Shared posts

13 Aug 06:01

Frozen Herb Starters

by Sara@Our Best Bites

Fresh Herbs introFresh herbs are one of my favorite things about having a home garden, but they’re also one of the hardest things for me to keep up with.  They need quite a bit of trimming and pinching back to really stay viable and they can get out of control really quickly.  I use a lot of fresh herbs in my cooking, and I still can’t keep up with my own plants.  I started making these little frozen herb cubes years ago, (long before the idea went viral on Pinterest!) and thought it was about time I shared it here because it’s a great way to preserve the fresh flavors of summer and then enjoy them all year long in lots of different recipes.  It’s so quick and easy, you can feel really productive with your preserving skills.  And I’m all about easy things that make me feel productive!

Fresh Herbs

Continue reading: Frozen Herb Starters

The post Frozen Herb Starters appeared first on Our Best Bites.

11 Aug 20:36

Magician Levitates a Sausage Weiner in Front of a Few Dogs Just to See How They’ll React

by Lori Dorn

Jose Ahonen, the Finnish magician about whom we’ve previously written, performs a magic trick in which he levitates a sausage weiner in front a variety of absolutely adorable dogs, just to see how they’ll react. While some of the dogs weren’t exactly sure as to what what happening, it was all in fun and, as Jose says, “everyone got to eat the weiner in the end!”

12 Aug 18:14

‘Flower Power’, A Photo Series That Shows the Softer Side of Pit Bulls In Soft Light and Floral Halos

by Lori Dorn

Sweetheart
Sweetheart

Photographer Sophie Garamand, whose work we’ve previously posted, has a new series in which she portrays adoptable pit bull dogs in soft light and floral halos, giving them an angelic hippie look that is in stark contrast to the usual gritty urban environments in which these dogs are usually portrayed. Dogs from three different New York City shelters, Sean Casey Animal Rescue, Second Chance Rescue and Animal Haven, participated in the shoot.

This project started as an excuse for me to discover more about pit bulls. Like many people, I admittedly had prejudices against them. But as an active volunteer with many rescue groups, I often came in contact with pit bulls and was slowly warming up to their sweet nature. I decided to confront my apprehensions and explore their soft side in a visual way. I realized pit bulls were always portrayed in very urban, gritty photographs. The imagery associated with these dogs is often harsh, very contrasted, conveying the idea of them being tough. In my opinion, this feeds the myth that these dogs are dormant psychopaths.So I decided to take the other route and portray them like hippies, soft fairy-tale-inspired characters, feminine and dreamy. The idea of Flower Power blossomed.

Cali
Cali

Rex
Rex

Jellybean
Jellybean

Lucy
Lucy

Minnie
Minnie

photos by Sophie Garamand

via My Modern Met

12 Aug 18:37

Adorable Photos of a Couple Posing with Their Dog As If She Were a Newborn Baby

by EDW Lynch

Doggy Newborn Photos by Jamie Clauss

Photographer Jamie Clauss — a specialist in maternity and newborn portraiture — recently created this ridiculously adorable portrait series of a young couple and their “newborn” dog Snuggles.

Doggy Newborn Photos by Jamie Clauss

Doggy Newborn Photos by Jamie Clauss

Doggy Newborn Photos by Jamie Clauss

Doggy Newborn Photos by Jamie Clauss

photos by Jamie Clauss

12 Aug 19:40

‘My Drunk Kitchen’, A Book Featuring Hannah Hart’s Inebriated Cooking Misadventures

by Lori Dorn

My Drunk Kitchen

Hannah Hart, the star of the very popular web series “My Drunk Kitchen“, has released her new book My Drunk Kitchen:A Guide to Eating, Drinking, and Going with Your Gut, a collection featuring many of the recipes that she created during her inebriated cooking misadventures.

My Drunk Kitchen includes recipes, stories, full color photos, and drawings to inspire your own culinary adventures in tipsy cooking. It is also a showcase for Hannah Hart’s great comedic voice. Hannah offers key drink recommendations, cooking tips (like, remember to turn the oven off when you go to bed) and shares never-before-seen recipes such as:

  • The Hartwich (Knowledge is ingenuity! Learn from the past!)
  • Can Bake (Inventing things is hard! You don’t have to start from scratch!)
  • Latke Shotkas (Plan ahead to avoid a night of dread!)
  • Tiny Sandwiches (Size doesn’t matter! Aim to satisfy.)
  • Saltine Nachos (It’s not about resources! It’s about being resourceful.

The book is currently available on Amazon and through other booksellers.

Hannah and My Drunk Kitchen

images via Hannah Hart

08 Aug 01:43

New Whovian Etsy Items

by Kitty B


As you know, Kevin and I operate a thriving Etsy shop. You may also recall that we love Doctor Who. We were approached by Buildasign.com to review their products, and jumped at the chance! It took us a week to think and determine what Kevin would be designing for the shop (and for our own personal use) and we came up with this:


We love every single one of these. My personal favorite is the fridge magnets. The price on these were great, and I could see so many cool opportunities for fridge magnets. I envision brides using them as save the dates, or it'd be a great way to show off your business instead of business cards! 


Kevin LOVES how the decal looks on his blue jeep too! So fitting seeing as how its a big blue box (and bigger on the inside).

Our items arrived just when they were supposed to, arrived safely and looked great
Great product, great website, great prices! 






*this is a product review request. I received product compensation in exchange for a review. All opinions are my own.

07 Aug 07:21

The Single Pancake

by joythebaker

The Single Pancake with blueberries and lots of chocolate

One of life’s small pleasures:  sharing breakfast with someone.

I mean… if you can find someone who will order the savory breakfast, but then let you pick at their hash browns… I’m pretty sure that’s a love for life.  The ultimate breakfast situation involves sharing an eggy-hash and then sharing a totally over-the-top pancake.  If you can find the human that wants to embark on this sort of breakfast endeavor with you, marry them or give them one of those BFF friendship necklaces.  Either way.  Shared breakfast is a big deal.

Breakfast isn’t always about a pair.  Heeeeck no!  The solo pancake expedition is just as important as the coupled pursuit.  This pancake recipe makes one giant pancake filled with fresh blueberries and chocolate pieces.  Just one!  Just one mega pancake with way too many fresh blueberries and a little too much chocolate.  It’s perfect for one hungry belly, or two bellies to serve after eggs as something I like to call… breakfast dessert.

The Single Pancake with blueberries and chocolate

This recipe comes together in little bits.

Little bits of flour and oats.  A little bit of sugar, cinnamon, and soda, powder.  A little bit of butter.  A lotta bit of fresh blueberries and chocolate.  Too many blueberries and too much chocolate… that’s really what we’re going for.

The Single Pancake with blueberries and chocolate

Dry ingredients frist.

Flour, oats, cinnamon, sugar, and the baking soda and baking powder.

It feels strange to mix together such small amounts.

The Single Pancake with blueberries and chocolate

Buttermilk because it’s nice, thick, and tangy, too!

If you don’t have buttermilk you can add dash of milk to yogurt and go with that!

The Single Pancake with blueberries and chocolate

Handfuls each of fresh blueberries and chocolate chips.  If it feels like too much, it is… and that’s exactly right.

The Single Pancake with blueberries and chocolate

The batter rests while the griddle heats.

You can make this batter as one single pancake (which is a monster and terrifying to flip) or as two small pancakes (which is civilized and easier to flip).  I went with one giant pancake because I like to be scared in the kitchen.  Next time (and there will be a next time), I’ll go with two small cakes.

The Single Pancake with blueberries and lots of chocolate

It’s Breakfast Dessert!  The most coveted meal / non-meal of the day!

The Single Pancake with blueberries and chocolate

As if sweet blueberries and melted chocolate weren’t enough for breakfast dessert… maple syrup and powdered sugar, too!?  Out of control.

The Single Pancake.  It is restrained in portion and totally bonkers in every other way.

The Single Pancake with too many blueberries and lots of chocolate

makes one large or two small pancakes

Print this Recipe!

1/3 cup all-purpose flour (a multi purpose gluten-free flour also works well)

1 Tablespoon dried oats (quick-cooking or old-fashioned)

2 teaspoons granulated sugar

1/2 teaspoon baking powder

1/4 teaspoon baking soda

pinch of salt

1 tablespoon unsalted melted butter

1/4 cup plus 2 tablespoons buttermilk

splash of pure vanilla extract

handful of fresh blueberries

smaller handful of dark chocolate chips

a bit of vegetable oil and butter for coating the griddle

In a small bowl, whisk together flour, oats, sugar, baking powder, baking soda and salt.  In a separate bowl whisk together melted butter, vanilla extract and buttermilk.  Combine the wet and dry ingredients and stir to combine.  The mixture will be thick.  Fold in the fresh blueberries and  chocolate chips.

In a small non-stick frying pan or a griddle  heat a teaspoon of oil and a dab of butter over medium heat.  Pour in the pancake batter and spread some with the back of a spoon.  Cook over medium heat until blueberries begin to bubble and the bottom of the pancake is golden brown.

Flip.  It’s ok if it doesn’t flip perfectly.

Cook until golden brown on both sides.  Remove from pan and onto a plate.  Top with maple syrup and powdered sugar.  Enjoy immediately.  

 

The post The Single Pancake appeared first on Joy the Baker.

05 Aug 19:00

How Fox Reacted To Guardians Of The Galaxy [Comic]

by Geek Girl Diva
Alisa.wray

awesome.

firefly guardians

(via Reddit)








05 Aug 21:01

Lights Out In 71 Seconds

by Brinke

Mr. Man here has no intention of going to bed at the beginning of this clip, and is quite vocal about it. At the 1:11 mark, he’s toast.

As seen on the @CuteEmergency Twitter.


Filed under: Uncategorized Tagged: frenchies, Prolly an Encore Presentayshe but I can't find it
04 Aug 13:00

Basic Airway Assessment: It’s as easy as… 1-2-3?

by Rob Woods

In medical school, many multiple-choice questions in the setting of an acutely ill patient have an option of “managing the ABC’s” and it is always the correct answer.  Unfortunately, saying “I would manage the ABCs as my first priority” is very different from actually knowing how to assess an airway, let alone managing abnormalities during a trauma resuscitation.

If you think this is going to be some crazy airway blog post, think again.  This isn’t a sexy topic on cool, cutting-edge airway interventions…. It’s a bread and butter BoringEM topic that deserves attention. Read on for an approach to basic airway assessment.

Misconceptions about the “A” of ABC

The biggest misunderstanding is around the A of the ABC’s: Airway. In the trauma room I regularly hear the statement, ‘They are talking, so their airway is patent’.  This is inaccurate.  Patency is our primary concern in airway assessment, but the patient who can talk does not necessarily have a PATENT airway.  Think about a patient with bad airway edema from a laryngeal fracture, or a patient with an inhalational injury.  They can talk, but their airway may be closing nonetheless.  The ability to talk usually implies a PROTECTED airway, not a patent airway.  Lack of airway protection is a less urgent matter than patency.

PATENCY is assessed through the presence/absence of obstructive symptoms (stridor, secretions, snoring, etc.), or findings suggesting an airway that may become obstructed (singed nasal/facial hair, carbonaceous sputum, stab to neck with risk of expanding hematoma).

Managing the Airway

The next issue is that the indications for definitive airway management involve both airway and breathing, so just because the airway is patent and protected, it doesn’t mean the patient won’t need to be intubated.

In general, the indications for intubation are (Walls et al., 2012):

  1. Failure to oxygenate
  2. Failure to ventilate
  3. Failure to maintain airway patency
  4. Anticipated clinical course: going for imaging/OR (airway or breathing)

1 and 2 relate to breathing issues, 3 is about airway patency, and 4 is about airway protection.

Look before you Leap:  Assess the airway for difficulty of potential interventions

From here, there is confusion about assessing the airway for PATHOLOGY (patency and protection issues) versus INTERVENTIONS such as: Bag-Valve Mask ventilation (BONES or BOOTS), difficult Laryngoscopy & Endotracheal Intubation (LEMON), difficult Laryngeal Mask Airway (RODS) and difficult Surgical Airway (SHORT).

Deciding that something is wrong with the airway SHOULD be the easy part, and simple interventions will deal with the most immediate airway issue of obstruction. (These simple interventions being:  suction, jaw thrust, oral-pharyngeal airway, supplemental O2).

Deciding if a definitive intervention (i.e. intubation) is required and how to go about that takes a lot more experience and training. The table below contains mnemonics for assessing a patient for intubation, bag-malve-vask ventilation, LMA placement, and cricothyrotomy.

Airway mnemonics modified from the STARSTM Manual & Walls et al. (4th edition)

Difficulty Endotracheal Intubation Difficult Bag-Mask-Valve (BMV)
L   Look externally
E   Evaluate 3-3-2
M  Mallampati*
O  Obstruction/Obesity
N  Neck Mobility**
B Beard
O Obstructed/Obese/OSA
N Neck Stiffness / Neck Mass
E Expecting (Pregnant)
S Stridor / Snores (OSA)**
Difficult Laryngeal Mask Airway (LMA) Difficult Cricothyrotomy
R  Restricted Mouth Opening
O  Obstruction
D  Distorted airway anatomy
S  Stiff Lungs / Neck
S  Surgery
H  Hematoma, Have Infection (Abscess)
O  Obesity
R  Radiation
T  Trauma, Tumor

* this is of limited use in non-elective intubations (e.g. Trauma)
** technically, can add an extra “S” behind all these mnemonics, since Stiff Lungs always makes any positive pressure ventilation strategy more difficult.

A suggested approach to basic airway assessment

My approach to airway assessment for PATHOLOGY is to assess the “S’s” in 3 steps:

The S’s of Airway Pathology

Step 1: Is there evidence of airway OBSTRUCTION now – is it complete or partial?

Complete Obstruction:
Silence without chest rise or
See-Saw Chest movement (chest down, abdo up with attempted respiration – resulting from diaphragmatic excursion with a closed glottis/obstructed tongue)

*Complete airway obstruction needs immediate intervention – cardiac arrest is likely within seconds to minutes of complete airway obstruction.

Partial Obstruction
Stridor – airway swelling/compression by hematoma
Secretions – saliva, blood
Snoring – tongue relaxation
Smash – risk of teeth/blood in the airway

Interventions:
SIMPLE = jaw thrust, suction, OPA, supplemental Oxygen, BVM
ADVANCED = Definitive airway management

Step 2: Is there a risk of ANTICIPATED airway obstruction?

Singe or Sputum (carbonaceous) – risk of delayed airway swelling from inhalational burn
Stab or Swelling neck – risk of delayed airway compression from expanding hematoma or neck mass

Interventions:
Frequent re-assessment, early intervention (if skilled), early consultation with experts

Step 3: Is there a risk of Aspiration from failure to PROTECT their airway?

Sleepy (low GCS)

Interventions:
Definitive airway management if decreased LOC (impaired gag reflex) is going to be prolonged, is not easily reversible, is deteriorating, or if intubation will facilitate further investigations (ie CT Scan).

The level of consciousness can always change and along with it the ability to protect the airway from aspiration, however aspiration is not an immediate event the second your GCS hits 8 or less.  GCS < 8 is not an absolute indication for intubation.  Many intoxicated patients and post-ictal patients live with a GCS or 5 or 6 and wake up a few hours later.  They don’t usually aspirate, and can be managed without definitive airway protection. Alternatively the head-injured trauma patient with a GCS of 12 at presentation that is a 10 now probably needs definitive airway management.

Conclusion

Always assess the S’s of the Airway.  If they are all normal, you can be confident that you are NOT dealing with an immediate or impending airway issue of patency or protection.  If there are abnormalities in the S’s, simple airway interventions will temporize the situation until more experienced providers can assist with definitive airway interventions. The table below summarizes the three steps and nine S’s. This approach is illustrated in 3 cases below.

  Step 1: Is there evidence of airway obstruction now? Step 2: Is there a risk of anticipated airway obstruction? Step 3:Is there a risk of Aspiration from failure to PROTECT their airway?
Signs Symptoms Complete Obstruction
Silence without chest rise
or
See-Saw Chest movementPartial Obstruction
Stridor – airway swelling/compression by hematoma
Secretions – saliva, blood
Snoring – tongue relaxation
Smash – risk of teeth/blood in the airway
Singe or Sputum (carbonaceous) – risk of delayed airway swelling from inhalational burnStab or Swelling neck – risk of delayed airway compression from expanding hematoma or neck mass  Sleepy (low GCS)

Cases

Case 1

44 y o male, assaulted to head/face with baseball bat.  Brought to ED in sitting position in c-spine precautions, normal Vital Sign, GCS 15.

Airway Assessment for Pathology:
Deformed nose bleeding into pharynx, difficulty opening mouth/sore jaw, spitting up blood continuously.  No trauma to neck, no stridor, no singed hairs or carbonaceous sputum, no see-saw respirations.

Q: What is going on with this patient’s airway?  What should you do immediately?
A: Partial airway obstruction from blood.  Awake and protecting airway.  Manage this airway with suction +/- supplemental O2, upright positioning.

Airway Assessment for Intervention:
History of Sleep Apnea, Obese, Beard, Unable to open mouth (likely from mandible fracture), and no neck mobility (c-spine collar).

Q: How should you proceed?
A: This person is a predicted difficult BVM, Laryngoscopy, LMA and Surgical Airway!  If you do need to intervene for a drop in GCS or loss of patency you would need additional airway experts to definitively manage this airway safely. 

Case 2

36 y o female single vehicle rollover on highway, brought in c-spine precautions.  GCS initially 15/15 by EMS, no signs of external head injury/trauma, complaining of abdominal pain.  Initial Vitals: HR 115, BP 92/68, RR/O2 sats normal.  On arrival to hospital, GCS now 11, HR 130, BP 68/40 with a distended abdomen (not pregnant).

Airway Assessment for Pathology:
Snoring respirations. No secretions, stridor, see-saw resps, singe or stab/swelling to neck.

Q: What is going on with this patient’s airway?  What should you do immediately?
A: This patient has a partial obstruction from her tongue due to decreased LOC and should be treated with jaw thrust/OPA/supplemental O2. Additionally, she may fail to protect her airway due to a low GCS secondary to hypovolemic shock.  Her ability to protect her airway is likely to correct with blood transfusion.

Airway Assessment for Intervention:
This patient has no predictors of difficult airway intervention except for a c-spine collar.

Q: How will you proceed?
A: Don’t just do something… Stand there!  Intubation comes with a significant risk of hypotension, both from the drugs given as well as the effect of positive pressure ventilation on pre-load.  You would NOT want to intubate this patient until their BP improved, or you might end up running a code.  If their BP improves, it is likely that their LOC will as well, so you probably won’t need to intubate at all.

Case 3

14 y o male flipped his quad, with quad landing on his head, brought in c-spine precautions.  EMS reports the helmet to be split in two.  GCS 12 (E4, V3, M3) with blood draining from both ears.  No visible trauma to chest/abdo or extremities.  HR 55, BP 177/94, RR/O2 sats normal.

Airway Assessment for Pathology:
Low and declining GCS. No see-saw resps, snoring, secretions, stridor, smash, stab, singe.

Q: What is going on with this patient’s airway?  What should you do immediately?
A:  This patient is at risk of failing to protect airway and has obvious signs of skull fracture for which they will need a CT scan.  Although the GCS is more than 8, it is deteriorating.  Also, the most predictive aspect of the GCS is the motor score.  As this patient is demonstrating flexor posturing and early Cushing’s response (hypertension/bradycardia), there is a high likelihood of intra-cranial injury.  This patient will likely need to be intubated.

Airway Assessment for Intervention:
There are no predictors of difficult airway intervention in this patient except for c-spine collar.

Q: How will you proceed?
A:  You need to get definitive control of this patient’s airway.  Hypoxemia and hypotension contribute to secondary brain injury, so management of this airway should pay close attention to these issues.  You would want to use apneic oxygenation as part of your RSI to mitigate the risk of hypoxemia, and choose a sedative agent that will maintain their blood pressure.

Case 4

56 yo female trapped in a housefire, no traumatic injuries.  Wheezy and SOB on scene once extricated from hospital, treated with Salbutamol nebulizer en route to hospital by EMS.  Wheeze/SOB settled upon ED arrival. Normal vital signs, GSC 15.

Airway Assessment for Pathology:
Black soot at the back of the throat, singed eyebrows.  No stridor, secretions, snoring, see-saw respirations, stab.

Q: What is going on with this patient’s airway?  What should you do immediately?
A: There is an impending loss of airway patency from airway edema.  Consider early intubation before airway before the swelling makes passing an Endotracheal tube difficult or impossible.

Airway Assessment for Intervention:
No predictors of difficulty for airway intervention.

Q: How will you proceed?
A:  Early definite airway management under the auspices of impending airway loss.  It’s impossible to know if she will swell in her airway or not, but if she does it could be life threatening.  Early management is the usual approach if there is reasonable suspicion for inhalational burn, although at times it is an unnecessary intervention.

Author information

Rob Woods
Rob Woods
Program Director at University of Saskatchewan
Rob Woods is the Program Director of the University of Saskatchewan Emergency Medicine Residency Program

The post Basic Airway Assessment: It’s as easy as… 1-2-3? appeared first on BoringEM and was written by Rob Woods.

31 Jul 14:00

Read Tom Hiddleston’s Thank You Letter To Joss Whedon For The Avengers

by Alan Kistler

loki

Loki - Norse god of mischief, lies and evil – is a sympathetic yet clear villain in the Marvel Cinematic Universe, arranging for people to die and war to erupt just to ruin his brother’s coronation, later robbing people of free will as he attempted planet-wide genocide. But we still love seeing him in action and a large part of the credit goes to Tom Hiddleston, a superb actor and all-around sweet guy. This Friday, Joss Whedon: The Biography will be released and it includes an e-mail exchange between Hiddleston and the director/screenwriter of The Avengers and Avengers: Age of Ultron. The actor was so overjoyed at Loki’s role in the script for Marvel’s The Avengers that he was compelled to write a thank you letter.

The letters can be read after the break.

Joss,

I am so excited I can hardly speak.

The first time I read it I grabbed at it like Charlie Bucket snatching for a golden ticket somewhere behind the chocolate in the wrapper of a Wonka Bar. I didn’t know where to start. Like a classic actor I jumped in looking for LOKI on every page, jumping back and forth, reading words in no particular order, utterances imprinting themselves like flash-cuts of newspaper headlines in my mind: “real menace”; “field of obeisance”; “discontented, nothing is enough”; “his smile is nothing but a glimpse of his skull” “Puny god”

Thank you for writing me my Hans Gruber. But a Hans Gruber with super-magic powers. As played by James Mason … It’s high operatic villainy alongside detached throwaway tongue-in-cheek; plus the “real menace” and his closely guarded suitcase of pain. It’s grand and epic and majestic and poetic and lyrical and wicked and rich and badass and might possibly be the most gloriously fun part I’ve ever stared down the barrel of playing. It is just so juicy.

I love how throughout you continue to put Loki on some kind of pedestal of regal magnificence and then consistently tear him down. He gets battered, punched, blasted, side-swiped, roared at, sent tumbling on his back, and every time he gets back up smiling, wickedly, never for a second losing his eloquence, style, wit, self-aggrandisement or grandeur, and you never send him up or deny him his real intelligence…. That he loves to make an entrance; that he has a taste for the grand gesture, the big speech, the spectacle. I might be biased, but I do feel as though you have written me the coolest part.

But really I’m just sending you a transatlantic shout-out and fist-bump, things that traditionally British actors probably don’t do. It’s epic.

Sweet, right? And here is Mr. Whedon’s reply:

Tom, this is one of those emails you keep forever. Thanks so much. It’s more articulate (and possibly longer) than the script. I couldn’t be more pleased at your reaction, but I’ll also tell you I’m still working on it … Thank you again. I’m so glad you’re pleased. Absurd fun to ensue.

Best, (including uncharacteristic fist bump), joss.

“Absurd fun” is an apt description of The Avengers. It’s good to see evidence that the folks behind the scenes had as much fun as the audience did watching the movie.

(via Collider)








29 Jul 13:00

These Amazing Fantasy Creature Sculptures Will Blow You Away

by Amy Ratcliffe

fantasy creatures 1

Lee Cross has skills. The talented artist has a knack for being able to sculpt life-like fantastical creatures that are breathtaking. The handmade critters appear to be armature wire covered in fabric, stuffing, and fur, and they come in a wide variety of sizes. They’re also fully posable! It’s like having an adorable, exotic pet without any of the work.

While she doesn’t take commissions or have an Etsy shop, Lee does offer her creatures on eBay from time to time.

See more of Lee’s work after the break.

fantasy creatures 2

fantasy creatures 3

fantasy creatures 4

fantasy creatures 5

fantasy creatures 6

fantasy creatures 7

fantasy creatures 8

fantasy creatures 9

fantasy creatures 10

(Wood-Splitter-Lee via GxG)








29 Jul 13:10

Salmon Sandwich with Creamy Dill Sauce

by Meghan B.

Getting back into the healthy eating routine is not so easy…

Salmon Sandwich_3

I have been trying to get inspired with new healthy recipes and lately fish has been the only way for me to start climbing back up on that diet bandwagon. Salmon in particular has been a welcome healthy (re)addition to my diet. I never seem to know what to make myself for lunch, so I thought, why not make a fresh salmon sandwich? 

This salmon sandwich is the ultimate lunch, particularly because it test just as heavenly warm as it does cold. It’s perfect for me to take to the office or to have as a casual lunch. Deceivingly simple to make AND it makes you feel somewhat elegant/sophisticated when you are eating it!

Salmon Sandwich_2

Unless you are me and end up with oh-so adorable dribbles of dill sauce running down your face (I hope you heard the sarcasm dripping from “oh-so adorable” there…). I might not be the most elegant of eaters, but I can’t possibly begin to care when a sandwich tastes as gosh darn good as this one does!

I rub the top of my salmon with a simple mixture of garlic powder, salt, and pepper which pairs perfectly with the slightly tangy creamy dill sauce and the peppery mixture of micro greens.

Salmon Sandwich_1

If only I could pair it with a glass of chilled white wine when I am at work… ;)

Recipe Tip: Any leftover creamy dill sauce can be kept in an airtight container for up to a week. 

Salmon Sandwich with Creamy Dill Sauce
 
My favorite fresh lunch packed with light and summery flavors. Perfect for taking with you to work or enjoying on a leisurely weekend.
Serves: 2
ingredients
  • 2 salmon filets
  • ¼ tsp garlic powder
  • ¼ tsp kosher salt
  • ¼ tsp freshly cracked black pepper
  • Ciabatta
  • Micro greens
  • SAUCE
  • 1 cup light mayonnaise
  • ¼ cup reduced fat sour cream
  • ¾ tsp white wine vinegar
  • ¾ cup fresh dill
  • ¼ tsp kosher salt
  • 3 tsp capers, drained
directions
  1. Turn your oven’s broiler to high. Line a small baking sheet with aluminum foil. Place the salmon filets side by side on the lined baking sheet.
  2. In a small bowl, mix together the ¼ tsp salt, pepper, and garlic powder. Rub the spice mixture evenly over the top of the two salmon filets. Place the baking sheet in the upper third section of the oven and broil on high for approximately 6 to 7 minutes, or until salmon reaches desired doneness. Remove from oven and set aside.
  3. In the bowl of a food processor, add mayonnaise, sour cream, white wine vinegar, dill, salt, and capers. Process until the mixture is well combined.
  4. Add approximately 1 tablespoon of the creamy dill sauce to one side of each slice of ciabatta. Add each salmon filet to the sauced side of two slices of prepared bread. Top with micro greens and the other slices of bread (sauce-side down). Enjoy immediately!
3.2.1311

 

The post Salmon Sandwich with Creamy Dill Sauce appeared first on Cake 'n' Knife.

24 Jul 15:00

Tiny Tips: Non-Cardiogenic Pulmonary Edema / ARDS

by Teresa Chan

When you see a pulmonary edema on chest x-ray (CXR), the knee jerk reaction is to attribute it to heart failure.  But what might you be missing?

Not all the glitters is gold. And not all that is wet on CXR is just plain ol’ CHF.

Non-Cardiogenic Pulmonary Edema (NCPE) is better known to the world when it it is at its most severe form – i.e. ARDS (Acute Respiratory Distress Syndrome) or ALI (Acute Lung Injury).[1] However, for the purposes of linking the concept to the mnemonic (and the CXR findings), I have chosen to file it as a Tiny Tip under NCPE.

First recognized in military casualties in the first and second World Wars, NCPE is a commonly discussed entity in critical care.  In fact, an international group of experts has met in Berlin recently to redefine the definition of ARDS/ALI (see the post by the LIFTL guys on this topic for a great primer). [2,3] NCPE can be caused by direct insults to the lung tissue or indirect mechanisms such as systemic inflammation.

Mnemonic  for Causes for Non-Cardiogenic Pulmonary Edema

IS NOT THE HEART

I nhaled Toxins (Ammonia, Chlorine, Phosgene, Nitrous oxide)
S IRS / Sepsis / Septic Shock

N eurogenic (seizure, strangulation, trauma)
O verdose (Heroin, methadone, cocaine)
T hyrotoxicosis

T rauma
H eat (Smoke! Remember to also consider carbon monoxide!)
E lectrocution

H igh altitude pulmonary edema
E mbolism (Pulmonary Embolism, Acute Gas Embolism, Amniotic Fluid Embolism)
A SA toxicity
R eperfusion or Re-expansion pulmonary edema (or Rocky Mountain Spotted Fever – This one is in here for the PGY5s: May the Force be with you until your quiz next year)
T ransfusion

Remember, this is NOT a comprehensive list, but it is a list that can help you think through alternative causes of a “wet” CXR.  Causes that it does not contain include Uremia, Cardiopulmonary bypass, DIC (RMSF is in the above list mostly due to this), other coagulopathies, pancreatitis… and more.

The mnemonic for this Tiny Tip, as well as a bunch of others, can be accessed and memorized using spaced repetition through Boring Cards as outlined here.

References

1.  Perina DG.  Noncardiogenic pulmonary edema.  Emerg Med Clin N Am ;21 (2003) 385–393. PMID: 12793620.

2. Nickson C.  Acute Respiratory Distress Syndrome (ARDS) Definitions. Life in the Fast Lane. Revised April 16, 2014.  Accessed July 13, 2014.  Available at: http://lifeinthefastlane.com/education/ccc/acute-respiratory-distress-syndrome-ards-definitions/.

3. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. doi: 10.1001/jama.2012.5669. PubMed PMID: 22797452.

Author information

Teresa Chan
Managing Editor at BoringEM
Emergency Physician. Medical Educator. #FOAMed Supporter, Producer and Researcher. Assistant Professor, Division of Emergency Medicine, Department of Medicine, McMaster University. + Teresa Chan

The post Tiny Tips: Non-Cardiogenic Pulmonary Edema / ARDS appeared first on BoringEM and was written by Teresa Chan.

28 Jul 17:00

That’s No Moon [Comic]

by Sean Fallon
25 Jul 12:31

Star Wars Darth Vader Lightsaber Barbecue Fork With a Hilt Modeled After the Sith Lord’s Iconic Weapon Design

by Justin Page

Star Wars Darth Vader Lightsaber BBQ Fork

ThinkGeek released an officially licensed Star Wars Darth Vader Lightsaber Barbecue Fork that has a hilt modeled after the feared Sith Lord‘s iconic weapon design. It is available to purchase online. This force-filled utensil would go great with the Star Wars Lightsaber BBQ Tong from The Fowndry.

Darth Vader loves nothing more than a grilled weenie, and the brand he likes best is Coruscant National (hey, they answer to a higher power: the Emperor). When Vader grills, he insists on using his favorite BBQ fork. You know, the one that looks like his lightsaber hilt? The one that we’re calling the Star Wars Darth Vader Lightsaber BBQ Fork.

Star Wars Darth Vader Lightsaber BBQ Fork

Star Wars Darth Vader Lightsaber BBQ Fork

images via ThinkGeek

via foodiggity

25 Jul 21:21

Survey Results for America’s Favorite ‘Star Wars’ Film and Character

by Rollin Bishop

538 Best Star Wars

FiveThirtyEight has posted some interesting survey results from a survey they recently ran based on the Star Wars films. The survey was run through SurveyMonkey Audience and collected 1,186 responses from June 3rd to June 6th. As it turns out, people still really hate Jar Jar Binks. More on the survey results is available at FiveThirtyEight.

538 Star Wars Characters

538 Star Wars Han or Greedo

images via FiveThirtyEight DataLab

26 Jul 16:44

Finding Rover, An App That Uses Facial Recognition to Help Reunite Lost Dogs with Their Humans

by Lori Dorn

Finding Rover is a handy free app that helps to reunite lost dogs with their frantic humans through the use of canine facial recognition.

Here’s how it works. If you ever lose your dog, the app will do an instant facial recognition search of all lost dogs in your area. Within seconds you’ll see a list of dogs’ photos with the contact information of the kind person (or shelter) who has the dog. Contact the person or shelter, and a blissful scene of face licking and tummy rubbing will follow. On the flip side, Finding Rover revolutionizes the process of helping lost dogs…Simply snap a photo and the app instantly shows you photos of matching dogs with the owners’ contact info.

The app is available via iTunes, Google Play or via the Finding Rover site.

Winnie

Finding Rover Instructions

Finding Rover

Registering Your Dog

images via Finding Rover

via SF Gate, The Daily Dot

23 Jul 14:19

Shiba Inu Brownies

by Clockwork Lemon

Shiba Inu Brownies-1-2

This weekend, whilst baking a birthday treat for my Brother's 30th, I realized a slab of brownies could be decorated just like a cake or a batch of sugar cookies. Perhaps this fact was already obvious to everyone else seeing as it IS a flat, frostable surface.. but I thought I'd share the revalation just in case it wasn't. Think about it! Who wouldn't welcome a platter of fudgy, chocolate frosted brownies adorned with adorable decorations at their next party? Why should sugar cookies get all the decoration glory?

Since these particular brownies were for my brother, I made a design partly inspired by the hilarious doge meme (because my brother is my go-to technology guru and enjoys all things internet),  partly by some cute cartoons of shibas, but it was mostly inspired by.....

 

 

Shiba Inu Brownies-24

 .. my brother and his wife's new Shiba, Laika. They adopted her shortly before my brother's bday and oh.my.god THE CUTENESS.. how can so much cuteness exist within one tiny animal?

 I'll be sharing how to make the brownies, but first: more Laika photos. Feel free to scroll past them to get to the brownie instructions (if your heart is made of stone..)

Shiba Inu-11Just look at her back legs: tiny adorable drumsticks!

 

Shiba Inu-2That face! Pure puppy joy.

Shiba Inu-13and that belly.. oh my god the puppy belly.

Ok. Puppy quota filled. Brownie time!

 .

Shiba Inu Brownies-1

The process began by drawing out the icing design along with some doge inspired captions. The best part about making royal icing transfers is you don't need to have mad piping skills to make a cute design. If you're good at drawing, draw a design out, then trace over it with icing. If you're NOT good at drawing simply print out a design or have someone else draw one for you. It's the poor-bakers version of a kopykake projector.

Royal Icing Transfer-1-2I like to photocopy the drawing, tape the copies to a table, place a piece of wax paper over top, tape it down, then lightly grease the wax paper with shortening.

Then, I use a wilton #1 tip to outline the drawing in black royal icing, and a #2 to fill in first the white details followed by the tan and red details. Once the transfers have dried I use a food colouring marker to add eyes, although a #1 tip and black royal icing works well too.

Two tips for royal icing transfers:

1. Make extra. These babies are delicate and it's better to have a few left over than is it to break a bunch and come up short. I often pipe out 4 - 5 extras because I'm clumsy and tend to snap them in half.

2. Give them day or two (or more if they are bigger/thicker) to dry completely. If you can, set up on a surface where you can leave them untouched for an entire day. If I know I'll be needing my table, I usually pipe them onto cookie trays that can be easily moved.

 

Shiba Inu Brownies-5For the brownies, I made a double batch of the fudgiest  of brownie recipes and once it was cool, spread a thick, even layer of chocolate frosting made with unsalted Stirling butter.

To decorate, I carefully peeled the Shiba transfers from the wax paper and placed them gently onto the frosting. Next, I piped out the doge captions then stuck the pan in the fridge to firm up the frosting.

 

Shiba Inu Brownies-17Once we got to my brother's house I sliced up the brownies and served them chilled.

And by "sliced up the brownies" I mean "was hopelessly distracted by Laika", it was a miracle that they came out even remotely square shaped.

  Shiba Inu Brownies-21But it's not my fault.

Happy 30th Chris!

(I've included recipes/instructions for the brownies and the royal icing transfers, but not for the chocolate icing. I like to make my icing free-hand/to taste and this one was a combo of salted butter, cocoa powder, icing sugar, and a splash of cream. Just mix butter, cocoa powder, and icing sugar and adjust to taste to find the right balance of chocolaty and sweet. Then (if it needs it) add a splash of cream or milk to smooth it out.)

Fudgy Brownies

 

Brownies (barely) adapted from The Patent and the Pantry

1 cup unsalted Stirling butter

1 cup cocoa powder, sifted

2 cup sugar

1/4  tsp salt

1 cup all purpose flour

1/2 cup milk

2 egg

2 tsp vanilla

1. Preheat the oven to 350 degrees and line an 9x13 baking pan with parchment paper

2. Melt the butter in a medium pot, then stir in the cocoa powder until smooth. Stir in the sugar and salt, followed by the flour, milk, egg, and vanilla. The batter will be very thick.  Use a spatula to spread the batter in an even layer in the baking pan. 

3. Bake at 350 for 25 - 30 minutes until the center is just set and the edges are starting to pull away from the pan. Use the parchment paper to pull the slab of brownies out of the pan and cool on a wire rack. I like mine to be slightly underbaked and served chilled for maximum fudginess. If you want them to be more chewy and firm, bake an additonal 5 minutes or so.

 

Royal icing for icing transfers

4 cups  icing sugar (powdered sugar)

3 tbsp meringue powder (available at stores that sell decorating supplies)

½ tsp lemon juice

½ cup warm water

1. In mixer bowl, stir icing sugar and meringue power until combined. Add lemon juice and warm water. Using the whisk attachment, mix on low to dissolve the sugar. Turn the mixer on high and whip until thick and glossy. Continue to whip on high until icing holds stiff peaks when you lift the whisk up. This should take about 3-5 minutes.

2. Tint the icing using gel food colouring (available at most craft/cake supply stores) then transfer them into piping bags fitted with a #1 tip for the black outline and any small coloured details and #2 tips for the larger areas of colour.

3. Carefully outline each drawing with royal icing.. Keep the piping tip a few centimetres higher than the cookie to prevent squished or smudged borders. Allow to dry 15-20 minutes. Then fill in the drawings with the appropriate colours. Allow the transfers to dry completely (1 - 3 days depending on how big/thick they are) before moving.

25 Jul 04:05

One-Pot French Onion Pasta

by joythebaker

one pot french onion pasta

I’m already anticipating Sunday.

Talk about putting the cart before the horse.  We haven’t even hopped around the weekend enough to make it to Sunday.

Sundays, I would argue, are the worst.  Actually… they’re the BEST but only between the hours of 8am and noon when we’re sleeping in, churching, brunching, or napping after pancakes.  After noon on a Sunday I find myself in the unfortunate task of pretending to be relaxed while stressing about the week to come.  We’ve talked about this before.  It’s called The Sunday Stresses, and it’s more real that we deserve.

Luckily there’s PASTA.  All healing, all comforting, all filling PASTA.  Thank you, Lord.  For real.

I have pasta every Sunday night.  I spoon myself an embarrassingly large bowl, sit cross-legged on the couch, watch Comedians In Cars Getting Coffee and just tear through a bowl.  I’m trying to fill the pit of Sunday Stresses and pasta usually works, until it doesn’t… but even still.

One Pot French Onion Pasta

This One-Pot pasta comes together easily and makes the house smell like an onion dream.  There’s just something so right about the smell of cooking onions.

While the onions, thyme, and chicken broth flavors have more of a Fall feel to them… well, The Sunday Stresses know no season.   Let’s just get some quality couch time in.  Let’s make out with pasta, just a little.

NOT WEIRD AT ALL!

One Pot French Onion Pasta

Fat spaghetti pasta, chicken broth and water, onions halved and sliced, butter and olive oil, thyme and cheese and arugula and seasoning.  Everything! Let’s go!

One Pot French Onion Pasta

The onions.  Oh the onions.  They actually cook longer than the pasta itself.  The onions need a bit of caressing with butter and olive oil and low heat.

One Pot French Onion Pasta

Progress.  It’s hard not to hover and stir, but the onions do need quality time with the heat.  They need to sit and simmer a bit.

One Pot French Onion Pasta

This is about when I get super impatient and start to think of worms.

One Pot French Onion Pasta

Golden brown, studded with fresh thyme, seasoned with salt and pepper rather aggressively.

One Pot French Onion Pasta

Deglazing the hot pan with water and chicken broth.  The steam!  The best part.

One Pot French Onion Pasta

Welcome to the party, pasta!  We need you.

One Pot French Onion Pasta

We do a little dance on the stovetop.  Simmer with the lid on for a bit.  Stir with the lid off for a bit.  Simmer with the lid on again.  Fluff with the lid off.

It’ll all come together in about 10 magical minutes.

Related:  I need more magical minutes in all of my days.  RIGHT!?

One Pot French Onion Pasta

Taste and most likely add:  salt and pepper, way too much parmesan cheese, and handfuls of fresh arugula.

One Pot French Onion Pasta

By now your neighbors are likely knocking on the door because you made the world smell AMAZING! Share the pasta, not the stresses.

This pasta is both slightly sweet and salty.  As the onions cook down, they take on a tender and sweet quality.  It’s lovely, but you may find yourself adding a bit more salt and parmesan cheese than you might expect.  I love the spice that fresh arugula adds to the pasta.  Red pepper flakes are also divine.  You want to add cooked sausage too!?  Heck yes!

Happy Weekend!

One-Pot French Onion Pasta

serves 4

Print this Recipe!

3 medium yellow onions, peeled and sliced

3 tablespoons olive oil

1 tablespoon unsalted butter

salt and fresh cracked black pepper

3 teaspoons fresh thyme

2 cups water

2 1/2 cups chicken broth

12 ounces uncooked spaghetti

salt and fresh cracked black pepper, to taste

parmesan cheese

fresh arugula

Place a large heavy bottom sauce pan over medium heat.  Add the olive oil and butter and stir until butter is melted.  Add the sliced onions all at once.  Stir to coat the onions in the fat.  Allow onions to cook, undisturbed, for about 4 minutes.  Add salt, pepper and thyme and stir.  Allow the onions to cook for about 4 minutes at a time.  Lower the heat if the onions are browning too quickly.    The onions will begin to brown, break down, and resemble an onion jam.

When onions are entirely browned and completely soft (about 15 minutes), add the water and chicken broth to the pan.  Using a wooden spoon, scrape any burned bits off the bottom of the pan.  Add the pasta all at once.

Return to medium heat and bring to a simmer.  Place the lid on the pan and allow to simmer for 5 minutes.  Remove the lid to toss and stir the pasta for about 3 minutes.  Return the lid and allow to cook for another 5 minutes.  Remove the lid and taste the pasta for doneness.  There will still be just under an inch of liquid in the pot.  Allow the pasta to cook more (if it was still crunchy), or allow some of the liquid to cook off.  It’s about your preference.  I like a bit of the broth remaining.  Plus, the pasta will absorb more of the liquid as it sits.

To serve, spoon into large bowls, top with parmesan cheese and fresh arugula.  

 

 

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.

Poll

Take Our Poll

 

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

| Twitter |

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

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

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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 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