Life in the Fast Lane - Latest Comments

Re: Why we should be very wary of using clotbusting drugs to treat acute strokes

Michelle Johnston — Thu, 10 Oct 2013 03:02:13 -0000

I would like to thank everybody for the involvement in the discussion around this topic. If I could make a few further comments – this debate has arisen because there is not clarity about the results and the interpretation of the evidence to date. As has been repeatedly stated during these discussions, those with wariness about the conclusions to date have consistently stated that it appears that tPA will definitely benefit some strokes, but based on the totality of evidence thus far, it is not clear who this is, and that tPA will definitely harm some patients. We have no doubt that the highly respected neurologists and stroke physicians are refining this all the time, as evidenced by the comments and the research currently underway.

Like Dr Cadogan. I work closely with our neurology team at my institution, and support in every way the coordinated rapid assessment and management plans by the stroke team, lead by very capable neurologists. This debate is not about preventing care, but understanding the limitations of the current state of evidence.

It is hard to disagree with the vast anecdotal and inspiring evidence of stroke patients getting better in front of the eyes of the thrombolysing team, although it is important to note that, in every study, this happens equally with placebo as well as tPA.

I would also not agree that non-specialty areas should not delve into the evidence that is not their area. Thank you for that point, Dr Carley.

There is no argument that we want the very best for our patients. It would also be mush easier, and less painful to not be involved in this discussion. We are not the equivalent of climate change skeptics.

When the evidence is unequivocal that we are choosing the most beneficial treatment, for the right patients, then this debate will be left long behind in a dusty corner. As stated in my previous post, Schroedinger’s Cat, we expect that with advanced imaging, drugs and techniques, it will not be long before that question will be answered, by the ground-breaking and trail-blazing researchers and clinicians for whom I have the highest respect.

And, as a final, (I promise) to those that have questioned my right to post, I would like to say that the layman’s post was written by Prof Daniel Fatovich and the critical care post preceding by Prof Simon Brown, both highly respected researchers and academics. I have edited and supported.

Thank you.

Re: Paracetamol… Too much, too often?

Chris Nickson — Wed, 01 May 2013 09:18:30 -0000

Hi Susie
I've corrected the discrepancy in accordance with the ANZ guideline flowchart, using the cut-off of <120micmol/L or <20 mg/L
C

Re: Paracetamol… Too much, too often?

Susie G — Wed, 01 May 2013 08:50:48 -0000

the paracetamol level on the ANZ guideline for no further investigations is <120micmol/L or 66 micromol/L (>10 mg/L)
OR ALT or AST >50 IU/L treat with NAC" why the discrepancy. I tend to use the flow chart to clear my RSI paracetamol pts- are we now saying this is not safe?

Re: Little Johnny and Grandad’s warfarin

MUHAMMAD Rafique — Fri, 15 Mar 2013 20:56:25 -0000

thanks

Re: Hypokalaemia and Metabolic Acidosis

Ben — Sun, 03 Mar 2013 03:22:02 -0000

Hi Mike and co! The PO2 seems very high at 234mmHg with an FiO2 of 0.21. Is this right? Was there an oxygen bubble in the ABG? Hyperbaric Oxygen? Cheers

Re: What is Wellens’ Syndrome?

Jaimie — Fri, 01 Mar 2013 01:37:41 -0000

Had a patient come in with one of these last night - thanks for your blog - explained it really well!

Re: Is Twitter the essential Blogging nutrient?

Tim Leeuwenburg — Fri, 15 Feb 2013 21:52:08 -0000

Hmmm, I must be the dung beetle in the ecosystem...

Re: FACEM VAQ Radiology 004

pranav — Fri, 01 Feb 2013 15:35:46 -0000

aortic rupture or haemomediustinum with contusion on left

Re: Online Medical Calculators

Gemma - ITALY — Tue, 15 Jan 2013 15:53:56 -0000

Hey all
I am organizing all the calculators we may need in Emergency medicine with the right links and alphabetic order at

http://www.medicinadurgenza...

I found it useful. Maybe not :)

Re: Egerton Y. Davis

DavidC — Fri, 14 Dec 2012 22:41:22 -0000

It can be ordered from this page: http://www.mcgill.ca/librar...

Re: Hypokalaemia and Metabolic Acidosis

Mike Cadogan — Wed, 12 Dec 2012 15:38:36 -0000

QTc 550

Re: Hypokalaemia and Metabolic Acidosis

Nadim — Wed, 12 Dec 2012 15:31:06 -0000

Hey mike, thx. Qt doesn't seem inordinately long - what was the Qtc?

Re: Blue Bottle stings in Australia

Reiner Schoenbrunn — Thu, 15 Nov 2012 21:22:57 -0000

Hi
Hot showers are not readily available near most NZ beaches, nor can one quickly boil a billy...

I usually carry some EMLA ointment in my beach pack which makes the area numb. That eases the pain of blue bottle stings within minutes and buys time to get off the beach to a shower or doctor. Got stung yesterday and know this is one way to cope. Cheers Reiner

Re: Citalopram overdose

Wytse — Mon, 29 Oct 2012 22:22:53 -0000

I was browsing around and found out citalopram is an inhibitor of CYP2D6, the enzyme that is also responsible for producing the cardiotoxic metabolite DDCT. I was wondering if it might be possible to use another drug to further inhibit the enzyme so metabolism gets shifted to other pathways. I've looked up some drugs but all I've found are other serotonergics and thinks like quinidine, which is obviously a bad idea.

Re: FACEM VAQ Radiology 004

Ed Burns — Tue, 16 Oct 2012 11:33:50 -0000

Also looks like there is a 1st rib # on the right and some subcutaneous emphysema on the left...

Re: Leonardo Da Vinci first Anatomist

Apostol Vaso — Thu, 04 Oct 2012 11:37:34 -0000

Dear Sir/Madam
I am sending you an abstract of my article,based on my observations on pain. I think is very important to have your opinion in relation with the scientific and methodology sense . I haven't any idea before about Da Vinci's work. Working every day with pain patients I find this relationship, with his anatomical drownings.
Please, see it and give your opinion and if you find it with interest I can send full article

Leonardo Da Vinci, the use of pictures in his view of medicine.
I think that Leonardo Da Vinci’s opinion has an important value in medicine applications, as it has been important and predictive in the field of technology. Based on his anatomical drawings, which also express the same spirit that stands out in all of his works, we can find some very important and basic medical data or at least we achieve to perceive his deep and dimensional views which previously we haven’t taken in consideration.
Based on my observations on the pain I think I have much to express regarding the validity of this genius drawing, during my medical daily practice. His commitment to observe a multitude of human bodies it is important to be emphasized; he forwarded important facts that even today science and scientific thought find it difficult to give explanations. I think that his characterized by a complex dimension which is not useable nowadays.
The drawing of the Vitruvian Man is the foundation and what describes all of the philosophy of this genius. In the center of this drawing is the perfect man, inserted within a circle and a square, this man is the formula of proportion and golden ratio. In contrast to the original Vitruvius man, which, from the first appearance creates the impression of a column, the Da Vinci Man, it clearly appears to carry the strength and power to achieve the impossible .He has the cosmos in his hands.

The first Vitruvian man is undoubtedly, super symmetrical and with the golden ratio, still it clearly appears to be immobile, due to his position within the square .The Vitruvian man proportion lies in its validity for the design and construction of the greatest works of antiquity, that as we know have in their functionality- consistency and excellency.
His proportionality and excellent symmetry originates from the feet placed in the pattern of a foundation. The figure of the Da Vinci Vitruvian man, contrary to this, the proportionality and excellent symmetry it is based on an asymmetric placement of the feet.
In a recent study, has been admitted the idea that Da Vinci has stated the possibility for the description of a patient suffering from inguinal hernia (1),but for the simple reason of the left proportionality it doesn’t stand as an affirmation. The left foot is set aside, while it is seeking to express the left diaphragm which surely it’s slightly more confined and lower than the right foot. The heart location and mediastinum’s is much more on left side, differing from the Roman Vitruvian man diaphragm which is completely symmetric.
The diaphragm’s setting and conclusion of dermatomes lines in both figures, as in the square and in a circle, changes a lot the situation and reveals us more, regarding what Da Vinci has concealed.

In fact, the placement of the diaphragm and dermatome lines immediately provides us the knowledge that Da Vinci’s work is not a casualty, but it’s a mosaic in which articulates all his philosophy. Looking to Vitruvian man drawings, with a diaphragm and dermatome, it is obvious that this is the symbol of health. It is understood here that the disclosure in a way, creating the circle is proportional only an attribute this man who simultaneously has and ideal breathing after his diaphragm is ideally proportionate. The attribute of an ideal breathing, makes this man, a perpetual mobile - so unique and immortal. Based on previous assertions on this drawing, related to the circle and a square, which respectively express the cosmos (the ideal, the thoughts and senses) and the earth realities, makes this man ideally balanced in both these realities.
Apostol Vaso
Tirana,Albania

Re: Egerton Y. Davis

Chris Nickson — Sat, 29 Sep 2012 11:58:21 -0000

Sadly I don't have access to a copy... Clearly a must read.
C

Re: Egerton Y. Davis

David C — Fri, 28 Sep 2012 20:18:18 -0000

I am surprised you do not reference the excellent book on Davis by Richard Golden. (The works of Egerton Y. Davis, Sir William Osler's Alter Ego.) Osler Library Studies in the History of Medicine #3 1999.) Copies are available from the Osler library at mcGill University.

Re: TB Learning Zone

Jimy Alex Merino Rivera — Sat, 22 Sep 2012 03:28:37 -0000

I am so very interested into the relationship phatogen-host specialy in Mycobacterium TB, because i want to design an investigation that contributes to clarify the molecular mechanism by which the bacillus should be attacked.

Re: Jack Barnes and the Irukandji Enigma

Chris Nickson — Tue, 11 Sep 2012 02:46:15 -0000

Wow - that's a study you'd see me run a mile from!
Cheers Dallas,
Chris

Re: Jack Barnes and the Irukandji Enigma

Dallas Fell — Mon, 10 Sep 2012 19:03:14 -0000

Hello. I just found a 1961 newspaper under my house - The Newcastle Sun Jan 26th 1961 - with an article as follows.
I have no idea what became of these volunteers, reportedly exposing themselves to the sting of the most deadly of the jellyfish, with penetrating barbs.
Dallas Fell

Volunteers To Risk 'Death Stings' In Antidote Search
DARWIN: Three volunteers will soon allow themselves to be stung by the deadly sea wasp in an attempt to find and antidote to the "two minute death".
The experiment will be supervised by the Health Department and private doctors. The wasp is known to have killed at least nine people in the past 20 years.
Doctors will have less than 2 minutes to cut away the stung flesh and skin before the wasp's deadly poison enters the bloodstream.
The volunteers are fisherman Bob Staff and his wife Lillian and and Rodney McMahon (25).
The volunteers, all skin-divers, believe they have been stung by jellyfish at some stage of their underwater career and survived without ill-effects.
. . . A serum has been discovered which, if injected immediately after the sting, theoretically should combat the poison.
. . . Mr Frank McNeill, a curator of Marine Invertebrates at the Australian Museum in Sydney, said today the sea wasp was also known as the "box" jellyfish.

Re: Top 12 deadly dangerous snakes

An Aussie — Fri, 31 Aug 2012 05:58:33 -0000

that's terrible, let's make sure that we never moved to Southeast Asia, Indonesia, South Asian waters, North America, Middle East, or Brazil okay?

Re: AVNRT for two

Francis — Sun, 19 Aug 2012 06:14:13 -0000

I agree with Zoltan regarding the first ECG, should be Slow-fast? An electrophysiologic examination may need to tell the truth.

Re: Penis captivus

Banjamin Hugh Osler — Wed, 04 Jul 2012 15:06:02 -0000

My great great grandfather was the Canadian Financier Sir Edmond Boyd Osler and his brother was the Canadian physician Sir William Osler. "Egerton Yorrick Davis" was the pseudonym that William used for his practical jokes. This letter was written by William as a joke on his colleague Theophilus Parvin who had written an article on the phenomenon of vaginismusin the same journal three weeks earlier.

Re: What is Brugada Syndrome?

LearnOnly Heart — Sun, 24 Jun 2012 16:32:43 -0000

thanks for nice informative article