Your calcluator always at hand

I've previously talked ranted about Google's web-browser Chrome and why you should master it to increase your productivity. Now here is a short tip I just picked up which will certainly save you time and mouse clicks while calculating your antibiotic dosing or critical care vital signs...

Google search is so much more than just a brainless search motor, it has built in special functions providing for semantic search (in short, semantic in this aspect means more meaningful) results, just try for example looking up your flight number, "weather xxx" for an inine weather forecast, "define:xxx" for a quick explanation of a word and it's synonyms... you get the catch. There's also a calculator so that you can throw any numeric equation at it you wish to have crunched.

The real magic lies in Chrome's address bar, as I've previously mentioned it has some amazing features making it much more than just a browser. This is what I'm talking about:

Thanks Guidingtech for teaching me this trix (well worth reading too, you can never know too much about your browser, the heart and lungs of your computer)!

Learned on the pedatric rotation

These are some of my learning points on my short pediatric rotation:

• A children's doctor is a pediatrician not a pedestrian!
• WBCs will rarely go higher than 20k for a pure stress reaction
• Children have a much more exaggerated glucose response to stress, isolated hyperglycemia does not routinely require follow up
• A tip for making an infant pee for urinary sample: put something cold on their stomach. Often it will be enough to just remove the diaper, the fresh air will do it!
• Do not forget the rarely seen but important to know ddxs to strep A tonsillitis;
• Vincent's angina: is a very aggressive necrotizing infection of the periodontal/gingival tissues commonly caused by Fusobacterium nucleatum or Treponema vincentii to name a few
• Lemierre's syndrome: primary tonsillitis with severe sepsis following by thrombosis of vena jugularis. Most commonly caused by Fusobacterium necrophorum.
• Ethmoiditis is an infection I had never heard of before but one of those that the pediatrician should have in his/her ddx list because of possible complications. I had subfebrile little girl with recurrent left orbital headache with discrete, hard-to-describe orbital soft-tissue oedema which we sent to the ENT for evaluation for E. This is the layman description: "Infection of the ethmoid sinus results in swelling of its mucous membrane, causing increased mucous production and nose block. Sometimes the ethmoidal infection can spread to the contents of eyeball and form pus collection. This condition is called orbital subperiosteal abscess."
• A patient who has GIT symptoms secondary to erythromycin should try lesser but more frequent dosage e.g. x4 instead of the common x2 or x3
• Betapred's (bethamethason) time of onset is 1-2 hours, peaks at 4h and duration of about 48 hours. Betapred can induce diabetes if used chronically but as usually the biggest worry is delayed growth.
• A pneumococcal vaccine does not neccesitate change of antibiotics even if suspected infection with these (e.g. otitis), it will only take the tip of the infective burden but not prevent infections.
• Capillary refill time seems to be a little overvalued for assessing circulation
  http://resusme.em.extrememember.com/?p=5167
• Never ever exclude streptococcal pharynigitis/tonsillitis in the febrile child with normally looking throat on examination - you will one day have a positive Streptest even though you were certain there was no focus there!
• Even the pediatricians are not really sure where to draw a line between bronchiolotis and bronchitis
• Vasovagal syncope in a teenage girl is almost invariably because of stress!
• SIDS statistics have changed a lot in twenty years and mostly thanks to academic research. The incidence is down from about 2-300 cases/year here in Sweden to 20-30, an incredible achievement where a single preventive measure (have infants sleep on back) is the single biggest factor.

The most important lesson learned though was the value of hearing a simple "I don't know" when asking senior colleges, an answer I fully respect and honor when appropriate. There is nothing more frustrating than hearing a long talk about everything but the original question and then finding out you are even more confused then when you asked the question. I will also this my self from now on!

Acute care testing

With so many new websites appearing every week I find that the 'word by mouth' - personal reference from those you know - is the only way to "stumble upon" new webs today. Here is one gem I'd like to share with you.

So often I have had test results showing what I didn't want to see; a high lactate in a perfectly well patient who wants to go back home or normal troponin in someone who screams acute coronary syndrome already by seeing him from the door. With so much traffic in the ED there is never time to pause and check the literature and if you call the lab they will only answer technical issues concerning their machines. They never see the patients and thus don't make clinical judgments, only bla bla their reference guides.

So what if there was a website where healthcare professionals and lab managers jointly push forward literature and opinions based on these, for you, the target-user specifically? This is what Acute care testing has to offer.

You can browse their collection of great articles on topics such as when d-lactate becomes significant (do you know even if your blood gas machine actually measures it?), clinical aspects of pleural fluid pH or an excellent article "Lactate and lactic acidosis" which actually was the one that led me to this fantastic site because it is happening all the time in the ED. This was exactly what I was looking for:
"In vitro glycolysis and therefore lactate production continues after sampling so that lactate concentration increases by 30 % in just 30 minutes if kept at room temperature"


So for lab analysis and thoughts, this is da shit!


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ps it's impossible to talk lab results without mentioning Life in the Fast Lanes's excellent "Medical investigations" page, everything you need for quickly evaluating your abnormal lab tests on the ward!

Where has Google body browser gone?

A little shocking news has arrived from the Google complex about the future of an all-time favorite, the Google body browser. Now that many physicians have just discovered this amazing application it is frustrating to find out that this project is being discontinued. Or is it really?

UPDATE jan 2012:

All is good and well, Body browser is back online but now as "Zygote body"!
http://googlesystem.blogspot.com/2012/01/google-body-browser-is-now-zygote-body.html

It seems by digging into this news that it isn't at all, rather it is part of Google's decision to stop the Google Labs project and move on all projects within to a finite application but in the hands of other developers. Which should mean that projects that have been in a standstill for years are now pushed to faster development, a win-win situation for everyone.

The same goes for Body browser which will now go to a private company, Zygote media group, which has promised to offer it for free in the future. Their connection to GBB is their ownership of the underlying 3d body model. The viewer itself will also be taken over by the open source community.

Reading all this I've also learned about another similiar 3d project, the BioDigital Human. It seems theirs is even more advanced, for example allowing real-time dissection for. Competition is always good for end users and so with news seemingly sad news we actually should cheer out loud.