Funtabulously Frivolous Friday Five 155

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 155

Question 1

Takotsubo syndrome from the Japanese word for an octopus trap has entered our common vernacular but what is moyamoya disease and what does it mean in Japanese?

  • Puff of smoke.
  • Moyamoya is a rare type of stroke. Arteries become blocked via constriction and thrombosis while a collateral circulation develops. These collateral vessels are weak and prone to aneurysm. On a conventional angiography these collateral vessels appear life a “puff of smoke”. [Reference]


Question 2

What is masque ecchymotic?

    • Craniocervical cyanosis
    • First described by Ollivier in 1837 at autopsy of a man trampled on by the crowds in Paris
    • Various hypotheses have been made about the pathophysiology.
    • One theory is the traumatic asphyxia is associated with a fear response in the accident victim just prior to injury. In this “moment of impending disaster”, the individual reflexly takes a deep breath, holds it, and braces himself. Since air cannot escape from the thoracic cavity during compression in the face of a closed glottis, the increased pressure is transmitted centrally to mediastinal veins, superior and inferior vena cave, and right atrium. The blood in these structures is squeezed from the chest into the valveless veins of the head, neck, and abdomen. [Reference]

masque ecchymotic

Question 3

How did warfarin acquire its name?

  • It was invented with the help of the Wisconsin Alumni Research Foundation (WARF) and -arin indicating the link with coumarin.
  • In 1933 a farmer from Deer Park showed up unannounced at the School of Agriculture and walked into a professor’s laboratory with a milk can full of blood which would not coagulate. In his truck, he had also brought a dead heifer and some spoiled clover hay. He wanted to know what had killed his cow. In 1941 Karl Paul Link gave him his answer and the rodent killer was born. [Reference]

Question 4

How did French gauge get it’s name, and how does it relate to diameter?

  • The French gauge was devised by Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments.
  • In French-speaking countries the symbol for French gauge is Ch (for Charriere, its inventor) instead of Fr, Fg, Ga, FR or F seen in other countries.
  • It refers to the external diameter of catheters and is three times the diameter in millimetres. A 1 French has an external diameter of 1/3mm and a 9 French has a diameter of 3mm. D(mm) = Fr/3
  • Note that the higher the French gauge the larger the diameter of the catheter. This is contrary to needle-gauge size, where an increasing gauge corresponds to a smaller diameter catheter. [Reference]

Question 5

What is “penis captivus” and who described it?

  • It is an urban myth – that a couple can become “entwined” by a severe form of vaginismus which causes a “locking” of the penis within the vagina during intercourse. So why is it funny?
  • The original description was by Egerton Yorrick Davis in the Philadelphia Medical News.
  • EYD was the pseudonym of Sir William Osler – father of modern medicine. He is purported to have invented the syndrome and written an article upon it in 1884 in order to basically get up the nose of one of his fellow editorial board members!
  • Why is it funny today? Well if you enter penis captivus into a search engine – you get a lot off hits – the main forum is the cosmetic penis-enlargement market, seems a lot of men are worried if they have the op – they might end up with this problem. Seems the tongue inserted in the cheek is tougher to dislodge than the other member from its vessel! [Reference]
Image from wikipedia

Image source: wikipedia

Last update: Jul 22, 2016 @ 8:25 am

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JellyBean 042 Liam Yore and MovinMeat

It is official; Donald Trump is the Republican Candidate for the Presidency on the United States of America. What does that mean? What does that mean for Healthcare in the USA? (Or world peace?) I don’t know so I asked someone who might. It’s Liam Yore. a.k.a. @MovinMeat

Liam Yore is a man that has stuff to say. He has been saying stuff for years on All bleeding stops and he is still saying stuff.

So Liam; healthcare in the USA whats up with that?
Dr Yore says; “It feels irredeemably broken.

Turns out there is stuff to be said. Liam has managed to marry his interest in progressive politics with his full time emergency physician role in the Pacific Northwest. He has written about policy and now he is starting to write policy. Does Policy matter? Hell, yes. Is policy interesting? Hell, yes and Hell, No. Do I understand it all? Hell, no. Do the guys who write policy understand what its actually like to be “us”, clinicians, nurses, paramedics and doctors at the “coal-face”? It doesn’t always feel that way.

I don’t understand the horribly expensive USA Health System. Apparently I am not the only one. I’ve worked there a little. I’ve read stuff about it. I watch as things like ObamaCare get attacked just for being associated with Obama. Turns out it wasn’t not really Obamas idea. It was a Republican idea. What? Someone help me here and please make it funny.

Liam and I talk about Donald, Narcissism, Celebrity, Pressure of Speech, Ugliness and ACEP. We talk about how he ended up on the inside of the Policy machine and I make fun of Trump. Go on, have a listen.

JellyBean Large

Last update: Jul 21, 2016 @ 5:02 pm

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Research and Reviews in the Fastlane 143

Research and Reviews in the Fastlane

Welcome to the 143rd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors

This Edition’s R&R Hall of Famer

Systems and Administration
R&R Hall of Famer - You simply MUST READ this!
Goleman, D. (2000) Leadership that gets results. Harvard Business Review, March-April, pp 78-90.

  • There are numerous leadership theories out there. Daniel Goleman’s approach to leadership styles is based on his research into emotional intelligence. It makes for interesting reading and may help you develop your own leadership skills and understand the leaders around you.
  • Recommended by Chris Nickson

The Best of the Rest

Emergency Medicine
R&R Hot Stuff - Everyone’s going to be talking about this
Long B and Koyfman A. Current Controversies in Thrombolytic Use in Acute Pulmonary Embolism. JEM 2016. PMID: 27071316

  • Not all patients with submassive PE require thrombolytics in treatment. To date there have been no studies showing mortality benefit, but there have been some studies showing benefit in functional outcome. Patients with Submassive PE require a case-by-case evaluation with shared decision making in the use of thrombolytics.
  • Recommended by Salim R. Rezaie

R&R Hot Stuff - Everyone’s going to be talking about this
Berger-Pelleiter E, et al. Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials. CJEM 2016. PMID: 26988719

  • Hypertonic saline seems to be recommended more and more often for intracranial hypertension. What is the evidence in traumatic brain injury?
    This is a systematic review and meta-analysis that identified 11 RCTs covering 1820 adult patients with traumatic brain injury comparing hypertonic saline to either mannitol (½ the studies) or another solution (often normal saline, or even hypotonic saline.) Hypertonic saline did not decrease mortality (RR 0.96, 95%CI 0.83-1.11). It didn’t lower intracranial pressure (weighted mean difference -0.39, 95%CI -3.78 – 2.99). And it didn’t improve functional outcomes (RR 1.12, 95% CI 0.92-1.36). Maybe we shouldn’t be rushing to adopt hypertonic saline in the management of traumatic brain injury.
  • Recommended by Justin Morgenstern

R&R Hot Stuff - Everyone’s going to be talking about this
Johnston SC et al. Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. NEJM 2016. PMID: 27160892

  • Another reminder that new does not mean better. In this RDCT of patients with stroke or high risk TIA (ABCD2 > 4), ticagrelor was no better than aspirin in preventing subsequent stroke, MI or death in the next 90 days. There was no increased bleeding or other side effects with ticagrelor but, aspirin costs pennies in comparison to the newer drug.
  • Recommended by Anand Swaminathan

R&R Hot Stuff - Everyone’s going to be talking about this
Maddow CL, et al. Efficient communication: assessment-oriented oral case presentation. Acad Emerg Med 2003. PMID: 12896884.

  • Nice little study on “assessment-oriented case presentations.” Briefly, give the answer first. Especially when talking to consultants (definitely with surgeons) rather than rambling on with a mystery story. COI: the first auther is married to my sister, and the last author’s office is adjacent to mine.
  • Recommended by Seth Trueger

Emergency Medicine

Friedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med 2016 PMID: 26320523

  • Looks like diphenhydramine doesn’t help all-comers with migraines in the ED. My bet is there might be a subset of patients it does help; if the patient has had it before and requests it, sure. But no longer a routine part of my migraine cocktail.
  • Recommended by Seth Trueger

The R&R iconoclastic sneak peek icon key

Research and Reviews The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE Hall of Famer R&R Hall of famer You simply MUST READ this! R&R Hot Stuff 64 R&R Hot stuff! Everyone’s going to be talking about this
R&R in the FASTLANELandmark Paper R&R Landmark paper A paper that made a difference R&R Game Changer 64 R&R Game Changer? Might change your clinical practice
R&R Eureka 64 R&R Eureka! Revolutionary idea or concept R&R in the FASTLANE RR Mona Lisa R&R Mona Lisa Brilliant writing or explanation
R&R in the FASTLANE RR Boffin 64 R&R Boffintastic High quality research R&R in the FASTLANE RR Trash 64 R&R Trash Must read, because it is so wrong!
R&R in the FASTLANE 009 RR WTF 64 R&R WTF! Weird, transcendent or funtabulous!

That’s it for this week…

That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

Last update: Jul 21, 2016 @ 8:57 am

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Critical Care Collaborative Conference, Melbourne 2016

The Critical Care Collaborative: Transitions of Change is an exciting interprofessional continuing education symposium, now in its second year. A joint ACCCN/ANZICS event, it will be held at Rydges Carlton in Melbourne on Friday 26th August 2016.

With a stellar, multi-disciplinary and diverse line-up of speakers, it promises to bring the latest research and best practice for all critical care clinicians through high-quality presentations and interactive sessions. Aimed at promoting our local ICU talent and fostering collegiality, there will be plenty of time for networking – post-conference drinks are even included!

Topics to be discussed include:

  • Transitions of care: experiences of ICU patients and families within and beyond
  • Learning to take the heat: training for stress
  • Don’t be sucked in just because it’s published!
  • The shocked patient: which inotrope?
  • Size matters! Tips and tricks for managing the paediatric patient
  • Humanising the ICU
  • Go with the flow: how to avoid crashing (the filter)
  • ICP management for the infrequent flyer
  • Ventilator troubleshooting

Speakers include LITFL’s Chris Nickson, colleagues from The Alfred Hospital Steve Bernard and Bianca Levkovitch, and intensivists from all over town including Irma Bilgrami, Peter Morley and Daryl Jones.Follow us on

Follow us on Facebook and Twitter for the latest updates.

For more information, including program and registration, go to the CCCC website – get in before early bird registration ends on July 26th!

Download (PDF?DL=1, 696KB)

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LITFL Review 240

LITFL review

Welcome to the 240th 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 chuck of FOAM.

The Most Fair Dinkum Ripper Beauts of the Week


TheResusRoom site just launched with great new podcasts on sepsis, CXR in trauma, PCI following ROSC and many more. For those more textually inclined there are paper summaries and guidelines to whet your appetite. [CC]

Iain Beardsell’s “Thrombolysis in PE” talk from SMACC dub has already acquired legendary status. The legend himself talks us through its inception and development. [SO]

The Best of #FOAMed Emergency Medicine

  • Joe Lex discusses his EM Mindset and some of what he’s learned in 50 years in Emergency Medicine. [AS]
  • EM Lit of Note discusses further evidence that IV antibiotics aren’t necessarily better than oral. [AS]
  • John Bucher walks us through the facts of cervical collars in trauma. [SR]
  • Michael Moss reviews some pearls and pitfalls in the diagnosis and management of spontaneous bacterial peritonitis. [SR]
  • Some great ‘what, so what and now what’ recaps from Rob Fenwick on alcohol withdrawal, CURB 65 and ectopic pregnancy. [SL]
  • A great take on spinal immobilisation and the approach to caring for these patients in this PHEMCAST episode on gentle patient handling. [SL]
  • Fans of the defunct Keeping Up with Emergency Medicine podcasts may be interested in the latest offering from the same group: EM Topics. In their promotional email they say, “In the spirit of FOAM, all the current and landmark article summaries are available on EM Topics for free. But if you want more convenience, we have a subscription service for a nominal fee to help offset the cost of maintaining the site…” [ML]

The Best of #FOAMcc Critical Care

  • Adrian Wong reviews the ATACH-2 trial.  Should we be implementing intensive BP control in patients with ICH?  Read this post to find out. [SR]
  • The Humanizing Intensive Care team discuss the recent call to action against burnout syndrome. A must read, for those unaware. [SO]

The Best of #FOAMed Resuscitation

The Best of #FOAMus Ultrasound

The Best of #FOAMped Paediatrics

  • Andrew Tagg discusses the usefulness of Capillary Refill Time in pediatrics to assess dehydration and cardiovascular collapse (i.e. shock). [SR]

The Best of #FOAMim Internal Medicine

The Best of #FOANed Nursing

The Best of Medical Education and Social Media

News from the Fast Lane

Reference Sources and Reading List

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