Arsenic Poisoning

This flashcard is one from my series on heavy metals.

To keep a sense of consistence, I incorporated a giant cube onto each flashcard. The front of the cube features the atomic number and mass from the periodic table, while the side of the cube features a list of signs and symptoms of toxicity. On the top of the cube, I drew a character that summarises the toxicity.

Arsenic is often used as a rat poison; it causes glove and stocking paraesthesia, scaly skin and garlic breath. I thought it was fun drawing a sexy rat with garlic breath…

Kloss and Bruce Arsenic Poisoning

Other Resources

The post Arsenic Poisoning appeared first on LITFL.

Competency standard 254: how to get laid.

Because even the most hardened  nurse needs a little love.

Its been another crazy shift.
And now you are home you have a hankering for some serious rumpy-pumpy post traumatic stress relief with the one you love.

But alas, you find your partner already in bed reading The Economist and wearing some sort of thick green sludgy avocado face mask on his/her face.
The signs do not look good.

Fear not.

After mastering a few basic competencies you will be offloading that pent up stress and feeling the love before you can hang your stethoscope on the bedroom doorknob and yell….Geronimo!

 

I will start with the competency standards for the male nurses because they are a little more complex and far less understood:

set the scene.

Foreplay begins now.
Set the scene before you leave for work.

Its those little corn-ball things that you read about in women’s magazines that really do count….
Like buying him/her some flowers,
or leaving a little note tucked in their luchbox,
or giving them a big hug while they are making breakfast,
or writing: I am dying for a shag, and if I don’t have you every which way in every room of the house including the garden shed by sun-up my private parts are going to explode, in large black letters on the fridge.

take a shower.

Scent counts.

Nothing will pour iced water on those flames of passion like a subtle musky aroma of Melena wafting between you.
Or the fragment top notes of a regurgitated, semi-digested Quarter Pounder with Cheese and a side of dried blood hanging in the air.
Make a bee line from the front door to the shower and scrub-a dub dub.

Once all those nooks and crannies are squeaky clean use a hint of aftershave.
Every male nurse should have their own signature scent. It helps us mark out our territories and identify each other when we are covered in full personal protective equipment.

My own preference is Cool Water by Davidoff: a blend of Mandarin, Kiwi, Cactus, Clary Sage, Cedar, Elemi, White Musk, Hinokiwood, and Smokey Gaiacwood.
Now that should cover the smell of any shift.
Careful though, don’t overdo it….just a homoeopathic wafting.

best behaviour.

Oh, and whilst you are in the shower, a couple of do nots:

  1. Do not fart loudly.
  2. Do not sing Act II from Verdi’s Il Trovatore at the top of your lungs.
  3. Do not blow snot out of your nose one nostril at a time.
  4. Do not get out of the shower and wave your willy around like a helicopter making woo woo noises.
  5. Working as a nurse, you may have become de-sensitised to see these as all perfectly acceptable behaviours.
    Maybe so, but they are not romantic ones.
    Set some boundaries man.

ancient secrets of foreplay.

I’m now going to give you a ancient secret instruction passed down an unbroken lineage of male nurses since the Celtic sages of King Arthur. A powerful foreplay incantation that will leave your significant other powerless to resist your most kinky desires.
It will de-calcify her backbone leaving her but love-putty in your hands.

Here it is: Clean……The……House.

Use this power only for good.

get re-focused.

Remember you are not at work any more.
Take a few seconds to let the shift drop away before engaging with your partner.

In order to set the mood, don’t talk shop when you get home.
Rather, ask about your partners day.
And for the love of Mike, stay focused when lovemaking. Yelling out STAND CLEAR! at the moment of climax may cause more than a little alarm for your partner. Or not. Whatever.

and for the females.

So. I have covered the complex rituals and preparatory competencies that male nurses should master in order to get some loving.

Now it’s time for the ladies. And the competency standards are essentially the same.
Except for one exception. If the one you love happens to be a male nurse it is a little more simple:

Step 1: turn up.
Step 2: undress.

 

References:

Featured image via: Numinosity.

A188E. Sample size in hypothermia randomized controlled trials

[Versión en español]

Until recently, only five randomized clinical trials (RCTs ) had been published on the effectiveness of induced hypothermia in recovered cardiac arrest, one of them only in abstract form. They were small size (figure), and suffered from methodological limitations. Two previous meta-analysis, carried out on four [1] and five [2] of these RCT concluded that hypothermia decreased mortality and increased the likelihood of brain function recovery, not taking into account the uncertainty arising from the limited available evidence, as shown in a third meta-analysis [3]. Empiric studies have shown that disregarding the inaccuracy derived from a small sample size in relation to the magnitude of the therapeutic effect can be misleading in many meta-analysis [4], and erroneously inform clinical practice guidelines.
   
Recently a new randomized clinical trial [5] on hypothermia in cardiac arrest has been published [5], which, besides being less prone to bias and more consistent with current standards of therapy than previous, includes many more patients, changing the sign of the summarized evidence [6]. Nielsen study alone provides twice as many patients than all previous studies combined. The most recent clinical trial (Nielsen 2013) includes almost four times more patients than the previous largest (HACA 2002). The total number of patients included now in the updated meta-analysis has been tripled by Nielsen study (Figure).




Eduardo Palencia Herrejón, Hospital Universitario Infanta Leonor, Madrid.
Domingo Díaz Díaz, Hospital Universitario Infanta Leonor, Madrid.
Ramón Díaz-Alersi, Hospital Universitario Puerto Real, Cádiz.
Ferran Roche Campo, Hospital Verge de la Cinta, Tortosa (Tarragona).
© REMI, http://medicina-intensiva.com. Enero 2014.

AUTHORS DECLARE NO CONFLICT OF INTERESTS.

Enlaces:
  1. Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients. Cheung KW, Green RS, Magee KD. CJEM 2006; 8: 329-337. [PubMed]
  2. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Arrich J, Holzer M, Herkner H, Mullner M. Cochrane Database Syst Rev 2009; 4: CD004128. [PubMed]
  3. Hypothermia after cardiac arrest should be further evaluated--a systematic review of randomised trials with meta-analysis and trial sequential analysis. Nielsen N, Friberg H, Gluud C, Herlitz J, Wetterslev J. International journal of cardiology 2011; 151: 333-341. [PubMed]
  4. Random error in cardiovascular meta-analyses: how common are false positive and false negative results? AlBalawi Z, McAlister FA, Thorlund K, Wong M, Wetterslev J. Int J Cardiol 2013; 168: 1102-1107. [PubMed] [REMI]
  5. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Aneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H; the TTM Trial Investigators. N Engl J Med 2013. [PubMed] [REMI]
  6. Palencia Herrejón E. Papel de la hipotermia tras la parada cardiaca: metaanálisis de ensayos clínicos. [REMI 2013; 13(12): A183

 

A188. Tamaño muestral en los ensayos clínicos sobre hipotermia en la parada cardiaca recuperada

[English version]

Hasta recientemente, solo se habían publicado cinco ensayos clínicos aleatorizados (ECA) sobre la eficacia de la hipotermia inducida en la parada cardiaca recuperada, uno de ellos solo en forma de abstract. Todos ellos eran de pequeño tamaño (figura), y adolecían de limitaciones metodológicas. Dos metaanálisis previos, realizados sobre cuatro [1] y cinco [2] ECA, concluían que la hipotermia disminuía la mortalidad y aumentaba la probabilidad de recuperación de la función cerebral, sin tener en cuenta la incertidumbre derivada de la escasa evidencia existente, lo que fue puesto de manifiesto en un tercer metaanálisis [3]. Hoy se sabe que el no tener en cuenta la imprecisión derivada del tamaño muestral y su relación con la magnitud del efecto terapéutico puede llevar a conclusiones erróneas en muchos metaanálisis [4], e informar así equivocadamente a las guías de práctica clínica.
      
Recientemente se ha publicado un nuevo ensayo clínico aleatorizado [5] sobre la hipotermia en la parada cardiaca recuperada, que, además de estar menos sujeto a sesgos que los estudios previos y ser más acorde con los estándares actuales de tratamiento, incluye muchos más pacientes, dando un vuelco a la evidencia [6]. El estudio de Nielsen aporta él solo el doble de pacientes que todos los estudios anteriores juntos. El ensayo clínico más reciente (Nielsen 2013) tiene casi cuatro veces más pacientes que el que hasta ahora era el de mayor tamaño (HACA 2002). El nº total de pacientes incluidos ahora triplica al que había antes del estudio de Nielsen (figura).




Eduardo Palencia Herrejón, Hospital Universitario Infanta Leonor, Madrid.
Domingo Díaz Díaz, Hospital Universitario Infanta Leonor, Madrid.
Ramón Díaz-Alersi, Hospital Universitario Puerto Real, Cádiz.
Ferran Roche Campo, Hospital Verge de la Cinta, Tortosa (Tarragona).
© REMI, http://medicina-intensiva.com. Enero 2014.

LOS AUTORES DECLARAN NO TENER NINGÚN CONFLICTO DE INTERÉS.

Enlaces:
  1. Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients. Cheung KW, Green RS, Magee KD. CJEM 2006; 8: 329-337. [PubMed]
  2. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Arrich J, Holzer M, Herkner H, Mullner M. Cochrane Database Syst Rev 2009; 4: CD004128. [PubMed]
  3. Hypothermia after cardiac arrest should be further evaluated--a systematic review of randomised trials with meta-analysis and trial sequential analysis. Nielsen N, Friberg H, Gluud C, Herlitz J, Wetterslev J. International journal of cardiology 2011; 151: 333-341. [PubMed]
  4. Random error in cardiovascular meta-analyses: how common are false positive and false negative results? AlBalawi Z, McAlister FA, Thorlund K, Wong M, Wetterslev J. Int J Cardiol 2013; 168: 1102-1107. [PubMed] [REMI]
  5. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Aneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H; the TTM Trial Investigators. N Engl J Med 2013. [PubMed] [REMI]
  6. Palencia Herrejón E. Papel de la hipotermia tras la parada cardiaca: metaanálisis de ensayos clínicos. [REMI 2013; 13(12): A183

   

Macitentan for IPF falls short in MUSIC trial

Blair Westerly, MD Effective treatment for idiopathic pulmonary fibrosis continues to elude patients and clinicians alike.  Multiple classes of medications have been studied, none with convincing data demonstrating efficacy.  Because of the proposed  contribution of endothelin-1 to the pathogenesis of IPF, receptor antagonists of this growth factor have previously been evaluated in IPF, but with [... read more]

The post Macitentan for IPF falls short in MUSIC trial appeared first on PulmCCM.