James Siy once commented that it was hard to keep thinking of new things to talk about week after week, and I ran into that wall about six months into the season. There wasn't a whole lot of new stuff in this episode to write home about, and I don't think there's much I haven't already covered this year. But, here we go:

Narcan is an opiod antagonist - it "rips" the drug molecules out of the receptor sites in the brain and reverses most of the effects of opiods. The effect is quite startling and rather violent if you're not ready for it; a lot of the patients who get Narcan aren't the nicest characters in the world to begin with, and they get downright nasty when they catch the full dose. (A common trick for paramedics in the field is to give half the normal dose - subcutaenously, this would be 5 mg, so you'd push 2.5 mg - en route, then bag vigorously. A block away from the hospital, push the rest, and keep bagging. The patient will start going nuts right around the time you get to the emergency department and, co-incidentally, right around the time you have to hand the patient off. How 'bout that?)

Hydrocephalus is, as the name might suggest, "water on the brain," and that's what it used to be called. It is seen in young children as a swelling of the head - the cerebrospinal fluid, produced by the choroid plexus in the ventricles of the brain, cannot drain into the spine, and so the pressure on the brain itself increases. With nowhere the go, the head swells up. This can kill. (Duh.) To correct this, neurosurgeons will install a shunt, a small tube that runs from the head and drains into a hollow organ, usually the stomach. The CSF is drained by pressure and gravity, and is excreted normally. Shunts are usually good for five years, but sometimes they get plugged and the surgeons have to go in and clean it out and re-install. I had a friend who had this when I was six or seven, and I remember visiting him in the hospital and being completely freaked out by the environment. Go figure the world, huh?

Carol: I never would have pegged you for a spammer. :)

I'm not 100% clear on Ritalin's activity profile, but most drugs need to be tapered before being stopped completely. Tapering is, as you might have guessed, reducing the dose gradually over time so that your body gets used to the changes. Going cold-turkey is not always the best course of action, and can sometimes be.. um.. bad. Obviously, doing this without physician supervision is dumb. Lucy should know better.

I've been told that Ritalin is purged from the body within four hours of the initial ingestion, which makes me even more suspicious of the use of the drug to treat attention deficit disorder. There'll be an essay coming on this later this month - watch this space for details.

More bad cervical spine care: Ever noticed I usually make mention of this every couple of episodes? It's because they get it so consistently wrong on such a regular basis. It drives me up the wall. Mr. Bengossi had been in a high-speed deceleration injury, and it looked to me like he hit something inside the car. Patients who are decreased and involved in an MVA get extricated with cervical immobilization, and the immobilization stays on until they're conscious and you can rule out c-spine injury. Forgive my gratuitous use of fonts here, but a head flopping around on the cot does not constitute immobilized and will probably result in you getting sued if there are long-term problems. Geez. Five years, and they still can't get this right? (Hey, John Wells: call me, and I'll come teach you guys how to do proper immobilization. For free. Really.) Briefly, the guy should have had a collar on and been taped or otherwise secured to a board.

(Interestingly, seizing drivers is something of a problem. Have you ever seen police, fire, or ambulance units with strobe lights as opposed to rotators or simple blinkers? Watch the sequence closely sometime if you can (and you're not epileptic) - you'll notice that there's a bit of a "wiggle" in them: the timing is not consistent so they won't induce seizures in people. Someone once told me that all strobe units were required to have that wiggle in them, regardless of their function or design,but I don't know how much credence to give that.)

I like John Alyward more and more every time I see him. He oozes credibility. I'm constantly having to remind myself that he isn't one in real life. He's got the right personality to be a chief of staff of a hospital, although I wish the writers would realize that it's a political position as opposed to a medical one, and I don't know a single chief anywhere that spends as much time in surgery or seeing patients as Don Anspaugh does.

And, oh yes - I still don't like Lucy. It's nice to know that some things don't change. Although I'm treading dangerously close to Phyl's turf here, I think her introduction has been roughly analagous to Paul Falsone's introduction on Homicide a few years back: too much, too fast. Here is a Good Cop, and You Will Like Him - never mind he screws up the balance of the unit, and never mind he's an obnoxious twerp (two words: "muh kid"), You People Are Going To Like Him. I'm aware that both Falsone and Lucy have their fans and supporters (Lucy seems to have more than Falsone), but the characters were basically rammed down our throats and we were asked to unquestioningly accept them.

That's it for me for this year. See y'all 'round these parts in September. For those who are curious, I'm going to try to add some more medical information to the site over the summer - probably an EKG tutorial, ACLS guidelines, that sort of thing. Requests are solicited, but won't necessarily be honoured. it.