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“My body, my choice” only makes sense when someone else’s life isn’t at stake.

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any other fandom ever: I love this show but wish this character wasn’t so problematic

artemis fowl fandom: if disney makes our rich, snobby trash boy a decent human being we will riot

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im literally not exaggerating when i tell you guys this video saved my life

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this cracked me up bc my water pipes are noisy like this too

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EAST 2016: Scene Time And Mortality

The old “scoop and run” vs “stay and play” debate has gone on for years. It would seem to be intuitive that trauma patients, who should be assumed to be bleeding to death, would do better with shorter prehospital times and quicker transport to definitive care. 

However, several studies have not shown worse outcomes in the “stay and play” patients. Once again, mortality is a very crude indicator of “worse” outcomes, and may not be a good enough measure. Nonetheless, the debate continues to rage. A group at the University of Pittsburgh used the Pennsylvania Trauma Registry to review a huge number of EMS transports, looking at mortality as the measure of interest.

Recognizing that total prehospital time can be influenced by delays in specific phases (response, scene, or transport), they analyzed the impact of problems in each. If one particular phase represented more that 50% of the total prehospital time, it was considered a delay. Logistical regression was used to match patients to try to control for any confounding issues.

Here are the factoids:

Over 164,000 records with prehospital times were reviewed over a 14 year period.

There was a statistically significant increase in mortality if the scene time phase was prolonged.

No differences in mortality were noted with longer response or transport times.

Prolonged extrication and intubation had a tendency to prolong scene time, and were independently associated with higher mortality.

Lengthy scene time without extrication or intubation was not associated with higher mortality.

Bottom line: This registry-based study has helped us to slice and dice the prehospital time issue a little bit better. As with other studies, the times themselves may not necessarily be the problem. It’s what is causing the delay that matters. Extrication and intubation tend to indicate sicker trauma patients, but they are also somewhat unavoidable. Prehospital trauma professionals will need to focus on tools and exercises that save time during these critical interventions.

Reference: Not all prehospital time is equal: influence of scene time on mortality. EAST 2016 Oral abstract #9, resident research competition.

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Dear baby nurse,

First I want to tell you not to worry too much about things like starting IVs and drawing labs, these will come easy soon enough. One day you will be really good at these tasks; one day you’ll be the one that people ask to help them.

Then, I would tell you this: if it doesn’t feel right, if you are having to convince yourself that this patient is okay, if something about it looks off, if your gut is uncomfortable, double check, call the doctor, ring the alarms. No one has ever gotten mad at me for being concerned for my patient.

I would tell you not to lose hope. One day you will come to work and look around and realize these coworkers no matter how loud and  insane they are, are your family. You will look around and not see the scary old nurse, but your sweet mentor who has taught you so much. You’ll see your work husband, your partners in crime, your best friends.

I would tell you to keep learning, keep trying. That patient that crapped out on  today, that left you sitting there wondering, “If I were a better nurse, would I have seen that coming?” will be a lesson for tomorrow. So the next patient that look like that you can recognize.

I want you to remember how kind people have been to you through this growing up phase. Remember every mama nurse that explained something to you, or placed an IV, or stood up to the cranky doctors for you. Remember your sweet manager that laughed when you told him how many times you put the same order in trying to make it right.

Most importantly, you can ask for help; no one here expects you to know everything.  I promise, I promise, I will not snap at you when you come to me with a question. I will not call you stupid. I will help you. I will explain it. I promise. I only ask that in a year, when you’re comfortable here, you do the same for the new baby nurse. I know you may not believe me when I say you will be comfortable here one day, that every patient cough won’t terrify you, but I’m telling you the truth. Someday you will come to work, and you will not have the feeling of fear or knots in your stomach. You probably won’t even feel this change happen, but one day you’ll just come to work, do your job and go home.

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View this post on Instagram

A post shared by chefsofinstagram (@chefsofinstagram)

Beautiful White Chocolate Sphere, with strawberry & chocolate on the inside. ✅ By Unknown. Let us know who is behind this great dessert ✅

#ChefsOfInstagram @DessertMasters

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I keep seeing this around and just found a copy on Google! Anyone know the original source??

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This slightly warms my cold snakey heart

life hack: be best friends with a slytherin. they will steal cupcakes for you from work and tell you to drop toxic people from your life with no reservations. they will be the ones ordering you to stop and breathe and call in sick, to screw your commitments if they see you’re sacrificing your mental health. they’re the ones to say “don’t you dare settle” and “you deserve better” in a ruthless, matter-of-fact tone. they’ll be the ones saying it’s okay to put yourself first, the voice you need to hear after a long day or week or month. trust me, be best friends with a slytherin.

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“What’s wrong with death sir? What are we so mortally afraid of? Why can’t we treat death with a certain amount of humanity and dignity, and decency, and God forbid, maybe even humor. Death is not the enemy gentlemen. If we’re going to fight a disease, let’s fight one of the most terrible diseases of all, indifference.”                                            — Patch Adams (1998)

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Congratulations

Steven Spielberg to George Lucas (1977)

George Lucas to Steven Spieberg (1983)

Steven Spielberg to George Lucas (1997)

George Lucas to James Cameron (1998)

Marvel Studios to Universal Pictures (2015)

Universal Pictures to “The Force Awakens” Team (2015)

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On any given night...

On any given night in the ICU, so many lives are at a turning point; so many stories are playing out. One neurosurgery resident, one ICU intensivist, 11 nurses, 20 patients, countless family members all colliding in this cold, busy place. It’s amazing how this place can mean so many different things at the same time, it’s all perspective really.

To the nurse taking care of beds 1 & 2 on her fourth night in a row, this place is the only thing standing between her and her bed. She really wants the families to go home, she’s tired and ready to quit telling them “everything is okay” when a number on the monitor changes. No one told her nursing was also about costumer service. 

To the patient in bed 3, a young woman, this place is nothing. She was brain dead when she got here- nothing could be done. But, to her husband and her parents and the 85 other family members circulating in and out of her room, this place is hell. This is the last place they ever pictured being on a Sunday night, yet, here we all are.

To the two nurse taking care of beds 7-10, this place is home; they are best friends and together they pass these long shifts together.

To the wife of the patient in bed 13, this place is new, and overwhelming. Well, the whole situation is new and overwhelming. She cannot understand how her husband went from fine this morning, to here in an ICU, on a ventilator, with 3 nurses and a doctor, running around the room trying to get him “stabilized.” She’s not sure what they mean by stabilized because nothing in her world feels like it will every be stable again.

To the nurse taking care of beds 15 and 16, this place is misery. She’s a brand new nurse and feels so far in over head, she cannot even see the surface of the water she’s drowning in. All of the other nurses are close, they have inside jokes, and routines. She worries she’ll never be a part of the group here.

To the patient in bed 18, this place is salvation. He would have been dead, should have died. But, the doctors and nurses here knew what to do; they acted fast and he’s alive because of them; he knows that. He’s a precious, grateful man and he’s made his nurse’s night with his sweet, resilient spirit.

To the nurse taking care of beds 19 and 20, this place is monotonous. He’s done this job for the past 3 years, nothing surprises him anymore, nothing touches him anymore. He felt himself quit caring about 7 months ago and has not been able to snap out of this compassion fatigue.

To the ICU intensivist, this place is his kingdom. He has a wife and new baby at home and he loves them, but he cannot always stop the baby from crying. But here, knows he can run an ICU. He has saved 3 lives this week, and he thinks that’s a pretty good week.

To the resident, this place is his dream and his nightmare all at once. He spent 7 years in school and $250,000 to get yelled at by attendings every day, but he’s becoming a real surgeon. He wants to get through this night on his own, without having to call one of the senior residents.

On any given night in the ICU, one family is hearing the best news, while others are hearing the worst. There is joy, pain, fear, and hope, each in their rawest state. Each person’s perspective is different. One nurse bored, while another is busy and overwhelmed; one family overjoyed, one devastated- all of this on an ordinary night.

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Repost. Wish I knew the author, who is clearly very clever.

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Happy New Star Wars Movie Day! Hope everyone can enjoy it like Sheldon and Puff here

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Human heart in ventricular fibrillation.

Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. It is the most commonly identified arrhythmia in cardiac arrest patients.

While there is some activity, the lay person is usually unable to detect it by palpating (feeling) the major pulse points of the carotid and femoral arteries. Such an arrhythmia is only confirmed by electrocardiography.

Ventricular fibrillation is a medical emergency that requires prompt Advanced Life Support interventions. If this arrhythmia continues for more than a few seconds, it will likely degenerate further into asystole (“flatline”). This condition results in cardiogenic shock and cessation of effective blood circulation. As a consequence, sudden cardiac death (SCD) will result in a matter of minutes. If the patient is not revived after a sufficient period (within roughly 5 minutes at room temperature), the patient could sustain irreversible brain damage and possibly become brain-dead, due to the effects of cerebral hypoxia. On the other hand, death often occurs if sinus rhythm is not restored within 90 seconds of the onset of VF, especially if it has degenerated further into asystole.

Causes of ventricular fibrillation are:

Abnormal automaticity: In the healthy myocardium, the rhythm of contraction is regulated by sinoatrial node,that acts like a pacemaker and generates the normal sinus rhythm. Automaticity is a measure of the propensity of a fiber to initiate an impulse spontaneously, separated from the sinoatrial node. The product of a hypoxic myocardium can be hyperirritable myocardial cells and these may then act as pacemakers. The ventricles are then being stimulated by more than one pacemaker. Scar and dying tissue is inexcitable, but around these areas usually lies a penumbra of hypoxic tissue that is excitable. Ventricular excitability may generate re-entry ventricular arrhythmia. It is interesting to note that most cardiac myocardial cells with an associated increased propensity to arrhythmia development have an associated loss of membrane potential.

Re-entry: The role of re-entry or circus motion was demonstrated separately by Mines and Garrey. Mines created a ring of excitable tissue by cutting the atria out of the ray fish. Garrey cut out a similar ring from the turtle ventricle. They were both able to show that, if a ring of excitable tissue was stimulated at a single point, the subsequent waves of depolarisation would pass around the ring. The waves eventually meet and cancel each other out, but, if an area of transient block occurred with a refractory period that blocked one wavefront and subsequently allowed the other to proceed retrogradely over the other path, then a self-sustaining circus movement phenomenon would result. For this to happen, however, it is necessary that there be some form of non-uniformity. In practice, this may be an area of ischaemic or infarcted myocardium, or underlying scar tissue.

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Human heart in ventricular fibrillation.

Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. It is the most commonly identified arrhythmia in cardiac arrest patients.

While there is some activity, the lay person is usually unable to detect it by palpating (feeling) the major pulse points of the carotid and femoral arteries. Such an arrhythmia is only confirmed by electrocardiography.

Ventricular fibrillation is a medical emergency that requires prompt Advanced Life Support interventions. If this arrhythmia continues for more than a few seconds, it will likely degenerate further into asystole (“flatline”). This condition results in cardiogenic shock and cessation of effective blood circulation. As a consequence, sudden cardiac death (SCD) will result in a matter of minutes. If the patient is not revived after a sufficient period (within roughly 5 minutes at room temperature), the patient could sustain irreversible brain damage and possibly become brain-dead, due to the effects of cerebral hypoxia. On the other hand, death often occurs if sinus rhythm is not restored within 90 seconds of the onset of VF, especially if it has degenerated further into asystole.

Causes of ventricular fibrillation are:

Abnormal automaticity: In the healthy myocardium, the rhythm of contraction is regulated by sinoatrial node,that acts like a pacemaker and generates the normal sinus rhythm. Automaticity is a measure of the propensity of a fiber to initiate an impulse spontaneously, separated from the sinoatrial node. The product of a hypoxic myocardium can be hyperirritable myocardial cells and these may then act as pacemakers. The ventricles are then being stimulated by more than one pacemaker. Scar and dying tissue is inexcitable, but around these areas usually lies a penumbra of hypoxic tissue that is excitable. Ventricular excitability may generate re-entry ventricular arrhythmia. It is interesting to note that most cardiac myocardial cells with an associated increased propensity to arrhythmia development have an associated loss of membrane potential.

Re-entry: The role of re-entry or circus motion was demonstrated separately by Mines and Garrey. Mines created a ring of excitable tissue by cutting the atria out of the ray fish. Garrey cut out a similar ring from the turtle ventricle. They were both able to show that, if a ring of excitable tissue was stimulated at a single point, the subsequent waves of depolarisation would pass around the ring. The waves eventually meet and cancel each other out, but, if an area of transient block occurred with a refractory period that blocked one wavefront and subsequently allowed the other to proceed retrogradely over the other path, then a self-sustaining circus movement phenomenon would result. For this to happen, however, it is necessary that there be some form of non-uniformity. In practice, this may be an area of ischaemic or infarcted myocardium, or underlying scar tissue.

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She on beat like a muhhfucka