blood

i gave blood a couple of weeks ago

i am ashamed to say it was only my second time

it was pretty painless & the actual blood-letting took 4 and a half minutes to take 468mL

[the ultra-rapid haemoglobin estimate is a thing of beauty - how does it compare to a lab test?]
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only 4% of the population are blood donors and as of today, stocks of O- blood will last just over 4 days

i am constantly amazed by the dedication and community spirit of the students i meet, so if you have ever thought about giving blood, but never quite got round to it, take the chance now

call 0300 123 23 23 or use the blood.co.uk website


Salaam

a young man who ingested 4.5g of cocaine

we did not see this gentleman and only discussed his case very briefly

however, as a clinical pharmacologist, this was too interesting not to share

we did not get onto signs, symptoms and treatment of cocaine toxicity, but it is an important clinical issue and is worth knowing something about

eMedicine has a decent review

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this gentleman swallowed 4.5g of 'cocaine' wrapped in cling film

my first question was: what is a lethal dose?

we discussed ways of answering this question in the UK, namely toxbase, and the national poisons information service

it turns out that there is a great deal of variability as to what a lethal dose might be, and it depends on the route of administration - IV as little as 20mg, orally or intranasally 500mg-1.4g

another key issue is the purity of the cocaine - most cocaine on sale in the UK is heavily 'cut' for example with lactose, mannitol, baking powder

average purity in the UK around 34%, price £30-50 per gram (data from drug scope)

one 'line' might contain 50-200mg (depending on how big the line is)

one cocaine cigarette might contain 300mg & is more commonly associated with myocardial infarction
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the clinical pharmacology of cocaine is fascinating

cocaine powder is often the hydrochloride salt which is snorted (white lines)

it is made by pulverising coca leaves, then mixing with an alkaline substance and organic solvent and removing leaves to produce coca paste

this paste is often smoked in south america

for transport, the paste is usually converted to cocaine salt (powder) via the addition of hydrochloric acid

this chloride salt has a boiling point of 190+ degrees which means it cannot be inhaled

however it is water soluble, and thus can be absorbed through mucous membranes
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freebase & crack cocaine are made by removing the chloride to leave the base alkaloid

cocaine base sublimates at around 90 degrees - it is thus smokeable
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we did not get onto signs, symptoms & treatment of cocaine toxicity, but it is an important clinical issue and is worth knowing something about

eMedicine has a decent review



Salaam

a new AAU firm

we had another firm of students join the acute admissions unit today

as usual we introduced ourselves, briefly mentioning our genetic inheritances

this time the group's knowledge of what a SNP is was good, thanks to the presence of a geneticist

i have written about SNPs before - it is an area of such growing importance that i would strongly recommend you find out something about them
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our case discussion, truncated because of time was again centred around 'dizziness'

while we did not go through things in great detail, the importance of disentangling the terminology was highlighted (see previous post)

the other thing that struck me was the need for detail when it comes to the history in this presenting problem

you really do need to find out everything you can about the circumstances of what happened

eg, where: which shop? which department? having just done what? carrying what? wearing what?

all these details will help you to build up a picture of 1) what this lady's cognitive function is like and 2) clues that point to a specific diagnosis (eg fast onset-fast offset for arrhythmia)
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we also mentioned how to start a case presentation well (content - the right amount of data & process - a positive, professional dialogue)

'framing' the problem is key, because without asking the right question, you cannot hope to find the right answer

i would encourage you to watch how real doctors present cases

how many of them need the notes to present? not many i suspect

could you present without your notes?


Salaam


sabih