Recently on a course I realised my watch, a Daniel Wellington, lacks a second hand. Obviously a flaw for taking pulses, not that I clinically have to do much of it. It got me thinking of whether specifically medically-focused watches exist. The thought being father to the web search, I quickly discovered this piece by Zach Weiss at Worn and Wound from 8 years ago. While much of the focus is on vintage watches, it turns out that some are being made still – for instance by St Gallen Horology. Here is the opening of Weiss’ article:
I was recently asked by a friend of mine if I could make any recommendations for an affordable medical watch. “I’d love to”, I thought, without realizing that I had no idea what a medical watch was. After doing some research, I’ve found that I was really missing out on an interesting genre of watches. For those of you similarly out of the loop, medical watches are offer a quick and easy way for a physician or nurse to take an accurate reading of a patient’s pulse. The face of a medical watch features a pulse scale, either on the inside or outside of the second scale (sometimes on the outer bezel). On most models, when the second hand reaches the 12 hour marker, you begin counting heart beats. When you reach 30, see where the second has reached on the pulse scale, and you’ll find the number of heart beats per minute. Pretty simple technology, but also kind of genius. I’ve found a few really beautiful examples of these watches which I don’t think you need to be a physician to appreciate, or wear for that matter.
The link is worth following to see the watches in their glory…
Utako Okamoto died three years ago today. Never heard of her? In 1962, she discovered transexamic acid (TXA) which highly lifesaving in haemorrhage. For the rest of her life, she tried to persuade Japanese obstetricians to use it; sadly, despite being one of the WHO’s essential drugs basic to healthcare, they didn’t until after her death.
Core Emergency Medicine Podcast on V Fib and Pulseless V Tachy
Take Home Points
In cardiac arrest, the most important interventions are to deliver electricity quickly when it’s indicated and to administer good high-quality compressions with minimal interruptions to maximize your compression fraction.
Medications like epinephrine and amiodarone have never been shown to improve good neurologic outcomes in the ACLS recommended doses. Don’t focus on them.
Consider pre-charging your defibrillator to minimize pauses in CPR and maximize your chance for ROSC
Finally, remember that as Emergency Physicians, we are specialists in the resuscitation of cardiac arrests. ACLS is just a starting point. Push your understanding of taking care of these patients so you can deliver the best care possible
A stimulating podcast on the use of TXA in trauma.
In case it isn’t obvious I am doing a course tomorrow – “Psychiatrist Response in Medical Emergencies” no less.
As my ItsMe2 experience surely proves, I like a grandiose megaproject as much as the next man. I am glad therefore to discoverEn-TIme-Ment, which is a Horizon 2020 funded project in Italy whose investigators are not at all humble:
EnTimeMent aims at a radical change in scientific research and enabling technologies for human movement qualitative analysis, entrainment and prediction, based on a novel neuro-cognitive approach of the multiple, mutually interactive time scales characterizing human behaviour. Our approach will afford the development of computational models for the automated detection, measurement, and prediction of movement qualities from behavioural signals, based on multi-layer parallel processes at non-linearly stratified temporal dimensions, and will radically transform technology for human movement analysis. EnTimeMent new innovative scientifically-grounded and time-adaptive technologies operate at multiple time scales in a multi-layered approach: motion capture and movement analysis systems will be endowed with a completely n
ovel functionality, achieving a novel generation of time-aware multisensory motion perception and prediction systems. The proposed model and technologies will be iteratively tested and refined, by designing and performing controlled and ecological experiments, ranging from action prediction in a controlled laboratory setting, to prediction in dyadic and small group interaction. EnTimeMent scenarios include health (healing and support of everyday life of persons with chronic pain and disability), performing arts (e.g. dance), sports, and entertainment group activities, with and without living architectures. EnTimeMent will create and support community-building and exploitation with concrete initiatives, including a community of users and stakeholders, innovation hubs and SME incubators, as premises for the consolidation beyond the end of the project in a broader range of market areas.
This fuller page is even more entertainingly dramatic:
The mother’s arm is moving upwards: how are we able to see in her gesture the tender sweetness leading her to caress the cheek of her sleeping child or the inner violence preparing to hit the soldier’s cheek? How can we foresee in the heavy murderer’s hand movement a slight faltering revealing his fragile uncertainty in finishing his task, how can we measure the hesitation of the woman’s arms closing to protect her crying, in resonant dialogue with the bodies moving around her?
Of course, I am plotting a way to get on board this particular train.
In 1949,Giuseppe Moruzzi and Horace Magoun published their paper describing the reticular activating system. By so doing, they began the process of realising that sleep was not merely a passive withdrawal of something, and waking the opposite, but a far more nuanced and complex process. From the Wikipedia page on Moruzzi:
Until the 1940s, some scientists felt like wakefulness simply required an adequate level of sensory input rather than a specific process inside the brain. In a 1949 experiment with a cat, Moruzzi and Magoun proved that stimulation of a certain brain region (near the intersection of the pons and midbrain) created a state of alertness. This stimulated area of the brain became known as the reticular activating system or reticular formation. In their experiments, Moruzzi and Magoun also transected the cat’s reticular formation without disrupting any of the sensory nerves; the cat was rendered comatose. The experiment shifted science’s conception of sleep from a passive process to one that was actively controlled by the brain.
Unfortunately I cannot get a full text of this paper via the UCD library online. I don’t think any particular fanfare is greeting this anniversary. believed Moruzzi and Magoun should have been awarded a Nobel Prize this speech bythe 1986 Nobel Laureate Rita Levi-Montalcini says so explictly
Transcranial Alternating Current Stimulation continues to be explored as a therapeutic option. Reading about the history of electrical stimulation of the brain, I came across this gem:
“Electric current from the chain was believed to be efficacious in applications to the head, and to stimulate mental performance. Samuel Patterson Evans, MD, Physician to the Newmarket-on-Fergus Dispensary, County Clare, Ireland, for instance, reported to PPulvermacher that it had successfully been used to restore mental energy. According to Evans, he advised one man who was not very strong intellectually, and whose mind became “tired and incapable of continued thought” after fatigue, to try the chain “applied round the head and forehead” on the basis that “the energy of the brain becomes exhausted, either from bodily labor or mental fatigue.” After undertaking the treatment, Evans believed that he had become “capable of more continued application in either thinking or writing since,” which he attributed to the fact that “the brain becomes stimulated by the outward dose of galvanic or electric energy supplied by the [Pulvermacher] Chain in action” which it had previously lost “either by its own loss of power directly, or indirectly by bodily fatigue.” Whilst warning that “its application in such cases should not be continued too long” in case the “constant and forced stimulation” caused serious injury to the brain, Evans believed that the application of the chain deserved to be “closely studied in relation to its action on the brains of intellectual individuals” and for all types of nervous condition (Pulvermacher, 1853, pp. 15, 16–17).”
From Emerging Infectious Diseases, Volume 10, Number 12—December 2004, who can resist a paper with a methodology section beginning with the subsection “Acquiring and Housing Alligators”?
Alligators as West Nile Virus Amplifiers