Funtabulously Frivolous Friday Five 339

It’s Cortical Bone weather here in Australia…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 339

Question 1

What do Alexander I of Russia, Isambard Kingdom Brunel, Bram Stoker and Duncan Goodhew all have in common?

Reveal the funtabulous answer

They are recipients of the Royal Humane Society award.

As you may recall from last week’s FFFF that the Royal Humane Society recognises individuals’ bravery when saving others.

Alexander I, Tsar of all the Russians, saved a Polish peasant while out riding.

Isambard Kingdom Brunel is best known for designing bridges, tunnels, and iron-clad ships. But did you know in 1828 he rescued five men in two separate incidents during the building of the Thames Tunnel?

15 years before Bram Stroker published Dracula he saved a man from the River Thames.

Duncan Goodhew is a national treasure in the UK for winning Gold at the Moscow Olympics for 100 metre breaststroke. He also won recognition for saving the life of an elderly man. Goodhew saw the man collapse and thought he was having a heart attack. He loosened the man’s collar and started giving mouth to mouth resuscitation. He later found out he saved a senior politician, the Labour MP, the Rt Hon Robert Sheldon.

But let us go further back what of the first award in July 1774…

Thomas, the son of John Joseph, a child aged about 14 months, dwelling by the Iron Foundry near the Falcon Stairs, wandering from its mother and other women who were drinking tea together in a chandler’s shop, got into a back kitchen, and fell through a trap, the door of which was carelessly left open, into an aqueduct communicating with the River Thames.

The women heard it fall, and ran to the place, but could not perceive the child. Their screams brought a shoemaker, who lived in an adjacent house, to the place, but he was fearful of jumping in, lest he should fall upon the child.

Thomas Vincent, a waterman, who was amongst the crowd brought together by the cries of the distressed mother, being informed of the event, ran round by several houses, and climbing over the walls of the aqueduct, waded up to the place to the height of his chest in the water, proceeding cautiously, and feeling for the infant with his feet as he advanced; for he imagined the returning tide might have carried it to a distance from the place: nor was he altogether deceived; as he felt the child about ten feet from the opening.

He took it up, and gave it to the women through the hole through which it had fallen. From seven to ten minutes must have elapsed from the falling-in of the child to the time it was taken out.

The women upon the strictest examination affirmed, that the child was to all appearance dead; its eyes were fixed, it lay breathless, and void either of motion or pulse.

They shook, and beat it on its back for some little time, and laying it upon a counter in the shop, rubbed tis belly and chest with dry salt; the friction was scarcely continued three minutes before the child began to gasp, and give other signs of returning life, which encreased [sic] till they were enabled to pour some salt and water down its throat.

This excited a vomiting, by which the child threw up a considerable quantity of water and mud from its stomach, and in a few minutes more it was restored to the joyful arms of its mother.

In the course of the evening it had two or three convulsive fits, but these were of short duration, and returned no more.

The person who had taken the child out of the water ran for Mr. Boyse, one of the Medical Assistants to this Society: he not being at home, his journeyman went to the house, but he found the child pretty well recovered.

The waterman had the reward promised by the society.

The First Award – Royal Humane Society

Reference:


Question 2

You are the Director of Patient Services at a residential facility for young adults with psychiatric disorders.  You are asked by one of the staff to look in on a 17-year-old patient with schizophrenia who has developed nausea, anorexia, epigastric pain, and hematemesis.  The staff notes that the patient’s penny collection is missing.  What do you suspect is going on, and what is the likely outcome in this patient?

Reveal the funtabulous answer

Zinc toxicity.

The scenario described is a real one.  A young adult schizophrenic patient has been reported who ingested 461 pennies. Within a few days, he had the noted symptoms.  Since the situation was not believed to be an emergency the coins were not removed.

Image Credit: Bennett DR, Baird SM, Chan K-M, et al. Zinc toxicity following massive coin ingestion.  Am J Forensic Med Pathol 1997;18:148–3

Twenty days after admission, the patient developed severe bleeding with hypotension requiring inotropic support as well as transfusion. A radiograph of the stomach revealed metallic densities consistent with coins in the stomach and groups of coins more distally in the bowel. Emergent laparotomy showed the stomach to be grossly distended with a blood clot. Through a gastrotomy, 2 L of clot were removed along with 461 coins, including 425 U.S. pennies, 11 nickels, 18 dimes, 6 quarters, and one Canadian cent 

Copper pennies made before 1982 contained 95% copper and only 5% zinc. However, due to the increasing cost of copper, pennies made in 1982 and thereafter contained primarily zinc (97.6% zinc and only 2.4% copper.

The patient died 3 weeks later of multisystem organ failure.  The patient’s autopsy revealed acute hemorrhagic esophagitis, acute tubular necrosis, massive acute hepatic necrosis, mild fibrosis of the pancreas, and hypercellular bone marrow.  The stomach, which had contained most of the coins, revealed mild chronic inflammation, dilated vessels with unorganized thrombi, transmural acute inflammation, and necrosis.  Thus, the ingestion of so many pennies, at one time, can be lethal.

Reference:


Question 3

You recount the above case to your surgical colleague over Friday drinks. They are not impressed.

Call that a coin collection?. Take a look at this…

How many coins do you think this patient ingested?

Reveal the funtabulous answer

1,894 coins weighing just over 8kg.

Despite us finding two interesting cases for our FFFFs. Coin pica in large amounts is actually quite rare. While we commonly see the accidental ingestion by an exploratory toddler there are only 7 documented cases of massive coin ingestion in the literature.

The case above is of a 51 yr old man who was later diagnosed with schizophrenia. He ingested mainly Yen which are primarily copper. He fortunately recovered from his perforated stomach and made a full recovery without any toxicity from the coins. Out of the seven cases in the literature, 3 died of multi-organ failure and the rest survived mainly suffering from anaemia.

References


Question 4

If you follow the national trend of imbibing larger quantities of soft drinks (an extra 2 fluid ounces (60 mL) a day) and if, everything else in your diet and life remains the same…

How much weight will you gain in a year?

Reveal the funtabulous answer

3 pounds (1.3 kg) each year.

Numerous studies have shown that food portion sizes in fast food restaurants are getting bigger and bigger, along with customers’ waistlines.  A study in the Journal of the American Dietetic Association (2003;103:41–47) has found that soft drinks are a particular problem.


Question 5

When people kiss, do they prefer to have their heads facing to the right or to the left?  

Reveal the funtabulous answer

Twice as many couples turn their head to the RIGHT when smooching

Onur Güntürkün (Ruhr University, Germany) spent two-and-a-half years watching couples kiss at airports, railway stations, beaches, and parks, in Germany, the United States, and Turkey, and found that almost two-thirds of people turn their heads to the right.

Keen to put aside suggestions of voyeurism, Güntürküm says he focused particularly on airports because people from so many cultures meet and mix within their confines. Criteria for a scientifically valid kiss were also strict: it only counted if it was the first observed between a couple, was face-to-face, and was on the lips. Any kisser who carried something in his/her hands was disregarded (for this might influence the delivery of the kiss), as were pecks on the cheek because of the cultural influences deeply affecting cheek-bussing encounters.

Such stringent criteria meant that valid kisses were surprisingly rare, with Güntürkün recording only 124 over the duration of his study. Of these, 80 turned their heads to the right and 44 to the left. He says the almost 2:1 ratio matches our preference for the right foot, eye, and ear, and probably has its basis in our tendency to turn our heads to the right in the womb and for up to six months after birth.

Reference


…and Finally
Cortical Bone weather….

FFFF

Funtabulously Frivolous Friday Five

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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