Funtabulously Frivolous Friday Five 187

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 187.

Question 1

You’ve been asked to make a memorable talk. As you prepare you study SMACC and TED talks then your colleague advises you to research Giles Brindley. What did Giles Brindley do in 1983 to make his lecture memorable?

  • There seemed nothing special about Brindley’s scheduled lecture on vaso-active therapy for erectile dysfunction, but little did the audience know he had injected his own penis with papaverine in his hotel room prior to the presentation. He indicated that, in his view, no normal person would find the experience of giving a lecture to a large audience to be erotically stimulating or erection-inducing.
  • He then proceeded to pull down his pants and show his erection to the audience. But the mere public showing of his erection from the podium was not sufficient. He paused, and seemed to ponder his next move.
  • The sense of drama in the room was palpable. He then said, with gravity, ‘I’d like to give some of the audience the opportunity to confirm the degree of tumescence’. With his pants at his knees, he waddled down the stairs, approaching (to their horror) the urologists and their partners in the front row. See Chris Nickson’s summary of events. [Reference]

Question 2

27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve.
A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe.
What unusual object had she inhaled 6 months ago? (Clue: taking a full sexual history would have been helpful)

  • Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed the presence of a condom.
  • Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio. [Reference]

From Failblog.org (click on image for source)

Question 3

Moving on from anything below the belt. How strong is your hair?

  • The combined hair of a whole head could support 12 tonnes, or the weight of two elephants.
  • Other facts include:
    • Up to 150,000 sprout from each human head.
    • Every strand grows at roughly one centimetre a month, making the gross product per head about 10 miles of hair each year.
    • After four years or so a strand reaches the end of its life and is shed: each human loses around 50 hairs a day.
    • Uncut, it can reach huge lengths. The world record is held by a Hindu holy man in the late 1940s whose tresses were estimated at seven to eight metres (23ft to 26ft). [Reference]

Question 4

As a profession we live in the 1980’s with pagers and fax machines, so it comes as little surprise to you when a colleague who is having trouble waking in the morning finds a teasmaid.

They state the smell of coffee will wake them up, but will it actually work?

  • No
  • Your olfactory senses shut down during REM sleep. So you literally have to wake up….. then smell the coffee (and probably why smoke alarms are so important). [Reference]

Question 5

What was reprieved from the death sentence in both 1986 and December 1993?

 

Last update: Apr 28, 2017 @ 7:27 pm

Funtabulously Frivolous Friday Five 187
Neil Long

Fracture Fridays: A A chip off the old bucket handle (Re-post)

The case

An 10 month old presents with swelling of the ankle after being picked up from the babysitter. He has been able to pull to stand and cruise for a while now, but appears to be in pain when he attempts to bear weight after he pulls up to stand. X-Rays reveal the following.

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Diagnosis

This is a metaphyseal corner fracture. AKA a metaphyseal chip fracture. It is very concerning for non-accidental trauma. It is though to occur when a limb is grabbed or twisted forcefully, perhaps while the child is being shaken, and the corner of the metaphysis shears off. It may present with pain and discomfort – or be seen incidentally on X-Rays obtained in a skeletal series. It is related to the “bucket handle” fracture which is more significant in terms of the degree of shearing. See the sample image below with both a corner and bucket handle fracture.

Corner fracture above, and bucket handle fracture below

Corner fracture above, and bucket handle fracture below

Management

This fracture does not require reduction or operative repair in the vast majority of cases unless the displacement is extreme. More importantly, as this fracture can be considered pathognomonic for non-accidental trauma, discovery of a corner fracture should prompt a more thorough workup. In the case above, this would include a skeletal survey, and labs designed to screen for intraabdominal injury (AST, ALT, lipase). If the AST and/or ALT are >80, or the lipase is high get an abdominal CT, as well as troponin, CBC, coags and a head CT. If the AST/ALT and lipase are normal you can stop with the skeletal series. Always consult social work![/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

MEdIC Series: The Case of the Solo Senior

Overwhelmed solo seniorWelcome to season 4, episode 7 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, Alkarim Velji and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine!

This month, we present a case of an emergency attending who questions the common consultant call-etiquette of not contacting attending physicians to provide back-up on a busy call shift.

MEdIC: The Case of the Solo Senior

By Dr. Kaif Pardhan

It’s a busy night at Willow Wind Hospital, a large academic teaching centre. Sheila, one of the staff emergency physicians, is just finishing up her evening shift.  She quickly looks up at the clock above stretcher 10. It’s just five minutes before midnight handover; just enough time to complete her last duty of the night:  Consulting the internal medicine resident to admit a hypoxic elderly woman with community acquired pneumonia.  It was a slam dunk case in her opinion.  The patient had a room air oxygen saturations of only 85% despite several hours of treatment in the department. She was delirious, short of breath and hypoxic. The emergency septic work-up was complete, the patient was appropriately resuscitated, antibiotics  and fluids had been initiated and she was now hemodynamically stable.

Sheila finds Jose, the PGY-2 Internal Medicine Senior resident, in the emergency consult room, diligently typing up a consultation, appearing quite frazzled. “Hey Jose, you doing ok?I’ve got a quick consult for you. It’s an easy one so shouldn’t take long!”

Jose was already stressed but hearing that he had yet another consult to complete was making him panic. His stomach was in knots and he could hear his heart beating rapidly in his chest. He had always heard that “The Willow” had a very busy internal medicine service and his first senior call was certainly holding true to its reputation! His pager started going off at precisely 5:00 pm when he started his senior shift and hasn’t stopped since. He’d already received 17 consults, not counting the 5 left over from the day team. Several consults still needed to be triaged and he hadn’t started reviewing with his juniors or medical students. He had just called his staff, Dr. Gupta, for the 11pm update and, not wanting to appear too needy, had put on a brave face and had told her everything was going well.

He resignedly grabbed his pen and consult sheets, took a deep breath, and turned to Sheila to take down the information:

“Can this consult wait a few hours? It’s been crazy and I haven’t started reviewing the prior consults yet… and I still have several consults to triage.”

“Sounds like you’re having a rough night!” Shiela responded, notably concerned. She could see Jose was overwhelmed and very stressed.

“Yeah, I have never had a call shift this busy before,” replied José.

“Have you called your staff to come in for back-up?”

“I just got off the phone with Dr. Gupta… It’s fine. I can handle it. Just give me the consult.”

“Well, is she coming in to help out?” Sheila was a good friend of Mindy Gupta, the staff internist on call.  Mindy was a rockstar educator, and there was absolutely no way that she wouldn’t be right next to José slugging it out if she knew he was drowning.  Everything seemed off.  “Hey, you know I went to school with Dr. Gupta, I can text her for you if you’d like?”

“No, please don’t. I’m fine. So what’s the consult? I have to get moving!”

Discussion Questions

  1. Whose responsibility is it to activate the back up for the Senior resident? Whether that be in the form of the staff or back-up senior resident?
  2. What role does the emergency department play in making sure that consultant services are not overwhelmed on busy nights?
  3. How might we create the conditions for senior residents in the hospital to be successful in managing large case loads? And how do we prepare them to take on this responsibility as they transition into independent practice?

Weekly Wrap Up

As always, we will post the expert responses and a curated commentary derived from the community responses 2 weeks after the case is published.

This month, our 2 experts are:

  • Dr. Lindsay Melvin
  • Dr. Alim Pardhan

On May 12,  2017 we will post the curated commentary and expert responses to this case! After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary. That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

MEdIC Series: The Concept

Author information

Tamara McColl, MD FRCPC MEd(c)

Tamara McColl, MD FRCPC MEd(c)

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba

The post MEdIC Series: The Case of the Solo Senior appeared first on ALiEM.