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This time we’ve got the snake with the most lethal venom in the world, Southey tubes, blindspot bias, the French gauge and the first cardiac catheterisation.
Which snake has the most lethal venom in the world?
- The Inland Taipan (Oxyuranus microlepidotus), also known as the fierce snake or small-scaled snake.
- The maximum venom yield recorded (for one bite) is apparently 110 mg. That would probably be enough to kill over 100 people or 250,000 mice (as impactednurse would say, the mice would need to be standing very close together…)
- Clinical manifestations of envenoming are (apart from potential death) venom-induced consumptive coagulopathy, neurotoxicity, as well as thrombocytopenia, microangiopathic hemolytic anemia and renal failure.
- This shy elapid is rarely encountered — most human victims are herpetologists or reptile handlers. I’ve only been involved in the management of one case of Inland Taipan envenoming — a man bitten by his pet snake… He had immaculate pressure immobilisation bandaging and turned up at the ED within 20 minutes of the bite. A fair few years later and we’re still waiting for his first blood sample to clot…
What are Southey tubes and what are they used for?
- Southey tubes were invented by English physician Reginald Southey (183-1899). They are small cannulae with an inner trocar that were inserted subcutaneously to allow the egress of edema in terminal cases of dropsy (heart failure) or anasarca. This apparently provided considerable symptomatic relief. You can examples of Southey tubes here.
- Southey tubes fell by the wayside with the widespread use of diuretics.
- Southey was a friend of Charles Lutwidge Dodgson (aka Lewis Carroll) who took this photo of the doctor:
What is blindspot bias?
- Blindspot bias is the general belief people have that they are less susceptible to bias than others, due mostly to the faith they place in their own introspections.
- The bias appears to be universal across all cultures.
- If you think you don’t succumb to blindspot bias, you are probably giving a good demonstration of it.
What is French gauge and how does it relate to the diameter of a tube?
- The French gauge was devised by Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments. It refers to the external diameter of catheters.
- In French-speaking countries the symbol for French gauge is Ch, rather than Fr for this reason.
- The diameter of a round catheter in millimeters can be determined by dividing the French size by 3: D (mm) = Fr/3
- Note that the higher the French gauge the larger the diameter of the catheter. This is contrary to needle-gauge size, where an increasing gauge corresponds to a smaller diameter catheter.
- Also note that French gauge is not a measure of the diameter of the inner lumen of tube. Thus a 20 Fr 3 way catheter will have smaller internal lumen diameters than a 20 Fr 2 way catheter.
Who performed the first cardiac catherisation and how?
- Werner Forsmann (1904-1979), who as a result earned a share of the 1956 Nobel Prize in Medicine.
- In 1929, Forsmann administered local anesthetic to himself and inserted a urinary catheter into his own arm. Fluoroscopy was used to confirm that the catheter had been passed into his right atrium. Forsmann later lost his job as he did not have permission to perform this nor other, later, experiments. At the time it was believed by many that cardiac catheterisation would be fatal.
- Later in life Forsmann became a member of the Nazi Party and also worked as a lumberjack.
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