Dan Martin undresses in 20-knot winds beneath the Everest summit to prepare for a femoral artery blood sample and muscle biopsy while a team of sherpas look on, entertained by what they see. The critical care anaesthetist and his three colleagues ended up on the top of the world’s highest peak two years ago as part of their research project to quantify the limit of human tolerance for hypoxia.

Describing the experiment so far at a Wellcome Collection event in London last week, Martin said he and his three colleagues recorded an average blood oxygen level of 54% (3.28 kilopascals or kPa). His was the lowest, at 34% (2.55 kPa). Patients with a level below 8 kPa are considered critically ill. more…

There have been mixed messages from the Patients Association in response to the announcement of plans for nursing in England to become an all-graduate profession. Writing in The Times on 12 November, the Association’s director, Katherine Murphy, said the move had “sent out all the wrong messages, as it has become more important to write about care than to give it”. In contrast, their vice-chairman, Mike Summers, welcomed the move, saying he didn’t think, “…anybody could really complain about nursing being taught to a high level.” Neither mentioned an essential point, apparently missed by other commentators, too, that common sense suggests that you cannot increase recruitment to a profession by making it more exclusive. more…

Are you an apple, a pear, or even a melon? Metabolic risk is less if you have the body profile of a pear rather than an apple. If you are shaped like a melon, it is definitely time for a serious diet. You may not have noticed, however, that you are now one of the 30-40% of the population classified as obese.  Individual risk perception is unrealistic and both men and women systematically underestimate their own waist circumference. It is not just our body shape that is important as Kamlesh Khunti, Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, pointed out at the RCGP Annual Primary Care Conference. Body fat percentage can vary greatly even in people with the same BMI. He emphasised, in particular, major ethnic differences so that South Asians not only have greater body fat, but have higher glucose levels at all corresponding levels of BMI. Change is subtle- who would have known, for example, that a portion of French fries that in 1960 contained 200 calories now carries 610 calories. Our genes have not changed but our environment has. more…

It’s nice to know how others see us. Several weeks ago, a journal editor based in Europe asked my opinion on a contentious paper he had agreed to publish, had posted online, but about which he now had concerns. I told him that I did not have the scientific expertise to provide a thorough review of the methodology.  However, I did know that, some years ago, one of the authors had been erased from the medical register by the GMC. This followed criticism and a complaint by a High Court judge before whom the doctor had given evidence. The basis of the Court’s criticism was regarding the same subject area as the paper which had been sent to me. more…

Fergie lost it with the referee. The Manchester United manager’s public criticism of the referee’s fitness in their recent match against Sunderland made headlines. Although subsequently making a personal apology he did raise the more general issue of referee’s fitness. Perhaps it was because he knew about the long established referee fitness programme in Scotland pioneered by Stewart Hillis, the recently retired professor of cardiology in Glasgow and doctor to the Scottish Football Association. Dr John McLean continues this cardiovascular screening initiative at the outstanding sports medicine facilities at Hampden Park, and hosted last Friday’s meeting on the benefits of exercise. It is good to be fit- not a new message, even for referees- but there are still many questions for patients and doctors. more…

A management consultant friend confessed last week that despite advising many media company clients about their digital strategy, he had little interest in Web 2:0 and social networking, shunned the TV when he got home, and ate dinner with his wife while BBC Radio 3 played in the background. more…

BMJ bloggers are in the habit of going to exotic places to listen to exciting lectures. In my time I’ve done my share of all that but a few weeks ago my medical education leapt ahead in an unlikely place – the Malvern Giant Flea Market.  In a subsidiary role as my antique dealer wife’s second opinion and general purposes porter, I rarely get to buy anything but, on this occasion, my eye was caught by a pair of medals on which serpents and staffs figured. A closer look disclosed one to be a medal commemorating the 1961 Hunterian Professor of the Royal College of Surgeons of England, Frank Groves Ellis (1925-2003). The other was awarded to Ellis when he was Lettsomian lecturer of the Medical Society of London in 1975. more…

That articulated lorry hurtling towards you may be driven by one of your fat beer drinking patients- who just has fallen asleep at the wheel. Sleep apnoea used to be a rather esoteric research field in the backroads of respiratory medicine but is now mainstream or, more alarmingly, main road.  Respiratory physicians may joke that if you make your patients wait 45 mins for their appointment, you need only investigate those who doze off in the waiting area. But, if the prevalence is 4% and rising in our increasingly obese population, with links to hypertension and diabetes, perhaps we should take a more active approach. Should we be doing routine pulse oximetry in all our obese patients? more…

‘The H1N1 pandemic-are we prepared?’ was the first hot topic at the 22nd congress of the European society of intensive care medicine (ESICM) in Vienna from 11th to 14th October 2009. The question of whether there will there be enough intensive care facilities for critically ill patients in a second wave of the pandemic was discussed extensively. Steve Webb from Canberra, Australia reported that, in the influenza A/H1N1 pandemic that affected Australia and New Zealand during the 2009 southern hemisphere winter, 133 patients with influenza had to have mechanical ventilation and 68 patients with severe influenza-associated acute respiratory distress syndrome (ARDS) were treated with extracorporeal membrane oxygenation ECMO. more…

Anticoagulation in patients with microbleeds and TPA for stroke beyond 3 hours

The 3rd World Congress on Controversies in Neurology, held in Prague October 8-11, used an all-debate format to highlight areas of uncertainty and disagreement in current neurological practice. With three concurrent sessions to choose from, I wasn’t able to attend everything of interest, but here are some highlights from two of the sessions: more…