Funtabulously Frivolous Friday Five 090

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 the Funtabulously Frivolous Friday Five 090

Question 1

Why should you avoid contact with caterpillars of the Lonomia genus, a type of moth native to South America?

Reveal the funtabulous answer

Lonomia caterpillars can cause Caterpillar-induced bleeding syndrome.

This syndrome is a venom-induced consumptive coagulaopathy caused by a pro-coagulant toxin, analogous to that caused by some venomous Australian snakes.

The lethal case report by Chan et al (2008) is well worth reading and has some great images (click on the PMCID link below),  However I wonder about the validity of the ‘adding-fuel-to-the-fire” assumption that dictates the avoidance of replacement blood products for venom-induced consumptive coagulopathies.

  • Chan K, Lee A, Onell R, Etches W, Nahirniak S, Bagshaw SM, Larratt LM. Caterpillar-induced bleeding syndrome in a returning traveller. CMAJ. 2008 Jul 15;179(2):158-61. PubMed PMID: 18625988; PubMed Central PMCID: PMC2443214.

Question 2

What is Obecalp?

Reveal the funtabulous answer

Obecalp is placebo spelt backwards and is the name of a cherry flavoured dextrose pill produced by a company called Efficacy Brands.

According to the BMJ’s Minerva Obecalp was the brainchild of a couple who wanted to give their hypochondriacal niece something to make her feel better. When they couldn’t find a placebo pill in the drugstore, they decided to invent one.

The understandable controversy over this agent was nicely covered in the NY Times.

Question 3

What are over 70% of antibiotics used for in the United States?

Reveal the funtabulous answer

Animal feeds

Antibiotics are put in animal feed to help keep them disease free, and thus grow larger and generate more produce.

This use is a major factor contributing to antibiotic resistance.

  • “Executive summary from the UCS report “Hogging It: Estimates of Antimicrobial Abuse in Livestock””. Union of Concerned Scientists. January 2001. [fulltext]

Question 4

What is the framing effect?

Reveal the funtabulous answer

A cognitive bias that is evident when presenting the same option in different formats alters people’s decisions. Individuals have a tendency to select inconsistent choices, depending on whether the question is framed to concentrate on losses or gains.

The framing effect is important in medicine as a physician’s perceptions of risk to the patient might be strongly influenced by whether the outcome is expressed in terms of the possibility that the patient might die or that they might live.

To negate this bias, whenever you consider the risk of something reframe the risk in terms of the other possible outcomes and see if you would still make the same choice.

  • Crosskerry P, Cosby KS, Schenkel SM, Wears RL. Patient Safety in Emergency Medicine. Lippincott Williams & Wilkins, 2009.

Question 5

If you were about to undergo a surgical procedure in 1945 and your surgeon’s name was Walter Jackson Freeman II, what unusual surgical implement would have been used on you?

Reveal the funtabulous answer

An ice pick

Freeman performed over 3500 lobotomies. In particular he developed the transorbital lobotomy, which became known as the ‘icepick lobotomy’.

The procedure performed by inserting a metal pick into the corner of each eye-socket and moving it back and forth, severing the connections to the prefrontal cortex in the frontal lobes of the brain.

Freeman used to travel across the USA visiting mental institutions in his personal van, which he called the “lobotomobile.” He only charge US$25 for the procedure. A bargain!

Freeman was not a surgeon – he had no surgical training. It was he who nominated his mentor António Egas Moniz for a Nobel prize, which Moniz won in 1949 for the invention of the leucotomy. The Neurophilosophy blog details the sordid but fascinating history of this procedure in The rise & fall of the prefrontal lobotomy.

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Funtabulously Frivolous Friday Five

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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