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The horror in the years

Good people, if you have a gout, which she gladly wanted to clarify whether medical, nothing is really Urgent, please, please just wait until after all the holidays. And then goes to the best first GP. And not just in the hospital.
On a day like today to go to the emergency room is pure madness. This week, meet many unfavorable conditions:
1) There were holidays. Many drag themselves just for Christmas, then on Monday embark with us.
2) Many family doctors have closed the practice.
3) Many are on vacation and finally have time to clarify the time banal things, because at the same time Item 2 applies), they come to us.
4) There are school holidays. The school children also have time, see Section 3), also have this time for reckless things like bike racing on ice and snow or sledding in the deep snow. The effects we see.
5) There are cold days.
6) Christmas predestined to be a sensitive time for psychosomatic disorders.
7) nursing homes run with reduced staff. This fact positively correlated with the number of hospital admissions.
All this together leads to the mega-mess. Full waiting rooms, staff and enervated enervated patients. Hours of waiting, unless there is a "real" emergency, of which only today but were very few here.

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The pre-Christmas offering

weekend I once again serve in the emergency room. Fortunately, otherwise I would have been tried immersing myself in the hustle and bustle of the city center and at the Christmas market or do other stupid things.
I can say is: everything was there. The fainting spell in the overheated Shopping Mall, the seizure from the flashing colored lights. The body of alcohol from the Christmas market. The half-cut hand from Baumklau in the forest. The happy smiling child with any Weihnachtsbaumbehang in the stomach. The grandfather, of the carriage driving with her grandson after sixty years of abstinence also wanted back on the sled, and at the end of the half face skull smashed added. The back pain from hauling tree. The cut on the foot after stepping in a broken Christmas tree ornament. The upper arm from spills scalding hot wine ...
Christmas is a public menace! So we can be glad that we must work.

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Doctor's Diary is back!

Now I oute me sometimes as a big fan I would love to see with even series, actually better than movies. Doctors series, I can usually find it difficult. Finally, you want after work so well see something different than his daily bread. There is one exception: I love Doctor's Diary. From 5 January, on commercial TV finally sent the third season. Juhu! Granted, the story was in the final season already very outrageous, but actually it is rather funny dialogue that made me become a fan. By the way, there are the first two seasons quite favorable in ordinary DVD retailers to buy, maybe a nice Christmas ...

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panic attack, Christmas is coming!

Okay, this is now a bit Offtopic. But damn, where's my package? If I ever get to the series well before the magical date of order to at least some of the gifts, but then it should slowly come again. But this is my favorite internet mail order company (probably the favorite internet mail order company of many people ...) are usually so fast ... Okay, maybe I'm doing it wrong, because the Shipping Confirmation came quickly, as usual, but the post will not appear afterwards. NOW KNOW! Here I have a not insignificant part a lack of gifts. What if I've struggled through the end of the week finally ordered it and it will not be until Christmas? What then, my mail? Okay, I realize I could go into town and buy the stuff as normal in the store, but first there is not everything, secondly, I do me the stress of Saturday's certainly not in the pedestrian zone (as am I prefer Saturdays in my emergency room) and thirdly, you pay it on it often. All right, hope dies last. Dear Post, do not let me down!

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Christmas parties are on

The annual Christmas celebrations are innumerable again. Always a source for gossip. Each department and each station is celebrating its own. And again it's interesting who gets invited to which party - or is just not even invited.
My first Christmas party is today at night. Let's see what is there to gossip again. At the most boring to us is likely to reflect the doctors' Christmas party, like last year elsewhere reported : beginning 20 clock, eating, end 22 clock. Maybe I can save myself that this year ...

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Blunder (20)

Black's last move 16.- Qe6-b6?? was really bad in Werle - Bartel (Bundesliga 2010).

17.Nxc4! (17.Bxc4 was also good) dxc4 (17.- Qxb5 18.Nd6+) 18.Qxf5 and White had no problems to make use of the won pawn, 1-0, 30.

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In coffee withdrawal

Day 2 As reported on Tuesday : the coffee has beaten me to the stomach. Now, thanks to exorbitant Supply of antacids and fennel-anise-cumin tea (bäh!) I survived the day somehow. And I am absolutely determined my stomach to treat first time out. Say, I have to make a coffee withdrawal. After I had spent the last week good in bed and slept a lot, accordingly, Wednesday was at work and no problem. Also this morning I felt when leaving the apartment still quite buoyant. After the morning meeting I went to the emergency room and saw my love nursing and medical colleagues for a cappuccino at a time by wearing on me. That is psychological terror! How is one to one be steadfast? But I remained steadfast. Well, almost. After my dear colleagues in the early afternoon on my ability to respond slightly reduced vibration I got myself a Coke indulged in guilty ***. *** And oh dear tomorrow is Friday, traditionally the worst day of the week in the emergency room ...

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Mate in 2

Here you have to solve a little chess problem: Mate in 2.

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Okay, this was easy ;

27.Qxg7+ Kd6 (27.- Ke8 28.Qf7#) 28.Ne4# was executed in Adams - Howell (London 2010).

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egg daus

Already upon arrival in the emergency room trying to catalog the patient sort of: emergency, urgent can wait.
recently settled with a teacher from the school bring with paramedics because it has been the consumption of a hard boiled egg in the interval become ill. The patient greeted me smiling and waving from the medical bed. Sorry, but what can one think first out "What's please in my emergency room? ". Accordingly, this patient received the category of "can wait" and I have dedicated myself first seem sicker patients. Until then it asked me
times Ilse sister to look after the patient ... I found the patient in addition to several bowls filled with green and reddish renal content writhing in pain before with very low blood pressure and shortness of breath in bed. My heart immediately evil. When, when you examine the skin at the neck was so strange and crackled all clear: the good lady had made it clear to perforate the sheer vomiting the esophagus, a classical Boerhaave's syndrome. So get yourself down to the operating room.
learn what we from that? The first impression is always a bit deceptive.
What an egg so all can cause ...

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Too much coffee will kill you

As reported elsewhere , we have here in the emergency room a great coffee maker. Caffeine is important if the night before too long, too short night, the morning too annoying, the working day too long, the closing time is too short (list of optional expandable ...) is. In recent days, all the previous unfortunately applied to the caffeine consumption increased in immeasurable heights. And now I actually permanently uncomfortable, especially after drinking coffee. What's up? I do not tolerate some more coffee? It seems as if I had a difficult Withdrawal before me. Help, how can I so want only the day?

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in the hospital laundry

Here are the order of at least three or at the latest to go every five days, work clothes. If set, every employee receives five coats and pants to change into. back up to a coat or a pair of pants from the laundry gets it will take about six weeks. Hello? Six weeks! It will work in the hospital no different than purely in the washing machine, out of the washing machine, get into the ironing machine, out of the ironing machine, which takes your mind six weeks? For a change of clothes every three days so you might very soon not there. However, changes only every five days to get straight in Sun At least at the beginning because
: Per half year of work at least a piece of clothing disappears mysteriously and was never seen again. One is in doubt, always blame themselves, for (O-Ton laundering) "it is quite impossible that we will lose any piece of clothing." Is clear. In the case of such daily Mount Everest-like mountain laundering unit in white, it is probably not actually imagine that something will spill. More likely it's that I'm confused after a night shift in the half-way home sleeping when the laundry basket with the paper standing next to the sink waste ...

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Red Cross Cookie

In Christmas cookies, there are some treat. A cookie can only be either a tasty cookie or a statement. The Red Cross local branch Beierfeld sold on its site for Red Cross cookie cutters cookies. Intended big success in the local Christmas market.

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Toller resuscitation Song: Nellie the elephant

There are indeed on emergency room and intensive training always fun guy to play for a while practicing CPR on a dummy of funny songs that pretend super bpm because of the number the beat of the heart massage. Is so old hat. Usually you get there, "Stayin 'Alive" by the Bee Gees to hear, because the text also so funny fit for resuscitation. Last year was "Another One Bites the Dust" by Queen is one - also fits the title, but perhaps a little macabre ... the bird was shot down but our latest trainers, he has given us played the following:


When I heard that, I'm in shock immediately stopped the press ...

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gift ideas for colorful GP

approaching Christmas. If anyone still needs the ultimate gift for a medical Junkie: here's colorful surgical caps for each (n), taste (lessness). Preferably, the colleagues of the guild would be cut about be glad. But even if you currently have no present need the things worth seeing! I think it's particularly successful model "Skunk", who does not want to walk like the skunk-look by the OP? This
the conservative media sources are too short, there is something really great in the shop: Stethoscope ties, perfect for a job interview in internal medicine. In order to stand out clearly from the crowd and nothing more can go wrong with the dream job! So strike as nothing!

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The second season begins

After my summer break has attracted little longer than planned, I sign up now for the start of the second season of "Tales from the Emergency Room" back. Also, the gossip in the hospital should of course not be neglected. It starts again the seriousness of life and the unpleasant autumn and winter evenings must eventually be filled somehow. I am looking forward to next time!

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Blunder (19)

In this position from Bok - Berelovich (Bundesliga 2010) Black blundered with 21.- Rc2??

One could call this an optimistic move, in fact this loses the rook since he has no squares if the white king goes to d1 and the pawn to c4, and this is how it happened: 22.Rxe8+ Nxe8 23.Ke1 Nd6 24.Kd1 Rb2 25.c4 Nxc4 26.Bxb2 1-0

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Blunder (18)

In this position from Robson - Perelshteyn (Lubbock 2010) Black blundered with 13.- Qh5??




Now White sealed the game with 14.Nd5! with the threats Nxe7+ and Nxf6+ followed by Qxh5 1-0
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Blunder (17)

A new blunder by Alexei Shirov. This time with the white pieces against Andreikin (Plovdiv 2010). In the position below he played 29.Rd1??

After 29.- Qa4 he had to resign.

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Tactics (38)

White to move had a very good idea in Bischoff - Meijers (Bundesliga 2010).




Solution (diff. 3/5): 1.Be6!! Rxc3 (1.- fxe6 2.Rc7! Rxc7 3.Rxc7 Qxc7 4.Nxe6+) 2.Bxd7 Rxc1+ 3.Qxc1 Rxd7 . The material is equal but the white queen is stronger in this position than the uncoordinated black pieces. 4.Qc4 Ba6 (Qb5 was the threat) 5.Qc3 Bb7 and with d5+, d6 it is clear that the black position is a mess. 1-0 ten moves later.



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Blunder (16)

In this position from Appel - Cioara (Bundesliga 2010) White blundered with 18.Rfc1??

After 18.- Nb3! 19.Rxc8 Bxc8 20.Qc3 Nxc1 21.Qxc1 he lost an exchange and resigned a few moves later.

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Blunder (15)

Position from Howell - Bindrich (Khanty Mansiysk 2010). Black with still 20 minutes on the clock played 29.- Nxe4??

White said: Thanks, and answered 30.Rd7! The mate with Bg7 cannot be prevented 1-0

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Blunder (14)

It does not surprise me that the Chess Olympiad 2010 in Khanty Mansiysk offers some serious blunders.

In the game Lin (1736) - Can (2500) the following position arose with Black to move:

Black could have continued with 44.- Qxf4 45.Rxf4 Bxb2 and the thing looks kinda drawish. Instead Black played 44.- Bd4?? and White mated with 45.Qc7#

Ouch.

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Tactics (37)

White to move wins in Zelbel - Gruskovnjak (Graz 2010) .

Solution (1 / 5): 2.Bd6 Qe7 + 1.Qe6! (2nd - Qxe6 3.fxe6 and the threat is deadly Rf8 #) 1-0

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private rooms at the Super Clinic

now there are all these super private stations. Recently I have been traveling again to Konsiltour in the house and have seen our brand new VIP lounge. And that looks like this:

from a double room was a single room. There is a bathroom with shower, a dressing room with mirrors, a leather sofa with matching coffee table and a chair on a beautiful rug, a dresser with a decorative figure and a telephone on the wall hangs a flat TV. Oh, and in the corner is the patient's bed. By the way, just the same, return in which all the other patients ...

That is a gentleman beyond the 80th Year of life in bed. Although he has accordingly been a few years ago, it was decided to build some new bypasses to the heart (A rogue who thinks that would have something to do with the insurance status ...). Then he developed a complication after another. At some point you have time then decided to let a blind eye to it and has paid to ordinary wards. Since he is now closer to death than to life. But the main thing he has his own bathroom, a leather sofa, rug, a Flat TV ...

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triangle maneuver

In a triangle maneuver is defined as a sequence of moves in which one party carries out a march on the triangle to the Zugrecht in the same position to the opponent submit. This is possible if the opponent can only commute between the two fields.

finds In general, this maneuver in pawn endings.

White on the train Zugrecht would like to submit to black in order to clamp the black king on the board edge.

1.Ke5 KC6 2.Kd4 Kd7 3.Kd5

now has been transformed in the same position, but with black on the train.

3rd - Kc8 4.Kd6 (? Kb8 4.c6 is drawn!) Kd8 5.Ke6 Kc8 6.Ke7 Kb8 7.Kd7 Ka8 8.c6 + -

shows a nice example of a triangular maneuver also the following problem of Carel Mann (1893). The default is Matt in 4

The practical benefits to a tournament player is low, since the easiest course 1.Dh4 + + Kf5 2.Dxg4 profit guarantees.

But to satisfy the requirement in Matt 4, White must play a triangle maneuver, for it is clear that Black would be checkmated on the course alignment (1 - Kf5 2.Dd5 #; 1 - f5 2.Dh4 #).

1.Da8! Kh6 (1 - f5 + Kh6 2.Dd8 3.Dh8 KG5 4.Dh4 + #) + 2.Dh8 (1.Da8 therefore had to be played, and not 1.Db7) KG5 3.Dh1! (now reached the starting position with Black to train;! White can checkmate as described above).

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Conservative relate to the operation like ...

... black to the top to bottom, God to the devil, salt pepper ... (list of optional expandable). You notice it most in the intersection, namely when Miss Conservative passes from the emergency room or from the patient station to the (emergency) surgery to Mr operative or in between (the anesthetic-Doc). Somehow you can never get it right:
time the patient is sedated to flat, sometimes the Oxylog is in the wrong place, sometimes the oxygen to empty and is also in the wrong place, sometimes has to use the wrong drugs, sometimes to much, too little time given. Blood pressure is sometimes too high or too low (but never just right). And woe to the patient is still held and does not have any urinary catheter, central venous catheter, artery, and no big red gift bow around his neck. For repositioning it is generally much too silly to the other better. Every time you get the feeling that the patient can speak of happiness when he arrives in the operating room alive ... I used to tell me yes or dispute. Does not matter. Meanwhile, I handled it this way: want to draft, moronic smile and think his part.

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In the emergency room has one more of life

It's not always terrible. In fact, has such an existence in the emergency room have its advantages:

1) Free bladder training.
Within Weeks increased the bladder capacity by countless times, until finally you have the whole day's not even on a loo. one can dare it indeed be assumed that the radio operator starts the same anyway. So thank you for this dear employer incontinence prophylaxis.

2) Survival Training.
after a short time one is prepared for a survival trip in the jungle. Never learns to survive without food and fluid intake as well as here.

3) self-control training.
Initially excited you are still on absurd or outrageous admissions to colleagues in other departments. After a few days you get used to the slightly elevated level of aggression and learn to keep calm.

4) calorie reduction.
especially for the ladies a pleasant side effect. The constant race from A to B to C, in combination with the lack of food and fluid flow (see 2), at least for the first time for a measurable and visible weight loss.

5) social contacts.
romp in the emergency room, many people. You meet colleagues from other departments, the administration, many patients, emergency physicians, paramedics. Nowhere else will you meet more people.

6) No mile-long discharge letters.
A real advantage. In the emergency room, people are more than a few hours. Most of the work with a four- or five rows done. Past writing eight-page essays on the ten-week stay of a complex patient.

7) Less national calls.
family discussions are important. But they are time wasters. And sometimes they can also be quite stressful. Until the members arrive at the hospital, the patient is often already installed on the ward. To this extent actually incurred in the emergency room less.

8) thrills.
The day is not calculable. Is it quiet, these things may change abruptly within a very short time. But that's what makes the tension out of the job.

9) coffee.
I have already mentioned elsewhere in . But we really have a damn good coffee.

10) Somewhat go home on time. Man
yes, the patient passed some of the service. Insofar as it actually happens that you walk on time.

I like my emergency room!

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Lasker combination - really played

The so-called Lasker combination, in which two runners will be sacrificed, is one of the spectacular attacks castling in chess. To apply, but must meet some requirements. Consider a castling position:

Such castling position is extremely safe. Tarrasch points out that a knight on f6 and f3 is the best protection for the short castling [1].

In the above position to meet the queen and runners also point g5, which can be important when playing white knight of want to go there.

play the Laskerkombination , you must be distributed by the Knight f6 and f3. In the lower diagram from the game Lasker - Bauer (Amsterdam 1889), White takes this company in the same attack.

1.Sh5! Sxh5? (even the crucial mistake; relatively best is 1 - Tfd8, but which receives a double black pawn on f6) 2.Lxh7 +! Kxh7 3.Dh5 + Kg8 4.Lxg7! (the second runner is sacrificed) Kxg7 5.Dg4 + Kh7 (chart)

now clear what the actual plan. The tower is by means of 6.Tf3 on the h-line is played (in the game now play e5 and Black had to give the queen on h6, which White could also bifurcate Qd7 with the two runners).

The Lasker combination, it is important that the attacker has available a tower that is threatening a checkmate on the h-line.

beginning I said that a lady is on d8 with the bishop on e7 is a good defense Figer. Had the lady of black not been on c6, but on d8, the combination would Lasker did not play. Consider the position after 4.Qg4 + with a black queen on d8: There

Black the bishop on g5 back and maintains a multi-character for two pawns. One must be careful so that not to overlook a defensive resource, otherwise the combination proves a boomerang.

In the earlier game played Burn - Owen (Liverpool 1884) overlooked the black attackers such a resource.

white has no knight on f3, then Black proposes equal to h2. 1st - Lxh2 +! 2.Kxh2 DH4 + 3.Kg1 Lxg2? (in this position, this train is a mistake, because White can sacrifice after the drawing of the f-pawn the queen against the black tower and two runners, and tower for ) Receives 4.f3!

After 4 - TF6 would play White 5.Dxg2. Black was forced 4 - play Lxf1 5.Lxf1 , after which there was no attack, and White won more later.

But how is the combination of increase? Tony Miles shows us in his game against Dizdarevic (Biel 1985).

1st - Lxh2 +! 2.Kxh2 DH4 + 3.Kg1 Bf3! (chart)

This is the train that Owen missed! Black blocks the f-pawn, so that it can no longer engage the white lady. Dizdarevic experimented 4.Sd2 . Since the Springer now access the lady to the king disguised wing, Black could take on g2. 4th - Lxg2! 5.f3 TF6 6.Sc4 LH3 0-1.

I must say that the so-called combination Lasker-playable only under certain conditions. Often these are not met, otherwise, one would see more often.

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[1] Tarrasch, Siegbert: The Chess Game

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Perspektiefe

Such a beautiful brain syndrome is every day again went to the emergency room. And somehow it is always the same: too little drunk, infection caught, you know the yes. What I do not understand, however, is that many patients develop this condition exhibitionist traits. Since you can as often discreetly put the blanket over it, already is that this stripped again - even if it is bitterly cold. Because sometimes reveal things that you will not see themselves as hard-core practitioners. And somehow, it is also sometimes a little uncomfortable for members of Omi and Opi exposed so as to see it lying there. But what can you do? So you fix or cut down with drugs, I think actually not in order. Whether that has anything to do with Freudian Seelenuntiefen?