and inside the nose. Most people carry it around without any ill effects though people with weakened immune systems and people who had surgery can develop serious problems.

The staphylococcus aureus bacteria can cause abscesses, boils, skin infections, septic wounds, toxic shock syndrome – and death. Treatment requires non-resistant antibiotics given through an intravenous drip or injection.

Bacteremia is an infection of the blood stream caused by bacteria. Blood is normally a sterile environment, so the detection of bacteria in the blood is an abnormality.

Bacteremia spreads through the entire body, causing the patient to become seriously ill.

How do bacteria get into blood?

during surgery
catheters
complications from pneumonia or meningitis
dental procedures, such as brushing teeth, are the most common cause of bacteremia, introducing a detectable amount of bacteria into the bloodstream but rarely induces serious reactions in a healthy person
colorectal cancer
intravenous drug abuse

Bacteria can also use the blood to spread to other parts of the body causing infections away from the original site of infection.

Pneumonia is the sixth most common cause of death in the United States. It is the top cause of death from infection. People who have a weak immune system are more likely to be sicker.

Hospital acquired pneumonia is far more common than community acquired pneumonia.

The most common way you catch pneumonia is to aspirate bacteria from your upper airway, usually your oral cavity. Pneumonia can be acquired by breathing in infected air droplets from someone who already has pneumonia. Bacteria can be generated by an improperly cleaned air conditioner or Jacuzzi. Oddly enough, an infection in your kidney can spread to an infection in your lungs. Bacteria can enter your bloodstream from any source and be deposited in the lungs, resulting in pneumonia.

A chest x-ray or a pulse ox can diagnose pneumonia. A pulse ox measures how much oxygen is in the bloodstream. Antibiotics usually cure bacterial pneumonia. Some people develop complications such as sepsis, meningitis, lung failure -- and death.

Hospital acquired infections (HAI) are the result of treatment within a hospital or medical care setting and appear 48 hours or more after hospital admission or within 30 days after discharge.

The Centers for Disease Control and Prevention estimate that approximately 1.7 million hospital-associated infections occur from all types of microorganisms, including bacteria and cause or contribute up to 99,000 deaths each year. These HAIs cause severe pneumonia and urinary tract infections, bloodstream and other parts of the body infections. Healthcare related or hospital acquired infections are difficult to treat with antibiotics because of growing resistance to antibiotics.

Some examples of hospital inquired infections are caused by contamination from catheters, hospital instruments, intravenous lines, and improperly washing hands.

Septicemia is a medical term for the presence of pathogenic organisms in the bloodstream that lead to sepsis. When bacteria enter the bloodstream, it triggers an immune response resulting in inflammation and a slow shutdown of the body's ability to handle infection. If septicemia is suspected, patients must go to the ER for immediate medical attention as it can quickly escalate into shock.

Septicemia or blood poisoning or sepsis starts with bacteria or toxins that they produce entering the bloodstream, resulting in a coagulation of the blood as the body tries to fight the bacteria. People acquire septicemia because they are medically vulnerable. Latent infections, surgery, deep puncture wounds, and burns can all lead to septicemia.

Antibiotics, blood transfusions, fluid replacement, dialysis, and possibly life support are treatments.

Sepsis is a potentially serious medical condition characterized by the entire body being in an inflammatory state. Severe sepsis is the systemic inflammatory response, plus infection, plus the presence of organ dysfunction.

Severe sepsis is usually treated in the intensive care unit with intravenous fluids and antibiotics.

Originally posted at InjuryBoard by Michael Monheit

Surgeon Uses Caulk Injections for Butt Enhancement Procedure

Ed Normand — Thu, 11 Mar 2010 16:03:12 GMT

We all get a little down now and then about our appearance and shape, especially in the buttocks. You know it sometimes gets a bit saggy and droopy and we want better. Some folks hire a personal trainer, some diet; others look for a quicker remedy. To the rescue came a plastic surgeon in New Jersey who (perhaps after watching an episode of Home Improvement) devised a brilliant plan: "why not use caulk, ya know Home Depot kind of caulk? After all, it sure does a job on that drywall!"

So, no lie, the surgeon injected his patients with a concoction of silicone, petroleum jelly and hardware-grade caulk. I guess the plan was that he could internally apply the sticky stuff to glue the buttock higher up the backside. Turns out the plan was not so brilliant after all: so far, six women have been hospitalized after getting seriously ill from the injections. Now as much as I blame this bad surgeon one has to wonder about the wisdom of succumbing to the injections in the first place. For starters, it may be an imposter surgeon operating without a license (the authorities are on the look out for him). A big clue to that was that he was doing the procedures out of hotel rooms in the Newark, New Jersey area.

Remember, while we all want a Super Booty, try the gym and diet first. If that fails, protect yourself from bad surgeons (real or imposters). Check out the surgeon's qualifications and track record with the local state medical board before you sign up for any surgery. Ask for proof of qualifications in the procedure recommended and make sure that the surgeon is a specialist in that area of practice. With cosmetic surgery, look for Certification by the surgeon from the American Board of Plastic Surgery or Dermatology before undergoing the medical procedure. Additionally, you can research the procedure yourself online before it is performed. The FDA website is a good place to find information about any drug or hardware store supplement before it is injected into your body. If the surgeon won't disclose the drug seek a second opinion. Finally if the surgeon operates out of a hotel room, run away fast!

Originally posted at InjuryBoard by Ed Normand

Allergan stops selling Lap-Band to 1-800-GET-THIN doctors

Paul Napoli — Wed, 08 Feb 2012 10:09:25 GMT

Allergan Inc., maker of the Lap-Band Adjustable Gastric Banding System, has announced it will no longer sell the weight loss device to troubled California surgical centers affiliated with the 1-800-GET-THIN marketing company, reports The Los Angeles Times.

The Lap-Band is a medical device approved by the U.S. Food and Drug Administration (FDA) for weight loss in obese patients. Doctors insert the Lap-Band laparoscopically and place it around the upper part of the patient’s stomach to create a small pouch that limits food consumption.

In a statement, Allergan Inc. said it had “made the decision to presently discontinue the sale of the Lap-Band … to all entities affiliated with 1-800-GET-THIN.”

Allergan’s action follows the launching of investigations by local, state and federal regulators into the practices of the surgical centers and 1-800-GET-THIN.

After becoming concerned that 1-800-GET-THIN’s billboards, bus placards, newspaper advertisements, website and other marketing was misleading consumers and failing to convey the risks, the FDA sent warning letters to these companies in December telling them to stop misleading consumers:

Marketing company 1-800-GET-THIN LLC
San Diego Ambulatory Surgery Center, LLC
Bakersfield Surgery Institute Inc.
Beverly Hills Surgery Center
Palmdale Ambulatory Center
Valley Surgical Center
Top Surgeons LLC
Valencia Ambulatory Center LLC
Cosmopolitan Plastic & Reconstructive Surgery

Some of the companies are also facing other allegations. Five patients who underwent Lap-Band surgery at clinics associated with 1-800- GET-THIN have died. California regulators are looking into the deaths and the families of some patients have filed lawsuits.

Medscape News reports that ex-employees and patients of the surgical centers have filed a lawsuit claiming the surgical centers performed Lap-Band and other medical procedures with staff personnel that were unqualified, in facilities that were unsanitary and utilized malfunctioning equipment.

Their lawsuit alleges:

Owners and staff at the Beverly Hills Surgery Center covered up the events leading up to the death of one patient;
Failure to maintain equipment and possess ventilators large enough for obese patients.
High incidence of post-operative infections due to substandard sanitation policies and inadequate equipment;
Unqualified nurses in operating rooms, nurses operating as surgeons and unsupervised administration of anesthesia;
Performing unnecessary procedures.

Owners of the surgery centers deny all the allegations.

“Our surgery centers are staffed with experienced bariatric surgeons, trained by Allergan on the proper procedures for implanting the Lap-Band,” a representative of the surgery centers said in a statement to KTLA News. “Patients interested in weight loss solutions have a range of options, of which the Lap-Band is only one. We will continue to work with our patients to find the best healthcare options for their medical needs.”

Allergan will continue to sell Lap-Band to other medical facilities and bariatric surgeons.

Originally posted at InjuryBoard by Paul Napoli

The Most Feared Complication of Prostate Biopsy

David Mittleman — Sun, 16 Nov 2008 09:20:00 GMT

For men 50 and over, digital rectal exams and PSA (prostate-specific antigen) tests have become a routine part of the annual checkup. These tests can uncover signs of prostate cancer, a disease that kills roughly 29,000 Americans each year. However, before a diagnosis can be made, a doctor needs to perform a procedure known as the prostate biopsy to confirm the presence of prostate cancer. In a biopsy, the doctor uses a needle to collect a sample of cells from the prostate so that a pathologist can distinguish cancerous from noncancerous cells. Prostate biopsy is generally considered a safe and simple procedure, but the main concern is that significant complications such as infections do occur if appropriate preventative measures are lacking.

Not long ago, a friend of mine underwent a transrectal prostate biopsy. To his surprise, this so-called simple procedure was not as simple or as safe as one may be led to believe, because according to him, the experience had taken him to "hell and back." The procedure itself went smoothly, but the sequence of events that followed was certainly not what he had signed up for. The first unpleasant episode began the very next day after the biopsy, when he found himself shaking so violently and uncontrollably that he thought he was having a seizure. When nighttime came, he suffered yet another violent bout of shakes which, again, lasted for a good half hour or more. Although the seizures discontinued after that, he was pretty much vegged out in bed for several days, and naturally, he became convinced that he was only suffering from a nasty flu. It was not until he had spoken to his friend, who is a physician, about his symptoms that he realized he was in for a long haul. He immediately contacted his doctor, and was told to get himself over to the emergency room ASAP. After running through bags of saline and drips of antibiotics, he was informed that he had E. coli bacteria in his blood stream which, if left untreated, could be life-threatening. If he hadn’t relayed his symptoms to his friend, he would have continued to believe that it was only a flu, and in the meantime, the infectious bacteria in his blood stream would have attacked his organs and eventually causing them to shut down.

As horrifying as it is, the fact of the matter is that about 800,000 men undergo prostate biopsy every year, and not every doctor perform sufficient preoperative preparation such as appropriate bowel preparation or pretreatment with antibiotics. Although different pre-biopsy protocols for bowel preparation have been suggested, there remains a lack of standardized consensus among urologists. However, studies have found a high infection rate associated with self-administered phosphate enema, also known as the traditional bowel preparation. An enema is a way of cleaning out the large intestine by introducing solutions into the rectum, causing it to expand, and thereby allowing the bowel to empty. Studies have shown that phosphate enema with providone-iodine administered at the hospital can reduce infectious complications for people who have poor compliance or inaccuracy when bowel preparations are self-administered.

Pretreatment with antibiotics is another effective way of reducing complications. Studies have shown that fever may be expected to develop in about 23% of patients who do not receive prophylactic antibiotics, and that infection rate was significantly lowered with the use of antibiotics. Furthermore, the cost of antibiotic medication was about $18 per patient and the cost-effectiveness compared to no prophylactic therapy at all was considered good. Although there are a variety of prophylactic regimens available, Dr. Jeffrey Pollen and Dr. Daniel Smiley’s studies indicate that ciprofloxacin prophylaxis substantially lowers the incidence of fever, especially when started preoperatively. Therefore, it is recommended that physicians who have not yet done so should consider a similar cost-effective policy.

The content provided here is for informational purposes only, and was not designed to replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding prostate biopsy and/or the use of antibiotics.

Originally posted at InjuryBoard by David Mittleman

Eye Lacerations: ER treatment of a cut on an eye

Sach Oliver — Fri, 12 Dec 2008 17:34:41 GMT

Eye injuries can be serious, involving several parts of the eye and are usually quite painful. Most minor eye injuries can be treated at your home. However, if you have a major eye injury, it should be taken seriously and quickly.

What to do if you suffer a minor eye injury:

Cut on your eyelid: apply a sterile bandage or cloth to protect the area. If you don’t have a sterile bandage, use a clean cloth. DO NOT use fluffy cotton bandages around the eye that could tear apart and get stuck in the eye. This could lead to infection or irritation of the eye. Keep bandages clean and dry.

Reduce swelling: apply ice or cold packs for 15 minutes 3 or 4 times a day during the first two days. The quicker you apply a cold pack, the less swelling you are likely to have. After the swelling subsides, a warm cloth may help relieve the pain.

What to do if you suffer a major eye injury:

If you are suffering from complete or partial loss of vision, severe itching, redness, or any other severe injury to your eyes, you need to get immediate attention from an ophthalmologist.

Corneal Abrasions:

A corneal abrasion is a scratch or injury to the cornea, the clear, dome shaped surface that covers the front of the eye. This is a very common occurrence. There are many things that can cause an abrasion to the cornea. The most common causes include foreign bodies in the eye (dirt, pebbles, insects), a scratch from a toy or fingernail, or contact lenses.

How do Emergency Rooms treat Corneal Abrasions?

A scratched cornea usually heals without complications. Pain relievers and surface antibiotics may be prescribed. The treatment of cuts vary according to the extent of the injury. A small cut usually does not need stitches, but a sever cut to the eyeball requires immediate treatment and usually surgery.

Overall, the seriousness of lacerations to the eye depends on the individual’s cut. This can range from small annoyance to serious. The potential risks of not seeing a doctor may be as serious as infection or blindness. If at all in doubt, see your nearest emergency room.

I would like to thank John Shaw, our law clerk, for helping me research this important topic.

Originally posted at InjuryBoard by Sach Oliver