Winter and Yellowknife's Climate.

Well it snowed some more last night. Like many days in Yellowknife I am tempted to say the weather is not usually like this. Isn't it supposed to be a semi arid climate? Anyways, winter has arrived... Really it has (although they're calling for rain tomorrow).

It makes me think we should have a few more words for winter in English. They say the Inuit have many words for snow. I suggest we should have at least three words for winter.

Maybe I'll just make them up - loosely borrowing from some other languages. In Italian and Spanish they use the term Inverno or invierno. In Russian they say Zima (pronouce the i like in the word pig) - kind of cool sounding. The local dogrib call it Zahk'e!

The Celts had an interesting idea of dividing the year into eight (2 equinoxes, 2 solstices and 4 midpoints). This fits the best for the climate in Yellowknife:

ZAHK'E: Hallowe'en to Winter Solstice - feels mostly like a real southern Canadian Winter with a few colder days.

WINTER: Winter Solstice to St Brigid's Day (aka Imbulc) - this is the depth of winter - cold and dark.

ZIMA: Imbulc to Spring Equinox: cold but getting clear, bright and lighter all the time.

SPRING: Spring Equinox to May Day (Beltane) - winter is ending, skiing is fun, it's warmer and the ice is thick; great time for winter sports.

SPRING THAW: May Day to Summer Solstice: The great thaw; itching to get boats in; warmer days finally coming; lots and lots of light all the time.

SUMMER: Summer Solstice to Mid Summer's eve: This is the yellowknife summer with loads of light, swimming, sunshine and warmth.

AUTUMN: Midsummer's eve to Fall equinox: I would call this our autumn. It can still be in the 20s but the feeling is that winter is around the corner.

FALL: Fall equinox to Halloween. Snow shows up and may melt. No lakes frozen enough to walk on. Maybe some rain.

Well, I haven't firmed up on the names of these seasons but if you have any ideas let me know!

Back in the Knife!

So, the Critical Care Forum in Toronto is a wrap. Here are a few highlights:

1) Fluids: Liberal use of fluids in the ICU seems to decrease lung injury (more than 2 L per day over baseline). So there's some evidence for the old "fluids and rest" approach to illness. Maybe gramma's chicken soup will turn out to be the ultimate fluid!

Albumin still sucks (although people still use it).

Plasmalyte may be the best fluid as it most closely resembles our normal plasma. Ringer's is good but not in head trauma as it is hypotonic. Normal saline isn't normal after all...

2) Pain and Sedation: There really needs to be alot more attention givne to pain in the ICU setting. About half of ICU patients recall it being a terribly painful experience (maybe even to the point of PTSD). We need to pay more attention to pain. Being sedated does not mean being pain free.

3) Delirium - there is no evidence for anti psychotics in the ICU. The best approach is to treat the delirium. Try to regulate a normal sleep wake cycle. Read to the patients. Give them some stimulus that makes sense. We do not need our patients to be in a drug induced coma.

3) Traumatic head Injuries - Nimodipine prophylaxis to prevent vasospasm (60 mg q4h). Bolus 7.5% saline 250 mL for increase ICP. Mannitol is OK but not likely to do much. Hyperventillation is just plain bad! Consider MgSO4 16g per day and pravastatin 40 mg / day in all head injured patients. If you suspect vasospasm order a CTA with CT perfusion. Give norepi for MAP goal of > 120 mmHg.

The food was great. Especially at the reception on the top floor of the Sheraton.