BEFORE, IT WAS JUST A RAY ROOM

My sister and I were talking medical imaging and the fact came up that modern chest plain films expose the patient to a mere 0.02mSv of radiation. She wondered how much older x-ray machines put out. Let’s ask the 1940s!

The early days of radiography were not without danger, not only to patients but also to scientists:

On 12 August 1896, Electrical Review reported that Dr HD Hawks, a graduate of the 1896 class of Columbia College, gave a demonstration with a powerful X-ray unit in the vicinity of New York. After 4 days, he was compelled to stop work. He noticed a drying of the skin, which he ignored. The hand began to swell and gave the appearance of a deep skin burn. After 2 weeks the skin came off the hand, the knuckles become very sore, fingernail growth stopped and the hair on the skin exposed to X-rays fell out. His eyes were bloodshot and his vision became considerably impaired. His chest was also burnt. Mr Hawks’ physician treated this as a case of dermatitis. Hawks tried protecting his hands with petroleum jelly, then gloves and finally by covering it with tin foil. Within 6 weeks Hawks was partially recovered and was making light of his injuries. Electrical Review concluded by asking to hear from any of its readers who had had similar experiences.

I’ve looked around for data to connect these two points—0.02mSv and melt-your-face-off TSv—to no avail.

From Applied Radiological Anatomy for Medical Students, Cambridge UP, p. 6
From Applied Radiological Anatomy for Medical Students, Cambridge UP, p. 6

Living in Paris for a year, FYI, exposes you to 0.7mSv of background radiation. Pt another way, one chest x-ray equals about 6 hours of flying from New York to London. If you’re still worried and you can recall every radiological procedure you have ever had, you can calculate your total exposure here.

That Sounds Fun

Many people believe that Michael Jackson died due to propofol.

Not so. He was murdered.

He had actually been taking propofol nightly since around 1980, not in order to make himself sleep, but to suppress REM sleep. After several months of REM sleep suppression, the user becomes “receptive,” in other words, they enter the same state achieved by prolonged continuous immersion in aerosol LSD.

Is it true? (Not the murder part but the REM part.)

Title Author Design Bottom Line
Recovery from Sleep Deprivation Occurs during Propofol Anesthesia Tung, et al., 2004 Prospective
Rats
n=32
“… sleep and anesthesia are neurophysiologically related and suggest that anesthesia and sleep may have similar effects on the sleep deprived state.”

Patterns in recovery REM/NREM cycles were essentially the same for the propofol and intralipid group.

Effects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study Kondili, et al., 2012 Prospective
Humans
n=12
REM was suppressed but not eliminated in propofol group. However, recovery was not studied.
Propofol-induced sleep: Polysomnographic evaluation of patients with obstructive sleep apnea and controls Rabelo, et al., 2010 Prospective
Humans
n=15
REM was totally absent in propofol group.
The hypnotic effect of propofol in the medial preoptic area of the rat Tung, et al., 2001 Prospective
Rats
n=?
Propofol may enhance sleep.
Changes in subjective sleepiness, subjective fatigue and nocturnal sleep after anaesthesia with propofol Ozone, et al., 2000 Prospective
Humans
n=7
Uncontrolled
No changes in REM activity but there was some changes in sleep stage activity the night after the propofol treatment.
Dreaming During Anesthesia and Sedation Mashour, 2011 REM and dreaming are highly correlated; dreaming occurs under anesthesia. Propofol has a stronger association with dreaming than some other agents.
Propofol-Induced Sleep: Efficacy and Safety in Patients with Refractory Chronic Primary Insomnia Xu, 2010 Prospective
Randomized
Controlled
Human
n=103
Not only was propofol effective in increasing sleep quality and quantity in insomniacs, but the effects persisted for at least six months.

Looks like Michael Jackson would have been better off with isoflurane or even scopolamine. Furthermore, he would have had to use the early, troubled formulation until 1986 when it was reformulated and introduced to the (New Zealand) market as Diprivan—the US would have to wait for FDA approval (1989).

In Front of Many Onlookers

Physician passengers may suddenly find themselves in a difficult environment, in front of many onlookers, managing conditions they do not normally treat.

—UpToDate, “Management of inflight medical emergencies on commercial airlines”

Abdominal pain, nausea, vomiting and, less often, diarrhea are commonly reported inflight complaints. Pain, nausea, and vomiting can sometimes be attributed directly to air travel, with the change in barometric pressure, dry air, noise, and vibration of the plane, dehydration, and poor diet.

—UpToDate, “Management of inflight medical emergencies on commercial airlines”

Interestingly, all commercial planes with a flight attendant and weighing than 7500lbs are mandated by the FAA to carry an “Enhanced Medical Kit.” (The basic kit includes bandages, splints, compresses, antiseptic swabs, tape, scissors, and ammonia inhalants.)

Medications

  • Aspirin tablets: 325 mg
  • Antihistamine (diphenhydramine) tablets: 25 mg
  • Antihistamine (diphenhydramine), 50 mg injectable single dose
  • Atropine: 0.5 mg, single 5 mL
  • Dextrose 50 percents/50 mL injectable
  • Epinephrine 1:1,000 (for IM injection)
  • Epinephrine 1:10,000, 2 mL injectable
  • Inhaled bronchodilator (metered dose or equivalent)
  • Lidocaine: 5 mL, 20 mg/mL
  • Nitroglycerine tablets: 0.4 mg
  • Non-narcotic analgesic
  • Saline solution, 500 mL
  • Instructions for medications

Equipment

  • Automated external defibrillator
  • Sphygmomanometer
  • Stethoscope
  • Oropharyngeal airways
  • Latex gloves or equivalent
  • Syringes
  • Needles
  • IV administration kit with tubing and connectors
  • Self-inflating manual resuscitation device (AMBU bag) with masks
  • Cardiopulmonary resuscitation (CPR) masks

Some United States airlines have enhanced EMKs containing additional acute cardiac life support drugs and equipment.

—UpToDate, “Management of inflight medical emergencies on commercial airlines”

I love it! Enhanced Enhanced Medical Kits!

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