Funtabulously Frivolous Friday Five 066

• Aortic aneurysm.

“There is no disease more conducive to clinical humility than aneurysm of the aorta.”
— William Osler

• Check out Renal Riddle 001 — Could it be renal colic? for an example of why Osler was right (as always).
• Click here for more Oslerisms.

• 2.7 minutes
• similarly the time is reduced in sick patients, e.g. about 5 minutes for ‘moderately ill’ patients.
• these times are affected by a number of factors such as the degree of obesity, adequacy of preoxygenation, pulse oximetry lag, and  how sick the patients is (e.g. shunt, hypovolemia, metabolic demand, cardiorespiratory dysfunction).
• In critically ill patients desaturation to <90% can occur within 20-30 seconds!
• This means clinicians need to do everything they can to optimally oxygenate critically ill obese patients before and during rapid sequence intubation. Find out how to do this at EMCrit.org — Preoxygenation, reoxygenation, and deoxygenation.

• Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Ann Emerg Med. 2011 Nov 1. [Epub ahead of print] PMID: 22050948.

• Bromo-dragonFLY — it’s chemical structure vaguely resembles said insect.
• BDF is usually sold as a “plant food” or “research chemical” and is often purchased over the Internet. It has no known medical or industrial use.
• It has 5-HT2A effects causing hallucinations and alpha-1 effects such as intense peripheral vasoconstriction and hypertension, limb ischemia, and probably coronary vasospasm. Onset may be delayed, and the effects may be prolonged.
• Deaths have occurred — see The Poison Review’s recent post: BromodragonFLY mislabeled as 2C-E caused two deaths in Oklahoma
• Over the past few days LITFL has had over 3000 pageviews of Life in the TOO fast lane, our Q&A review of novel street drugs including bromo-dragonFLY. Leon Gussow at The Poison Review has reported a similar surge… Something must be up…

“It was like being dragged to hell and back again. Many times. It is the most evil [thing] I’ve ever tried. It lasted an eternity”
— quote from from a Danish user of Bromo-DragonFLY (source: Wikipedia)

• That’s the massive cranium of LITFL’s own Mike Cadogan (@sandnsurf) on the left, and the equally massive cranium of ERCAST‘s Rob Orman (@emergencypdx) on the right. In between is EMCrit‘s Scott Weingart (@emcrit). He also has a massive cranium but we managed to photoshop it to make look smaller…

• I don’t know Mel’s answer, but my guess is that it must be the one and only Joe Lex.
• Who is Joe Lex you ask? Well, since you obviously don’t practice emergency medicine, this is how the Temple residents describe him at  Free Emergency Medicine Talks:

“Joe is too humble to mention it, but he has been described by Amal Mattu, one of the most famous Emergency Medicine physicians in the world, as “the most famous Emergency Medicine physician in the world.”  Mel Herbert, one of the most interesting people in Emergency Medicine, called him “the world’s most interesting man,” though reports of a Joe walking across Florida are not entirely true.”

Joe Lex

• BTW…Joe, tell me if I’m right/ wrong!