Shared posts

22 Jul 10:00

Diagnose on Sight: Bilateral Leg Rash

by Jeff Riddell, MD

Erythema Nodosum

Case: A pre-teen girl, living in central California, recently started on fluconazole, now presenting with a bilateral leg rash. What is your diagnosis? Click on the image for a larger view.

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Diagnosis

Erythema nodosum, secondary to coccidioidomycosis

Explanation

Erythema nodosum is a cutaneous reaction consisting of inflammatory, tender erythematous subcutaneous nodular lesions. The classically painful rash is located on the lower extremities and usually regresses spontaneously. It is associated with a wide variety of disease processes [1,2] including:

  • Most common cause: Streptococcal infections
  • Other causes:
    • Behcet’s syndrome
    • Oral contraceptive use
    • Pregnancy
    • Sarcoidosis
    • Tuberculosis
    • Viral infections

Coccidioidomycosis is endemic to certain arid parts of the Southwest United States. Erythema nodosum is the most characteristic reactive cutaneous manifestation of coccidioidomycosis. It presents 1-3 weeks after onset of illness and is usually self-limited [3]. While strep infections are the most common cause of erythema nodosum, in a patient who has recently visited the American southwest, suspect coccidioidomycosis.

 

Master Clinician Bedside Pearls

Stuart Swadron, MD

 

 

 

Stuart Swadron, MD – Professor of Emergency Medicine, Keck School of Medicine of the University of Southern California (provided to ALiEM and recorded by Swadron, 2014)

 

References

  1. Psychos DN, Voulgari PV, Skopouli FN, Drosos AA, Moutsopoulos HM. Erythema nodosum: the underlying conditions. Clin Rheumatol. 2000;19(3):212-6. PMID: 10870657.
  2. Schwartz R, Nervi S. Erythema Nodosum: A Sign of Systemic Disease. Am Fam Physician. 2007 Mar 1;75(5):695-700 PMID: 17375516.
  3. DiCaudo DJ. Coccidioidomycosis: a review and update. J Am Acad Dermatol. 2006 Dec;55(6):929-4.2 PMID: 1711021.

Author information

Jeff Riddell, MD
Jeff Riddell, MD
Chief Resident
UCSF-Fresno Emergency Medicine Residency

The post Diagnose on Sight: Bilateral Leg Rash appeared first on ALiEM.

09 Jun 10:00

R.E.B.E.L. ECG of the Week: LBBB and STEMI

by Salim Rezaie

R.E.B.E.L. ECG of the Week

89 year old male with PMH of hypertension, stage 3 chronic kidney disease with chief complaint of shortness of breath. Several days ago patient had a laminectomy for radicular pain. He was doing fine post-operatively and began to develop gradual shortness of breath.  He had no complaints of chest pain, nausea/vomiting, fevers, diaphoresis, but did have some weakness.  There were no prior ECGs for comparison.

BP: 98/48 HR: 103 RR: 18 O2 on RA: 94% Temp: 38.6

JVD to the angle of the mandible
Bibasilar Crackles
Sinus Tachycardia
Bilateral lower extremity pitting edema

Labs: Na 125, K+ 4.2, Creatinine 2, BNP > 2500

ECG from triage is shown…

Before reading on, try to come up with your own interpretation of this ECG before moving on to the final impression

R.E.B.E.L. ECG of the Week: LBBB and STEMI

Rate: 103
Rhythm: Normal sinus Rhythm, 1st degree AV Block
Axis: Normal Axis
QRS: Left bundle branch block (LBBB)
ST/T Waves: Flattened ST depression in Leads II, III, aVF and V5 – V6, J point elevation in leads V2 – V3, V3 concordant ST depression
Final ECG Interpretation: LBBB with concordant ST depression in lead V3

Putting all this together we have a patient with new onset congestive heart failure based on physical exam, and based on the fact that there is no old ECG it is unknown if this LBBB is new, but there is concordant ST depression in lead V3.  In this case cath lab should be activated.

What is the ACC/AHA STEMI guideline recommendations for LBBB and STEMI?

The 1996 and 2004 ACC/AHA STEMI guidelines recommended emergent repercussion therapy including fibrinolytics or primary percutaneous coronary intervention (PCI) in patients with symptoms compatible with STEMI and new or presumably new LBBB if these symptoms arose in the prior 12 hours (Class I Indication)

The 2012 European Society of Cardiology STEMI guidelines also recommend early PCI or fibrinolytics in patients with a clinical presentation of STEMI and new or presumably new LBBB if symptoms arose in the prior 12 hours (Class Ia Indication)

The 2013 ACC/AHA STEMI guidelines changed previous recommendations for patients with suspected ischemia and new or presumably new LBBB should not be treated as a STEMI equivalent

What is the role of the Sgarbossa criteria and modified Sgarbossa criteria in patients with LBBB?

  • For a complete explanation checkout this post from REBEL EM, Modified Sgarbossa Criteria: Ready for Primetime?
  • The bottom line of that post:
    • Suspected Acute Myocardial Infarction (AMI) + LBBB needs to have emergent primary PCI or fibrinolysis IF:
    • Hemodynamic instability or acute heart failure (Validated)
    • Sgarbossa score ≥ 3 (Validated)
    • ST/S ratio < -0.25 (Proposed, NOT Validated)

R.E.B.E.L. ECG of the Week: LBBB and STEMI

Image modified from:[1]

Conclusion to the case:

  • This patient has an ECG with LBBB and hemodynamic instability with signs of acute congestive heart failure which according to the above algorithm requires primary PCI or fibrinolysis
  • It was decided to activate the cath lab, and patient was found to have a 100% RCA lesion, and 80% LM stenosis.
  • Sensitive Troponin I showed an initial Troponin of 45 before cath was performed

Take Home Point for R.E.B.E.L. ECG of the Week: LBBB and STEMI

Patients with LBBB, concordant changes in any one lead (i.e. Sgarbossa Criteria ≥3), and signs of hemodynamic instability or congestive heart failure, STEMI is the diagnosis until cardiac catheterization proves otherwise

 

There has been more discussion about this case at:

REBEL EM Google+ Community

ECG+ Google+ Community

References

  1. Q. Cai, N. Mehta, E.B. Sgarbossa, S.L. Pinski, G.S. Wagner, R.M. Califf, and A. Barbagelata, "The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from falsely declaring emergency to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time?", American heart journal, 2013. http://www.ncbi.nlm.nih.gov/pubmed/24016487

The post R.E.B.E.L. ECG of the Week: LBBB and STEMI appeared first on R.E.B.E.L. EM - Emergency Medicine Blog.

30 Jun 22:22

Update on Age-Adjusted D-Dimer

by Salim Rezaie
Alisa.wray

burns was talking about this at a journal club a while ago...

Update on Age-Adjusted D-DimerD-dimer has been shown to increase with age, which can cause a lower specificity (i.e. more false positive tests) in older patients. The result of this would be that older patients would often have more diagnostic imaging or downstream testing, but on the other hand, maybe a higher cut-off d-dimer value may lead to increased false negative cases (i.e. missed venothromboembolism) and make this strategy less safe. Recently, I wrote a post on age-adjusted d-dimer testing on REBEL EM, but since that post there was a new article that was published in Chest 2014. This post, will specifically focus on an update of age-adjusted d-dimer testing based on the above article.

What article will we be discussing?

Woller SC et al. Assessment of the Safety and Efficiency of Using an Age-Adjusted D-Dimer Threshold to Exclude Suspected Pulmonary Embolism. Chest 2014. [Ahead of Print] PMID: 24831769

What is the clinical question we are trying to answer?

Is the use of age-adjusted d-dimer testing in patients ≥ 50 years of age safe for clinical practice?

What did they do:

  • A retrospective review of 923 patients, age > 50 years evaluated for suspected PE
  • All patients had a Revised Geneva Score (RGS) calculated, a d-dimer performed, and a computed tomography pulmonary angiography (CTPA)
  • A 64-slice CT scanner was used and high sensitivity d-dimer test (Stago latex agglutination)
  • Compared false negative rate for PE of a conventional d-dimer threshold with an age-adjusted d-dimer threshold

Results

Results:

  • 104 patients had a negative CONVENTIONAL d-dimer and RGS ≤ 10, with NO PEs observed within 90 days (False Negative Rate = 0%)
  • 273 patients had a negative AGE-ADJUSTED d-dimer and RGS ≤ 10, with 4 PEs observed within 90 days (False Negative Rate = 1.5%)
  • AGE-ADJUSTED d-dimer resulted in 18.3% absolute reduction in patients age > 50 years who would undergo CTPA vs CONVENTIONAL d-dimer
  • In a subcohort evaluation a negative AGE-ADJUSTED d-dimer and RGS≤ 10 was seen in:
    • Age > 50 years: 273/923 pts with 4 (1.5%) missed PEs at 90d (95% CI 0.4 – 3.7)
    • Age 51 – 65 years: 130/480 pts with 1 (0.8%) missed PEs at 90d (95% CI 0.02 – 4.2)
    • Age 66 – 74 years: 66/186 pts with 0 (0.0%) missed PEs at 90d (95% CI 0.0 – 5.4)
    • Age ≥ 75 years: 77/257 pts with 3 (3.9%) missed PEs at 90d (95% CI 0.8 – 11.0)

Limitations:

  • If you look at each of the sub cohorts in the results section, the maximum confidence interval ranged from 3.7 – 11.0% increasing with age, which means we are potentially missing more PEs in older patients (i.e. upto 11.0% at the maximum CI in patients 75 years and older)
  • LimitationsThe prevalence of PE in this study was 10.6%.  In the US prevalence has been reported as 5.1% [1], but in contrast in European studies the prevalence for PE ranges from 24 – 31% [2] [3] [4].
  • This study was a retrospective chart review, so if hemoptysis or leg edema were not recorded they were considered negative, and actually underestimate RGS.  Also how may patients don’t go to doctors and have not had their initial malignancy diagnosed?  This will also reduce the RGS, when it is well known that malignancy risk increases with age
  • All patients in this study received a CTPA, which is not what is done in clinical practice, and excluded all patients who did not receive imaging.  Therefore this study population differs from an unselected patient population, making this a higher risk population for PE

Authors’ Conclusion: Using an age-adjusted d-dimer threshold reduces imaging among patients age > 50 years with a RGS ≤ 10, but at the cost of missing an additional 1.5% of PEs and requires a prospective study before this practice can be adopted into routine clinical care

Take Home Message

Take Home Message

Using an age-adjusted d-dimer strategy in patients age > 50 years would result in 18.3% fewer scans, but would miss up to 3.7 – 11.0% of PEs at 90 days of follow up based on the highest confidence intervals.  Therefore a prospective, randomized control trial with narrower confidence intervals would be needed before implementing this strategy into clinical practice

 

References

  1. A. Penaloza, P. Roy, J. Kline, F. Verschuren, G. LE Gal, S. Quentin-Georget, N. Delvau, and F. Thys, "Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism.", Journal of thrombosis and haemostasis : JTH, 2012. http://www.ncbi.nlm.nih.gov/pubmed/22568451
  2. R.A. Douma, G. le Gal, M. Söhne, M. Righini, P.W. Kamphuisen, A. Perrier, M.J.H.A. Kruip, H. Bounameaux, H.R. Büller, and P. Roy, "Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts.", BMJ (Clinical research ed.), 2010. http://www.ncbi.nlm.nih.gov/pubmed/20354012
  3. M. Jaffrelot, F. Le Ven, P. Le Roux, V. Tissot, E. Rame, P. Salaun, and G. Le Gal, "External validation of a D-dimer age-adjusted cut-off for the exclusion of pulmonary embolism.", Thrombosis and haemostasis, 2012. http://www.ncbi.nlm.nih.gov/pubmed/22399072

The post Update on Age-Adjusted D-Dimer appeared first on R.E.B.E.L. EM - Emergency Medicine Blog.

21 Jul 14:21

Two Skydivers Jump From 5,000 Feet and Successfully Land on a Slip ‘N Slide

by Brian Heater

In this footage by Caters News, skydivers Niklas Daniel and Brianne Thompson leap from a plane at 5,000 feet above Arizona and manage to successfully land on a Slip ‘N Slide, traveling the length of the backyard toy at 50MPH.

21 Jul 08:30

Mushroom Gouda Quinoa Bake

by Annie

It all started with an omelette.  That tends to be my go-to meal on the nights when I get home late after barre class.  I’m famished, Ben and the kids have already eaten, and I’m looking for quick and healthy fare.  I make them a bit differently every depending on what veggies and cheeses we happen to have in the fridge at the moment. One evening a few months ago, I added some sautéed mushrooms and shredded gouda to my omelette and I don’t know if I was having an exceptionally good cooking night or if I was just incredibly hungry, but it was just soooo good.

Since then, I’ve been looking for every opportunity to combine mushrooms and gouda. I made them into burgers. I continue to put them in omelettes. And now, I baked them with quinoa. It’s a bit reminiscent of mac and cheese, but it’s really all about the mushrooms here. I included three of my favorite varieties, but feel free to use whatever you like best.  I also included a bit of greek yogurt to add a bit of creaminess, but if you don’t have it on hand, not to worry. It’s still pretty great even without it.  I know this meal will be on heavy rotation here, since this mushroom gouda thing doesn’t seem to be just a phase anymore.

16 Jul 12:18

The LITFL Review 144

by Kane Guthrie

The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.

Welcome to the 144th edition, brought to you by:

The Most Fair Dinkum Ripper Beaut of the Week

The Best of #FOAMed Emergency Medicine

  • Stephen Smith reposts on a Certain Pattern of PseudoSTEMI to remind us that WPW can cause STEMI-like findings on the 12-lead ECG. Patients with chest pain and this finding should be considered for cardiac catherization or thrombolytics but caution is advised. [AS]
  • Audio from NYU/Bellevue Grand Rounds in June 2014 featuring Jerry Hoffman on Over-diagnosis and David Newman on Chest Pain posted this week to the All NYC EM Conference site. Great talks from a couple legends in Emergency Medicine on topics critical to us all. [AS]
  • Richard Body at St Emlyns uses his own research to answer the question How accurate is clincal judgement for acute coronary syndromes? He highlights the relative uselessness of historical features and risk factors – but interestingly the combination of clinician gestalt, normal ECG and negative troponin looks very promising… more studies needed, but a must read all the same. [CN]
  • TTL Podcast 1. Getting to CT in 30 mins is a St. Emlyns podcast examining what aspects of initial trauma managment are really needed before going for a scan, when you have to have the scan done within 30 minutes of arrival. This sparked
  • Hippo EM present a videocast on pus and stones discussing how you can diagnoses UTI in patients with ureteric calculi. Or rather, how you can’t. [CN]
  • Are topical anesthetics dangerous in the treatment of corneal abrasions or is withholding them simply evil? Ken Milne and Salim Rezaie discuss on The Skeptics Guide to Emergency Medicine. Ken even brings in an opthalmologist who says it’s “okay” to give topical anesthetics! [AS]

The Best of #FOAMcc Critical Care

  • Speak up! on INTENSIVE focusses on speaking up, an obligation of all healthcare professionals to ensure that patients are not harmed. It can be difficult, requires skill, and requires courage – but is essential. [CN]
  • Cliff Reid has looked into the options for rewarming when you are faced with profound hypothermia and no ECMO. [CN]
  • PulmCCM highlight a recent meta-analysis showing that Prone positioning reduces ARDS mortality by 26%. Is your ICU proning yet? [CN]

The Best of #FOAMPed Paediatrics

  • In yet another superb smaccGOLD talk, Paediatric INtensivist and Palliative Care physician Greg Kelly tells us what to do when children die. [CN]

#FOAMTox Toxicology

News from the Fast Lane

LITFL Review EM/CC Educational Social Media Round Up

Show Reference list

Emergency Medicine and Critical Care Blogroll — Emergency Medicine and Critical Care Podcasts — 123Sonography.com — Academic Life in Emergency Medicine — A Life at Risk — Bedside Ultrasound - BIJC — Boring EM — Broome Docs — CCM-L — Critical Care Perspectives in EM — Dave on Airways — Dont Forget the Bubbles — Dr Smith’s ECG Blog — ECG Academy — ECG Guru — ECG of the Week — ED ECMO — ED Exam — ED-Nurse — EDTCC — EKG Videos — EM Basic — EMCrit — EM CapeTown — EMCases — EMDocs — EMDutch — EMin5 — Emergency Medical Abstracts — EM Journey — EmergencyLondon — Emergency Medicine Cases — Emergency Medicine Education — Emergency Medicine News — Emergency Medicine Ireland — Emergency Medicine Tutorials — Emergency Medicine Updates — EM on the Edge — Emergucate  — EM Journey —  EM IM Doc — EM Literature of Note — empem.org — EMpills — Emergency Physicians Monthly — EM Lyceum —EM nerd— EMProcedures — EMRAP — EMRAP: Educators’ Edition — EMRAP.TV — EM REMS — ER CAST — EXPENSIVECARE — Free Emergency Medicine Talks — Gmergency! — Got Resuscitation— Greater Sydney Area HEMS — HQmeded.com — Impactednurse —Injectable Orange  — INTENSIVE — Intensive Care Network — iTeachEM — IVLine — KeeWeeDoc — KI Docs— ER Mentor — MDaware — MD+ CALC — MedEDMasters — Medical Education Videos — Medical Evidence Blog — MedEmIt — Micrognome — Movin’ Meat — Paediatric Emergency Medicine — Pediatric EM Morsels — PEM ED — PEMLit — PEM Cincinnati — PHARM — Practical Evidence — Priceless Electrical Activity — Procedurettes — PulmCCM.org — Radiology Signs — Radiopaedia — REBEL EM - Resus.com.au — Resus.ME — Resus Review — RESUS Room — Resus Room Management — Richard Winters’ Physician Leadership — ruralflyingdoc — SCANCRIT — SCCM Blogs — SEMEP — SinaiEM — SinaiEM Ultrasound — SMART EM — SOCMOB — SonoSpot — StEmylns — Takeokun — thebluntdissection — The Bottom Line — The Central Line — The Ember Project —The Emergency Medicine Resident Blog — The Flipped EM Classroom — thenursepath — The NNT — The Poison Review — The Sharp End — The Short Coat — The Skeptics Guide to Emergency Medicine — The Sono Cave - The Trauma Professional’s Blog — underneathEM.com  — ToxTalk — tjdogma — Twin Cities Toxicology — Ultrarounds — UMEM Educational Pearls —Ultrasound Podcast

LITFL Review

The post The LITFL Review 144 appeared first on LITFL.

18 Jul 09:02

China – Men’s Group – Acro Worlds

by coach Rick

Very impressive.

… 24th Acrobatic Gymnastics World Championships – Levallois (FRA), July 10 – 12, 2014. China (Zhou Yi, Wang Lei, Tang Jian, Wu Yeqiuyin). Men’s Groups Dynamic, Qualification …

Click PLAY or watch it on YouTube.

(via GymCastic)

15 Jul 22:10

The Ancient Kaiju Project, Classic Paintings Augmented with Skillfully Inserted Pop Culture Monsters and Objects

by EDW Lynch

Classic Works of Art with Monsters by Oliver Wetter

In his ongoing digital illustration series “The Ancient Kaiju Project,” German artist Oliver Wetter skillfully augments classic paintings with the addition of fearsome creatures and objects from pop culture like Godzilla, a Star Wars AT-AT, and Howl’s Moving Castle. According to Wetter he is using the project as a way improve his ability at replicating classic painting styles. He has posted process images and making-of videos on his blog.

Classic Works of Art with Monsters by Oliver Wetter

Classic Works of Art with Monsters by Oliver Wetter

Classic Works of Art with Monsters by Oliver Wetter

Classic Works of Art with Monsters by Oliver Wetter

images by Oliver Wetter

via DesignTAXI, Archie McPhee’s Endless Geyser of Awesome

16 Jul 01:06

French Supermarket Chain Launches Food Waste Reduction Campaign that Celebrates Ugly Fruits and Vegetables

by Lori Dorn

The French supermarket chain Intermarché has launched “Inglorious Foods“, a unique campaign developed by Marcel Worldwide as a way to highlight the enormous amount of food wasted due to imperfect appearance. Instead the store celebrated the ugly fruits and vegetables and put them on shelves, either in their natural form or in soup or juice, and sold them at a significant discount to shoppers.

Intermarché launched the Inglorious Fruits & Vegetables, a film, print, poster and radio campaign, celebrating the beauty of the Grotesque Apple, the Ridiculous Potato, the Hideous Orange, the Failed Lemon, the Disfigured Eggplant, the Ugly Carrot, and the Unfortunate Clementine to call attention to our problem with food waste.

Inglorious Foods Group

Inglorious Orange and Carrot

Moches in Store

Soup and juice

images via Marcel Worldwide, Intermarché

via Good, Design Taxi

15 Jul 18:11

‘Marvels of Nature’, A Series of Animal Body Paintings Created on Contortionist Models

by EDW Lynch

Marvels of Nature Animal Body Paintings by Emma Fay

“Marvels of Nature” is a series of beautiful animal-themed body paintings by artist Emma Fay featuring contortionists as models.

Marvels of Nature Animal Body Paintings by Emma Fay

Marvels of Nature Animal Body Paintings by Emma Fay

Marvels of Nature Animal Body Paintings by Emma Fay

photos by Jonathan Macauley

11 Jul 15:23

A Dad Makes His Six-Year-Old Son a LEGO ‘Star Wars’ Boba Fett Minifigure Costume

by Justin Page

LEGO Boba Fett

The Dented Helmet member and father CGS1 recently made his six-year-old son an awesome LEGO Star Wars Boba Fett minifigure costume to wear at a local ToyCon. You can view more “making of” photos on the The Dented Helmet forums.

We took the costume for a trial run at a local toycon this past Sunday. I still have to finish building the arms and blaster, as well as tweaking a few things such as the cape fabric. I approached the components of this project as if they were actual Lego elements. In doing so, I created the jetpack to be removable as it appears in the actual minifigure as well as the range finder stalk. The entire costume is built from scratch using photo references and scans I took myself. The costume is built primarily out of sintra with pink insulation foam used to carve the helmet dome and a small amount of plastazote foam used on the tips and base of the jetpack rockets. Torso and leg graphics are printed on adhesive vinyl while a custom green was used to colour match the helmet and jetpack.

LEGO Boba Fett

photos via The Dented Helmet\

via reddit, Fahionably Geek, Archie McPhee’s Endless Geyser of AWESOME!

11 Jul 20:30

LEGO Sculptures That Portray Iconic Superheroes and Movie Characters as Lazy Couch Potatoes

by Justin Page

Bat Couch

Pixar director and LEGO fan Angus MacLane has built a great series of LEGO sculptures that portray iconic superheroes and movie characters as lazy couch potatoes. More characters from MacLane’s collection can be viewed online at Flickr.

Optimus Couch

Iron Couch

Robo Couch

Kane Couch

photos by Angus MacLane

via Geek Art, DesignTAXI

27 Jun 20:42

Goodnight Darth Vader, A ‘Star Wars’ Children’s Book by Jeffrey Brown Filled With Bedtime Stories for Future Jedi

by Justin Page

Goodnight Darth Vader

Goodnight Darth Vader is a fun new Star Wars children’s book created by cartoonist Jeffrey Brown and published by Chronicle Books that is filled with bedtime stories for future Jedi. The book is a follow-up to Brown’s children’s stories, Darth Vader and Son and Vader’s Little Princess. Hardcover editions of Goodnight Darth Vader are available to purchase from Chronicle Books and Amazon.

It’s bedtime in the Star Wars galaxy, and Darth Vader’s parenting skills are tested anew in this delightful follow-up to the breakout New York Times bestsellers Darth Vader™ and Son and Vader’s™ Little Princess. In this Episode, the Sith Lord must soothe his rambunctious twins, Luke and Leia—who are not ready to sleep and who insist on a story. As Vader reads, the book looks in on favorite creatures, droids, and characters, such as Yoda, R2-D2, Han Solo, Chewbacca, Darth Maul, Admiral Ackbar, Boba Fett, and many others as they tuck in, yawn, and settle down to dream. As ever, Jeffrey Brown’s charming illustrations and humor glow throughout, playing on children’s book conventions to enchant adults and kids alike.

Goodnight Darth Vader

Goodnight Darth Vader

Goodnight Darth Vader

images via Chronicle Books

submitted via Laughing Squid Tips

30 Jun 22:30

A Delicious Life-Size Chocolate Replica of a Human Skull

by EDW Lynch

Life-Size Chocolate Replica of a Human Skull

UK-based chocolatier BlackChocolate uses a mold based on an actual human skull to cast a life-size, anatomically correct Belgian chocolate human skull.

Life-Size Chocolate Replica of a Human Skull

Life-Size Chocolate Replica of a Human Skull

photos via BlackChocolate

via Joanne Manaster, Boing Boing

06 Jul 16:30

Bunday Morning Comix

by Brinke

1959217_10152179505267549_6270182706573710006_nAs seen on the Hundeurlaub FB page, original artwork by “Ayka.” We think. Thanks to Aunt Bonnie P.


Filed under: Uncategorized Tagged: Bunday Morning Comix
03 Jul 16:00

Dogs of the World Illustration Series by Lili Chin

by Katherine Becker

Dogs of the World Illustration Series by Lili Chin

We love keeping up with what the fabulous Lili Chin is up to, and her newest collection of illustrations totally rocks our world. Lili’s been compiling a massive Dogs of the World illustration collection – a breakdown of dog breeds by the region of their provenance, all rendered in Lili’s distinctive, adorable style. Check out the full collection on tumblr as well as prints, tees, and other goodies for sale!

Dogs of the World Illustration Series by Lili Chin in other for humans

Dogs of the World Illustration Series by Lili Chin in other for humans

Dogs of the World Illustration Series by Lili Chin in other for humans

Dogs of the World Illustration Series by Lili Chin in other for humans


Share This: Twitter | Facebook | Don't forget that you can follow Dog Milk on Twitter and Facebook.
© 2014 Dog Milk | Posted by Katherine in For Humans, Other | Permalink | 4 comments
18 Jun 19:02

A Knife Holder Shaped Like an X-Wing Starfighter From ‘Star Wars’

by Justin Page

Star Wars X-Wing Knife Block

The officially licensed Star Wars X-Wing Starfighter Knife Holder from The Fowndry will “give your regular old kitchenware a rebellious kick in the vegetables.” Their chrome-effect plastic knife holder comes loaded with five stainless steel knives and is available to purchase online.

Chrome finished and standing over 20cm high, the X-Wing Knife Block raises the status of the humble knife holder. Heck, with this in the kitchen even Aunt Beru would be signing up to give the Empire one in the eye. And as for the Force? Well… it’s useful. But can it chop an onion, dice peppers, and slice a loaf? Can it? We’ll ask George, as soon as he picks up.

Star Wars X-Wing Knife Block

Star Wars X-Wing Knife Block

Star Wars X-Wing Knife Block

images via The Fowndry

submitted via Laughing Squid Tips

19 Jun 14:44

How to Cut a Cake Using Scientific Principles in Order to Best Maintain Freshness

by Brian Heater

Math writer Alex Bellos demonstrates a more scientific alternative to cake cutting which better maintains the moistness of the innards in the latest episode of the Mathematical Science Research Institute series Numberphile. The method dates back to a 1906 letter to Nature by renowned British scientist Francis Galton, entitled, “Cutting a Round Cake on Scientific Principles”, detailing a method that involves removing thin slices from the cake’s center. Galton also suggested employing a rubber band to help keep the segments together.

via The Presurfer

19 Jun 17:11

Future Lifelong Companions Ruuxa the Baby Cheetah and Raina the Puppy Meet For First Time at San Diego Zoo

by Lori Dorn

Ruuxa the baby cheetah and Raina the Rhodesian ridgeback puppy meet for the very first time, clumsily climbing all over each other, biting each other and cementing their lifelong friendship through the San Diego Zoo’s Ambassador program in this adorable video posted by the San Diego Zoo.

A 6-week-old cheetah cub at the San Diego Zoo Safari Park is spending lots of time with his new dog companion. The young cheetah, Ruuxa, was chosen to be raised as an animal ambassador at the Safari Park after he was rejected by his mother and had to be hand raised by keepers…Safari Park cheetahs selected for training as ambassadors are paired early in life with a domestic dog. As the two companions grow up together, the dog’s body language will communicate to the cheetah that there’s nothing to fear in new or public surroundings, which relaxes and calms the cheetah. The Safari Park currently has four cheetah ambassadors all of which are trained to participate in the Park’s Cheetah Run experience.

Raina the Puppy

Raina the Puppy

Raina the Puppy

via Daily Picks and Flicks

19 Jun 18:50

A Behind the Scenes Look at Sophie Gamand’s ‘Wet Dog’ Photo Shoot

by Lori Dorn

Photographer Sophie Gamand goes behind the scenes of her imaginative award-winning photo series “Wet Dog” to talk about how she framed and styled the shots (with the help of pet stylist Ruben Santana), what camera equipment she used and the book she has planned for the future in this video posted by Sony. We previously wrote about this photo series in November 2013.

via PictureCorrect, PetaPixel

20 Jun 20:55

Soldier Comes Home to an Exuberant Greeting at the Door by His Cat

by Lori Dorn

An Army Reserve soldier, returning home from drills, was exuberantly greeted at the door by Finn, his beautiful and very vocal ragdoll cat in this video posted by wildlimeyogi

via reddit

13 Jun 20:23

Buddy the Iguana Comes Running Like A Dog When His Human Calls

by Lori Dorn

Buddy, a very clever 12-year old iguana comes running like a dog when his human calls, as demonstrated in this video posted by Dave Durham.

via reddit, Tastefully Offensive

14 Jun 18:02

Custom Engraved Rolling Pins That Imprint Designs into Dough

by EDW Lynch

Custom Engraved Rolling Pins That Imprint Designs into Dough

Polish designer Zuzia Kozerska uses a laser engraver to engrave custom designs into wooden rolling pins. In addition to being pleasing to the eye, the engravings will imprint custom patterns into dough for patterned cookies, pastries, and other dough-based creations. Kozerska makes a variety of standard designs and will also customize pins to order.

Custom Engraved Rolling Pins That Imprint Designs into Dough

Custom Engraved Rolling Pins That Imprint Designs into Dough

Custom Engraved Rolling Pins That Imprint Designs into Dough

photos via Zuzia Kozerska

via swissmiss

16 Jun 20:43

Wolf Puppy Is Confounded By a Case of the Hiccups

by Lori Dorn

8-week old Nikai, the big-eyed, big-pawed, insanely adorable wolf puppy, is utterly confounded by a case of the hiccups that’s plaguing his little body in this video posted by the Wolf Conservation Center in South Salem, New York.

Wolves can make a variety of vocalizations. They growl, whimper, whine, bark, huff, howl… Although the wolf’s howl is has been the inspiration for films, essays, poems, etc… we think there is another sound that evokes equal levels of emotion and excitement – a wolf pup’s hiccup!

Nikai the Wolf Puppy

image via Wolf Conservation Center

via Tastefully Offensive

16 Jun 22:33

Ethereal Underwater Fashion Photos Taken at a Shipwreck Off the Coast of Bali by Benjamin Von Wong

by EDW Lynch

Ethereal Underwater Fashion Photos by Benjamin Von Wong

Photographer Benjamin Von Wong recently shot these ethereal underwater fashion photos in a complex shoot at a shipwreck off the coast of Bali. Von Wong describes the many complications of such a shoot on his blog, which included finding underwater models — they are all free-divers — and convincing a designer to create clothes that would be destroyed by the water. This behind-the-scenes video offers a good glimpse of the complexity of Von Wong’s project.

Ethereal Underwater Fashion Photos by Benjamin Von Wong

Ethereal Underwater Fashion Photos by Benjamin Von Wong

photos by Benjamin Von Wong

via PetaPixel

17 Jun 16:29

SoundWorks Collection Interviews the Sound Team Behind ‘Maleficent’

by Brian Heater

For their latest video, “The Sound of Maleficent,” SoundWorks Collection talks to Tim Nielsen of Skywalker Sound, the sound designer for the Disney film Maleficent.

The one sound reoccurring moment that we refer to the original is the classic Maleficent laugh — the deep, bellowing evil laugh. A lot of work was done to pay homage to it.

submitted via Laughing Squid Tips

11 Jun 19:02

Hyperrealistic Wax Sculptures of Famous Actors and Movie Characters by Bobby Causey

by Justin Page

CHRISTOPHER REEVE SCULPTURE

Allen Park, Michigan-based professional sculptor Bobby Causey has created a beautiful collection of hyperrealistic latex sculptures based on famous Hollywood actors and movie characters. You can view more from Bobby’s series on his website and deviantART gallery.

HEATH LEDGER JOKER

David The Lost Boys

Jack Nicholson shinning wip

NINA1

Working on David

photos via BobbyC1225

via Daily Art, DesignTAXI

11 Jun 20:58

Smile, Eet’s Time For Yer Bath!

by Brinke

This Little Orang Bebeh doesn’t seem to mind it one beet!!!

BIdDJRi
Imgur.


Filed under: Uncategorized Tagged: Orangutan
09 Jun 22:35

Loyal Service Dog Gets His Own Photo In His Human’s 7th Grade Yearbook

by Lori Dorn

Yearbook Photo

Taxi, a loyal service dog in San Antonio, Texas, took his place in the 7th grade school yearbook right next to Rachel Benke, the young girl with epilepsy who had been in Taxi’s charge for the past four years.

He goes everywhere with the soon-to-be eight-grader, including accepting awards at school, celebrating birthdays, and even on the school track where he one day sprung into action. “Her aide was holding Taxi on the side and he just started pulling away from the aide as hard as he could trying to get to Rachel,” [Theresa] Benke said. She said once they got her inside, Rachel had a grand mal seizure, and Taxi wouldn’t leave the girl’s side. “I don’t know how Taxi new this, but he wouldn’t let anyone near her until the paramedics arrived,”- KHOU 11.

image by Theresa Benke

via KHOU 11, Doggington Post, ABC 15, KRON 4, Huffington Post

09 Jun 22:43

California Extreme 2014, A Celebration of Coin-Operated Arcade Games in Santa Clara

by EDW Lynch

California Extreme 2014

California Extreme 2014, a celebration of coin-operated arcade games, takes place at the Hyatt Regency Santa Clara on July 12 and 13. The show will feature pinball machines, video games, and other arcade novelties, all available for free play. As the games are all in the hands of private collectors, the show is also a venue for buying, selling, and trading of vintage arcade machines.