Funtabulously Frivolous Friday Five 352
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 352
Question 1
You are prepping to intubate your next patient. No particular reason, your caffeine levels are low, and they won’t stop talking to you, so we’ll put them to sleep for a bit.
In this hypothetical situation, when you give your induction agent, what percentage of patients will become hypotensive, maintain systolic BP or become hypertensive?
Reveal the funtabulous answer
33% for each category (hypotension, normotension and hypertension)
This is at least from the anaesthesia literature. And before you argue, they use propofol, and I use etomidate or ketamine. There is still value in the lesson. Remember, this is in healthy individuals. We are often intubating the sick, elderly or trauma patients. Sometimes they are all of the above, and even using etomidate or ketamine, you can take away sympathetic drive and still cause hypotension.
While the paper referenced doesn’t exactly give a 30:30:30 split, it’s close enough for a ‘medical life lesson’. While we need to be cautious about our induction, we also need to plan what medication we may give post-induction should the blood pressure go in an unacceptable direction.
Reference:
- Nair BG, Horibe M, Newman SF, Wu WY, Peterson GN, Schwid HA. Anesthesia information management system-based near real-time decision support to manage intraoperative hypotension and hypertension. Anesth Analg. 2014 Jan;118(1):206-14.
Question 2
True story: I get a call from triage for a hot stroke. A 30 year old male who has a facial drop. Eye roll ensues and I send the medical student and my trainee (they are doing a teaching session) to go sort out the Bell palsy. I figure my trainee and teach the medical student the difference between a stroke and a Bell palsy. 10 minutes later I get a clear history of a left sided facial palsy but the trainee says the “blokes eyes look funny” They don’t really move and one has nystagmus.
On my review he has a left facial palsy (no forehead sparing), the left eye doesn’t not move on horizontal gaze in either direction and the right only abducts on horizontal gaze. He can however converge his gaze. What is this syndrome?
Reveal the funtabulous answer
8 and a half syndrome
Now I wish I had diagnosed this, but every day is a school day.
You’ll be familiar with the 1-and-a-half syndrome. One eye is frozen and incapable of horizontal gaze (one), and the other can only gaze outward (a half). You get the other 7 for taking out the facial nerve nuclei, which is close to the 6th nerve nuclei and the MLF. See the excellent youtube video below by Dr Andrew Lee – amazing education.
Question 3
Where would you find Rokitansky-Aschoff sinuses?
Reveal the funtabulous answer
In the gallbladder.
Named after the pathologists that discovered them in the 1800s, Karel Freiherr von Rokitansky (1804-1878) and Karl Albert Ludwig Aschoff (1866-1942). They are diverticula of the gallbladder wall, which can be microscopic or macroscopic. They are not considered to be worrisome per-se but represent chronic inflammation from cholecystitis. They can mimic gallbladder adenocarcinoma.
Question 4
What drug was previously known as “The Devil’s Lettuce”
Reveal the funtabulous answer
Cannabis
Its hard to find the exact link but Harry Anslinger from the Federal Bureau of Narcotics began demonising cannabis from the 1930s. One piece of anti-cannabis propaganda was a 52-minute film titled “Devil’s Harvest”, this is in stark contrast to it being in the US Pharmacopeia in the 1850s as a herbal remedy. Anslinger also referred to it as “marihuana” to play a xenophobic sentiment to Mexican immigrants (so try not to use the term marijuana).
In a little sense of irony, Anslinger, from being head of the Federal Bureau of Narcotics, required regular doses of opiates to control his angina towards the end of life.
Question 5
Space tourism is coming fast.
What abnormality would we find on a full blood count if you spent significant time in space?
Reveal the funtabulous answer
Low haemoglobin or ‘space anaemia’
Three million red blood cells are destroyed per second in space, compared to two million on terra firma. Fortunately, we can compensate but scientists are unsure for how long, thus limiting the length of future missions.
The mechanism is unknown, and strangely the astronauts still lose red blood cells at a higher rate one year later. A similar occurrence can occur in ICU patients that have a long stay. Finding the cause and solution may have impacts both in space and in an ICU near you.
Reference:
- Trudel G et al. Hemolysis contributes to anaemia during long-duration space flight. Nature Medicine 2022;28:59-62
… and finally, quotes:
Let us not take ourselves too seriously. None of us have a monopoly on wisdom and we must always be ready to listen and respect other points of view.
Queen Elizabeth II
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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.
