Funtabulously Frivolous Friday Five 189

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 189

Question 1

In the mid-1980s Alastair Coutts was the surgeon for the Solomon Islands. What did he use to stem the bleeding from a ruptured middle meningeal artery?

Reveal the funtabulous answer

Chewing gum

He skillfully rammed it into the left foramen spinosum after the artery decided to complicate an already high risk evacuation of a extradural haematoma.

Question 2

On the subject of medical techniques in austere environments, what would you do if you ran out of saline on a tropical Island and needed a substitute?

Reveal the funtabulous answer

Use coconut water

The story of coconut water being similar to human blood plasma originated during World War II when British and Japanese patients were given coconut water intravenously in an emergency because saline was unavailable.

It’s specific gravity is similar to plasma but other than that it is a hypotonic solution, low in sodium, high in potassium and calcium making its use really only in extreme cases and in small amounts. It has also been documented during Pol Pot’s regime as a crime against humanity, so probably best to continue with your current 0.9% saline supplier.

Question 3

What is the Ulnar paradox?

Reveal the funtabulous answer

An injury to the ulnar nerve will result in the classical ulnar claw. However this is mainly seen in more distal injuries. The ulnar nerve also innervates the ulnar half of the flexor digitorum profundus (FDP) muscle. If the ulnar nerve lesion occurs more proximally (closer to the elbow), the flexor digitorum profundus muscle may also be denervated. As a result, flexion of the IP joints is weakened, which reduces the claw-like appearance of the hand.

Simply put, as reinnervation occurs along the ulnar nerve after a high lesion, the deformity will get worse (FDP reinnervated) as the patient recovers – hence the use of the term “paradox”.

A simple way to remember this is: ‘the closer to the Paw, the worse the Claw’.

Question 4

DJ Robert Miles has died aged 47 and the track “Children” defined his career. Miles had an unusual motivation for the track – helping to tackle “Saturday night slaughter” on Italy’s roads. How did his track prevent this?

Reveal the funtabulous answer

It prevented clubbers in Italy driving off in a adrenaline hyped state.

In the mid 90s the clubbing scene was full of amped-up tracks and hard beats. The Italian authorities blamed the combination of the music and substance abuse for high levels of adrenaline in clubbers leaving for the night and crashing their cars. It was so bad the Italians even had their own term “stragi del sabato sera” – Saturday night slaughter.

Children was a different option with a soft beat and slower music and to those in the right frame of mind brought feelings of nostalgia and calm.

Did it change the death toll, who knows but it did result in chart success with multiple number one slots across Europe for up to 13 weeks, praise from Italian Authorities and parents of car crash victims.

Question 5

On June 29, 2011, the Wyoming Department of Health was notified of two laboratory-confirmed cases of Campylobacter jejuni enteritis among persons working at a local sheep ranch. What activity led to these people becoming infected?

Reveal the funtabulous answer

They ‘used their teeth‘ as ‘castration aids’

C. jejuni is frequently transmitted by fecal-oral contact or consuming contaminated food or water. And infections are commonly associated with eating poultry or unpasteurized dairy products.

In this case, the two ‘victims’ were the only 2 of 12 people who got sick as they worked to castrate and dock tails of 1,600 lambs at a Wyoming sheep ranch.

They were the only two who ‘used their teeth’.

“Ranch owners and employees were advised to use standardized, age-specific techniques for lamb castration (e.g., Burdizzo, rubber rings, or surgery) and to wash their hands thoroughly after contact with animals.”… not their teeth

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Funtabulously Frivolous Friday Five

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

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