TiL (click to go to the thread, which probably has more interesting tidbits I missed).
Bonus:
These are my people.
Show & Tell

izzy's playlists!
we're not kids anymore.

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Today's Document
let's talk about Bridgerton tea, my ask is open
Sweet Seals For You, Always
macklin celebrini has autism
Game of Thrones Daily
KIROKAZE
noise dept.
Keni

JBB: An Artblog!
Mike Driver
Xuebing Du
hello vonnie

blake kathryn

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Cosmic Funnies
cherry valley forever
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@randisandlin
TiL (click to go to the thread, which probably has more interesting tidbits I missed).
Bonus:
These are my people.
there’s nothing purer or better than how much kids enjoy being picked up and then hurled at soft surfaces
anyone who’s ever been around kids for ay meaningful amount of time should know exactly how much kids long to be hefted up and then just fuckin tossed! it’s so good! they’re so excited to get fucking tossed around like a sack of potatoes it’s so pure
Why do kids love it so much? Like I remember when I was a kid at diving practice during the summer, the best part was when one if the coaches would toss you into the deep end. And in gymnastics coaches would toss us into the foam pit. Do kids just have a evolutionary urge to die?
https://themilitarywifeandmom.com/why-kids-wont-listen/
“Vestibular sense provides information about where the body is in relation to its surroundings. This is the sense that helps you understand balance, and it connects with all the other senses.
When the vestibular system does not develop properly all other senses will struggle to function properly. Without a strong vestibular sense, kids will have no choice but to fidget, get frustrated, experience more falls and aggression, get too close to people when talking, and struggle with focusing and listening. Because they literally cannot help it.”
“Here are a few ways to support your child’s vestibular sense:
Spinning in circles.
Using a Merry-Go-Round.
Rolling down a hill.
Spinning on a swing.
Going upside down.
Climbing trees.
Rocking.
Jumping rope.
Summersaults or cartwheels.
Using monkey bars.
Skating.
Going backwards.
Swimming.
Dancing.
Wheel-barrel walks.”
Yeeting kids, spinning them, flipping them upside down, tossing them in the air, and otherwise disrupting their balance temporarily, is Important For Their Development, specifically for their vestibular sense.
Kids love this because they NEED it.
In other words: Don’t forget to calibrate your child’s GPS!
Can intubated patients smell?
Someone help. I have drank a lot of Robitussin and have debated this with myself.
Okay now that I’ve gathered myself. Here is my thinking. I’m legit typing as I think so bare with me folks. I think the answer is yes and no. Simply put, try to breathe in thru your mouth and nose at the same time. Not impossible, but very hard to do. The body has a natural reaction to close off the oral passageway when breathing. You know, the fatal flaw of human anatomy - food tube right next to the air tube.
So, with that being said. Smell would not happen for someone on control or assist control. They could only take breathes via the ETT. Even if they tried to initiate a breath thru the nasal airway, the vent would trigger and push air down the oral airway. No nose, no smell. Same concept for a long term trach with a total laryngectomy: no oral or nasal airway anymore.
But, perhaps, if a patient is on a SIMV or a similar mode they can initiate there own breathes. Same for most long term trach patients. So they can take in breaths thru their nasal passage way?
Idk. I’m thinking. My brain is churning. Keep the messages flowing. I love these convos.
I’ll ask one of my favorite pulmonologists on Monday and we will see what the verdict is.
@umbillicus
I think they would be able to smell. To smell, particulates just have to pass through the nasal cavity. If the nasal passage is patent, there would still be passive air movement in and around the nasal passage. It isnt a vacuum. This has nothing to do with breathing. Just air circulating in and around a room.
I think they can smell. It may take more time for those particulates to passively travel into the nasal passage, but I think it is entirely possible.
Shout out to all my straight sisters I’m so sorry 😞
Jesus, leave his ass.
We learn fast to be very kind and attentive, tho.
My mom, who got her degree in Marriage and Family Counseling when she was 60, says studies show that women will sometimes sometimes leave a long term relationship to live on their own for a while before seeking a new relationship, but men will almost never leave a long term relationship without having a new relationship either in progress or just beginning. They don’t want to give up the caretaker they have without another one on deck or in the wings.
This is so sad
This isnt cute or quirky. This means hes a fucking hopeless user
Please date a man who actually acts like an adult.
Ok I lived with my ex for 2 years and he literally wouldn’t be able to get his own food if I wasn’t at home, I’d get home from work and he’d be angry at me for “making him starve”
My current partner has lived on his own for 8 years and the absolute most I have to help him with is maybe sending him $20 so he can make a bill payment on time
It made me realise for 2-4 years I wasn’t a girlfriend I was a fucking mother
Men who have been independent are capable of reverting if given the slightest excuse. When we married, my ex husband was 10 years older than me and had lived on his own for 8ish years. Yet (and I allowed this until I finally got fed up and took us to counseling) I did 80% of the cooking, because I was better at it. Same with the cleaning, shopping, social planning, etc.
After I left, in the first six months I got texts or calls asking me to please tell him:
The online banking password (dude, I left you, you should really change that)
Where I ordered his special-wecial organic underwear
Where the good cutting board was (my dad gave it to us at our wedding, genius, I took it with me along with the rest of the stuff from my family)
What brand butter we bought
What brand of local kielbasa we bought
Who his doctor was
What RMV office had the shortest lines
Where the old tax returns were (in the fucking box labeled tax returns)
The phone number for his best friend
I shit you not.
Then he had a heart attack (mild) and none of his family or friends were around to take him to the hospital. But instead of calling 911, he called me, who by then lived 45 minutes away. He lived 5 minutes from an EMS dispatch location. He called me, despite the fact that he didn’t believe me 8 months prior when I was feeling suicidal and I had to call a cab to go alone to check myself into the hospital for a 72-hour hold. I told him to call 911, hung up on him when he whined about “making a fuss”, called 911, called his siblings and then texted them “your brother is having a heart attack, I called 911 for him, come home,” and washed my hands of it.
Emotionally vacant men who won’t do household labor or emotional labor are not Nazis, but they aren’t good people, either, and you don’t have to put up with their shit.
Millennial women of Tumblr, please read this post.
And then please: make the decision for yourself to never stay with a man who expects you to be his mother and servant.
zombiesusingtheinternets:
damnthatswhatshesaid:
Significant piece of childhood, get your ASS on my blog
This was my ringtone for years. I still love it
HPV Vaccine Masterpost
aivarobinson asked: What’s your opinion on the HPV vaccine, especially for those not sexually active? I’ve heard so many conflicting things and I was curious about your take on it.
Let me start by saying that my opinion shouldn’t matter.
What really matters is that vaccines save lives. It has been proven time and time again. (Sources at the bottom).
So let’s talk about HPV:
It causes cervical cancer, oropharyngeal cancer, anal cancer, vulvar/vaginal cancer, penile cancer, genital warts, and laryngeal papillomas. Risk factors for being infected are age less than 25, sexual activity prior to age 16, and multiple partners or a partner who has had multiple partners. Millions of Americans are infected and millions more will become infected every year.
The Gardasil-9 vaccine (the only HPV vaccine available in the US right now) protects against 9 high risk strains of HPV which are responsible for causing 70% of cervical cancers and 90% of genital warts.
The original Gardasil vaccine was studied in 29,000 patients and Gardasil-9 was studied in an additional 15,000 and continues to be studied now. The only significant adverse event was an increase in syncope (passing out) immediately after being given the shot, which is why it’s recommended to be observed for 15 minutes after getting the shot.
Keep reading
Deadpool’s instructive video may save your testicles
This is both entertaining and really important.
Yo if you’ll reblog the boob campaign, you can damn well reblog Deadpool discussing bollocks.
Deadpool is canonically riddled with cancer this is actually such an appropriate campaign
Take This Survey On ED Thoracotomy At Your Hospital
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Hello all! I’d like to invite you to participate in a brief survey regarding ED thoracotomy at your hospital. I’m curious about who can and does perform the procedure. The survey is very short and should only take a minute or two to complete.
Please take a moment to participate by clicking here to take the survey. Although entering your center name is optional, I do require the city, state/province, and country so I can eliminate duplicates.
The survey will officially close in 2 weeks, so please fill it in soon! I’ll publish the results in a post shortly afterwards.
Thanks! Michael
Click here to take the survey
Source: http://thetraumapro.com/2018/05/29/take-this-survey-on-ed-thoracotomy-at-your-hospital/
For those who are afraid to become a nurse because they have a weak stomach,
It won’t be the vomit or needles or blood or urine or feces that turns your stomach. You’ll get used to that. You’ll come to accept it’s just part of the job and get to the point where you’re thinking of the 38 different things you have to do while absentmindedly cleaning up a bowel movement.
What will turn your stomach will be 40 shallow breaths a minute in a patient in respiratory distress
A freshly born infant that is limp and blue and hasn’t cried yet
Tripled troponin levels on your sweating and anxious patient as you realize they’re having a heart attack
Feeling cord during a cervical check, then trying to hide from your patient the shaking in your voice as you call for help
The pale skin of a Jehovah’s Witness with a hemoglobin of 4 as she declines a blood transfusion and says goodbye to her family because they haven’t found the source of the bleed and she’s running out of time
A blood alcohol level of .18 on a 4 year old who is barely responsive and being intubated after getting drunk on mouthwash and then hitting his head
An elderly woman in the ICU signing her DNR while her sobbing daughter begs her to reconsider, knowing if treatment is stopped then her mother will die
A child in the pediatric ICU who hasn’t had a visitor in months
Not being able to find the heartbeat on a pregnant mom who hasn’t felt the baby move in a while
In the face of everything else that comes with being a nurse, I promise you’ll get used to the poop.
While this post is absolute truth, there is also so much joy.
My patient tonight had to lay flat after a procedure. His wife was feeding him since he couldn't get after it himself. I walked in the room and they are giggling like school children because she is haphazardly spilling potatoes on his chin. They are in love after all these years and we saved his heart muscle so they can giggle for another day.
Nurses do amazing things. We save lives in ways that people don't even notice. It has nothing to do with blood, or sweat, or tears, or poop. It has everything to do with the people.
Nothing to see here folks…..
Woah.
Better give them some insulin and start squirting the potassium in too - gonna fall hard
Via @chadhayesmd on Twitter.
When oh when will I escape the Valley of Despair?
Oh wait….that’s AFTER the program is done. I haven’t even started crossing the Valley yet.
I’m on the downslope of Mt. Stupid.
“I’m a doctor. We get all the glory. And credit. And guess what? We only deserve part of it. I started out in medicine in the mid-80′s, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Doctors will see you anywhere from 5 to 30 minutes a day, depending on how sick you are. And the rest is the nurses. They’re the ones making sure you get your pills and checking that your vital signs aren’t dropping. They make sure you don’t fall down and break something. If you start vomiting, doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They’ll bring you a warm blanket. And clean disgusting things off you. Even if you’re drunk. Or delirious. Or mean. And through all of this they try be friendly and positive. Even though you aren’t their only sick patient. I respect nurses. I learned early on that they’re key to being a good doctor. You piss off the nursing staff, and you’ll have a miserable career at that hospital. Respect and treat them well, and you’ll never regret it. They’re as important to being a good doctor as your medical degree. Maybe more. If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they’ll teach you. A good neurology nurse is often a better inpatient neurologist than some doctors I’ve met. I remember a guy named Steve, who was an intern with me a long time ago. We were only a few months out of medical school, and as we were writing chart notes one morning a nurse came over and asked if he’d go listen to his patient’s heart. With icy contempt, and not even looking up from the chart, he said “I don’t have to listen to his heart, because I looked at his EKG.” They ain’t the same thing, dude. If he’d listened he might have noticed that the patient had developed a loud murmur in the last 24 hours. When the attending caught it a few hours later, Steve got chewed out. If he’d taken the nurse’s advice, and listened, he wouldn’t have gotten reprimanded by the residency board. Here’s a quote from “Kill as Few Patients as Possible” by Oscar London, MD: “Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom.” Those doctors are also depriving themselves of friends. On a difficult day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn’t make the day any less busy, but helps you absorb the punishment better. What got me started on this? While I was rounding this weekend, a grateful patient’s family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said, “Oh, this kind is my favorite, it has cream filling.” And a patient in one of the rooms yelled, “Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!” You say that to a waitress, and you’d likely get your kicked out of the restaurant. You say that to a co-worker, and you’d be fired and/or sued for harassment. You say that to a lady in a bar, and you’ll likely get a black eye. And what did the nurse do? In spite of the patient said, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way. And I admire that. Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.”
—
Angela Ar (via
theitunurse
)
This makes me feel good.
(via adenosinetriesphosphate)
Omg this makes this preggo nurse cry 😭
Where Did The French Tube Size System Come From?
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Medicine sure has some weird measurement systems. Besides the more standardized units like microliters, milligrams, and International Units, we’ve got some odd stuff like French (tubes) and gauge (needles). When dealing with tubes and catheters, the size is usually specified in French units.
Where did the French system come from? It was introduced by a Swiss-born gentleman named Joseph-Frédéric-Benoît Charrière. He moved to Paris and was apprenticed to a knife maker. At the age of 17, he founded a company that manufactured surgical instruments. His company developed and improved a number of surgical instruments, including hypodermic needles and various catheters.
Charrière introduced the system for describing catheters based on their outer diameter (OD). It was actually named after him, and in France one will occasionally see catheters described in Ch units. Unfortunately, we Americans had a hard time pronouncing his name, and changed it to the French system (Fr).
So what’s the translation? The Ch or Fr number is the outer diameter of a catheter in millimeters multiplied by 3. It is not the outer circumference in millimeters, and the use of pi is not involved. So a big chest tube (36 Fr) has an OD of 12 mm, and a bigger chest tube (40 Fr) has an OD of 13.33 mm.
Tomorrow: Where did the needle gauge size come from?
Source: http://thetraumapro.com/2018/03/27/where-did-the-french-tube-size-system-come-from/
Emergency meds 16: Fentanyl
This smug bastard prefers to be more difficult just to make my life harder by being measured in micrograms MY ONLY WEAKNESS also intubation but that’s an issue for a later day
BTW for reference, I have annoyingly small hands so keep that in mind. This vial is actually really small, maybe an inch and a quarter tall
This is one of the other meds we have that, like morphine and ketamine, as well as the benzos, requires extremely precise measurement, 13 pages worth of documentation signed in your own blood, as well as a witness, just to draw up into a syringe. God help you if even 0.0000005 micrograms is missing and you don’t have full documentation of it. (I may be exaggerating a bit but seriously god help you if you miss even a tiny bit of detail in your PCI about this drug because if they find even a tiny error in how much was measured out or wasted you’ll have your ass handed to you. I’ve witnessed this in my ER days, it’s not pretty.)
CLASS:
- Narcotic agonist/analgesic
MOA:
- elevated pain threshold by acting on pain receptors in the brain
- depresses CNS, depresses brainstem respiratory centers, decreases responsiveness to changes in PaCO2
- vasodilation, reduces preload and afterload
INDICATIONS
- analgesia (especially burns, MI, renal colic)
- sedation in post-intubation state
- RSI adjunct
CONTRAINDICATIONS
- known allergy or intolerance
- elevated ICP
- head injury with ALOC (relative)
- asthma (relative)
- abdominal pain (relative)
ADVERSE FX
- CV: bradydysrhythmias (common), hypotension, tachydysrhythmias
- RESP: respiratory depression
- CNS: excess sedation, pupil constriction, seizures
- GI: nausea/vomiting
- Derm: histamine release may cause local/general urticaria
ADULT DOSE:
- IV/IO/IM/IN: 25 - 50 mcg increments
- IV: slow push over 1-5 minutes
- TOTAL DOSE: not to exceed 200 mcg
PEDIATRIC DOSE
- IV/IO/IM/IN 12 months to 17 years of age: 1 - 2 mcg/kg increments
- IV: slow push over 1-5 minutes
- TOTAL DOSE: not to exceed 50 mcg
Not a correction, just my own observation.
Fentanyl is one of my favorite drugs because it’s EXTREMELY potent, hundreds of times stronger than morphine (hence the dosage in mcg). We almost don’t use it in patients who aren’t ventilated because if pt ODs on it they will stop breathing in a blink. I’m also yet to hear about the kind of pain that can’t be helped with fent.
Downside, it’s as addictive as it is potent and also has short time of action, hour or two, no more.
Aside from uses indicated in the post, it’s also ok for procedural sedation, but most anesthetist opt for different drugs because of the danger and the loads of paperwork.
Might I add that this should be pushed significantly slowly. If pushed fast you can cause them to stop breathing and have a rocking chest... It has a real name... But you will have to ventilate them ans reverse it.
Got a new job…
And I’m sooooo fucking excited. My coworkers were telling me that I was too good for my current place of employment, and deep down inside, I kind of believed it.
Here I am, almost five years of ICU experience going into a job at a medical center twice the size of my current hospital. Code blue RN.
It’s badass, it’s tough, it’s amazing. I’m sooooo fuckkng stoked and soooooo fucking terrified, but I’m so excited for this next step!!! Chicago is finally looking up for me. 😬☺️☺️☺️
So what exactly does a code blue RN do?
Likely run a good code... But what about when there isnt one?
“Successful people are not gifted. They just work hard, then succeed on purpose.”
— G.K. Nielson