Emedinews:Makesure:A diabetic hypertensive was denied a beta–blocker because of the traditional teachings.

Situation: A diabetic hypertensive was denied a beta–blocker because of the traditional teachings.
Reaction: Oh my God! You should have used nebivolol.
Lesson: Make Sure that diabetics are not denied beta-blockers when indicated. Nebivolol has no side effect on glucose metabolism unlike atenolol.

Emedinews:Inspiration:The Lesson of the Homeless

It was a cold winter's day that Sunday. The parking lot to the church was filling up quickly. I noticed as I got out of my car fellow church members were whispering among themselves as they walked in the church.

As I got closer I saw a man leaned up against the wall outside the church. He was almost lying down as if he was asleep. He had on a long trench coat that was almost in shreds and a hat topped his head, pulled down so you could not see his face. He wore shoes that looked 30 years old, too small for his feet, with holes all over them, his toes stuck out.

I assumed this man was homeless, and asleep, so I walked on by through the doors of the church. We all fellowshipped for a few minutes, and someone brought up the man lying outside. People snickered and gossiped but no one bothered to ask him to come in, including me.

A few moments later church began. We all waited for the Preacher to take his place and to give us the Word, when the doors to the church opened.

In came the homeless man walking down the aisle with his head down. People gasped and whispered and made faces. He made his way down the aisle and up onto the pulpit where he took off his hat and coat. My heart sank.

There stood our preacher...he was the "homeless man." No one said a word. The preacher took his Bible and laid it on his stand.

Emedinews:Makesure: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.

Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid.
Lesson: Make sure, to evaluate only moderately tap ascitic fluid as overenthusiastic tapping can be life-threatening.

Emedinews:Insights on Medicolegal issues:What is Forensic Thanatology?

Thanatology is the branch of science that deals with death in all its aspects. Shapiro, a well-known thanatologist defined death as the irreversible loss of the properties of living matter. However, it is difficult to appreciate his claim that this definition satisfies the practical requirements for death certification.
• Black’s law dictionary (Black 1951) in United States defines death as “The Cessation of life, the ceasing to exit”, defined by physicians as total stoppage of circulation and cessation of vital functions, thereupon such as respiration and pulsation
•Section 46 IPC states that death denotes the death of a human being unless the contraryappears from the context.
•Section 2 (b) of the Registration of Births and Deaths Act defines death as Permanent disappearance of all evidence of life at any time after live birth gas taken place.
(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Concise Textbook of Forensic Medicine & Toxicology, Peepee Publishers)

(Contributed by Dr Sudhir Gupta)

Emedinews:Insights on Medicolegal issues:What is a dangerous injury?

An injury is said to be dangerous, if the nature of injury is such that it may put the life of the injured in danger. An injury caused on the vital part cannot be called a grievous injury unless the nature and dimensions of the injury or its effects are such that the doctor is of the opinion that it actually endangers the life of the victim. To designate the injury as grievous hurt danger to life should be imminent. Dangerous injuries are those which cause imminent danger to life, either by involvement of important organs or structures or extensive areas of the body. If no surgical aid is available such injuries may prove fatal.

• Some examples of injuries which endanger life are: stab on the abdomen or head or vital part, hurt causing rupture on spleen, squeezing testicles, incised wounds on the neck, compound fracture of the skull, rupture of an internal organ, and injury of a large blood vessel.
• Danger to life should be imminent
• Injuries are extensive and implicate important structures or organs, so that they may prove fatal in the absence of surgical aids. For instance a compound fracture of the skull,
• Wound of an artery or rupture of some internal organ such as the spleen, should be considered “dangerous to life”.
• There is a fine distinction in the degree of body injury between dangerous to life and likely to cause death.
• Another type of bodily injury which is sufficient in the ordinary course of nature to cause death is also to be recognized. But the injuries which prove fatal remotely by incurrent diseases such as tetanus should not be considered as dangerous.
• If an opinion as regards the nature of a particular injury cannot be formed at the time of the examination as in the case of an extensive swelling of a limb when its fracture cannot be detected, or in the case of a head injury where the symptoms are obscure, the injured person must be either re-examined 12-24-48 hours after the initial clinical examination or admitted under observation until a definite opinion can be formed and the police should be notified of the fact.

Emedinews:Makesure:A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh by God! Why was additional insulin given?
Lesson: Make sure that the insulin dose is correctly calculated. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.