Wednesday morning, Rep. Steve Scalise and 5 others were gunned down during a baseball practice at the Eugene Simpson Stadium Park in Alexandria, VA while they were prepping for a charity event that was to be held the next day.

 

Reports say Rep. Scalise was “shot in the hip” and “shot in the calf”, but had been stable upon initial treatment in the hospital.  Currently we are told by MedStar Washington Hospital Center at approx. noon PT, that the House Majority Whip  “was critically injured and remains in critical condition.”

 

Rep. Mo Brooks who was at the scene, removed his belt to apply tourniquet pressure to Rep. Scalise’s leg.  This implies heavy bleeding was occurring and witnesses state Scalise, after he was shot, tried to drag his body away from the shooter, leaving a trail of blood behind.

 

Sen. Rand Paul and Rep. Brad Wenstrup also administered first aid to the victims.

The victims, including Scalise, were:

 

Zachary Barth:  Shot in the leg, expected to recover. Serves as Congressional staffer for Rep. Roger Williams.

 

Matt Mika:  reportedly shot multiple times, currently having surgery and in critical condition.  Serves as a lobbyist and Tyson Foods employee.

 

David Bailey and Krystal Griner – the US Capitol Police who exchanged gunfire with the gunman and were wounded in the process.  It's been reported they are in stable condition.

 

The 66 year old gunman, James T. Hodgkinson, was shot, and taken into custody.  He has since died of his injuries.

 

Many are relieved the heroic Bailey and Griner are both in “stable condition,” but deeply concerned about those in “critical condition.”  Let’s break down what these descriptors mean:

 

“Conditions” are based on vital signs (heart rate/pulse, blood pressure, respiratory rate, oxygenation) and a current medical “picture”.  According to the American Hospital Association Guidelines these are divided into:

 

Undetermined: Patient awaiting physician and assessment.

 

Good: Vitals signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.

 

Fair: Vital signs stable and within normal limits. Patient is conscious, but may be uncomfortable. Indicators are favorable.

 

Serious: Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable.

 

Critical: Vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.

 

However this causes confusion as many ask how one could be “critical AND stable?”

 

In medical settings, we say someone is “stable” when their condition is not worsening.  It's a calming descriptor allowing families and friends to take a deep breath and know their loved one is not on the verge of death.

 

A stable patient, however could be critically injured and need intensive care.  One could be stable coming out of surgery, but become unstable if an unfortunate medical incident occurs afterwards.

 

“Critical” specifications are given to those whose injury could have been life threatening and who needs to be monitored and tended to continuously.  One may remain stable during this time.

 

This is a developing story:

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

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June 14th is World Blood Donor Day.  Established by the World Health Organization in 2004, World Blood Donor Day thanks donors and raises awareness for the global need of blood products. Blood banks throughout the country, including American Red Cross and United Blood Services, are holding drives to help keep their stores full for local hospitals and medical centers.

 

Blood products are used for trauma patients,  those whose blood counts are low due to anemia, and many who suffer from blood disorders. One pint of blood could be used to save three lives.  Whole blood donations can last “on the shelf” for 42 days, but platelets, which provide clotting factors, only last for 5 days.

 

Donors are therefore needed year round.  One can donate blood every 60 days and platelets can be donated every week for up to 24 weeks a year. Although 38% of the US population is eligible to donate blood, less than 10% actually do.

 

World Blood Donor Day helps bring much needed blood during the summer months when less people donate. In 2016 a United States National Blood Donation Day was created along with a National Blood Donation Week, with multiple states creating state blood donation days during the first full week of September.

 

nvbloodme

Doc. Daliah putting her blood money where her mouth is.  

 

Campaigns such as these remind people that blood is needed year round.

The World Blood Donor Day slogan this year is “What can you do?”….

Give Blood, Give Now, Give Often…..

 

To find the nearest blood bank near you, visit:

http://www.unitedbloodservices.org/

http://www.redcross.org/give-blood

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

 

 

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Multiple states in the US currently allow recreational marijuana or medicinal use of cannabis and multiple more states may be following suit in upcoming elections.

Even those who support the legalization have concerns over driver safety and how to determine if one is impaired.

Breathalyzers are currently being developed and tested but are not ready for roadway spot checks.  Moreover, breathalyzers may have difficulty accurately detecting both inhaled and ingested marijuana.

California law enforcement officers are piloting road-side saliva tests but objective data is still lacking regarding the accuracy of oral fluid tests.

Currently when law enforcement tests an impaired driver for marijuana use, a urine test can be performed which only looks for a metabolite called THC-COOH.    Despite its abbreviation it is a non-psychoactive component of marijuana, as opposed to delta-9-tetrahydrocannabinol (delta-9-THC), which does cause euphoria.  Hence the shortcoming to this testing method are twofold, as the non active THC-COOH isn’t even the correct metabolite to measure intoxication and it can linger in the body for weeks, hence not allowing an adequate quantitative measure to determining one’s impairment.

Two medical students, however, figured out what needs to be tested and how.  Graham Lambert and Charles Cullison, both entering their third year at Touro University Nevada, performed research for an American College of Legal Medicine (ACLM) poster contest.

One of the lead researchers and osteopathic medical student Graham Lambert said, “This is an issue because it’s non-psychoactive. It stays in the body for long periods of time, long after any psychoactive effects.” Their research lead them to conclude that testing should instead look for an alternate THC metabolite, 11-OH-THC.

Why?  Let’s break this down.  Now both delta-9-THC and 11-OH-THC are psychoactive compounds that can be tested in the blood.  However law enforcement has to determine whether euphoria was present and a factor in one’s unlawful driving.  Both delta-9-THC and 11-OH-THC crosses the blood brain barrier, a semi-permeable endothelial cell barrier that helps decide what substances can enter and leave the brain.  But 11-OH-THC’s is more readily active and can bind to the brain’s cannabinoid receptors tighter, lasting longer and causing more of a psychoactive effect.

Additionally, 11-OH-THC is a metabolite also seen in high quantities after ingesting marijuana edibles.

 

 

IMAGE FROM SAPAINSOUP.COM

 

In 2012, Sharma et al found the 11-OH-THC to last twice as long in the blood than delta-9-THC, which would make sense due its strong binding properties.  Yet the psychoactive 11-OH-THC will rapidly be metabolized to an inactive form hence its presence on a test will signify activity rather than just “hanging around”.

Once Lambert and Cullison determined this, they went to Assemblyman Steve Yeager, D-Las Vegas, who is Chair of the Assembly Judiciary Committee.  Yeager helped sponsor a bill, AB135 that would convert marijuana testing for drivers from the inaccurate urine test to a blood test that would look for specifically 11-OH-THC.

Also lead researcher and osteopathic medical student, Charles Cullison said, “Blood alone accurately shows the levels of hydroxy (11-OH-THC) and marijuana.”

In regards to getting the bipartisan law passed through the State Senate with a “Veto-less” majority,  Cullison stated, “We couldn’t have done this without the help of many people.”

After Nevada lawmakers passed AB 135, Governor Brian Sandoval signed it into law. The antiquated urine testing will not be used to test drivers pulled over for possible DUI but a blood test instead.

 

The legal limit of marijuana that is measured in nanograms per milliliter ng/ml would be 2 ng/ml for delta-9-THC and 5 ng/ml for 11 Hydroxy-THC.  This does not change with passage of AB135, nor do the circumstances surrounding when to test, as current protocols are in place once a person fails his sobriety test.

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

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