Come to Critical Care Collaborative 2018!

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

This is a guest post by Diane Kelly, Intensivist and Educator at Epworth Healthcare, Melbourne.

The Critical Care Collaborative is a one-day conference with contemporary updates in Critical Care, delivered by entertaining engaging speakers, aimed at Intensive Care Registrars and Nurses…. why spend time searching for information when someone can just tell you about it? This year we are covering a very broad range of topics from Organ Donation and Obstetric ICU, to sepsis and ECMO.

It is great for those preparing for exams, with the most recent evidence presented in a very digestible way. It is definitely worth going to from a learning perspective, very reasonably priced, and proudly supported by ACCCN and ANZICS… and most of all it will be fun!

The venue this year is Pullman on The Park, East Melbourne, and the date to save is 17 August 2018.

Early Bird closes this week (22nd of July), so get in quick

Check out the programme and register via the ACCN website.

See you there!

Come to Critical Care Collaborative 2018! Chris Nickson

Article source here:Life in the Fast Lane

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LITFL Review 340

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

LITFL review

Welcome to the 340th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.

Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription

The Most Fair Dinkum Ripper Beauts of the Week

Nick CumminsSkeptic’s Guide to Emergency Medicine (SGEM) Xtra has posted Season #4 Book! Ken Milne continues in his quest to shorten the KT window in his latest season of the SGEM. (The first link also provides access to Books 1-3). [MMS]

 

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care and #FOAMres Resuscitation

The Best of #FOAMtox Toxicology

  • Poisonings treated (and caused by) the ICU are presented in this latest post from the Maryland CC Project. Josh D. King, MD reviews common toxicities that warrant ICU admission as well as their toxidromes. Novel antidotes and several iatrogenic toxicities are discussed as well. [TCN]

The Best of #FOAMus Ultrasound

  • We don’t often feature Twitter thread, but this is an amazing diagnosis made using #POCUS post op/ See this thread by @PARADicmSHIFT [CMD]
  • Resa Lewis in her AHRQ commentary discusses POCUS as powerful and intimately connected to patient safety. Its strength and limitations should be understood in the context of clinical evaluation to elevate its practice. [MMS]
  • Pneumatosis Intestinalis is an important sign in the diagnosis of intraabdominal pathology- and can be seen with POCUS. Thanks Sonostuff for the clip! [SO]

The Best of #FOAMped Pediatrics

The Best of #FOAMim Internal Medicine

  • Smallpox (variola) has been eradicated, but it remains in laboratories in the United States and Russia (and hopefully nowhere else). With herd immunity gone, the nightmare scenario now is a weaponized smallpox.. With that in mind, F. Perry Wilson, The Methods Man, takes us through tecovirimat, a newly FDA-approved treatment for smallpox. [RP]

The Best of #MedEdFOAM and #FOAMsim

Reference Sources and Reading List

Brought to you by:

LITFL Review 340 Marjorie Lazoff, MD

Article source here:Life in the Fast Lane

Episode #69: Lee Hersh – Round 2!

On Episode #69 of That's So Maven Podcast, we're chatting with a return visitor, Lee Hersh from Fit Foodie Finds! As one of Davida's closest friends, this episode is a more personal discussion on life, business and how to remain body positive in the pressures of the wellness space.

Guess who’s baaaaack! Now that we’re almost 2 years into the podcast, it’s been fun to bring some return visitors back on the show to catch-up about life and what’s changed since we last spoke. Today’s guest is no exception and likely requires no introduction: Lee Hersh from Fit Foodie Finds. I’ve known Lee for 5 years now after meeting through the blogging space and we’ve chronicled our friendship online and in our last podcast episode together. Today’s episode is a bit different. We kept things conversational and open and I loved the result! A true reflection of our friendship but also some much necessary realness.

On Episode #69 of That's So Maven Podcast, we're chatting with a return visitor, Lee Hersh from Fit Foodie Finds! As one of Davida's closest friends, this episode is a more personal discussion on life, business and how to remain body positive in the pressures of the wellness space.

Lee reaches millions of visitors every month and has inspired so many with her recipes and body positive content. Today we’re chatting about what it’s really like behind the scenes of FFF and how things have changed recently.

Here are some other things we chatted about:

  • Lee’s recent trip and what she learned from going off the grid
  • Expanding her team and how Team Fit Foodie has changed
  • The term “influencer” and how she describes her business
  • Body image and why it’s a conversation we both don’t find ourselves having
  • Mental health and sharing your mental health struggles on the internet
  • Her relationship with Mark and how he’s helped to balance her out
  • What she’s looking forward to in the future and big projects she’s working on
  • The advice she wishes she’d gotten when she started out on this journey

LISTEN HERE:  iTunes | Stitcher | Google Play | Player.FM | Podbean | Spotify

On Episode #69 of That's So Maven Podcast, we're chatting with a return visitor, Lee Hersh from Fit Foodie Finds! As one of Davida's closest friends, this episode is a more personal discussion on life, business and how to remain body positive in the pressures of the wellness space.

Do you have any questions for Lee? Did you find THM through Lee and Fit Foodie Finds?

The post Episode #69: Lee Hersh – Round 2! appeared first on The Healthy Maven.

Article source here:The Healthy Maven

Tropical Travel Trouble 010 Fever, Arthralgia and Rash

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

aka Tropical Travel Trouble 010

Peer Reviewer: Dr Jennifer Ho, ID physician QLD, Australia

You are an ED doc working in Perth over schoolies week. An 18 yo man comes into ED complaining of fever, rash a “cracking headache” and body aches. He has just hopped off the plane from Bali where he spent the last 2 weeks partying, boozing and running amok. He got bitten by “loads” of mosquitoes because he forgot to take insect repellent.

On examination he looks miserable, temp 39.8 °C, HR 115, BP 108/60, blanching maculopapular rash over his face, thorax, and flexor surfaces.

Questions:

Q1. What could this be?

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  • Acute febrile illness in the returned traveller can be a number of diagnoses (not exhaustive):
    • Bacterial: strep throat, leptospirosis, toxic shock syndrome, rickettsia, typhoid, Melioidosis and meningitis.
    • Viral: Fifth disease, enterovirus, scarlet fever, hepatitis, zika, Chikungunya, Roseola, EBV, HIV seroconversion, West Nile virus, influenza, adenovirus, measles and Rubella.
    • Parasitic: malaria
    • Non infectious: ITP, Acute leukaemia, drug reaction and Kawasaki in the young.
  • Due to fact this is a tropical post the most likely culprit is an arbovirus (any disease transmitted by arthropods – insects).
  • There are three main groups of arbovirus presentations in humans:
    • FAR (Fever, arthralgia and rash – as in our patient),
    • CNS (central nervous system symptoms most predominantly an encephalitis e.g. Japanese encephalitis),
    • VHF (viral hemorrhagic fever e.g. Crimean-Congo hemorrhagic fever).
  • While it can be overwhelming the number of possibilities on presentation, a thorough travel history, history of presenting illness and examination will help you to narrow down your testing (yes this is why the ID team get you to order a raft of investigations as there is no other way). Travel health Pro is an excellent resource for looking up what travellers are at risk for including outbreaks and news for that country (I see Australia has a highly resistant Gonorrhoea at the moment!)
  • See the diagram below to narrow down your arbovirus differential.
Venn diagram of arboviruses from Dr Tom Solomon et al.

Q2. What is Dengue Fever and how do you contract it?

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  • Dengue is the most common mosquito borne viral illness in humans. Derived from the Swahili word “dinga” which likely influenced the spanish word “dengue” meaning fastidious or careful which would describe the gait of someone with the bone pain of dengue fever.
  • Dengue viruses are single-stranded RNA viruses that belong to the genus Flavivirus.
  • The dengue virus comprises of four distinct serotypes (DEN-1, DEN-2, DEN-3 and DEN-4). Among them the “Asian” serotypes of DEN-2 and DEN-3 are frequently associated with severe disease accompanying secondary dengue infections. This may be because these strains are more virulent or antibodies against one dengue virus serotype (from a previous infection) enhance the entry of a second dengue virus into macrophages, leading to a more severe infection. The latter theory has made some scientists nervous about creating a vaccine only covering one strain.
  • Dengue virus is transmitted by the bite of the female Aedes genus mosquito found in tropical and sup tropical parts of the world. They are the same mosquitoes that transmit Zika virus, Yellow Fever and Chikungunya but are different to the mosquitoes that transmit malaria (Anopheles).
  • Annoyingly Aedes mosquitos feed during the day whereas Anopheles mosquitos feed at night. Hence the usual methods of mosquito nets +/- insecticide impregnation fail. Approximately 40-50% of the world’s population are at risk of contracting the virus.
  • The disease mainly affects children and travellers as adults develop immunity to the serotype in their area.
World map showing habitat suitability for Aedes mosquito.

Q3. What is the incubation period for Dengue Fever?

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  • The incubation period for dengue fever is 3-14 days; usually 4-7 days – just long enough for a week in Bali!
  • Consider differentials if someone presents 2 weeks or more after returning from an endemic area.

Q4. How does Dengue Fever present clinically?

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  • Dengue Fever has 3 stages of infection:
    • Febrile phase last 2-7 days (viraemic phase):
      • Dengue presents with sudden onset high fever (often up to 40.5°) with associated chills, severe ‘breakbone’ myalgia, arthralgia, retro-orbital pain and headaches. Additional GI symptoms (anorexia, nausea, vomiting and loose stool are common).
      • On day 2-5 after fever onset, a blanching maculopapular rash develops over the face, trunk and flexor surfaces. This rash usually last 2-3 days. In addition petechiae and ecchymoses may also be present.
      • A second measles-like (morbilliform) rash may appear within 1-2 days of defervescence (abatement of fever), this rash spares the palms and soles, and occasionally desquamates.
    • Critical (plasma leak) phase – riskiest time for developing complications:
      • If the temperature drops below 37.5 celsius during the first 3 to 7 days, some patients may experience an increase in capillary permeability as well as increased haematocrit levels.
      • This phase lasts 24 to 48 hours and can be associated with bleeding (epistaxis, vaginal, gastrointestinal, gums).
      • The mechanism is not well understood but in those patients who have greater capillary permeability they will rapidly develop tissue hypo perfusion and hypovolaemic shock. Pleural effusions, ascites, nephropathy and myocardial injury are all possibilities during this phase.
    • Recovery phase – where there is gradual reabsorption of the leaked fluid from the extravascular to the intravascular space:
      • The reabsorption takes 48 to 72 hours but some patients may develop a late appearance rash called “white isles on a red sea” accompanied by generalised parities.
      • Sinus bradycardia can also occur during this stage.
      • Full blood counts, haemocrit and platelets also recover.
Dengue phases

Q5. What is the modified dengue severity classification?

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  • Previously Dengue Shock Syndrome (DSS) and Dengue Haemorrhagic Fever (DHF) where by DSS, was an acute increase in vascular permeability leads to extensive third spacing and plasma volume loss with associated clinical shock. If untreated it may lead to metabolic acidosis, cellular hypoxia and death. The hallmark features of DHF are vascular changes, thrombocytopaenia and coagulation disorders (DIC). A rising haematocrit with continually dropping platelets suggests the onset of shock.
  • Based on the DENCO study and multiple round the table discussions a new criteria was set to include ‘Dengue with warning signs’ as these patients often had a real possibility of progressing to severe disease:
Dengue classification WHO

Q6. How do you diagnose Dengue Fever?

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  • Clinically if no tests are available (see diagram above), patient travelled through an at risk area with two symptoms. Can include a positive tourniquet test (sensitivity 58% and specificity 71%) as one of the symptoms.
    • 10 or more petechiae in a 1 square inch on the patients arm after 2 mins with a BP cuff inflated to their mid DBP and SBP. See how to do one here.
  • Bloods for dengue NS1 antigen +/- PCR and dengue serology. IgM and IgG will only start becoming positive after day 5.
  • Other tests to perform include:
    • Full blood count – leucopenia and thrombocytopenia are common. Monitor for a low haematocrit.
    • Coagulation studies – detect DIC.
    • LFT/albumin/protein – detect hypoproteinaemia; elevated AST/ALT.
    • CXR and Ultrasound if effusions and ascites are possible in patients in the critical phase.

Q7. How do you treat Dengue fever?

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    • Dengue is usually a self-limiting illness.
    • Treatment is entirely supportive – fluids, analgesia, rest.
    • Avoid aspirin, NSAIDS, steroids, antibiotics and oral anticoagulants.
    • Patients who can tolerate adequate volume of oral fluids, passing urine every 6 hours and have no warning signs can be managed as an outpatient with follow up blood tests and a check for any warning signs every 24-48 hours after defervescence. Patients should be advised to return for medical attention if they develop any warning signs.

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    • Patients who have Dengue without warning signs but have an associated disorder or social risk should be managed as an inpatient (e.g. social isolation, far from medical centre, pregnant, under 1 year of age, over 65 years, obesity, HTN, diabetes, asthma, renal failure, haemolytic disease, chronic liver disease, peptic ulcers and the use of anticoagulants).

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    • Dengue with warning signs require inpatient monitoring +/- IV fluids along with close haemtocrit, blood count, platelet and electrolyte monitoring. IV fluids should be titrated along normal parameters of blood pressure, urine output, conscious state and an awareness of third space losses/complications.

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  • Severe Dengue is a medical emergency that requires meticulous attention to fluid resuscitation in an intensive care setting.
    • 2 – 3 boluses of crystalloid at 20ml/kg is recommended prior to commencement of inotropes but this will be patient dependent (i.e. the elderly).
    • A sudden drop in haemotocrit but lack of clinical improvement may indicate major bleeding and necessitate transfusion.
    • If fibrinogen <100 mg/dl, transfuse 0.15 U/kg of cryoprecipitate.
    • If fibrinogen >100 mg/dl and PT and aPTT are more than 1.5x the standard reference values consider fresh frozen plasma 10 ml/kg.
    • Consider platelets for uncontrolled bleeding or emergent operations (platelets should be >50,000 mm3 for most operations or >100,000 for eye and neurosurgery). Patients can drop their platelet count to below 10,000 mm3, if stable only require strict bed rest.

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Q8. How do you prevent Dengue Fever?

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  • There is no commercially available vaccine at this stage.
  • Prevention consists of avoiding mosquito bites by using repellent, covering up, using indoor insect sprays and by not travelling to tropical/sub-tropical parts of the world e.g. Bali!

Case Resolution:

You strongly suspect Dengue Fever and a dengue antigen test confirms this the following day. Your patient improves with paracetamol and fluids and his platelet count is low-normal. You advise him to follow up with his GP for daily FBE/haematocrit and to return if his platelets are dropping or haematocrit is rising. You send him home to his Mum with paracetamol.

Learn more:

Great CDC learning module on Dengue.

WHO treatment guidelines including advice about patients with co-morbidities and pregnant patient.

References

LITFL Resources

Tropical Travel Trouble 010 Fever, Arthralgia and Rash Amanda McConnell

Article source here:Life in the Fast Lane

What To Do In Boise, Idaho + Why You Need To Visit ASAP

A boise, Idaho travel guide and what to do on your next trip to Southwest Idaho! #Idaho #Boise #travelguide

I’ll be honest, when Southwest Idaho Travel Association (SWITA) reached out a few months ago about spending a few days in Southwest Idaho I wasn’t sure what to think. I’d been hearing a lot of buzz around Boise and the surrounding areas and how it’s an up and coming destination but I can’t say it was at the top of my bucket list. All of that changed after 4 days exploring Boise and beyond!

There's no denying that Boise, Idaho has been getting a lot of buzz lately. But what's it all about? We decided to explore Boise ourselves and find out what to do in Boise, where to stay and what to eat when you visit!

Boise, and just Idaho in general is so much more than anyone expects it to be. I think that’s what makes it so great. It feels like this undiscovered paradise. An underdog of sorts. Of course, most people know that if you a) like adventure or b) like potatoes than Idaho is your place. But it truly is more than just an adventure-junkie, potato-growing mecca. If you love wine, Southwest Idaho is for you. If you like farm-to-table food, Southwest Idaho is for you. If you like live music or theater, Southwest Idaho is for you. The list goes on…

I honestly never thought I’d see “What To Do In Boise, Idaho” and “Why You Need To Visit ASAP” in the same title, but here we are! Boise and Southwest Idaho truly blew me away. Here’s why…

Where To Stay In Boise, Idaho

Without question you MUST stay at the Inn at 500 Capitol. Besides the accommodations being top-notch, the location can’t be beat. It’s right in downtown but a block or two away so you’re not directly in the madness. If you’re not planning to rent a car and want to exclusively explore Boise than I recommend staying here as you can walk all of downtown.

Our room had a double balcony with a gorgeous view of the capitol building and the foothills to the right of it. Though my one complaint is that there wasn’t a bath (#bathjunkie) they made up for it with free snacks and a glass a wine upon check-in. Also they’re dog-friendly so you better bet we’re coming back with Bodhi!

Visiting Boise, Idaho? Here's where to stay, what to do and where to eat on your next trip! #boise #travelguide

Visiting Boise, Idaho? Here's where to stay, what to do and where to eat on your next trip! #boise #travelguide

What To Do In Boise, Idaho

Where do I even begin with this? There is so much to do. Some activities are right in Boise but others definitely require a car. If you want to get outside the city and explore the rapids, the foothills and local vineyards, I highly recommend renting a car. It was worth it!

1. Explore Downtown Boise

There are so many cute little shops and corners to explore. Stop in the Capitol building if you’re an architecture nerd like C or the art that is placed throughout the city. If you like records definitely stop in at Record World where C and I got a few great finds!

Visiting Boise, Idaho? Here's what to do in Boise before your next visit! #boise #travelguide

2. Go Rafting at Cascade Raft and Kayak

If you’re up for a short ride outside the city (just under an hour) than definitely go rafting at Cascade Raft and Kayak! Be smarter than I was and bring some water shoes but despite my poor footwear, I had the best time! Our guide, Tango was so much fun and totally made us feel safe as we sped over class 2 and 3 rapids. A great activity for families too!

A Boise, Idaho Travel Guide including what to do, where to stay and where to eat on your next visit to idaho!

A Boise, Idaho Travel Guide including what to do, where to stay and where to eat on your next visit to idaho!

3. Stop by the Farmer’s Market

By now you all know I’m incapable of visiting a city and not checking out their farmer’s market. I’ll be honest, I didn’t have high expectations of the Boise Farmer’s Market before our trip. I was wrong. It became clear immediately upon arriving that the farm-to-table scene is BIG in Boise. Naturally their Farmer’s Market was a reflection of this. They had everything all from local area farmers and it honestly put my local area Farmer’s Market to shame. It happens every Saturday morning so be sure to stop by!

A visit to The Boise Farmer's Market and a Travel Guide for your next trip to Idaho! A visit to The Boise Farmer's Market and a Travel Guide for your next trip to Idaho! A visit to The Boise Farmer's Market and a Travel Guide for your next trip to Idaho!

4. Go Wine Tasting

Idaho and wine tasting?! No, I’m not kidding! This is perhaps the part that most surprised me and just about everyone I have told to visit Idaho. The wine scene outside Boise or more accurately, the Snake River AVA is about to explode in a big way. The wines coming out of this region will blow your mind and the landscape holds up to some of the nicest wineries and vineyards in Napa and Sonoma. Head out to Caldwell, Idaho (about 40 minutes outside Boise) for some wine tasting including must-make stops at Koenig Winery, Sawtooth Winery and Fujishin Family Cellars. All show-off different sides of the region but I especially recommend grabbing a to-go lunch from The Orchard House and driving around the corner to Koenig Winery to enjoy lunch on one of the terraces. It’s spectacular!

Wine tasting in Idaho - the best vineyards to explore in Idaho + your Boise, Idaho Travel Guide

Wine tasting in Idaho - the best vineyards to explore in Idaho + your Boise, Idaho Travel Guide

Wine tasting in Idaho - the best vineyards to explore in Idaho + your Boise, Idaho Travel Guide

5. See a Play at The Idaho Shakespeare Festival

We had such a cool experience at The Idaho Shakespeare Festival! If we’d known better we would have brought a picnic dinner with us and eaten it at the venue, but we made do with beer and wine! They run plays all throughout the summer season which include Shakespeare but also plays and musicals. The venue is beautiful so be sure to walk around. We saw deer just 10 meters away from us drinking from the Barber Pond right behind the venue.

A visit to The Idaho Shakespeare Festival and a Travel Guide for your next trip to Idaho!

A visit to The Idaho Shakespeare Festival and a Travel Guide for your next trip to Idaho!

6. Try Some Local Brews

You MUST stop by Payette Brewing Company for some locally made and sourced beers. Their new facility is in an old gymnasium with the old pool as the tap room and the brewery in the former gymnastics studio. You can take yourself on a self-guided tour with the open track to view how the beer is made. Or if you just want to rest your feet after a long day post up in their taproom or hangout in the huge outdoor garden area.

Payette Brewing Company and local craft beer from Boise, Idaho

Where To Eat In Boise, Idaho

If you’re not out doing some kind of activity in Boise, then you are most definitely eating some great food. I asked you guys on Instagram to give your best Boise food recommendations and they did not disappoint. We loved every single meal we ate and in addition to the wine tasting, would say that the food was a highlight for us!

Fork 

a Boise classic and one of the most recommended restaurants. We loved our meal at Fork but especially the apps! Don’t miss the asparagus fries and the brussels sprouts. Accidentally filled up on both but we both still loved our Idaho trout and Short Ribs. They emphasize locally sourced ingredients and local Boise vendors.

Fork + Where To Eat and What To Do In Boise, Idaho

The Modern

We loved our meal here. It’s located at The Modern Hotel so be sure to snag a seat in their courtyard if you can. Another farm-to-table restaurant using interesting flavor combinations and ingredients. The cocktails are supposed to be amazing but we had just come from the brewery so we were tapped out.

The Modern + Where To Eat and What To Do In Boise, Idaho

Wild Root Cafe

We ended up going here twice! It’s a fast-casual restaurant right downtown cooking up healthy bowls, local ingredients and can accommodate pretty much every diet. We had breakfast here one morning that was amazing and then ended up going back for dinner that evening because yo’ girl needed some vegetables after a day of wine tasting!

Wild Root Cafe + Where To Eat and What To Do In Boise, Idaho

Coiled Wine Bar

If you’re not able to escape the city to check out the local vineyards, be sure to stop by Coiled Wine Bar to try some locally produced Idaho wines. Or you know…if you want a wine slushie! The wines are great and the atmosphere is awesome for a little happy hour wind down.

Coiled wine Bar+ Where To Eat and What To Do In Boise, Idaho

Slow by Slow Coffee

We went here every single morning because the coffee could not be topped. I’m told there’s a lot of great coffee shops in Boise but this one stole our heart on the first day and we couldn’t help but go back! Also their cherry croissants were unreal. Definitely grab one!

Slow By Slow Coffee + Where To Eat and What To Do In Boise, Idaho

Places we didn’t get to but were highly recommended: Bar Gernika, Red Feather Lounge, Juniper, Big City Coffee

All in all we were both surprised and amazed by Boise. Beyond the incredible food and local adventures, the people were so nice. Everyone was so welcoming and helpful and we loved the feeling of community we felt there.

It may not have been on our bucket list before but it’s officially on our “must revisit” list now. Idaho, we’ll be back!

A boise, Idaho travel guide and what to do on your next trip to Southwest Idaho! #Idaho #Boise #travelguide

Disclaimer: This post was sponsored by SWITA, however all opinions expressed are 100% my own.

Have you been to Boise or Idaho? What did you love about it?

The post What To Do In Boise, Idaho + Why You Need To Visit ASAP appeared first on The Healthy Maven.

Article source here:The Healthy Maven

Funtabulously Frivolous Friday Five 244

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 244

Readers can subscribe to FFFF RSS or subscribe to the FFFF weekly EMAIL

Question 1

What is the Mandela effect?

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  • A false memory, shaped by social reinforcement or false news and misleading photographs.
  • The name of the theory comes from self-described ‘paranormal consultant’ Fiona Broome in reference to her belief and of many people, feeling certain they could remember Nelson Mandela dying while he was still in prison back in the ’80s. Her explanation was about alternative realities but most commentators believe in the social reinforcement theory. [Reference]
  • One of the most famous examples that comes to mind is the Darth Vader line “Luke, I am your father.” He actually says, “No, I am your father.” [For more examples click here]

Question 2

What is the ‘Bix rule’?

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  • The rule states: with SVT, in which visible P waves are situated midway between ventricular complexes, there is a probability that there is a P wave lurking within the QRS. Thus, it can be an atrial tachycardia or atrial flutter with a 2:1 AV conduction. [Reference]
  • The rule is named in honour of Viennese cardiologist, Dr Harold Bix who worked in Baltimore. [Reference]
Flutter 2:1 AV block

Question 3

If you were climbing Everest why might you see Osborn wave at you?

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  • Because you are hypothermic. 
  • The Osborn wave or J wave is a positive deflection at the J point (negative in aVR and V1).
  • Typically seen in temps under 30 degrees Celcius but they can be a normal variant, due to medications, hypercalcaemia, neurological insults and idiopathic VF.
  • Eponymously named after John Jay Osborn (1917-2014) following his 1953 ‘current of injury‘ description in hypothermic dogs.

J waves in moderate hypothermia (30 degrees C)

Question 4

What would you use a facial Goniometer for?

Facial Goniometer, mid-19th century. Collin, Paris

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  • A goniometer is any device that measures angles. A facial goniometer is specifically concerned with calculating the angle of the face from the jaw to the forehead. 
  • The instrument was introduced in the mid-19th century by anthropometrists. This particular example was made by Adolphe Collin, the well known surgical instrument maker from Paris. [Reference]

Question 5

What tropical disease did Homer call Dog-star fever?

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  • Malaria
  • Homer was fascinated by the stars and linked the appearance of Sirius, the dog star (in late summer and Autumn) with malarial fever and misery. [Reference]

…and finally

Funtabulously Frivolous Friday Five 244 Neil Long

Article source here:Life in the Fast Lane

Wedding Recap #4: The Brunch + DIY Wedding Details

Green and white with gold wedding table

Before you read this check out the last 3 posts:

Part #1: The Welcome Dinner

Part #2: Getting Ready, The First Look + The Ceremony

Part #3: The Reception

We’re officially on recap #4 of our wedding! I’ll be honest, I’m a bit relieved to be wrapping up these recaps. Not because I didn’t love our wedding but because I’m feeling ready to close this chapter and open a new one. I don’t mean this in a negative way, but after a year of planning I’m SO okay with moving on. That being said, I want to make sure that I a) capture the memories (I like looking back on these posts!) and b) know that I learned a lot along the way and would love to impart some of this knowledge onto you if you’re in this season of your life.

This is especially true as C and I enter our own round of wedding seasons and now have the honor and privilege in supporting our friends as they take this next step. If my excessive list-making and newfound discovery for DIY Wedding Details can be of service to someone else than I’ve done my job well!

But before we get into the DIY wedding details, let’s first recap the brunch. Now, as I mentioned in the welcome dinner post, because 120 of 135 guests were from out of town, our wedding was more than just a one-night affair. We welcomed everyone on Saturday night, the wedding was Sunday and then Monday morning of Memorial Day Weekend we hosted a brunch to say our farewells and thank everyone for coming.

So the morning after the wedding, C and I rallied ourselves to the Marriott Marquis for the Goodbye Brunch. At this point I need to credit Mama Maven for all of her hard work in putting together this event. The brunch was 100% her doing and would not have happened without her. One of the first things Mama Maven did when we confirmed our wedding was book off room blocks at a couple hotels in SF. Not everyone stayed at the hotels, but we wanted to ensure people had the option and Mama Maven being Mama Maven negotiated an insane deal (she’s the best!).

Given that most people were staying at the Marriott Marquis, we though hosting the brunch there would be ideal. It’s also a pretty central location so it was easy to access for everyone. If anyone has ever been to a Marriott breakfast buffet you know it’s really good. So we basically gave access to everyone to the buffet and then the Marriott blocked off the “Chill Lounge” (yes that’s the name…) for us. They set up tables and chairs, coffee and orange juice and made sure everyone was accommodated. We also reused the flowers from the wedding that Mama Maven dropped off the night before. #WIN.

Overall it was a perfect way to recap the weekend and say our goodbyes to everyone before they went home and we left on our honeymoon. HUGE thanks to Mama Maven for organizing!

* * * * *

At this point I want to share some DIY wedding details with you guys in the hopes that I can be helpful to some of you as you plan your big day. We didn’t have a planner for the wedding and most definitely did not have a big budget so doing things ourselves was key. I like small DIY projects, but this was definitely way bigger than anything I had ever worked on before, but luckily I had a lot of help. To save money, here are the things we DIYed for the wedding:

  • Signs (welcome signs, seating cards, table sign, guestbook sign, hashtag sign etc…)
  • Flowers (bouquets, boutonnieres, tables, aisle, brunch)
  • Table design
  • Chuppah (wedding arch)

I can’t even tell you how much money we saved by doing these things ourselves. Of course, they took a lot of time but saving thousands of dollars was definitely worth it!

Let’s start with a few tips before you DIY your wedding.

  1. Pick a theme – even if it’s just colors, having a theme will help you reel in ideas. We kept it simple by doing green, white and gold.
  2. Pinterest– pinterest is your best friend through the wedding process. I created a secret board where I pinned all the things that inspired me. I also stayed away from pinning anything inspirational and only included things that were within reason, our budget and our abilities.
  3. Give yourself time– everything takes wayyyyy longer than you think so plan ahead

The Signs

I made all the signs myself using photoshop. Because our theme was green, white, gold and greenery I kept to this theme when creating the signs. Here are the signs I created:

  • 2 welcome signs (displayed at the two entrances)
  • 1 reminder to sign guestbook
  • 3 hashtag reminder signs
  • 1 seating sign
  • 14 table signs
  • signs we didn’t use: menu cards (didn’t have time!), gift sign (forgot to make this)

After designing each sign in photoshop, we went to Fedex and had them printed to the correct size ($100 total). We then put all of our signs with the exception of the welcome signs in these 5 x 7 Umbra frames. These frames were actually life-savers. They’re beautiful, went with our theme and kept things consistent. Umbra to the rescue for so many things!

DIY Wedding Table Signs in Umbra gold frames for a green and white wedding table

For the welcome signs we also had them printed at Fedex and then pinned them onto two sheets of wood we purchased at home depot and stained. We spent $60 total on them when they were $80 each on Etsy. Felt good about this one!

DIY Welcome Wedding Sign for half the price of Etsy Signs!

Also the hashtag signs were displayed in these adorable picture holders from Umbra. Like I said, Umbra is a wedding mecca.

DIY Wedding Hashtag Sign // #wedding #weddinginspo

The Flowers

This was definitely the more daring DIY piece we undertook. Especially because it had to be done the day before the wedding. Luckily we were prepared for this and I came equipped with a group of women who had done wedding flowers before. C’s sister Lauren got married in Carmel a few years ago and they had done their flowers themselves so I definitely feel like I lucked out having this crew with me, but I also think anyone could do this if they put in enough preparation. So let’s talk flowers.

The San Francisco Flower Mart is a huge warehouse in SOMA where most flower vendors in the city come to purchase their flowers. After 10:00 AM they open to the public and you can go in and purchase as many flowers as you want. It has everything! The key is to go in with a plan AND an open mind.

We went in on Friday morning with the plan of putting together the flowers on Saturday morning before dropping them off at the venue on Sunday. We ordered all vases and buckets in advance so we knew exactly how many flowers we needed. That being said, you can’t know 100% what kind of flowers they will have in stock so we went in knowing my theme (green and white) but weren’t attached to any specific flower. I had pinned some pictured for inspiration but we interpreted them based on what we found at the flower mart.Pro tip! Buy big buckets from home depot to store the flowers in and then have the vendors add water to them so they stay fresh.

Green and white with gold wedding flowers

After we had purchased all of our flowers we squished them into the cars and stored them at Lauren’s house. The next morning I rallied the troops aka C’s cousins and we did an assembly line to put together all the flowers for the tables and the aisle buckets. It was a team effort putting together my bouquet and my niece’s and C’s mom did an amazing job making the boutonnieres with succulent clippings from Lauren’s garden. It definitely requires some courage and faith to do the flowers yourselves but honestly, these are some of my favorite memories of the weekend. Thank you to everyone who helped out ❤

Green and white with gold wedding table

DIY Green and White Wedding Bouquet #wedding #weddinginspiration

DIY Green and White Wedding Bouquet #wedding #weddinginspiration

Green and white with gold wedding table

DIY Wedding Succulent Boutonniere // #wedding #weedinginspiration

Table Design

Not surprisingly, having a theme makes table design so much easier. A few things we thought about: height of the flowers (we wanted people to be able to talk with people across the table), a feeling of warmth (candles) and pulling the outside, inside (leaves on the table). I also didn’t want it to feel cluttered or wind up with a ton of stuff we’d never use again after the wedding.

The flowers were the centerpiece and we worked around those. I actually put together a mock-up of the table on photoshop because I’m such a visual person. The signs are as indicated above where I designed them on photoshop, had them printed at Fedex and then put them in these Umbra frames. We then ordered some candle holders from Amazon and used greenery from the Flower Mart to finish out the rest. It wasn’t anything over the top, but neither are we and we’re really happy with how it turned out.

green and white wedding table // #greenandwhite #wedding

Green and white with gold wedding table

Green and white with gold wedding table

Chuppah/Wedding Arch

I honestly shouldn’t be the person writing this portion because I had very little to do with the chuppah design. For those of you who don’t know, a chuppah is a traditional jewish wedding canopy. It represents the home you’re building together with open sides to remind everyone that the home is open and welcoming. C and his uncle built the Chuppah using douglas fir and that’s about all I know. I gave them pictures and they used their engineering/architect skills to make it happen. Given that there were hurricane-force winds and the thing didn’t blow over, I’d say that did a pretty epic job!

We covered the top with the tallit (jewish prayer shalls) from the women of my family and stood on top of a rug that C’s parents gave us from one of their trips to Pakistan. Somehow, C’s uncle was able to get the plants to stay on the chuppah despite the winds. That might be the most impressive piece. We kept the chuppah design pretty simple because we wanted the outdoor space to speak for itself.

DIY Wedding Chuppah for San Francisco, California Wedding

Wedding In The Presidio - A green and white San Francisco, California eucalyptus-inspired wedding #wedding #weddinginspo #sanfrancisco

* * * * *

Weddings are a very individualized experience. There’s a good chance you’re looking at this recap and not liking any of our design. That’s totally fine! Everyone has different tastes and the point is not to create a wedding that pleases all these tastes…because that’s impossible. C and I are pretty classic. Even though I know I’ll probably look back on our wedding in 30 years and think everything was tacky, I did my very best to not include anything super trendy that I know I’ll hate in the future (I’m looking at you flower crowns…). But if mid-century modern, moody, flower crowns is your jam, by all means – DO IT. Your wedding should be a reflection of you right now, even if it makes you cringe 30 years from now.

We didn’t DIY the entire wedding (some things just weren’t worth doing ourselves) but I have no regrets on the parts that we did. They’re weren’t all perfect, but they made for some great memories that I’ll cherish for a lifetime. Also I’m a sucker for saving $$$ so I’m feeling good about that.

This is the final wedding recap, but hold tight because next week I’m sharing our honeymoon to Napa and Sonoma! Possibly one of the best week’s of my life and favorite post to write. Stay tuned!

Photography: Sierra Ashleigh Photography (digital + film)
Invites
Minted
DressBlush by Hayley Paige
ShoesRaye Laurel Heel (sold out unfortunately!)
Venue + CateringPresidio Golf Course Clubhouse
Dessert: Marla Bakery
Flowers: We did them!
Hair: Sarah Jordan from Harper Paige Salon
MakeupNikol Elaine
DJFox Sounds
Brunch: Marriott Marquis

Did you do any DIY projects for your wedding? What advice would you have for someone looking to DIY their wedding?

The post Wedding Recap #4: The Brunch + DIY Wedding Details appeared first on The Healthy Maven.

Article source here:The Healthy Maven

Running for Weight Loss: How to Do it Without Injuring Yourself

If you’re looking to start running for weight loss, it’s important to make sure that you take the right steps beforehand to make sure that you don’t injure yourself. An injury will only put you that much further away from losing the weight. A lot of people believe that overweight people shouldn’t run because it […]

The post Running for Weight Loss: How to Do it Without Injuring Yourself appeared first on Avocadu.

Article source here:Avocadu

MRaCC Alice Springs – a retrieval experience like no other!

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

This is a guest post by Dr Michelle Withers (@desertoak), emergency physician at Alice Springs Hospital

On February 12th, 2018, a new and completely unique service went live in Alice Springs – the Medical Retrieval and Consultation Centre (MRaCC). The Central Australian Retrieval service has been operating from the Alice Springs Hospital in conjunction with RFDS in various guises for many years, and we were first accredited for training in 2006. We already consider ourselves an “interesting” place to work, and we’ve been the subject of a previous LITFL article, and a number of Jellybean Podcasts.

The opening of MRaCC caused a seismic shift in how retrievals are handled in Central Australia, bringing all co-ordination together via the one service. Since we started operations, all clinics, stations, mines, and anyone else requiring emergency advice or evacuation in our (1.26 million km2) catchment area, now call a single number to contact MRaCC, which is staffed at all times by specialist retrieval clinicians.

Since the red dust has settled, we are seeing obvious benefits to patients – better and faster communication, earlier specialist input, the use of telehealth, and improved integration of care.

Something none of us had really anticipated though, was what it would be like to co-ordinate in a service where there is one hospital (where we all work) and one retrieval service (for which we all fly). Some of the unexpectedly satisfying things about this are continuity of patient care, and the collegial nature of the job. Let me explain further.

As the Medical Retrieval Consultant on a co-ordination shift in the MRaCC, I will usually have the duty flight doctor sitting in the office with me whilst awaiting tasking. That way, the flight doctor is involved with the pre-hospital consultations, engages with the pre-hospital staff, and discusses the plan with me before departing on an evacuation. They are also able to assist with taking consult calls, following up patients from previous retrievals, and (occasionally) with minor but life-sustaining tasks such as retrieving burritos for the team. The next day though, I could be the flight doctor with the roles reversed, and I may even get to fly to the clinic that I was talking to the previous day.

The RFDS flight nurses often drop into our office on their way to the hangar, the St John Ambulance station officers visit when passing through the hospital, and the ICU and ED consultants pop their heads in every now and then to see if there is anything needing their input. Sometimes, we even get visits from the medics, paediatricians or obstetricians – this has ABSOLUTELY nothing to do with the MRaCC coffee machine and comfy couch…

We work alternate weeks in MRaCC and our ‘base speciality’, so the critical care specialists on duty are often “us”. Even those that aren’t, work closely with us on a regular basis, and we all know each other fairly well. One of the best things about working as a specialist at the Alice Springs Hospital, is that (mostly) the different specialities actually work together to try and achieve the best outcomes for patients, rather than having silly disputes about whose bed card they should come in under. By the end of my shift, some of my patients (whom I may have already “met” on telehealth) will be in ED or ICU. I can follow them up, or even just have a brief chat with them, because we are based just next door to ICU and upstairs from ED. If they need transfer out to an interstate hospital, or medical repatriation to get back to country, MRaCC will co-ordinate that as well.

MRaCC photos

So, it really is a unique job, and would suit any enthusiastic critical care retrieval specialist (or fellow) who wants to get “out bush” and be part of consolidating a dynamic new service. We do all of the usual stuff as well – orientation, teaching, training (for ACEM, CICM and ACCRM), QI, and research. Watch the brief “official” video of the Central Australian Retrieval Training course, which forms part of our orientation programme, below. We even cater for those who don’t want to commit, offering three- or six-month sabbaticals, with the potential to extend if you like it. Oh, and if you are still in training – we also employ retrieval registrars!

If interested, drop me a line, or send an email to Tracy Walczynski, Director of Retrieval, at the addresses below. You never know…

Cheers, Michelle.

Michelle.WithersATnt.gov.au

Tracy.WalczynskiATnt.gov.au


MRaCC Alice Springs – a retrieval experience like no other! Chris Nickson

Article source here:Life in the Fast Lane

LITFL Review 339

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

LITFL review

Welcome to the 339th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.

Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription

The Most Fair Dinkum Ripper Beauts of the Week

Nick CumminsFirst10EM features an excellent one-stop shop for reading up on the different types of biases that are commonly seen in the literature. [AS]

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care and #FOAMres Resuscitation

  • Is there a better way to treat Torsades de Pointes? And does anyone (besides me) use atropine or isoproterenol to increase base heart rhythm rate and shorten QTc? [AJB]
  • Jo Davy discusses a now classic trial of balanced solutions vs starch in the critically ill – another great contribution to The Bottom Line. [SO]
  • Want to get faster and slicker at ECMO cannulation? A wire assistant is an essential part of the team, and the ED ECMO guys tell us how that works. [SO]
  • How asleep should patients be? Bruno Tomazini discusses the adverse associations between deep sedation and mortality in the latest ICU revisited post. [SO]

The Best of #FOAMtox Toxicology

The Best of #FOAMus Ultrasound

  • Looking for a realistic vascular access simulator? Jason Bowman and Jacob Avila show a simple technique using a chicken breast and penrose drain. [MMS]
  • Download the free Google Play store #POCUS app Bulldog Sonobites, by @Yale_EUS, perfect for just-in-time learning [CMD]
  • Listen to @nobleultrasound talk about everyday uses of lung #POCUS from the folk at @ultrasoundpod [CMD]

The Best of #MedEdFOAM and #FOAMsim

  • Looking to start a wellness project at your shop? The WRaP EM team are developing “How to” guides on this. My personal favorite: the “Staff Resus Trolley”. [MMS]]

Reference Sources and Reading List

Brought to you by:

LITFL Review 339 Marjorie Lazoff, MD

Article source here:Life in the Fast Lane