Hairspray, Not Just a Musical Anymore!

I had an interesting handover a few weeks ago. After the initial steaming pile of handover patients, my colleague gave me this:

This is Ms. S, one of our regular alcoholic patients. She is intoxicated, as normal, but today she has bruises all over her body. When I did some labwork, her platelets came back at 8!  I have no idea why she is acutely thrombocytopenic.

My first question was, “Was she drinking hairspray?”

He looked over his horn-rimmed glasses at me, “Yes, she had a big bottle of it with her.  How the fuck did you know that?”

I did my training on the Canadian Praries, and Hairspray is one of the favorite OTC intoxicants there.  His question stopped me in my tracks…  I just assumed that this was one of the many toxicological minutiae I had forgotten since I wrote my EM exams, but a quick Google Search brought up nothing useful, and my colleagues had never heard of this connection, so my search went deeper.

[Aside: the local OTC intoxicant in Vancouver is mouthwash.  It has few toxicological concerns beyond the ethanol in it, and has the bonus side effect of making the patient smell cleanish if not downright refreshing.]

‘Hairspray’ does not have a single chemical composition, and can contain a variety of fun and interesting substances. These range from relatively innocuous to downright scary from a toxicological perspective.  The most likely culprits that I could find were the copolymers (the bits that make your hair stand up straight), and particularly a variety of esters of Poly methyl vinyl ether/Maleic Acid copolymers (PVM/MA).

This International Journal of Toxicology Report deemed it safe for cosmetic use, but I will quote from its MSDS (note the substance also contains some Benzene):

The chief target organ is the hematopoietic system. Bleeding from the nose, gums, or mucous membranes and the development of purpuric spots, pancytopenia, leukopenia, thrombocytopenia, aplastic anemia, and leukemia may occur as the condition progresses.

So, nasty.  While this stuff is present in small amounts in hairspray, it was never meant for ingestion.

There may be other culprit substances, and I would invite the toxicologists out there to chime in, correct and/or chastise me as you see fit.

Bottom line – if your intoxicated patients are thrombocytopenic ask them if they have been drinking anything new.

WikEmerg

Well this is a big step.

I am announcing that my latest project is now a beta launch.  Check out WikEmerg.ca

wikemerg.ca

WikEmerg is a curated collection of Emergency Medicine resources to support teaching and practice.  It is an attempt to synthesize the massive amount of information that exists on the web into a useful format.

I have grown deeply dissatisfied with doing a Google search (or worse, resorting to UpToDate) when I want to answer a question.  Wading through the chaff is a waste of time, and the lack of FREE resources specific to EM is frustrating.

There are great Emergency Medicine blogs,  resources and tools.  There is lots of high quality information out there, but finding a specific resource when I want it is difficult.  I thought about a Tumblr, Delicious, or Pinboard feed (all great resources).  I use Instapaper, and Readability looks awesome too.  There are other similar services, but they all have limitations and the biggest is still finding  that one piece of information – none of these puts the saved resource IN CONTEXT.

That is what I want WikEmerg to be – a place to search for the topic (context) and then have links to the best stuff on the web from within that recognizable Emergency Medicine specific context.

But it can’t be just me – I want the content creators (bloggers, presenters, developers) and users (EM educators, practitioners, and learners) to help curate WikEmerg.  We all have favorite topics and pet projects, our own collection of links and resources.  But these only benefit us and our (usually small and local audience).

I want to invite all of you to join me in this first, tenuous attempt to curate the web for the EM audience.  Contact me (info at wikemerg dot ca)with your particulars (name, e-mail, and EM cred) and I will invite you to join WikEmerg as an editor, and then you can start – add all of your favorite resources to the relevant topics (don’t see the relevant topic – create it).  Bloggers, add links to your own posts – I want to drive traffic to you.

If you like WikEmerg spread the word.  The future is collaborative.

First Post

Original, I know.

But I wonder how many people don’t get here simply because they are terrified that they have nothing to say, or at least nothing useful or interesting.  Well, Seth Godin says you just have to deliver, and then  continue to deliver.  The rest will come.  Nike says Just Do It.  Zen Philosophy tells us that the journey of a thousand miles begins with one step.  The same sentiment across broad domains suggests they are on to something, so here I am.

There, that is out of the way.  The real stuff starts next.