LITFL Review 307

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

LITFL review

Welcome to the 307th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.

The Most Fair Dinkum Ripper Beauts of the Week

Nick CumminsHere’s a series of integrated Sepsis lectures from the Maryland CCProject. [SO]

 

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care

  • How does protocolized sepsis care play out in a resource-limited setting? The Bottom Line reviews a recent trial on the subject. [MS]

The Best of #FOAMres Resuscitation

  • Holy HITTS! A challenging ECMO case is presented by the team from the Alfred. [SO]

The Best of #FOAMus Ultrasound

The Best of #FOAMped Pediatrics

The Best of #FOAMim Internal Medicine

The Best of #FOANed Nursing

The Best of #MedEd FOAM

Reference Sources and Reading List

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Last update: Nov 20, 2017 @ 9:12 am

LITFL Review 307
Marjorie Lazoff, MD

Funtabulously Frivolous Friday Five 214

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 214.

Question 1

Who first described the phenomenon of malignant hyperthermia?

Question 2

Fox’s Sign is not Fox’s Sign! See the correct answer below as Mike Cadogan slowly corrects the wrongs of Wikipedia (and my FFFFs) and the phenomena of “copy and paste”?

  • Fox’s sign was thought to be: Bruising over the inguinal ligament that occurs in acute hemorrhagic pancreatitis. Named after the the dermatologist George Henry Fox according to Wikipedia. However, George Henry Fox never described this sign but instead “Apocrine miliaria” along with John Addison Fordyce.
  • A chronic itchy papular condition occurring in areas of the skin with apocrine glands especially the axilla of young women. Chronic blockage of the sweat gland ducts with a secondary, non-bacterial inflammatory response to the secretions and cellular debris in the cysts.
  • Similar to hidradenitis but without secondary bacterial infection so that no pus-draining sinuses are formed.Fox's sign

Question 3

Some months ago, whilst dancing, I trod on the outer side of my foot, my heel at the moment being off the ground. Something gave way midway down my foot, and I at once suspected a rupture of the peroneus longus tendon. By the help of a friend I managed to walk to my cab, a distance of over 300 or 400 yards. The following morning I carefully examined my foot and discovered that my tendon was intact. There was a slight swelling over the base of the fifth metatarsal bone. I endeavored to obtain crepitus and failed. A finger on the spot gave exquisite pain. Who’s landmark paper is this the opening paragraph?

Question 4

What evidence is there that Sir William Osler was a pimp?

  • Eye witness testimony:
    “Rounded with Osler today. Riddles house officers with questions. Like a Gatling gun. Welch says students call it ‘pimping.’ Delightful.”
    – Abraham Flexner

Question 5

What was tested on orphans and condemned felons in Newgate before being given to the Royal family?

  • Inoculation against smallpox.
  • Charles Maitland was granted the royal license to perform a trial of variolation on six prisoners in Newgate on August 9, 1721. The prisoners were granted the King’s favor if they submitted to this experiment.
  • All prisoners survived the experiment, and those exposed to smallpox later proved to be immune. [Reference]

Funtabulously Frivolous Friday Five 214
Neil Long

Jellybean 83 Pre-Hospital Medicine with Gregor Prosen

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

ED people doing house visits?
Medical retrieval teams having a cup of tea and taking a detailed social history?
Emergency doctors going to someone’s home before they come to the ED and recommending treatment at home?
Including End of Life treatment?
Sound Crazy?
Ever been to Maribor? Slovenia?

I spoke with Slovenian Emergency Physician and Pre-Hospital Gregor Prosen at dasSMACC. He talks like an emergency physician. He curses like an emergency physician. Gregor just exudes a type of ultra-competent critical care cool. He can do some fantastic shit and he does do it. He also goes on home visits. He gets in a car or 4wd and heads out into the country to see little old ladies, big old men, kids and strudel-makers. That part represents fantastic shit too. Listen to Gregor talk you through pre-hospital medicine in Maribor.

So here I am in Australia, in the western emergency medicine workforce. We are struggling with this and that. We are struggling with end of life care. We are struggling with the filter, or lack of a filter, between primary care and the so-called critical care service that emergency personality types all signed up for. We wanted to be intubating vomiting people, with no blood pressure, while upside down in a straitjacket and wrapped in chains and underwater. In a crater lake. Over an active volcano. Using an expensive machine. Any expensive machine really. That’s what we call rewarding. It’s just not fair. Whinge. Whinge.

So you go and try a bit of retrieval medicine. It looks very cool. Especially in the promo videos. (To quote Alex Psirides; “Helicopters!!!”) However, when you are getting around in one of those helicopters, or some other platform, there is a certain pressure on your use of that platform. How many times have aeromedical retrieval teams gotten out to the “scene” and decided to NOT bring that patient back to the hospital? Maybe that’s the best thing to do? And if it is the best thing to do then will your service get paid as much? Will your service get paid at all? How much does it cost to run an aeromedical retrieval helicopter anyway? (Clue; shit-loads.)

So at the end of the day it’s hard to use your judgement for some of the most important decisions. It’s hard not to get into the “You Call we Haul” trap. We even use “Time on Scene” as a KPI.

The pilot, the crew, the co-ordinator and even the helicopter itself seems to want you to get back to base ASAP. It might be whirring overhead or if it has landed just sits there and bristles. I do love these impressive women and men. I love working with them. I love flying around over Australia.

Slovenia clearly has a different history, different culture, different healthcare system, but maybe it has some seriously useful different perspectives.

Gregor Prosen is pretty bloody cool. He does cool stuff. He has a cool job and some of that cool stuff is done really very differently. Let’s learn.

I like FOAMed. I like it a lot. I would really like it to continue to facilitate knowledge transfer. We can learn something from the Slovenians. We can learn from the South Africans and Ugandans. We can learn something from the New Yorkers. It is not a one-way street.

Long live FOAMed. Long live non-english speaking FOAMed. Long live FOAMed from everywhere for everyone.

Long live the legendary Slovenian accordion player Bratko Bibič and thanks to him for the wonderful tune “Na Domačem Vrtu” or ”In the family garden” from the eponymous album by Bratko Bibič and the Madleys. I liked that title given Gregors story. You can find Bratko Bibič on iTunes but if you find it in on vinyl it would be more impressive.

If Slovenian or Serbian music is your thing check out Gregors friend and colleague; Sara Nikolić

Get in touch. Leave a comment or contact me via Twitter @TheTopEnd

Further Listening

JellyBean Large

Last update: Nov 14, 2017 @ 9:24 am

Jellybean 83 Pre-Hospital Medicine with Gregor Prosen
Doug Lynch