Funtabulously Frivolous Friday Five 151

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 151

Question 1

Your house surgeon, having just reversed a patient on unfractionated heparin with haematemasis is agitated because the patient has “sulphur drugs – anaphylaxis” as an allergy alert and you’ve just given them protamine sulphate! Is it time to grab the adrenaline? Is this allergy relevent for protamine sulphate? What about furosemide – which is derived from the sulfonamides and contains a sulphur group?

  • Patients who have “sulphur drug allergy” typically have had reactions to sulfonamide antibiotics.
  • It is possibly the arylamine group in the sulfonamides that is responsible for the allergic response. While many drugs contain a sulfonamide moiety, they don’t contain the arylamine group.
  • There is limited evidence to support true cross-reactivity between the sulfonamide antibiotics and non-antibiotic sulfonamides (e.g furosemide).
  • Sulfhydryl and sulfate drugs have no relationship to sulfonamide allergy and there is no evidence to support cross-reactivity. You can put away that adrenaline now….[Reference]

Question 2

Your colleague has been reading the “mystery of the purple spotted pillowcase”, “the case of the red lingere” and “the mystery of the blue girl”. What speciality is he in and what condition has led him to this reading material?

  • Dermatology
  • These are all case reports of chromhidrosis – or coloured sweat.
  • A classification system based on the sweat glands has been proposed; apocrine chromohidrosis, eccrine chromohidrosis and pseudochromhidrosis.
  • The pathophysiology of apocrine chromhidrosis is unclear, but it is postulated that oxidized lipofuscin is the responsible pigment.
  • Eccrine chromohidrosis is due to water-soluble pigments being excreted via the eccrine glands. There have been cases of this with quinine, various dyes in the coating of tablets, and food pigments.
  • Pseudo-chromhidrosis is discolouration of the sweat from an exogenous source – typically caused locally by bacterial species like Corynbacterium and Pseudomonas. [Reference]

blue sweat

Question 3

A tropical fish keeper comes in with uveitis. He’s 27 and has no past medical history and doesn’t take any medications. He had been well recently – other than coming off his bike while mountain biking in the outback. He’s particularly annoyed about that, as the multiple abrasions include a recently done tattoo on his right arm – which is now swollen and inflammed. You immediately hear the hoof-beats of zebras and think…?

https://en.wikipedia.org/wiki/Uveitis

https://en.wikipedia.org/wiki/Uveitis

  • ….of tattoo-associated uveitis. A case series has reported uvetitis asscoiated with black ink used in tattoos. The uveitis occurs simultaneously with inflammation of the skin over the tattoo.
  • This condition responds to high-dose oral steroid. [Reference]

Question 4

Who might suffer with tomomania?

  • A surgeon! – a madness for cutting
  • It is an irrational desire to use operative procedures which can be by a doctor or a patient.
  • It is suspected that many avid plastic surgery enthusiasts. [Reference]

Question 5

What Split Enz song is a patient recovering from optic neuritis most likely to sing?

    • “I see red, I see red, I see red”.
    • Red desaturation is a feature of optic neuritis. [Reference]

//www.youtube.com/watch?v=vKj4upY1VYI

 

…and how to give a generic TED talk.

//www.youtube.com/watch?v=8S0FDjFBj8o

Last update: Jun 24, 2016 @ 10:38 am

The post Funtabulously Frivolous Friday Five 151 appeared first on LITFL: Life in the Fast Lane Medical Blog.

Clinical Trials Worth Knowing – CRICU Sepsis Nursing Workshop

This post is a collation of references and resource material from my second presentation in the inaugural Caboolture Redcliffe ICU Sepsis Workshop for nurses. The objective of this session was to work through critical appraisal of 5 prominent critical care trials with particular significance to our practice context. The completely unambiguous overtone of this session was to practice critical appraisal and engage with the literature that informs the medical decisions in our ICU.


Following a brief introduction and overview of the constructs of evidence based practice and grading of evidence, I lead the group through a structured critical appraisal of the SPLIT Trial (Young et al 2015). We used the Critical Appraisal Skills Programme (CASP) Randomised Contol Trial (RCT) Appraisal Tool to dissect the study. Following this, the participants were broken into four small groups and each given a prominent sepsis trial to appraise and feedback to the whole group in 30 minutes time.

The trials were purposely selected for discussion as they all hold specific relevance to practice in our ICU. These trials also share one commonality – they were all ‘negative’ or no difference trials. One key aspect discussed was the importance of no difference trials. During the group feedback particular focus was drawn to identifying the Population, Intervention, Comparison and Outcome (PICO), whether the study was believable (internal validity and biological plausibility), and whether it should change practice or confirmed our current practice.

About 20 minutes into the appraisal activity the groups were provided with the Bottom Line review for their relevant study to aid in synthesising final feedback and as an example of an excellent critical appraisal. The Bottom Line is an excellent critical appraisal and literature resource for Intensive Care. Founded by members of the Wessex Intensive Care Society and now with international authorship, this is one of my absolute go-to resources to help filter and process the swathe of ICU trials.

Primary Literature

Secondary Appraisal

HEAT Trial – Acetaminophen for Fever in Critically Ill Patients with Suspected Infection (Young et al 2015) Bottom Line on HEAT – Steve Mathieu
ARISE Trial Goal-Directed Resuscitation for Patients with Early Septic Shock (Delaney et al 2014) Bottom Line on ARISE – Steve Mathieu
CORTICUS Trial – Hydrocortisone Therapy for Patients with Septic Shock (Sprung et al 2008) Bottom Line on CORTICUS – Duncan Chambler
BLISS Trial – Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis (Abdul-Aziz et al 2016) Bottom Line on BLISS – Adrian Wong
SPLIT Trial – Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit (Young et al 2015) Bottom Line on SPLIT – Adrian Wong

Anthony Crocco from Sketchy EBM – How to read (most) research papers