March 18, 2010

UCEM Develops Waiting Room Video

In an effort to reduce the number of comedy Emergency Department presentations, UCEM is pleased to endorse the playing of David Shrigley’s ‘Don’ts’ in all Australian Emergency Department waiting rooms. Cutbacks hindered the visuals but we feel the message is strong despite this.

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The Lyrics for those with no patience:

Don’t stick your hand in the blender.

Don’t use the hairdryer while you’re in the bath.

Unplug the electric saw before you try to fix it.

Don’t point the crossbow at your friends.

Don’t trim your toenails with a carving knife.

Don’t climb inside old freezers at the junkyard.

Don’t put your nephew in the microwave.

Don’t summon demons with the ouija board.

Don’t try to make new holes in your belt while you are still wearing it.

Don’t try to swim to the island.

Don’t throw darts at people.

There is no such thing as a metal frisbee.

Don’t climb on the roof.

Don’t throw stones at me to try to attract my attention.

Don’t shut your eyes while you’re driving.

Don’t drink the grey wine.

Don’t swallow pills that you find in the street.

Don’t stab people with old syringes.

Don’t make your own fireworks.

Don’t drop slabs from motorway bridges.

Don’t take the batteries out of the smoke alarm.

Don’t throw grit at the driver.

Don’t make your own flame thrower.

Stay out of the chemistry labs when the supervisor is absent.

Don’t throw ammunition on the campfire.

Don’t play games with poisonous snakes.

Don’t eat glass.

Don’t smoke in the refueling depot.

Be careful with the nail-gun, and the air rifle, and circular saw.

Don’t glue razorblades onto things.

Don’t pick fights with known psychopaths.

Don’t touch the hot plate.

Don’t hang-glide over the volcano.

Don’t lean out the window while the bullet train is in motion.

Don’t put old car batteries in the furnace.

Don’t play chicken.

Don’t fly a kite beneath the electricity pylons.

Don’t be dared to do dangerous things by people with missing limbs.

Don’t make roadblocks on the bobsleigh run.

Don’t pretend to be a doctor.

Don’t tamper with the braking system.

Don’t shout at old people.

Don’t liberate zoo animals.

Don’t use the lawnmower to trim the hedge.

Don’t give bayonets to children.

Don’t hide the fire extinguisher.

Don’t run in the hospital.

Don’t stick metal coathangers in the toaster while it’s still on.

Don’t buy bomb making equipment.

Don’t slash my tyres while i’m driving.

Don’t play war in the electricity sub-station.

Don’t stage mock executions.

Stay away from the ski jump and the cable car and the funicular railway.

Don’t volunteer for the drugs testing.

Don’t go in hot air balloons.

Don’t press the red buttons.

Obey the stop signs, and the no entry sign, and the speed limit.

Don’t jump over the barriers.

There is no such thing as a metal frisbee.

Don’t try to perform surgery on yourself.

Don’t stick kebab skewers up your nose.

Don’t join the army.

Keep your hands off the gas tap and the welding equipment and the railway signals.

Don’t break into peoples houses and climb up their chimneys.

Don’t park in the fast lane.

Don’t steal police cars.

Don’t pretend to be an acupuncturist or a pilot or a back specialist.

Don’t try to grow biological weapons.

Wash your hands after using pesticides and attempting to grow biological weapons.

And above all, don’t eat scorpions.

Honorary Fellowship of the UCEM

The Utopian College of Emergency for Medicine takes umbrage with the theory that honorary degrees are just a little bit bullshit.

University is tough, a PhD is even tougher. You have to write a 70, 000 word thesis over a minimum of 4 years that adds and expands upon an existing body of academic work, in the specific field you’re working in. Sounds tough eh?  But fear not, if you’ve written a great song, been in a few amazing movies, or just done them with thorough mediocrity you can get an Honorary degree from your local university. Yay for humanity! @NickHayden_

The UCEM is an institution steeped in tradition; founded on the very principles of bigotry and eminence Based Medicine that the HungryBeast team chide with nonchalance.

To maintain our semblance of superiority it is imperative that our inner workings be as cryptic, indecipherable and impenetrable as practicable. Without this operational opprobrium, we would be vulnerable to pellucidity and prone to the prosaic. This would dilute the sententious ethos to which we (the Grandfathered Executive) are steadfast.

To maintain our ameritocratic Professorial ranking structure it is essential that we hand pick our nonpareil leadership and abstain from the randir of a common members vote. Aggregation by commonality of the famous or rich (preferably both) allows for a symbiotic relationship  (read parasitism) from which all parties benefit. The famously stupid gain credence through letters whilst the monetarily grandiloquent gain altruistic appeal. Honours bestowed upon one final group (the dissenters) preserves the ostensible status quo sanctioning the ship of fools allegory to drift silently into the sunset.

With this final point in mind the UCEM is honoured to present it’s third Grand Fellowship to Dr Dr Nick Hayden

Lunchbox War on Disease

UCEM’s Demographically Impartial Public & Social Health Improvement Taskforce have released the first in a series of lunchboxes designed to raise awareness of the importance of gas masks in preventing a range of miasmatic diseases such as syphilis and shame. Each lunchbox will feature the distinguished likeness of the Taskforce’s fearless leader, Egerton Y. Davis IV.

Syphilis lunchbox

The lunchbox war against disease

Remember, ’shame may be fatal’.

Place your orders here (hat tip to FashionablyGeeky.com).

Ameritous Professor Broughton-D’Lirium

 Ameritous Professor Broughton D’LiriumThe Utopian College of Emergency Medicine warmly welcomes the arrival of Ameritous Prof Jeremiah McSeptic Broughton-D’Lirium from Chocadeira in Portugal. His new roles include Chair of Infectious Diseases, full member of the Council of Utopian Microbiologists and Cultural attaché for the UCEM

A/Prof Broughton-D’Lirium is a natural rabble-rouser, incapable of staying quiescent for more than one agenda item. His tirades of virulent invective usually falter when challenged by senate colleagues armed with an appropriate anti-invective agent.

Broughton-D’Lirium has been known to phase up to criticism for lagging behind the main body of opinion, yet he has a fine sense of dequorum when in polite company. Originally a cultured soul, his academic progress was matched by a voluntary descent into basement laboratory grime where he has been know to pass the time watching biofilms in black and white with subtitles. It’s been said that in these dark, anaerobic recesses he ferments the germ of a new idea before setting it loose on his colony of research assistants.

Growth and development only reach stagnation point when there’s nothing left to ferment. The earthy stench of media incubating in Broughton-D’Lirium’s basement subsides briefly when he prepares for a visit from his Auntie Septic; a lady of advanced years, reputed to have first uttered the phrase; “Long may your inocu-lum reek.”

The most recent infernal machine to emerge from the basement miasma is a solar powered bicycle he calls a thermocycler. There are rumours this contraption may evolve into a multiplex fishing rod holder for binary fishin’. Like many of his peers, he has little time for evidence-biased medicine, preferring an eminence-based model of corsality. This he insists is the proper conflation of cause and rough approximation.

The Ameritous Professor is a master of genomorphometry and an armchair authority on biocurtailment. Most of his clinic appointments are recorded as DNA.

A/Prof Broughton-D’Lirium’s official UCEM Council Executive Roles include:

  • Chair of Infectious Diseases
  • Full member of the Council of Utopian Microbiologists
  • Cultural adviser to overseas trained physicians

The Levels of Eminence

Egerton Y. Davis IV spoke to an assembled horde of Genghis Khan’s descendants in Ulaanbataar today, the first stop on the 2010 UCEM World Tour. He made a key announcement regarding the formation of the new Center for Eminence Based Medicine now operating under the auspices of the Utopian College of Emergency for Medicine.

mobgolian honor guard

Egerton Y. Davis IV was greeted by a Guard of Eminence (Level 2) on his arrival in Ulaanbataar.

Davis IV said:

“For too long medical professionals have been slaves to the Evidence Based Medicine Leviathan. Doctors are sick of hearing the constant refrain – “But what level of evidence supports that?” – emanating from Blackballers, wannabe Devil’s Advocates and downright annoying medical students whenever they make diagnostic or therapeutic decisions.”

“We at UCEM, like you, the practicing doctor, lament the stranglehold that this tyrannical rule has on our profession. Clearly we need to go back to the ‘good ole days’ and create a system by which we can simplify and clarify the justifications for our decision-making based on the things that really matter.”

“Fortunately, our prayers have been answered. UCEM is pleased to unveil the Center for Eminence Based Medicine’s new ‘Levels of Eminence’. Let the new golden age of Eminence Based Medicine begin!”

Mongolian camels

Attendees at the UCEM World Tour in Ulaanbataar literally turned up in their droves.

Davis IV’s presentation compared and contrasted the Centre for Evidence Based Medicine’s cumbersome system:

CEBM's Levels of EvidenceGrades of Recommendation…with the new streamlined and practical system developed by UCEM’s Centre for Eminence Based Medicine:

Levels of Eminence Based Advice

  • Level 1 — Advice from Sir Hubert Ignatius Thompson III, UCEM President
  • Level 2 — Advice from an UCEM Council Executive Member
  • Level 3 — Advice from an UCEM Fellow
  • Level 4 — Advice from an UCEM Trainee (aka MUPPET)
  • Level 5 — Something you just made up
  • Level 6 — Advice from a member of a College of Medicine other than UCEM

Grades of Eminence Based Recommendation

  • A — Consistent Level 1 advice
  • B — Consistent Level 2 or 3 advice, or extrapolations from Level 1 advice
  • C — Consistent Level 4 advice, or extrapolations from Level 2 or 3 advice
  • D — Consistent Level 5 advice, or extrapolations from Level 4 advice
  • E — Consistent Level 6 advice, or troublingly inconsistent or inconclusive advice of any level

UCEM hopes the medical practitioners of the world will adopt this new system with the same enthusiasm as the expert bactrian camel herders of Outer Mongolia.

Mongolian warriors The Levels of Eminence

Mongolian doctors settling their differences the old fashioned way – now they can just refer to the 'Levels of Eminence'.

The Staghorn Challenge

You may remember that Professor Staghorn was recently inaugurated as the newest member of the UCEM Council Executive. Hidden in Prof Staghorn’s profile were about 30 veiled references to kidney stones, particularly those of the staghorn variety. The following challenge was put out to the entire webosphere: can anyone identify at least 20 of these references?

“After much struggle and sacrifice” – his own words – one man crossed the line first to become the esteemed winner of the ‘Staghorn Challenge’. He is:

Leon Gussow

of The Poison Review fame

[WARNING: Spoiler alert - if you want to try the challenge for yourself, you need to read this first.]

Here are Leon’s answers (with my clarifications in italics):

  1. iliacus
    - one of the 3 most common sites for kidney stone obstruction is the pelvic brim where the ureters arch over the iliac vessels.
  2. anaconda (The website for the Maryland Kidney Stone Center is copyrighted by Anaconda Partners LLC (okay, I was desperate)
    - admirable desperation!
  3. Struvite
    - refers to kidney stones that contain calcium magnesium phosphate, and that may form staghorn calculi.
  4. Staghorn
    - struvite-containing kidney stones that are named for their appearance, and are associated with infection.
  5. calyxia
    - the calyces (plural of calyx) are tubes that collect urine into the renal pelvis from which the ureters arise.
  6. uretica
    - the ureters are the tubes that transmit urine from the kidneys to the bladder, and become obstructed by larger kidney stones.
  7. colica
    - ‘renal or ureteric colic’ is the severe pain associated with restlessness and nausea/vomiting caused by kidney stones.
  8. calculus
    - the branch of mathematics that shares its name with the medical term for stone.
  9. candiru
    - the fish notorious for lodging itself in the urethra of unwitting victims who choose to urinate in rivers.
  10. hematuria
    - blood in the urine, may be caused by kidney stones.
  11. crystal
    - crystals may be seen in the urine of patients with kidney stones – ‘coffin-lid’ crystals may be present in those with struvite-containing kidney stones.
  12. (Rolling) Stones
    - if only they did…
  13. ejaculated
    - a term used to describe an event considered important by most urologists.
  14. p*sshead
    - a hint: * means ‘i’.
  15. grown men cry
    - a common end result of kidney stones.
  16. (slow) passage
    - the slower the passage, the longer the pain lasts…
  17. shadowy (stones may shadow on ultrasound)
    - stones cast a shadow on ultrasound because they do not transmit ultrasound waves. Uric acid stones and blood clots tend to be radiolucent and may be invisible or appear as ’shadows’ on plain X-rays.
  18. caustic
    - struvite stones are associated with alkaline urine (pH >7.5).
  19. CT
    - non-contrast enhanced helical computed tomography is now the standard imaging modality for identifying kidney stones and renal tract obstruction.
  20. gripping (his opponent’s groin)
    - colic-type pain is sometimes described as gripping, and the pain of kidney stones is classically referred from ‘loin to groin’.

For completeness, here are the other hidden references:

  1. Professor Inglebert Struvite Staghorn
    - the initials form a urologically relevant acronym. The astute reader always looks for the acronyms in any UCEM-related announcement…
  2. Ear-splitting
    - a somewhat cryptic reference to the fact that struvite stones are associated with infections by urea-splitting organisms like Proteus spp.
  3. Portuguese União Júnior
    - PUJ refers to the pelvi-ureteric juction, another of the three common sites for kidney stones to become lodged.
  4. Urologist
    - a type of medically-qualified plumber with an interest in unblocking the pipes that pass urine.
  5. Protean
    - Struvite stones are associated with infections caused by Proteus spp.
  6. Providential
    - … and infections caused by Providentia spp. (Klebsiella is another important cause, but was not included in Staghorn’s profile).
  7. (blow to the) loin
    - the pain of kidney stones is classically referred from ‘loin to groin’.
  8. Universidade de Virgens e Jogadores
    - UVJ or VUJ refers to the vesico-ureteric junction, the third of the common sites for kidney stones to become lodged.
  9. UCEM’s Inquisitorial Disciplinary Committee
    - IDC refers to indwelling catheter.
  10. Utopian Border Patrol
    - could this be a cryptic reference to stones preventing the passage of urine? @justrobyn thought so, who are we to argue?

As UCEM have generously agreed to confer an honorary Fellowship of the winner of the Staghorn Challenge, Leon can now add FUCEM to his list of credentials.

But wait, there’s more…

UCEM have also decided to reward the exceptionally lateral thinking of

Robyn Flach

who came a close second to Leon in ‘The Staghorn Challenge’. Robyn will be able to bask in the eternal glory of being the first Fellow of UCEM to have no medical qualifications whatsoever!

Congratulations Leon and Robyn!… and relax – Prof Stickler has exempted you from the viva voce exam. You will be forwarded your diploma and fellowship paraphernalia at UCEM’s bureaucratic leisure.

UCEM Announces Electropenogram

The Utopian College of Emergency for Medicine (UCEM) is pleased to announce the introduction of a new diagnostic tool – the Electropenogram (EPG).

Professor Throckmorton, our new Head of the Committee Of Continuing Knowledge, has spent the last 13 years investigating Wolkenkuckucksheim and ithyphallic activity occuring in Electrocardiographs.

After an exhausting 12 month statistical analysis by the backroom boffins, the retrospective review of 26 832 ED cardiac tracings has finally been completed. The results of this BACCHUS-II trial are open to interpretation, lack little scientific credibility and are on the whole inaccurate. However, in this world of eminence based medicine where the statistics never lie it is prudent to take note of the studies findings.

  • Resting Positive Electropenograms were recorded in 2.6% of the general population, 3.4% of inmates and 13% of administrators (p = 0.02; 95% confidence interval, 1-99%)
  • The maximum prevalence of Positive Electropenograms occurred on Friday and Saturday evenings (80%) with a staggerring 93% on Public Holidays.

As yet it is uncertain as to what a positive Electropenogram might mean for the patient but some of the LITFL team have their theories…

ECG penis 600x600 UCEM Announces Electropenogram

EPG positive

Prof Staghorn joins UCEM

Professor Inglebert Struvite Staghorn hails from the village of Calyxia nestled on the anaconda-infested shores of the Amazon River. Although the young Staghorn’s missionary parents encouraged him to study the healing arts, he instead discovered a taste for the no-holds-barred fighting arts. With a reputation for ear-splitting roundhouse kicks, he emerged undefeated from the Portuguese União Júnior vale tudo championships as the foremost exponent of an unorthodox move best described as  ’starting the lawnmower’ while gripping his opponent’s groin. Having mastered the art of making grown men cry, Staghorn entered undergraduate studies at the Universidade de Uretica e Colica where he obtained a first in Calculus.

Staghorn Prof Staghorn joins UCEM

Prof Staghorn in his Vale Tudo heyday

Staghorn’s eyes were opened to the awesome possibilities of medicine after he had an unpleasant encounter with a candiru necessitating the urgent attention of a urologist. Fortunately, his protean talents, combined with the providential demise of a competing student (who sadly died of hematuria following a blow to the loin by an unknown assailant – he was buried in a crystal-lidded coffin), led him to the prestigious Universidade de Virgens e Jogadores, located a few miles south of Iliacus. Staghorn’s passage was at first slow, but it soon became clear that his caustic personality would see him attain greatness as a radiologist. Although he remained a somewhat shadowy figure in the world of roentgenography he achieved prominence with the rise of computed tomography. Indeed, he is credited with the first use of the Rolling Stones’ song “You can’t always get what you want” as call waiting music when taking calls from the ED.

Upon meeting Staghorn, Sir Hubert Ignatius Thompson III ejaculated that he had found the perfect man to occupy the vacant position of Director of UCEM’s Inquisitorial Disciplinary Committee. Staghorn has also been tasked with heading the Radiology, Alcohol and Violence in Emergencies special conflict-of-interest group and coordinating the Utopian Border Patrol. Although, sometimes criticized as being something of a ‘p*sshead‘, Prof Staghorn stands by the aphorism, “You’re only an alcoholic if you drink more than your doctor”. Like all good doctors, he tends to treat himself.

Prof Staghorn’s official UCEM Council Executive Roles include:

  • Director, Inquisitorial Disciplinary Committee
  • Head of the Radiology, Alcohol and Violence in Emergencies special conflict-of-interest group
  • Coordinator of the Utopian Border Patrol

UCEM Header

UCEM Warns Against ADHD Treatment

Professor Stickler, who holds the Chair of Pedantry and heads UCEM’s Education and Training program in the School of Health and Information Technology, addressed an army of riveted journalists at UCEM headquarters in Pyongyang today. Stickler warned of the negative consequences of the current epidemic of methylphenidate and dexamphetamine used for the treatment of Attention Deficit/ Hypersensitivty Disorder (ADHD) in young people.

Professor Stickler said:

“While we are not the first to raise the alarm concerning the widespread prescription of these drugs, we are the first to identify a particularly nefarious consequence that threatens our utopian medical objectives.”

“What crisis awaits us? Well, nothing less than the eradication of the ideal emergency physician personality type and the meltdown of utopian emergency medical practice”.

Professor Stickler quoted a much cited career chart published in the British Medical Journal that clearly identified ADHD traits as a necessary prerequisite for entry into the emergency medicine career path.

BMJ career flowchart UCEM Warns Against ADHD TreatmentProfessor Stickler elaborated further:

Instead of trying to ameliorate these personality traits with drugs we should be trying to accentuate them. In the era of the 4 picosecond rule, pre-departmental medicine, the emergency circle of care, and ‘Downstairs Patients, Upstairs!‘ we need emergency physicians with more pronounced ADHD traits more than ever.”

“At UCEM we value hyperactivity, we value impulsive people who don’t like waiting their turn and have no compulsions about interrupting others, we value people who finish off what other people are saying, we value those who have a heightened sensitivity to extraneous stimuli, and we especially value those who don’t get bogged down by focussing their attention on one task for too long.”

“Finally, and most importantly, those who learn to live with the low self esteem and social otracism that comes with full-blown ADHD are already preadapted for life as a successful emergency physician.”

So there you have it, UCEM says ‘NO!’ to drugs like methylphenidate and dexamphetamine.

Reference

  • Veysman, B. Physician, Know Thyself. BMJ 2005;331:1529, doi:10.1136/bmj.331.7531.1529

UCEM Recruitment Drive

The Utopian College of Emergency for Medicine has been astounded by the despicable tactics employed by the Anaesthetic College in their recent recruitment drive.

The College wishes to reassure all fondling members that no such underhand tactics will be employed to engorge its membership.

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UCEM Promotes ‘Toughen Up’ Pill

Following on from its Campaign against Softness, the Pharmacological Hegemony of the UCEM is pleased to announce, in conjunction with TTFU Pharmaceuticals the release of its new pill which it expects to be in widepsread use in Emergency departments before the end of the day…

growacet bp UCEM Promotes Toughen Up Pill

TTFU Pills

UCEM Promises Communication Training

Although UCEM are reassured that their ELF regimen for weight loss is gradually gaining wider acceptance, the college is concerned that the ELF message is not being communicated according to utopian ideals.

This concern is based on reports such as this from New Zealand:

A foul-mouthed New Zealand surgeon has been reprimanded after swearing at a severely obese patient…

The doctor said f— at least three times to the Maori woman after she told him she didn’t like the word “diet” and preferred the term “lifestyle”.

He told her she was, “going on a f—ing diet”.

In the letter of complaint, the woman wrote: “[The doctor] said if I couldn’t handle the word diet then he challenged my motivation and stated that I would never survive surgery because I was still bullshitting myself and therefore my thinking was still f—ed”.

- Read the full story at the New Zealand Herald.

In a press release today, Assistant Sub-Professor Egerton Yorick Davis IV confirmed that UCEM were currently working on a Communication Skills program to ensure that MUPPETs achieve their core competencies and to prevent such misunderstandings from happening in the future. Davis IV stressed that no matter how obesive a patient is, those aspiring to become Fellows of UCEM must refrain from dropping F-bombs on their patients.

UCEM Guidelines on Resuscitation

With the International Liaison Committee on Resuscitation (ILCOR)’s worksheets now being made available for viewing as part of a worldwide effort involving hundreds of dedicated researchers working together over many years, UCEM has decided to preempt the next iteration of guidelines by creating their own. These guidelines were compiled from Professor Bristol’s toilet-side notebook in under 12 minutes. Nevertheless, UCEM is confident that even the most hardened of resuscitators will find these guidelines informative, realistic and highly practical.

As a wise man once said:

First check your own pulse.

Then start with the ABCs:

Arrive

Blame

Criticise

And end with D and E:

Declare dead

Exit

Between C and D, consider the following therapeutic options :

  • Shout — communication is paramount. The best approach is to establish your leadership role on entering the room by shouting at a deafening volume: “If you are not doing anything, get out of the room!” With a bit of luck, you might be able to leave as well…
  • Help — always call for help, even if that means curling up into the fetal position on the floor, sucking one’s thumb, and screaming “help, help, help!”…
  • Intubate as required — to save on cost, don’t bother with a laryngoscope, a torch and a bent spoon will suffice.
  • Tobacco smoke enemas should be considered as a last ditch measure — As Prof Bristol always says, “If you’re going out, you might as well go out in a puff of smoke”.

Assign appropriate tasks to Medical Emergency Team (MET) members:

  • Stand back and let the MET CNL (senior nurse) run the show — things will go much more smoothly and you can sit back and relax.
  • House officers — Keep them as far away from the patient as possible by assigning them the job of looking through the patient’s medical records for the ‘Do Not Resuscitate’ order that surely must be there somewhere…
  • Invite the biggest burliest orderlies you can find on the way to the code to come along with you, to ensure that the CPR is effective.
  • Telephone duty — An important role best assigned to the medical registrar, with the added advantage of also keeping him or her as far away from the patient as possible.

Remember these points:

  • Stab the patient in the heart with an adrenaline-filled syringe at the first available opportunity — after all, it worked well in Pulp Fiction, and even if it doesn’t work it looks heroic and is bound to impress the medical students.
  • How many minutes should you continue to resuscitate for before calling it a day? If in doubt, try this formula: 80 – (age in years). Multiply by 3 if a toxicological cause is suspected.
  • Is your suction working? If you haven’t checked you’d better be wearing gumboots as you have a 99.9% chance of ending up wading through a pool of vomit.
  • The outcome of the resuscitation has no relationship to the effectiveness of the resuscitation effort – unless more than one person ends up dead at the end of it.

PulpFiction adrenaline heart UCEM Guidelines on Resuscitation

And finally, The Bottom Line (aka ‘the Flat Line’):

The likelihood of a good outcome following cardiac arrest follows a ‘flat, line-shaped‘ curve after the first few minutes.

Good outcome is on the y-axis (admittedly you need a magnifying glass to see it) and any variable you can think of goes on the x-axis.

icprlite3 UCEM Guidelines on Resuscitation

UCEM Guidelines for Constipation

Ucem are proud to announce a new technique for the management of constipation in the emergency department.  We like to call it ‘hemicorporeal evacuation’.

stop whining UCEM Guidelines for Constipation

The Intern being supervised by his Registrar and Consultant

Downstairs Patients, Upstairs!

UCEM have enlisted the help of Dr. Scott Weingart (without his knowledge of course) to improve the care of patients presenting for assessment by Waiting Room Medicine subspecialists.  UCEM’s Chair of Pedantry and resident super-genius, Professor Stickler is almost impressed by Dr. Weingart’s view that hospital geography should not determine the level of care a patient receives:

“My career goal and the purpose of this blog and podcast are to bring ‘Upstairs Care, Downstairs’ – that is to bring ICU level care to the ED, so our patients can receive optimum treatment the moment they roll through the door.”
- Scott Weingart, emcrit.org

However, Professor Stickler has taken this philosophy a step further, ingeniously inverting Weingart’s philosophy of emergency care, so that even greater gains can be achieved. Thus, UCEM is introducing a new policy of ‘Downstairs Patients, Upstairs!’.

As Professor Stickler’s explains:

“I had just sent an email to Professor Andrew Wiles suggesting a few subtle corrections to his much feted solution to Fermat’s Last Theorem, when it hit me in an orgasmic wave of synaesthetic bliss like a Kekulian snake eating its own tail… I jumped straight up and out of the bath and thought to myself, “Archimedes, 11000101110102, ha!’.”

“Clearly the transition of care should not be a one way street. ‘Upstairs Care, Downstairs’ is a moderately impressive concept, but it pales in comparison to my revolutionary ‘Downstairs Patients, Upstairs!” paradigm.”

Although It may be some decades before the complete ‘Downstairs Patients, Upstairs!’ manifesto is published, UCEM have issued a press release highlighting some of the benefits of transferring patients typically treated in the emergency department straight to the intensive care unit:

  • Is your patient a really mean, sociopathic nasty piece-of-work? Or does your patient just talk too much? Well put up with it no longer… Free-and-easy employment of the endotracheal tube – aka ‘the ultimate personality improvement device’ – brings peace to one-and-all faster than a double dose of UCEM’s new polypill.
  • Sick of all the drunks clogging up your waiting room? Is your patient too intoxicated to be assessed by the psychiatricians? Can’t tell if its the bang on the head or the grog in the blood that’s the problem? Pop in a vascath and fire up the dialysis machine, they’ll be sober in no time.
  • Got problems with patients with gut problems? They’ve got diarrhoea and are due to travel, but are allergic to lomotil? Send them home with a rectal tube and everyone’s happy. Or, you need a stool specimen stat and the patient’s blocked through-flow is blocking the flow through the department? Give ‘em a neostigmine infusion and you’ll have enough specimens to keep Prof Bristol happy for life.
  • Are your patient’s whiskers are an affront to civilized sensibilities? Once in ICU the nurses there will do what they do best: ridding the world of offensive facial hair. If Samuel Johnson was around today he would think differently about which profession is the ‘Greatest Benefit to Mankind‘…
  • Does your patient say they’ve tried everything to lose weight? In ICU they will go straight to Phase 3 of the ELF dietary plan – the ‘Sleeping Beauty’ diet. Warning: may not be effective for somnophages.
  • Does your patient have back pain and is lying around feeling sorry for himself? Get the ICU physiotherapists to work on him – they are renowned for their brutality – sorry, I meant ‘enthusiasm and efficacy’ – he’ll be up and moving in no time. And he’ll be more than happy to be on his way home.

Of course, there will be a major plus for those working in ICU too, after all, that calm and serene ICU atmosphere could do with a bit of livening up, something to drown out the machines that go bleep

UCEM welcomes any and all submissions for inclusion in the ‘Downstairs Patients, Upstairs!’ manifesto.

UCEM to Save the NHS

Egerton Y. Davis IV, Head of UCEM’s Demographically Impartial Public & Social Health Improvement Taskforce, made an important announcement today. Davis announced that his team have been allocated the task of saving Britain’s National Health Service.

Davis said:

“We’ve only been on the job for three-and-a-half minutes but I think we have already started to make progress. This first step of the plan is both simple and elegant. Instead of the NHS having an annual budget of FOUR MILLION POUNDS allocated to homeopathic non-treatments, we will use this money to fund medications and therapies that actually work… Heck, we might even be able to supply everyone with their own personal gas mask to stave off the ever-present threat of miasmatic disease.  Yes, I know, it is a revolutionary idea.”

This timely announcement coincides with reports that, despite UCEM’s toxicologists being placed on standby, and aside from a small collective sugar rush, all victims of the 10:23 movement’s mass homeopathic overdose emerged from the ordeal unscathed.

Viva la Revolución!

Even Che is surprised!

Even Che is surprised that money can be made out of water just like that…


UCEM welcomes any and all submissions that may help save our comrades in the Mother Country – this is but a small first step…

UCEM Prepares For Mass Overdose

Egerton Y. Davis IV has urged UCEM toxicologists to be on stand-by for potentially one of the worst voluntary mass poisonings the world has seen.

Davis IV’s actions are a response to the breaking news that sceptics in the UK are planning a protest against the unethical sale of homeopathic pills by the chain store Boots. The protest will involve mass overdoses of the offending remedies outside of Boots’ stores. UCEM fears that copycat poisonings may follow the world over.

The Demographically Impartial Public & Social Heath Improvement Team are currently preparing management protocols for the treatment of homeopathic overdoses – a sadly neglected area of toxicology. It appears the main risks are dumping syndrome or hyperglycemia from the excessive intake of sugar contained in the pills, not to mention the worrying potential for water intoxication and even drowning. The wearing of gas masks is, as always, recommended as a precaution.

Decontamination of clothing currently poses a significant therapeutic dilemma. As pointed out by Dr. Leon Gussow, the malign influence of water memory may mean that the dilutional effects of stripping down and showering the victims may actually increase the toxicity of the homeopathic agents…

homeopathic2 UCEM Prepares For Mass Overdose

UCEM Adopts New Polypill

UCEM is pleased to announced that all fondling members of the college subspecialising in the ‘Brave New World‘ of Waiting Room Medicine will be provided with access to this new productivity aid:

image0162 UCEM Adopts New Polypill

UCEM Guide to Psychiatric Referrals

In a bid to comply with the 4 second rule, the UCEM is proud to announce its official guide to personality disorders to facilitate quick Psychiatric referrals from the waiting room.

UCEM Psych Assessment UCEM Guide to Psychiatric Referrals

Simplify your Psychiatric Referrals

ME, ELF and UCEM

Egerton Y. Davis IV, Hygienist for the Council Executive and Head of the Demographically Impartial Public & Social Health Improvement Taskforce, held a press conference at the UCEM headquarters on Enlightenment Boulevard today.

Utopian College Letterhead

He proclaimed:

“Long have we been in a pitched battle against the foot soldiers of the seething armies of Death. We few, we happy few, we band of brothers. We have championed the wearing of gas masks to fight off miasmastic pestilences like the ingrown toenail. We have fought to keep us all sane with the miracle of our Mental Health Hotline. We have strived to advance the science of coprology with our Herculean efforts to expand the Bristol stool chart. We have banished softness from our Emergency Departments…. Now we want to banish softness from around our midriffs.”

“Mark my words, from this day to the ending of the world, today shall be remembered as the day that UCEM fought against fat – the Lieutenant-Colonel of all these men of Death – and began to win the war. And those that were not here shall think themselves accursed. They shall think their manhoods cheap that they did not witness the unveiling of UCEM’s regimen for combating the crisis of post-Christmas corpulence, Byron’s ‘oily dropsy’.”

Unfortunately, although Egerton Y. Davis IV’s announcement overran even the longest and most monotonous of Fidel Castro’s speeches, little else could be deciphered as his voice was muffled by his ever-present miasma-proof gas mask.

Fortunately, further details were able to be gleaned from UCEM insiders. The bi-pronged regimen is devilishly original:

The ELF (Eat Less Food) dietary plan

and

The ME (More Exercise) activity plan

In order to facilitate Phase 1 of the ELF dietary plan, UCEM have employed Predictably Irrational’s Dan Ariely (without his knowledge of course) to devise a series of fool-proof strategies to cathartically cut away post-Christmas corpulence.

These include:

  1. Utensil substitution
    ELF practitioners will only eat with chopsticks. The only exception being those who adopt UCEM’s patented Mini-fork System, which may be used instead of chopsticks, to help people take smaller bites.
  2. Far away food
    ELF practitioners will position food at great distances from themselves, so that they wil burn more calories when they go to get another serving. This ties in nicely with the ME activity regimen.
  3. Fill the tank
    ELF practitioners will start with a soup course, and only be served other foods that are filling but low in calories.
  4. Course capitation
    ELF practitioners will limit the number of courses in any given feeding opportunity. By limiting the variation in food available they will lose the desire to eat to excess.
  5. Feed thyself
    ELF practitioners will only be allowed to eat food that they themselves have prepared. ELF practitioners will attend mandatory (un)cooking classes including those based on  popular books such as ‘Natural Harvest – A Collection of Semen-based Recipes‘.
  6. Expansion restriction
    ELF practitioners are only allowed to eat while wearing extremely tight clothing.

These strategies will be combined with Portion de-distortion (eat like its 1990) and the use of Vision-dieter glasses to make food look less appealing.

ELF practitioners with persistent Pickwickian portliness despite completing Phase 1 of the ELF dietary plan will advance to Phase 2. Phase 2 employs three strategies:

  1. Fletcher’s mastication diet
    This tried-and-tested technique dates back to 1903. Its genius is its simplicity: the practitioner chews each food morsel 32 times  – one for each tooth – then spits it out without swallowing.
  2. Wear a Gas mask
    The rationale for this dates back to Thomas Short’s “The Causes and Effects of Corpulence” published in 1727. Short observed that fat people were more likely to live near swamps. Given such a clear association with a well established source of miasmas, Egerton Y. Davis IV has mandated the wearing of gas masks in those practitioners advancing to Phase 2. The gas mask not only protects against the miasmatic causes of corpulence, wearing one makes it impossible to put anything in your mouth.
  3. The Cigarette Diet
    ELF Phase 2 practitioners who are still struggling are advised to adopt the cigarette diet during the brief occasions when they remove their gas masks. A cigarette in one’s mouth prevents food from entering said orifice, suppresses the appetite and restricts weight gain in the pregnant by promoting intra-uterine growth retardation.

A small number of large ELF practitioners may need to resort to Phase 3 of the ELF dietary plan:

The ‘Sleeping Beauty’ Diet
How could someone known as ‘The King’ possibly be wrong? Between cheese burgers, Elvis Presley tried heavy sedation for a few days in the hope that he would awaken in a less corpulent state. UCEM notes the unerring effectiveness of this method in patients admitted to intensive care facilities.

Should any ELF practitioners still fail to meet their weight loss targets they will progress to Phase 4:

The William the Conqueror Diet
William the Conqueror was so fat he couldn’t get on his horse. To combat this he devised a personalised dietary regimen: he locked himself in a room with alcohol the only substance available for him to consume. Unfortunately, the effectiveness of the strategy has been scurrilously questioned on the following basis: when William the Conqueror died he was so obese he could not be squeezed into his sarcophagus and he stunk out the chapel with his decaying corpse. UCEM intends to recruit volunteers for a doubly-blind-drunk randomised controlled trial of phase 4 of the ELF dietary plan in the very near future.

As a last resort, ELF practitioners with the most recalcitrant cases of ‘oily dropsy’ – many of whom will no doubt suffer from obesiveness – will enter phase 5:

The Tapeworm diet
Having kept Hollywood stars slim and trim for decades, surely there can be no drawbacks to being fed a diet of tapeworms?

Although UCEM have guaranteed that the ELF dietary plan will be effective in combination with the ME activity plan, they are rumoured to have crack teams of bariatric surgeons and Breatharians on stand-by. Details of what exactly is involved in the ME activity plan have not yet been divulged.

Finally, comment has also been obtained from  the new poster boy for this public health initiative: Santa Claus. Santa Claus agreed to be first to enroll in the ME and ELF regimen to fulfill his obligations as a public health role model in the wake of the agreement to ‘can‘ UCEM’s planned cancellation of Christmas. Speaking on vacation in the Bahamas he said:

“In my time I’ve tried pretty much all the diets under the sun – the Atkins diet, Protein Power, the Grapefruit diet, the Scarsdale diet, the Zone dietFruitarianism, the South Beach Diet, Master Cleanse, Nutrisystem, the Sonoma Diet, the Cabbage soup diet, the Astronaut’s Diet, the Paleolithic diet, the F-Plan diet and Gerson therapy – none have worked for me in the longterm. Who would have thought though, that after just a month of ‘more exercise’ and ‘eating less food’ I’m feeling lighter and healthier than ever. If you don’t believe me, just ask my reindeer.”

Santa after ME and ELF

Santa Claus succeeds with the ME and ELF regimen.

An elf, who asked not to be identified, stated that Santa Claus skipped phases 1-3 and went straight onto the William the Conqueror diet as soon as he delivered his last Christmas present and returned to the North Pole. Furthermore, he is now the proud host of over 30 tapeworms.

Recommended Links on Dietary Fads and Healthy Living:

“The glutton digs his own grave with his teeth.”
- William Osler