Funtabulously Frivolous Friday Five 350

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 350

Question 1

Roald Dahl is a beloved children’s author the world over, and interestingly a medical inventor as those FFFF aficionados will know. But today’s question relates to the book George’s Marvellous Medicine, by 2010 there was a declaration at the begining of the book which read:

WARNING TO READERS: Do not try to make George’s Marvellous Medicine yourselves at home. It could be dangerous

So what harm could become of Grandma if you gave her the same medicine?

Reveal the funtabulous answer

Mainly GI related, but some highlighted in bold are a little more toxic:

  • Golden gloss hair shampoo – nausea, vomiting, renal injury
  • Toothpaste – nausea and vomiting
  • Superfoam Shaving soap – renal injury and lung injury
  • Vitamin enhanced face cream – CNS depression
  • Scarlet nail varnish – nausea, vomiting and diarrhoea
  • Hair remover – erosion and lung injury
  • Dishworth’s dandruff cure – nausea, vomiting and diarrhoea
  • Brilliant false teeth cleaner – nausea and diarrhoea
  • Nevermore ponking deodorant – CNS depression
  • Liquid paraffin – nausea and diarrhoea
  • Helga’s hairset – CNS depression
  • Perfume “Flowers of turnips” – CNS depression
  • Lipsticks – nausea, vomiting and diarrhoea
  • Superwhite washing powder – nausea, vomiting, diarrhoea, erosion and lung injury
  • Maxwell floor polish – kidney injury, CNS depression, erosion, lung injury and cardiac toxicity
  • Flea powder for dogs – nausea and vomiting
  • Dark tan shoe polish – kidney injury, CNS depression, erosion, lung injury and cardiac toxicity
  • Gin – CNS depression
  • Extra hot chilli sauce – diarrhoea
  • Purple pills for horses – CNS depression and cardiac toxicity
  • Thick yellowish liquid for cows – nausea, diarrhoea, kidney injury, CNS depression and cardiac toxicity
  • Sheep deep – nausea, vomiting, diarrhoea, kidney injury, CNS depression, and seizures
  • Pig pills – nausea and diarrhoea
  • Engine oil – nausea, vomiting, CNS depression, seizures, lung injury and cardiac toxicity
  • Antifreeze – nausea, vomiting, CNS depression and seizures
  • Grease – nausea, vomiting, CNS depression, seizures, lung injury and cardiac toxicity
  • Dark brown gloss paint – nausea, vomiting and diarrhoea

If you click on the reference and can access the BMJ there is an interactive medicine pot in case you want to experiment safely. I’ll leave you with a quote from the discussion section in the BMJ paper from Drs Johnson and Davies. Remember, keep your kids safe and your grandma’s safer (even the cranky ones):

The account given of the likely effects of ingesting the medicine was extremely accurate (allowing for some poetic licence). Grandma initially “shot up whoosh into the air” and when she landed she shouted suddenly “My stomach’s on fire!” This immediate effect was likely due to the high level of capsaicin—however, ingredients such as sheep dip (organophosphate), dark tan shoe polish (white spirit, heavy naphtha, trimethylbenzene), and floor polish (heavy naptha) cause mucosal erosion and are likely to have contributed to severe gastric dyspepsia. George’s treatment using half a jug of water is unlikely to have been helpful and might have increased the risk of later aspiration as well as of later cardiogenic shock due to excess preload if grandma had developed myocarditis.

Reference:

Question 2

What do NHS wound care nurses, mongolian warriors and tribes from New South Wales in Australia to Burma and Central America all have in common?

Reveal the funtabulous answer

Maggots

Biosurgery or maggot therapy is a non-operative treatment method for chronic skin and soft tissue wounds. The best part is the maggots eat unhealthy tissue and are not affected by biofilms or antibiotic resistance.

Legend has it that Gengis Khan would have a cart full of maggots to heal his soldiers from battle wounds; while I couldn’t find proof of this, the tradition of maggots is documented in the Ngemba tribe in New South Wales in Australia, north Burma and Mayan healers in Central America.

The French surgeon Ambroise Paré (1510 – 1590) was the first doctor to document the effects of fly larvae on wound healing. He incorrectly thought they damaged healthy tissue when a skull was damaged, but it was probably a case of osteomyelitis.

Dominique-Jean Larrey (1766 – 1842), a founder of battlefield surgery, noted in one of Napoleon’s campaigns the blue blowfly maggots fed only on dead tissues but positively affected the underlying living ones.

Maggots were officially adopted by John Zacharias (1837 – 1901) during the Civil War in the US but still the current thought was that maggots would just bring more disease to the wound.

William Baer was a military surgeon in World War I and is considered the founder of maggot therapy after he used it to reduce the mortality rate of open fractures and abdominal wounds. Since then, maggot therapy was widely used in hospitals up to the 1940s. Along comes penicillin, and people prefer a tablet over the application of maggots. I wonder why? But with the advent of antibiotic resistance, there has been a resurgence in the use of sterile maggots.

Reference:

Question 3

What is a Déjerine syndrome?

Reveal the funtabulous answer

Better known as Dejerine-Roussy syndrome or thalamic pain syndrome.

It is a condition that develops after a thalamic stroke. As initial stroke symptoms dissipate, an imbalance in sensation develops. Some patients develop persistent cutaneous hyperaesthesia or severe persistent or paroxysmal intolerable pains on one side of their body.

Jules-Joseph Déjerine (1849-1917) was a Swiss-French neurologist and along with Gustave Roussy (1874-1948), first described thalamic pain following lesions of the ventroposterior thalamic nuclei or the deep white matter of the parietal lobe following contralateral hemiparesis, hemiataxia and choreoathetosis (le syndrome thalamique).


Question 4

Which drug no longer in the ACLS algorithm, was E.T. given when they were in cardiac arrest?

Reveal the funtabulous answer

Bretylium – no wonder they didnt get them back.


Question 5

What number systolic do young athletes get when they are bench pressing or performing leg presses at the gym? 150, 200, 250, 300 or 350?

Reveal the funtabulous answer

The highest recorded BP was 370/360, with a mean BP of 311/284 while doing 100% max double-leg press sets.

A group of 10 healthy male athletes had a radial artery cannulated and performed double-leg press sets at 85% and 100% of their max. The research group were trying to see if breathing techniques brought down their maximal systolic pressure. As it turns out, the numbers above were with a closed glottis, whereas if they slowly exhale during contraction, the mean BP is 198/175.

While completely not generalisable, it’s good to see they don’t burst a gasket at these pressures, and maybe we can not treat every adult with a systolic over 200 as a medical emergency. Also, exhale when you are lifting weights, your head will thank you for it later.

Reference:
  • Narloch JA et al. Influence of breathing technique on arterial blood pressure during heavy weight lifting. Arch Phys Med Rehabil. 1995:76(5):457-62

… and finally, quotes:

Vulnerability sounds like truth and feels like courage

Brené Brown

FFFF

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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