Meh.

Food extract is the flavoring of something cooked down into a carrier oil or alcohol that is safe for human ingestion.

Essential oil is the pure extract of the plant refined down and distilled for concentrated medicinal purposes to a significantly higher strength than simply adding ground up mint leaves to your water. The two are not comparable in any way.

Cinnamon extract and cinnamon essential oil are not the same thing.

One is about 100 times the strength of the other and can also cause acute organ failure. I’ll give you a hint, it’s not the food extract.

Yeah.

I’ll never forget the look on her face.

So to reiterate, children under the age of ten should not be directly exposed to things like eucalyptus oil, peppermint or wintergreen. If you are using such things in your house and your child starts to complain of headaches, lethargy and general “feel worse”, don’t just assume it’s the cold/flu. Those are all signs of menthol sensitivity and they only get worse with increased exposure. Ventilate the room, take them outside if you can until the air clears. Do not apply again.

Rapid onset wheezing may be a sign of allergic reaction or possible asthma attack triggered by the menthol too. If they tell you their chest is warm or fuzzy when you use it, that’s another sign it’s not going down well with them. Again, ventilate the area or remove anything you applied to them. Administer inhalers if necessary. Watch for any more labored breathing or if they suddenly go limp or you can’t wake them up. If they do call 911.

This can also apply to people with allergies and asthma who are otherwise healthy.

Hyperkalaemia ECG changes in 15 seconds. 

High levels of potassium destabilise the cardiac membrane causing arrhythmia’s which lead to cardiac arrest. This can be a real life-saving opportunity if you can catch and treat it!

A friend once asked me how I manage to do my tasks so efficiently. I wrote a 500-word essay in 20 minutes. I finished my math homework and studied for a quiz in the half hour before morning assembly. I sleep at 9 pm on most nights. But how can I possibly achieve that?

I’ve seen people, even good students, check their phone every minute or two as they’re studying. I’ve seen students “study” for six hours straight, meaning taking down some notes then watching a YouTube video then reading their textbook then opening Instagram… you know what I mean.

My advice is to commit to whatever you’re doing. Not too long ago, another friend asked me, “Jo, do you ever get distracted at home?” to which I replied, “Distracted by what?” They told me about how they always have the urge to check their phones, talk to their friends, or get some food.  I can’t say I never get distracted, but it very rarely happens to me because I focus on what I’m doing–and only what I’m doing. Here’s how:

1. During the time I allocate for working, I turn my phone to airplane mode (with WiFi switched off, of course). No messages or notifications will distract me from what I’m currently doing. Recently, though, I’ve left my phone on in case there’s anything important. There might an RMUN photoshoot tomorrow, or a Physics quiz, or a music showcase. I know myself well enough to know that I have the discipline to do nothing more than glance at the notification. However, if this isn’t true for you, then I suggest you keep your phone on airplane mode.

2. When I allocate time for relaxing, that’s all I do. No homework. No textbooks. No opening emails as they come. Just me and a good book or Photoshop or the piano or something. That way, I can satiate my thirst to relax within the half hour or so and not crave more when I start working

As for music, it’s been proven that music makes you less productive when trying to recall and absorb information (studying, in other words). Music only makes you happier when you’re doing things but not more productive.

By this, I don’t only mean which ones are most urgent, but which ones you can’t accomplish anywhere other than at home. For example, let’s say you have these three tasks: a) research about structural unemployment; b) write a poem with the theme of death; c) answer some questions about quantum physics; d) do a problem set about implicit functions; and e) memorize a set of chemical reactions. This is how I would do them:

Write the poem on the way to school. Maybe this is just because I like poetry. And because I can’t write when other people are around. I’d probably get a first draft done by the time I get home.

Do the research about structural unemployment. My school’s WiFi is terrible.

Answer the quantum physics questions. The new information is still fresh in my brain and doing the homework will help me revise, easing the process of spaced repetition.

Memorize the chemical reactions before I go to bed. Studying before you sleep is supposed to improve your memory, and since my memory is terrible, that’s exactly what I’ll do.

Do the implicit functions problem set as soon as I get to school the next morning. Math is undoubtedly my best subject, and it’s very refreshing to do math at 6:45 AM in the morning.

If you saw the pattern, I assigned each task a time slot when I would be most productive. I also did them from easiest to most difficult to the easiest again. Because everyone works differently, I suggest you find out which types of tasks are the most difficult (memorizing, in my case) and which types of tasks require a certain environment (e.g. requiring WiFi for doing research).

I guess that’s pretty much self-explanatory. I like to nap right after I get home from school if I’m feeling especially tired. As for breaks, I prefer to take them between tasks instead of every 25 minutes because of my high study inertia.

Commit to what you’re doing

Delegate and prioritize

Give yourself shorter deadlines

Take breaks!

Do you know your basic fracture types? Can you name the above fracture types just from the picture? This is a very important essential skill to have when studying archaeology and anthropology. These skills are also widely transferable to other subjects, such as forensic science and medicine. But these posts focus on the archaeological significance of the fractures, but can be used as a starting point for other disciplines.

Quick Tips: Fracture Types – The Basics.

In this Quick Tips post I will show you some ways to identify and deduce common fracture types, (Top Image), and their key characteristics. The definition of a fracture is a break in the continuity of a bone. There are three major causes of fractures: acute injury (an accident); underlying disease which then weakens the bone making it susceptible to fractures; and repeated stress (as seen in athletes).

All fracture types can be placed in two categories; open and closed. An open fracture, also known as a compound fracture, is where the bone breaks through the skin causing an open wound. It is called an open fracture as there is an open connection between the fracture site and skin. A closed fracture is where the bone has no connection between the outer skin surface and the fractured bone itself; it does not cause an open wound. A closed fracture is classed as a ‘simple fracture’. (Top image fractures) Click here to carry on reading.

Quick Tips: Fracture Types – The Basics Pt 2.

In my previous Quick Tips, which you can find by clicking here, you were introduced to the first six basic types of fractures, what the main causes of fractures are, and the two main categories they are classed in. It is important that you know the information in the previous Quick Tips post before learning these last few basic fractures, as it discussed the fundamentals of fractures. (Bottom image fractures)

Click here to carry on reading.

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A lot of people have been viewing and requesting this post recently.

Here’s a neat trick for finding hard to see rib fractures on standard chest xrays.

First, this is not for use with CT scans. Although chest CT is the “gold standard” for finding every possible rib fracture present, it should never be used for this. Rib fractures are generally diagnosed clinically, and they are managed clinically. There is little difference in the management principles of 1 vs 7 rib fractures. Pain management and pulmonary toilet are the mainstays, and having an exact count doesn’t matter. That’s why we don’t get rib detail xrays any more. We really don’t care. Would you deny these treatments in someone with focal chest wall pain and tenderness with no fractures seen on imaging studies? No. It’s still a fracture, even if you can’t see it.

So most rib fractures are identified using plain old chest xray. Sometimes they are obvious, as in the image of a flail chest below.

But sometimes, there are only a few and they are hard to distinguish, especially if the are located laterally. Have a look at this image:

There are rib fractures on the left side side on the posterolateral aspects of the 4th and 5th ribs. Unfortunately, these can get lost with all the other ribs, scapula, lung markings, etc.

Here’s the trick. Our eyes follow arches (think McDonald’s) better than all these crazy lines and curves on the standard chest xray. So tip the xray on its side and make those curves into nice arches, then let your eyes follow them naturally:

Much more obvious! In the old days, we could just manually flip the film to either side. Now you have to use the rotate buttons to properly position the digital image.

Final exam: click here to view a large digital image of a nearly normal chest xray. There is one subtle rib fracture. See if you can pick it out with this trick. You’ll have to save it so you can manipulate it with your own jpg viewer. 

Related posts:

CT scans for rib fractures?

Rib fractures in the elderly

Epinephrine is a little fucker but it’s pretty useful so that’s ok.

Here’s me holding the 1:10,000 prefilled syringe (try to ignore my classmate’s horrifying neon-red shoes, his normal boots went missing that day or something)

NOTE: this med comes in two concentrations, 1:10,000 and 1:1,000. NEVER give 1:1,000 concentration through an IV/IO. It’s used for IM/SC.

CLASS:

- sympathomimetic (stimulates the sympathetic nervous system, or as I like to call it, the “Gas pedal”, with the parasympathetic nervous system as the “brake pedal”)

MOA

- Alpha receptor Agonist: vasoconstrictor, increases systemic vascular resistance (SVR)

- Beta2 receptor agonist: bronchial smooth muscle relaxation/bronchodilator

- beta1 receptor agonist: positive inotropic effects (contractility), positive dromotropic effects (electrical conduction velocity), and positive chronotropic effects (increases heart rate). These, hopefully, can sort of “jump-start” the heart to start doing something, even if it’s something horrible but still treatable, like VFib or Vtach.

- Increases myocardial workload and oxygen demands

- histamine blocker

INDICATIONS

- VFib/Pulseless Vtach/PEA/asystole

- croup

- anaphylaxis

- bronchospasm

- symptomatic bradycardia

- hypotension that refuses to respond to other treatments (like fluids)

CONTRAINDICATIONS:

- none for cardiac stuff

- hypothermia (relative)

ADVERSE EFFECTS

CV: ventricular dysrhythmias, tachycardia, hypertension, angina

CNS: anxiety/agitation

GI: nausea/vomiting

ADULT DOSE FOR PULSELESS ARREST

- 1 mg of 1:10,000 solution every 3-5 minutes IV/IO OR 2-2.5 mg of 1:10,000 via ET tube

ADULT INFUSION FOR BRADYCARDIA/HYPOTENSION:

- 1mg 1:10,000 added to 500 ml of Normal saline administered at 1 mcg/m titrated to desired effect (range of 2-10 mcg/m)

ADULT DOSE FOR ANAPHYLAXIS/ASTHMA

- 0.3-0.5 mg 1:1,000 solution IM/SC, may repeat every 15 to 20 minutes

- IN EXTREME CASES, 0.1 mg of 1:10,000 solution given IV/IO every 5 minutes, or infused at 1-4 mcg/m

PEDIATRIC PULSELESS ARREST

- 0.01 mg/kg of 1:10,000 every three to five minutes (maximum single dose of 1 mg) IV/IO

- 0.1 mg/kg of 1:1,000 solution diluted with normal saline to a volume of 3-5 ml via ET tube, max single dose of 10 mg

PEDIATRIC ANAPHYLAXIS/ASTHMA

- 0.01 mg/kg of 1:1,000 solution, via IM/SC, max single dose of 0.5 mg

PRDIATRIC IV INFUSION

- 0.1-1 mcg/kg/min

CROUP:

I don’t have a pic of ketamine because my class drug boxes don’t have it, but dammit we’re getting there.

CLASS:

- dissociative anesthetic

MOA:

- rapid acting in producing a dissociative anesthesia (patients consciousness is detached from their nervous system, kinda..)

- bronchodilation with minimal to no respiratory depression

- potent analgesia

INDICATIONS

- pre- anesthetic (induction agent) for Rapid Sequence Intubation (RSI)

- pre-anesthetic in critical asthma patients needing aggressive airway management/intubation

CONTRAINDICATIONS

- angina

- CHF

- symptomatic hyperthyroidism

- pregnancy

ADVERSE FX

- emergence reaction in around 12% of patients may occur near end of medication half-life

ADULT DOSE

- 15 years of age and older

- IV/IO: 0.5 - 2 mg/kg over 1 minute. Half life of 5 to 10 minutes

- IM: 2 - 4 mg/kg. Half life of 12 to 25 minutes

NOTES:

The curious thing about it, is that ketamine often causes hallucinations. In adults, these are horrid, imperative visages that scare people half to death, but children usually see something sweet and cute and pure (depends on your definition of cute and pure, I, for one, consider snakes of various kinds cute), they are never scared of these hallucinations.

There are exceptions and paradoxical situations. An adult once admitted to be he is seeing dragons flying around the room (tiny ones, apparently), but he wasn’t scared, because they didn’t see him, and that will continue to be the case if he lies very very still. I was very happy to hear that.