Alisa.wray

The post R.E.B.E.L. ECG of the Week: Wellens’ Syndrome or STEMI appeared first on R.E.B.E.L. EM - Emergency Medicine Blog.

Fresh 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!

Continue reading: Frozen Herb Starters

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

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!”

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

Rex

Jellybean

Lucy

Minnie

photos by Sophie Garamand

via My Modern Met

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.

photos by Jamie Clauss

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.

images via Hannah Hart

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.

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.

Dry ingredients frist.

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

It feels strange to mix together such small amounts.

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!

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

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.

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

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 post The Single Pancake appeared first on Joy the Baker.

(via Reddit)

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.

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 STARS^TM Manual & Walls et al. (4^th edition)

* 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.

Cases

Author information

Rob Woods

Program Director at University of Saskatchewan

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

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

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)

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.

(Wood-Splitter-Lee via GxG)

Looking for a tasty and healthy meal to enjoy during the warm summer months? Try a mouth-watering salmon sandwich recipe! From fresh salmon fillets to a creamy dill sauce and fresh greens, this is the ultimate summer sandwich that will satisfy your cravings and leave you feeling satisfied and energized.

about this salmon sandwich recipe

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

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 healthier eating 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 easy salmon sandwich recipe is the ultimate lunch, particularly because it tastes just as delicious warm as it does cold.

When I’m at home, it’s an easy lunch to make for myself and eat fresh. For those of you who go to the office, it’s perfect to eat cold. Deceivingly simple to make AND it makes you feel somewhat elegant/sophisticated when you are eating it!

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 spice mixture which pairs perfectly with the slightly tangy creamy dill sauce and the peppery addition of arugula.

If only I could pair it with a glass of chilled white wine when I’m working…

Note: this is an updated version of the original recipe and post published on July 29, 2014.

how to buy the best fish for these salmon sandwiches

Just like with any salmon recipe, I recommend buying thick, center-cut pieces of salmon.

The tail end pieces are too thin for this recipe and you will not be left with the correct balance between fish, sauce, greens, and bread.

You can buy your salmon in the grocery store, butcher, or seafood market.

Simply tell them exactly what you need and they’ll get it prepped for you! I prefer to buy skin-on salmon fillets, but if you are planning to grill the salmon (more details on that further below), you can by skinless fillets.

As to the type of fish you buy, there are many options from Atlantic salmon to sockeye salmon. I prefer to look at Seafood Watch when I’m looking for sustainable fish to source.

ingredients

salmon. I’ve already reviewed how to select the best fish for this sandwich above. Make sure that you take the time to make sure all pin bones have been removed from the fillets before you get started on the recipe.

spices. For this recipe (for the fish and the sauce), you will need a combination of garlic powder, onion powder, smoked paprika, kosher salt, freshly ground pepper, and red pepper flakes (the last one is optional).

ciabatta. I love to use fresh ciabatta bread for this sandwich! You can also use soft Kaiser rolls or brioche buns, if you prefer, but I like the crust on the ciabatta for texture.

arugula. Fresh arugula or micro greens will work on this sandwich. You could also use spring greens or skip them altogether, depending on your preference.

mayonnaise. I prefer to use light mayonnaise, but you can also use full fat mayo.

sour cream. Again, I opt for reduced fat, but either reduced fat sour cream or regular sour cream will work.

vinegar. The dill sauce calls for white wine vinegar. If you don’t have this one hand, you could also use rice vinegar or swap out vinegar for fresh lemon juice.

dill. Fresh dill is key! Since you are adding it to a food processor, you don’t have to worry about chopping it up. Simply remove the leaves from the stems.

capers. I love the brininess that capers bring to the party in the sauce! It adds an extra depth of flavor to pair perfectly with the salmon.

this recipe’s must haves

You don’t need too many tools to make these simple sandwiches! For the creamy dill sauce, you will need a food processor.

To cook the salmon, you will need a half sheet baking pan and a silicone mat (or aluminum foil).

Finally you will need a spatula to remove the salmon from the pan.

here’s how to make a salmon sandwich

make sauce

Add mayonnaise, sour cream, vinegar, dill, salt and capers to the bowl of a food processor. Puree until the mixture is smooth and well combined.

Set aside in the refrigerator until ready to serve.

make seasoning

In a small bowl, stir together garlic powder, onion powder, smoked paprika, salt, pepper, and red pepper flakes (if using) until combined.

Rub the tops of the salmon fillets with the seasoning evenly.

broil

Place salmon fillets skin side down on a baking sheet that’s been lined with a silicone mat or aluminum foil.

Broil for about 5 to 7 minutes, depending on how cooked through you like your salmon. Remove from the oven and set aside to rest for 5 minutes.

To remove the salmon from the skin, simply use a spatula to slide in between the fillet and skin. The fillet should come right off with the skin sticking to your liner in the pan!

assemble

Cut four slices of bread. Add about one tablespoon of creamy dill sauce to each slice of bread.

Top two slices with arugula, then add the salmon fillet to each. Top with the other slices of bread, sauce side down, and serve.

tips for success

make the dill sauce ahead of time. The creamy dill sauce takes only 5 minutes to whip up. Therefore it’s fantastic to make ahead of time!

You can make it up to 5 days in advance. Simply store in an airtight container in the refrigerator until you are ready to use it.

use really good bread. The better the bread, the better the sandwich is going to taste. That’s just a fact! I love to go to the farmer’s market for a fresh loaf of ciabatta to make these sandwiches, but you could also use your favorite rolls.

More tasty salmon recipes to explore: Baked Lemon Garlic Salmon | Grilled Salmon with Charred Corn Salsa | Salmon Chowder | Smoked Salmon Bagels

what kind of salmon should I buy?

Be sure to select a great piece of salmon when you go to your local store or seafood shop. Poor quality salmon never tastes good, and when it’s the star of the recipe, you really need to have the good stuff. Otherwise it will taste fishy and the texture will be mush.

I recommend picking up fresh salmon instead of frozen since it is higher quality. Look for US caught fish (this will ensure that you have less risk of overfished or environmentally harmful catching).

Wild caught salmon is oftentimes sustainable, but you can also check Seafood Watch for well-regulated farms, which is what I usually do.

can I grill the salmon instead?

I love the convenience of broiling salmon because the broiler preheats in no time and there’s no long cook time.

If you prefer to grill your salmon, you certainly can! All you need to do is clean the grill grates well and oil them thoroughly with olive oil or canola oil. I recommend getting skinless salmon fillets and applying the seasoning to the entire fillet on all sides.

Preheat the grill to medium-high heat and cook the fish for 4 to 5 minutes per side, until the fish starts to look opaque.

You can also use an instant read meat thermometer to check the doneness. Aim for 125˚F internal temperature in the thickest part of the fish.

Let the salmon rest for 5 minutes, then assemble your grilled salmon sandwiches as instructed in the recipe card!

don’t have time to make a sauce?

If you don’t have time to make the sauce, you can use a couple of other options that are easily purchased online or in your local store:

• Tartar sauce is tart and creamy, making it an ideal match for any fish.
• You could also use a remoulade sauce that’s creamy and tangy.

Need more inspiration for creative sandwiches? Check out my sandwich recipes page!

what to serve with this sandwich

When it comes to a light and hearty salmon sandwich recipe like this one, I don’t like to get complicated with side dishes. I usually revert to an arugula salad with a simple lemon vinaigrette dressing as the easiest side.

Add some shaved parmesan on top and it’s the ideal summer meal. Alternatively a caesar salad is always delicious with salmon!

You can also go more classic and pair this sandwich up with your favorite chips, whether they are kettle, ruffled, or baked.

Finally, if you make this salmon sandwich recipe, please be sure to give this recipe a rating or leave a comment!

I love to hear when you all make recipes, and I do take the time to respond to every single comment. Feel free to drop questions below too, if you have them!

Oh and be sure to tag me on Instagram if you make the recipe! I love being able to see these recipes come to life in your homes – it’s my favorite thing to look through those photos. It really means the world to me!

Salmon Sandwich with Creamy Dill Sauce

Yield: 2 sandwiches

Prep Time: 5 minutes

Cook Time: 10 minutes

Total Time: 15 minutes

My favorite fresh lunch packed with light and summery flavors. Perfect for taking with you to work or enjoying on a leisurely weekend.

Print

Ingredients

creamy dill sauce

• 1 cup light mayonnaise
• 1/4 cup reduced fat sour cream
• 3/4 tsp white wine vinegar
• 3/4 cup fresh dill
• 1/4 tsp kosher salt
• 3 tsp capers, drained

salmon sandwich

• 2 salmon filets (about 6 to 8 oz each)
• 1/2 tsp garlic powder
• 1/4 tsp onion powder
• 1/4 tsp smoked paprika (or regular paprika)
• 1/4 tsp kosher salt
• 1/4 tsp freshly cracked black pepper
• Big pinch of red pepper flakes (optional)
• 4 slices of ciabatta
• Arugula (or micro greens)

Instructions

1. 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. Place in the refrigerator until ready to serve.
2. Turn your oven’s broiler to High. Line a small baking sheet with aluminum foil or silicone mat. Place the salmon filets side by side on the lined baking sheet.
3. In a small bowl, mix together garlic powder, onion powder, smoked paprika, salt, and pepper. Rub the spice mixture evenly over the top of the two salmon filets.
4. Place the baking sheet in the upper third section of the oven and broil on high for approximately 5 to 7 minutes, or until salmon reaches desired doneness. Remove from oven and set aside to rest for 5 minutes. To remove the salmon from the skin, simply use a spatula to slide in between the fillet and skin. The fillet should come right off with the skin sticking to your liner in the pan!
5. Add approximately 1 tablespoon of the creamy dill sauce to one side of each slice of ciabatta. Top two slices with arugula. Add each salmon filet on top of the greens. Top with the other slices of bread (sauce-side down).

Notes

Note: Any leftover creamy dill sauce can be kept in an airtight container for up to a week!

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• 
  Measuring Spoons
• 
  Small Glass Bowls 
• 
  French Wire Whisk
• 
  Mixing Bowls
• 
  Silicone Baking Mat Sheets
• 
  Half Sheet Pan

© Meghan Y.

Category: Main Dish

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

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

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

(via Pictures In Boxes)

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.

images via ThinkGeek

via foodiggity

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.

images via FiveThirtyEight DataLab

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.

images via Finding Rover

via SF Gate, The Daily Dot

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.....

 .. 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..)

Just look at her back legs: tiny adorable drumsticks!

That face! Pure puppy joy.

and that belly.. oh my god the puppy belly.

Ok. Puppy quota filled. Brownie time!

 .

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.

I 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.

For 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.

Once 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.

  But 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

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.

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!

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!

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.

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.

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

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

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

Welcome to the party, pasta!  We need you.

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!?

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

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!

Author information

Jeff Riddell, MD

Chief Resident

UCSF-Fresno Emergency Medicine Residency

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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.

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.

The post The LITFL Review 144 appeared first on LITFL.

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)

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.

images by Oliver Wetter

via DesignTAXI, Archie McPhee’s Endless Geyser of Awesome

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.

images via Marcel Worldwide, Intermarché

via Good, Design Taxi

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

photos by Jonathan Macauley