#Hypoxic Brain Injury

[koibish]

sometimes I think about how a matter of minutes changed our whole lives. how without air, a minute can feel like a lifetime.

[athomerehab]

Brain injuries come in various forms and can have significant impacts on an individual’s life. Understanding the different types of brain injuries and the recovery process associated with each is crucial for both patients and their loved ones.

[queer-anarchist-rat]

I'm tired of people saying "if you have ADHD to make tasks easier turn it into a game" especially as someone with limited brain function I can't just 'turn something into a game' because I don't have the mental capacity, AKA my brain doesn't understand HOW to do that

[xtruss]

I Gave George Floyd First Aid. Police Have Learned Nothing

— Jeremy Norton | July 30th, 2023 | Newsweek Magazine

Jeremy Norton (Pictured) has been a Fire Captain for the Minneapolis Fire Department for over 22 years.

I watched my city burn. Saw the anguish caused, and suffered. Saw fractures and fissures in public fabric—Good Cops Castigated and Lumped with the Bad. Unfair, certainly, but so many citizens have suffered blanket judgments without redress.

The city leaders made promises—most of which have remained abstract, or abandoned. Floyd, his name, and image took on a life after his death, tragically. But: I stress, we still are missing the point.

I testified in the State and Federal Trials of the officers involved in killing Floyd. I have seen convictions, payouts, and reams of social media postings and think pieces, and declarations from civil leaders.

And yet, I must ask, Structurally, Systemically, and Institutionally: What changes have been made to prevent more Avoidable Deaths?

I argue we have yet to recognize or understand the fatal dynamics that caused the deaths of George Floyd, Keenan Anderson, Ivo Otieno, Elijah McLean, Yia Xiong, Travis Jordan, and David Smith.

The names spill off my page: I cannot tabulate the dead in the space allotted here.

We must distinguish between the truly rare aggressive and hostile person and the too-common civilian experiencing some form of altered mentation. Someone who is Incoherent, who is experiencing Emotional or mental Distress for any reason, this person's behaviors must be recognized and treated as something other than "Resisting" and "Refusing to Comply."

Someone in crisis and someone aggressively hostile are not the same. It is that simple.

Anderson had caused a Minor Traffic accident and appeared Incoherent and Agitated when the police officer engaged him. The officer escalated from speaking to shouting to physical restraint to fighting against a man who was clearly in distress.

More officers joined the fray. They shouted multiple commands, some contradictory; they piled on him on the ground, then deployed their Tasers—multiple times. The young man was not resisting or fighting them; he was having a crisis. His death was Unnecessary and Avoidable.

Otieno was experiencing a Mental Health crisis. His family called 911 for help. The responding officers escalated a Physical Struggle with the Agitated, Panicked young man. This began a multiple-hour process of Prone Restraint, Physical Abuse, Positional Asphyxia, and Medical Neglect. His death was unnecessary and avoidable.

In my 23 years as a Minneapolis Firefighter and EMT, I have been on multiple scenes with Agitated Civilians experiencing altered Mental Conditions, many people Incoherent and Unreachable through Words and Force.

George Floyd was not my first fatal call. We worked hard yet in futility to revive someone killed by overly aggressive officers. Every one of us at the scene carries the tragic horror with us.

I have seen far too many interactions go south explicitly due to the responders' Blind Demand for Immediate Submission and Acquiescence—generally the police, but at times EMS, too.

Relatives of George Floyd carry candles during a vigil at George Floyd Square on May 25, 2023 in Minneapolis, Minnesota. Stock image. Stephen Maturen/Getty Images

Here's the crucial point, what should be at the forefront of police and EMS training as well as state and city legal discussions: The majority of these calls go badly because emergency responders are not trained, equipped, or disposed to understand what they are actually encountering.

Police, Fire, and Paramedics must recognize that a person experiencing altered mentation is not the same as a person refusing to follow orders. Treating emotional and behavioral crises as deliberate aggression fails the public and the fundamental concept of emergency response.

How many civilians experiencing a mental health crisis—overwhelmingly men of color—must die at the hands, knees, and weapons of peace officers?

An investigation—of a minor vehicle collision, a bogus twenty-dollar bill, a man walking down the street—spirals out of control. Not because the subject means to harm the police officer, but because the Police Officer Demands Compliance, and if the person does not, or cannot, immediately comply, that is seen as a challenge and a threat.

If we do not Change Our Tactical Approach when encountering someone not in their right mind, We will Continue to Kill Innocent People.

The job can be dangerous: You never know what you will encounter. But that is the essence of emergency response. It is unpredictable and often chaotic.

Responders are given scant information via dispatch; we must make swift inferences immediately upon arrival. Daily, The Police, Paramedics, and Firefighters encounter civilians in conditions or crises of altered mentation. We should expect these folks. We must be prepared for a range of people who are not going to respond coherently.

What if the person does not speak English? Has a Brain Injury? Is Hypoxic or Hypoglycemic? In shock? Is under the Influence of Narcotics? What if it's my father with Alzheimer's? What if it's someone having a mental health emergency, a psychotic break?

I have responded to people with each of These Conditions and none of them were Lucid or Immediately Compliant. None of them were deliberately a threat, either.

There are numerous videos of police encountering civilians in emotional distress, mental crisis, and incoherence, with the officers escalating a physical battle. Yelling Orders at someone who is Incoherent is a Flawed, Futile Approach. Using Joint Locks, Pressure Point Attacks, Chokeholds, and Bodyweight—all the forms of overwhelming Physical Engagement—do not calm or control a person in crisis or altered mentation. The Pain Inflicted by the Officers will Not 'Bring Them to Their Senses' but will provoke panic and a fight-or-flight response.

When someone is pinned on the ground by several people, there can be Panicked Agitation, Hyperventilation, and Positional Asphyxia.

We are directly causing a growing cardiac and respiratory crisis, one that would not be occurring had we not physically restrained the person.

For Years, the City Leadership Repeated the Police Narrative: The Man Refused to Comply. Officers attempted to subdue him. He resisted. He suffered a medical event. There was nothing else we could have done.

What strikes me is that So Many Killings have Occurred Without any Significant Accountability, No Rules or Laws Changed, No Legal Interventions, No Oversight of Department Policies or Training.

Allowing the behaviors to persist, despite the number of dead and the settlements after the fact, is a Moral Failure by Local, State, and National Leaders.

These deaths have been accepted as the cost of policing. With increased public pressure, and abundant video evidence, more cities are prosecuting the officers involved.

This might be a step toward justice for the families of the dead, but it avoids addressing what is at the root: Poor Understanding, Poor Training, Poor Guidelines, and a Healthcare Crisis that leaves so many people struggling with Mental Health, Substance Abuse, Medication Shortages.

We, the emergency responders, are the ones who engage those in crises. The Cities Won't Do What is Necessary to Equip Their Responders with the real tools to better recognize, assess, and engage the vast range of civilians.

I am not naïve. I have been on tumultuous, violent calls. I have seen aggressive, agitated, and unstable people. There was no calming or cajoling them. The longer it took us to recognize the person was beyond reaching, the more the scene deteriorated. These are scary situations. On the streets, away from the emergency departments, we need a means to safely subdue a person in crisis.

Sedation works. But sedation should not be dispensed wantonly. We must recognize that if we sedate someone after several minutes of agitated struggle and physical engagement, they might already be heading into respiratory or cardiac collapse.

If emergency responders cannot distinguish between someone who is a deliberate threat versus someone who is in crisis, and if we act as if there is only the former—we will continue to murder innocent people.

“If City Governments Can Only Exonerate Their Officers, No Matter Their Misdeeds, or Else Vilify the Individual Officers As Rogues and Lone Wolves — Avoiding the Crucial Roles that Systemic and Cultural Behaviors Play—They will Continue to Fail Their Citizens and Their Employees.”

The final line of Langston Hughes' powerful poem "Harlem" (commonly referred to as "A Dream Deferred") is: "Or does it explode?"

Why must it take a riot to get our attention? What will it take to make actual changes?

— Jeremy Norton is a Fire Captain for the Minneapolis Fire Department and the Author of Trauma Sponges: Dispatches from the Scarred Heart of Emergency Response.

[professional-manwhore]

I don't know what having tics is like but I wonder if it's similar to my neck, facial and shoulder spasms or what I like to call my twitches. Sometimes they're painful because it strains my sciatica nerves, even causing blips of static feeling but sometimes it's painless. I always had this after a head injury (HIBI)

But these spasms are like sneezes. They happen randomly without warning, and are worse when I'm stressed.

[srbhawaiilaw]

If your child has acquired hypoxic brain injury or even suffered from wrongful death due to medical malpractice, know that a Honolulu hypoxic brain injury lawyer is here to help. For more information contact us at (808) 809-7010.

[indynerdgirl]

[Image Text: Please, please, please, if you even so much as glance at this post - share it for us and help us storm heaven!!! Our little girl needs a miracle and I beg any and every one of you to pray, pray, pray! Even if you don't know how to pray, please just ask God to heal Vianney’s brain. Now is the time for her miracle. We are devastated. Ever since we first found out about her diagnosis of left hemimegalencephaly, we have been praying and asking you all to pray that her right brain be spared. And you have shown up and helped us pray for this intention! All along the doctors have told us how strong and beautiful her right brain looked. However, this all changed sometime in the night between Friday and Saturday. At a time when we thought we were in the clear and were actually making plans to go home in a couple of weeks (!), something happened. The doctors can't explain it, they are looking into every avenue, as this was completely unexpected and unexplainable. She was awake. She was breathing on her own. She was moving. Shad was with her Friday night and video chatted me and I could not wait to see her the next day, finally alert! But suddenly very early that morning she took a turn and stopped responding. That's when her seizures started and they were indeed coming from the right side this time, due to whatever injury the right side sustained. They said her injury looks consistent with hypoxic-ischemic encephalopathy but none of her vitals ever changed and her labs have remained great. There is truly no explanation at this time. My heart is broken. I cry out to God to understand why, in this final moment, when we were so close to her recovery, did this happen? I am trusting in Him with all my might and KNOW in my heart and soul that He is loving her far greater than I, but oh man I am absolutely broken. She has lost 40-60% of function in her right brain. Even typing it out and reading it in this post is too cruel to bear. They don't expect that she is in dire life threatening circumstances yet but they also can't say that her brain won't be injured further - since we still don't have a cause. Even if she survives all of this and is able to come home, we don't yet know what kind of life our little, beautiful perfect girl will have with only 25% of her brain. At this point, the most basic expectation is that she will not be able to walk or talk along with many other difficulties. She is outside of what they can do (other than trying to prevent more damage) and is truly in God's hands now. I told our priest yesterday before we got the full news - perhaps God is giving us the most dire of circumstances to give us the most miraculous of recoveries. In a world that needs to witness a miracle more than ever, I am praying to God that He show us one now. Please, please, please, keep praying for our Vianney - that her brain is completely healed and she can defy all medical expectations. And if now is the time for a miracle, then we are asking you to also beg for the prayers of the Blessed Ulma family. Soon I will share more about this incredible family, but for now we are asking them to pray along with us for our little Vianney’s miracle!]

Please storm heaven for my friend's little girl! 🙏

You can follow their GiveSendGo for updates

Prayer for the Intercession of the Ulma Family

Almighty and eternal God,

We thank You for the testimony of the heroic love of the spouses Józef and Wiktoria with their children, who gave their lives to save persecuted Jews.

May their prayers and example support families in Christian life and help everyone to follow the true path of holiness.

Lord, if it is in accordance with Your will, kindly grant the grace for the complete healing of little Vianney, for which we are asking You through their intercession and count them among the Blessed.

Through Christ Our Lord

Amen

Our Father…, Hail Mary…, Glory Be…

[clarepreed]

Not for the Faint of Heart, Pt. 1

Story Summary and Content - 3,473 words. Larissa has long term side effects from her multiple hypoxic injuries. Explicit sex, seizure, drowning, on-site resuscitation.

__

Six months after the events of Hostile Work Environment

Larissa

“Alright, then, if there aren’t any more questions, I’m going to let Mark wrap up.” This was code. She’d texted him near the end of the presentation to tell him she was feeling off, and he slipped in no more than two minutes later.

She smiled at the group, ignoring Mark’s openly concerned look, and excused herself. As she made her way out through the back exit of the conference room, she kept her head held high, moving at a reasonable pace. They could still see her; it wouldn’t do to collapse in the hall, or take off running.

Not that she thought she could run right now. She felt heat roar up her chest and neck and into her face. It was close. She could see the door she shared with Kieran up ahead. Her face started to tingle. She got the door open, took a couple of steps inside, and before she could get herself down onto the floor, her brain took over, fading everything to black as it dumped her body on the carpet.

Mitchell

Most of the C-level employees were in his office, drinking coffee and discussing what needed to go on the agenda for an upcoming work session. Mitchell sat on the corner of his desk, listening to them talk.

“Well,” Cherise said. “I should definitely go before Dennis. We all know Finance is his favorite part.”

Everyone laughed and Dennis rolled his eyes. They continued to banter, and Mitchell saw his door open just wide enough for Liam to slip in.

This wasn’t unusual; his assistant had carte blanche to do so if he determined it was necessary. What was unusual was the look on his face. The younger man looked worried, and he urgently motioned for Mitchell to come to the door.

This was also unusual; Mitchell stood, murmured: “Excuse me,” and hurried to meet his assistant.

Liam waved him out of Mitchell’s office and into his own, then pulled the door closed and said: “You need to go to Kieran’s office, Larissa fainted.”

“Is she okay?” Mitchell asked, already headed that direction. 

They exited into the hall together, and Liam continued: “Kieran was really worked up, so I came to get you instead of just checking on her myself.”

“You did the right thing,” Mitchell said, jogging the last few meters down to Kieran and Larissa’s office suite. He opened the door without knocking, and was confronted with the sight of Larissa sprawled gracelessly on the carpet, her hair fanned out around her head and her skin and lips the color of sour milk. Kieran hovered over her, the much younger woman looking like she was about to have a panic attack.

“Woah, shit,” he heard Liam say. “Should I—”

“Larissa!” Mitchell called out sharply, dropping to his knees next to her. He cupped her cheek and was about to check to see if she was breathing when she stirred, her limbs flinching and her eyelids fluttering. “Hey, Larissa, open your eyes.”

“She did that two or three times right before you walked in,” Kieran sniffled. “But then she didn’t wake up!”

“Larissa!”

She made a groaning noise and then her eyes opened, staring up at him in incomprehension while she blinked and took a deep breath. She frowned, and then she said: “Mitchell?”

He wanted to say something silly, like: Last time I checked, or Were you expecting your other boyfriend?, but he just couldn’t muster his sense of humor. Instead, he kept his hand on her face and then reached down and found hers with the other, squeezing. “Hey, are you okay?”

Someone knocked on the door, and Liam cracked it open to see who it was.

“I was in a meeting,” she murmured, looking confused. 

“It’s Mark,” Liam said. 

“Go out and let him know she’s okay, I don’t want more people crowding in here. Then go make excuses for me in my office,” Mitchell requested.

“Of course, got it. Feel better, Larissa,” Liam said before closing the door. 

“What happened?” Larissa whispered, her eyelids fluttering even as her eyes roved around the room.

Kieran had stopped sniffling, and she looked over at Mitchell. “She seems really out of it this time.”

“Agreed. Clear her schedule for the rest of the day, and one of us will let you know about tomorrow.” 

“Of course, sir,” she said, climbing to her feet.

“And thank you for being so caring, Kieran. I appreciate it.” He looked down at Larissa, trying to decide if she could stand long enough for him to get her to the sofa in her office. 

“What happened?” Larissa asked again, her voice thick. “Mitchell?”

“You fainted,” he said. “In front of Kieran’s desk.”

“I finished the meeting,” she muttered, frowning. “I texted Mark, and let him say the goodbyes, and came down here. I wasn’t feeling right…”

He could see that her color was already improving; lips and cheeks pinking up. To his dismay, however, he saw tears well in her eyes.

“Would it be okay if I sat you up?” Mitchell asked, stroking her cheek. “I’m thinking you might be more comfortable on the sofa in your office, but let’s start with sitting up, okay?”

“Okay,” she said, nodding. He took his hand off her cheek and slipped it under her shoulders, lifting her upright. Her hair was mussed, fluffed up in the back like they’d been doing something much more pleasant. He smoothed it down for her and then leaned in to kiss her temple.

“How’s that?”

“Fine, actually. I don’t feel too bad.” She scrubbed her hand across her face and then said: “I could probably stand, if we’re just going into my office.”

He looked her over, decided she didn’t look any worse, and nodded. “Okay. On three? One, two, three…” He pulled her to her feet and wrapped an arm around her waist, letting her lean on him as they walked. He pushed the door closed behind them and sat her down on the sofa, dropping down beside her.

Larissa sagged against him, sighing. “I’m really tired.”

“I can tell.” He reached over and stroked her hair. “Do I need to take you to the hospital?”

“No,” she said. He felt her shake her head. “I might need a nap, though.”

“Would you like to lay down here for a while before I take you home, or do you want me to take you straight home?”

“Here, please. Then I can muster a public appearance for the staff on my way out the door.”

“Alright.” He helped her lay back, slipped off her shoes. He pulled the afghan off the end of the sofa and tucked her in, leaning over to give her a quick kiss. Even though she looked a lot better, he could still feel tension across his shoulders and the pounding of his heart in his chest. He took in her face and then said, clearly: “I love you.”

“Oh,” she said, her tired eyes going wide. “We haven’t said that before.”

“I know, I just—”

“I love you, too.” She pulled his head down for another kiss.

A few moments later, she was asleep. Mitchell sat in her desk chair, watching her doze, not quite able to shake the feeling that something was wrong.

Larissa, three months later

“How are you?” Mitchell asked, his arm brushing hers as they hiked up the trail.

“I’m good.” She chose, early on, not to be irritated by reasonable and solicitous questions such as these. He genuinely cared, and she genuinely needed him to care. She reached over and squeezed his arm.

“If you get too hot or something, just let me know. I can’t always tell just by looking at you.”

“I know,” she said. “It’s been a while, though. I’m just crossing my fingers that it never happens during a presentation.”

“I guess right after doesn’t count?”

“No, not since my client had no idea it even happened.”

“Ah, I see.”

She slipped her arm around his. “I am sorry. I was okay, I just needed a minute. Well, an afternoon. And it hasn’t happened since.”

“I know you were okay,” he said, his voice quiet. “But I wasn’t.”

She pulled him to a stop. She’d noticed recently that his hair had started to turn grey, at his temples and the outer edges of his eyebrows, and wondered if that was her fault.

“I’m sorry,” she murmured, reaching up to caress his face. “I didn’t mean to ignore your feelings.”

He leaned over and kissed her forehead, then her lips. “I love you.”

“I love you, too.”

They continued up the trail, chatting about everything except for her health, much to her relief.

“I expected more people to be here,” she said. “Though I’m glad there’s not. I suppose it’s because it’s a weekday.”

She opened her water bottle and took a long swig. She thought they were nearing the top; the plan was to see the top of the trail’s small waterfall and then hike back down and go for a swim in the pools at the bottom. She was enjoying the fresh air and the exertion; any chance to feel alive.

They hiked the last stretch hand-in-hand, neither bothered by sweaty palms. As they climbed the steps to the observation deck, the air grew cool and moist.

“Oh, that’s nice,” she murmured, leaning against the rail and turning her face toward the spray. She felt Mitchell lean in and kiss the back of her neck. “That’s nice, too.”

She closed her eyes and tipped her head back. He kissed her, his arms going around her body. Then he kissed down the side of her neck.

“I’m all sweaty,” she murmured.

“Mmm.” He nibbled on her ear.

“You’re going to get me all wound up and it’ll be hours before you can do anything about it.”

One of his hands ran down the front of her body and cupped her through her shorts. “There’s no one around.” She felt his tongue behind her ear.

He wasn’t wrong. They hadn’t seen anyone all morning. She leaned back against him and rolled her hips. He dropped the day pack he was carrying and turned her in his arms, his mouth hungry against her lips. His hands were everywhere, caressing the sides of her breasts through her top, grabbing her ass, tugging on her ponytail. She opened her mouth so he could plunder it with his tongue, ran her hands underneath his shirt.

He grasped her ass and lifted her, and she wrapped her legs around him. He walked them toward the far side of the deck, into the corner tucked behind a rocky outcropping. Mitchell sat her down on the deck and pressed her back against the rock, reaching between them to unbutton her shorts.

She felt his hand slide inside her shorts and bathing suit bottoms, his fingers lightly tracing her folds to test her readiness. Then he broke the kiss and lowered himself to his knees, his hands pulling her shorts and suit bottoms down to her ankles. She stepped out of them, leaving her bottom half exposed to the sunshine.

He placed his hands on her inner thighs and encouraged her to widen her stance before he leaned close and put his mouth on her, licking her clit with the flat of his tongue. She flinched and drew in a deep breath, tipping her head back against the rock.

He licked her with several long strokes before fastening his lips over her clit and sucking. Two fingers slid inside her and curled, pumping in and out. She moaned and leaned back against the rock.

After a few moments, once she was panting and writhing against his hand, he withdrew his fingers.

She watched him strip off his shirt and lay it on the decking, then he pulled her down, his mouth seeking hers. She spread her legs wide as he laid down on top of her. He didn’t bother removing his shorts; he pulled his erection free and then slid himself inside of her.

They didn’t last long. Larissa wrapped her legs around him and met him thrust for thrust, moaning each time he bottomed out. He slid his hand between them, circled her clit with his thumb. She felt herself tighten, the pleasure coiling inside her almost painful in intensity. Then her back arched off the deck and she cried out, her muscles clenching hard around him. A few seconds later, she heard him groan and felt him pulsate inside of her.

They laid there for a moment until he stirred, kissed her, and helped her to her feet, a broad smile on his face. She pulled on her suit bottoms and shorts, grinning back at him as he pulled his shirt over his head.

“Ready for a swim?” he asked, retrieving his pack and reaching for her hand.

She took a deep breath, relishing the fresh smell of the air and the well-used feeling between her thighs. She could feel him leaking out of her as she walked.

The trail for the swimming hole branched out from the main trail, quickly descending toward the water. By the time they got to the flat rock along the edge, they were racing to take off their clothes and shoes. Mitchell won, stripping down to his swimming trunks and creating a big splash as he jumped in. Larissa approached the edge of the rock in her two-piece and stood there for several seconds to give him time to appreciate the view before she jumped in after him.

The water was significantly cooler than the air temperature. She popped back above the surface, sweeping water out of her eyes and grinning. “God, this water feels good!”

They spent a while splashing each other and swimming around. After a while, she clung to a rock, idly treading water with her feet. “How deep is this, do you know?”

“I read that sign outside the bathrooms when we got here,” he said. “It’s almost 12 feet deep.”

She watched as he climbed out and padded over to their pack. As he walked, she realized the air was filled with strange, little colored dots of light. She blinked her eyes and tightened her grip on the rock. Mitchel spoke, but she didn’t catch what he said.

Despite the cool water, a wave of heat rolled up from her navel and burned into her hairline. Her face began to tingle and the colorful lights bleached to white.

Dammit. “I need to get out,” she mumbled. There wasn’t a good spot to climb up from where she was. She released the rock, intending to swim back across, when she felt her body stiffen and a blackness descended over her consciousness.

Mitchell

Taking a swig from his water bottle, he reached into his pack, feeling for the small box stowed in one of the smaller pockets. He’d wait until they were out of the water; he’d wanted to propose at the top, but thought she’d be reluctant to wear the ring in the swimming hole.

“Are you thirsty?” he called out.

He couldn’t make out her response, so he zipped up his pack and turned to look.

He was just in time to see her push away from the rock. Then she went stiff, bowing back in the water as her eyes rolled back in her head. To his horror, she sank like a rock.

His water bottle hit the boulder with a clang, and he ran forward and jumped in after her. The cold water closed over his head and he opened his eyes, looking wildly around him. It took him longer than he wished to find her; she’d descended faster than he expected. She was ghost pale when he saw her, limbs jerking as though she’d regained consciousness and was trying to swim. He swam over and grasped her wrist, pulling her close and then heading for the surface.

He realized his mistake when they broke the surface; she wasn’t swimming, she was seizing. He wrapped his arm around her chest and tipped her head back against his shoulder, trying to keep her face above water while he swam with one arm to the lowest section of rock he could find.

Getting her out was difficult. Initially, she convulsed against him, throwing him off balance as he tried to haul her out of the water. Then she went limp.

He finally pulled himself out, keeping a grip on her upper arm, then dragged her out after him. Her body was limp, her head lolling. He was breathing hard as he cradled her head, lowering her to the flat surface of the rock. 

“Larissa!” He tipped her head back and leaned his ear close to her mouth, resting his hand on her chest. He took a few steadying breaths to calm himself and held his own breath, waiting.

She wasn’t breathing, and when he pulled back, he could see that she was already going gray. He leaned over and pinched her nose, inhaling deep and pressing his mouth over hers to make a seal. Then he breathed into her.

He felt resistance, but her lungs inflated. Her chest rose under his hand, and fell when he broke the seal.

“Come on, baby…”

He pressed his lips to hers again. They felt cold, but he told himself it was due to the temperature of the water. Her chest fell, and he pressed his fingers to the pulse in her throat. His own heart was pounding so hard he couldn’t tell if what he felt was her pulse or his own. He was afraid to wait until he was sure.

“Don’t do this, Larissa!” He clasped his hands together and pressed them between her breasts, eyeballing the correct spot. Then he pushed down, hard. Her chest gave under his hands, her large breasts threatening to wobble out of the cups of her top. “One, two, three, four, five, six…”

He heard a deep gurgle from her lifeless body, and a small amount of water trickled out of her mouth. Her stomach was distended, made more evident by his compressions, which caused her soft abdomen to quake. “…twenty-one, twenty-two, twenty-three, twenty-four, HELP!”

He finished the round of compressions and gave her a breath before he stretched back, snagging the strap of his pack and dragging it closer. Another breath, and then he dug his cell phone out. No service. 

Foam bubbled inexorably from her nose and mouth, pouring out onto the rock.

“Fuck!” He shoved his hands back between her breasts, pounding mercilessly, so hard her body made a rhythmic gagging sound and her head flopped to the side, a gush of water streaming from her mouth. “…ten, eleven, twelve...”

Preserve brain function until help arrives. But no help is coming. Jesus, please start breathing!

“…twenty-two, twenty-three, twenty-four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty!”

Another breath, and then he looked at her phone just in case, to no avail. More foam was welling up out of her nose and mouth. He forced another breath past it.

“HELP!” he shouted. Now, he regretted the lack of strangers on the trail. 

“One, two, three, four, five, six, seven…” Her eyes were closed, her unresponsive body taking his assault hard. Every compression forced a wet gagging sound from between her lips. Another spurt of water escaped her mouth, sweeping away the foam. “Please, Larissa, please don’t die…”

He turned her face upright and sealed his mouth over hers, breathing for her. Then sucked in another breath and screamed: “HELP!”

Her limbs flinched, head rolling back to the side as her throat worked. Mitchell gasped and bent close, cupping her face in his hands. “Larissa! BREATHE!”

He stared at her for several seconds and then straightened her head and gently opened her airway. He gave her another two deep breaths, then reached down and pressed his hand hard into her abdomen. Her chest heaved and she started gagging, water and foam coming out of her nose and mouth. He rolled her onto her side, fingers grasping for her jaw so he could point her face toward the ground. She coughed up and vomited copious amounts of what appeared to be mostly water. He checked her mouth anyway, terrified that she would choke.

“Just breathe, Larissa. Breathe, baby!”

She seemed to retch and cough for a long time before her breath came regularly, chest heaving and lungs wheezing. He moved around so he could see her face. Her eyes were still closed, and her mouth hung open. He could see a fresh bruise forming between her breasts.

“Larissa, can you hear me?” He ran his thumb over her cheek. “Wake up, Larissa, please!”

She didn’t respond.

--

Part Two

[science-lover33]

Unveiling the Marvels of Neurological Development 🧠✨

Hey, Tumblr fam! 👋 Today, let's embark on an exhilarating journey deep into the captivating realm of neurological development. 🌟 Buckle up because we're about to delve into the intricate science of how our brains come to life! 🧠💡

Embryogenesis Essentials:

Our journey begins during embryogenesis, the magical phase when the neural tube takes center stage. This seemingly simple structure holds the key to the brain's future complexity, as it gives rise to the brain and spinal cord. 🤯 Picture it as the canvas upon which the brain's masterpiece is painted. 🎨

But here's where it gets truly extraordinary—neurogenesis. Think of it as the birth of neurons, those remarkable cells forming our nervous system's building blocks. They multiply and differentiate, creating a neural orchestra that will play throughout our lives. ⭐️✨

Synaptic Wonders:

Fast forward to synaptogenesis—the symphony of the developing brain. Neurons extend their tendrils and engage in a breathtaking ballet of connection-making through synapses. 💃🕺 These connections aren't just beautiful; they're the basis of our cognitive abilities. These intricate connections that evolve with us make every memory, skill, and thought possible. 📚🧠

As if that's not mind-blowing enough, consider this: By the time you're a toddler, your brain has formed trillions of synapses! 😲

A Lifetime of Adaptation:

What's truly remarkable about the brain is its resilience and adaptability—neuroplasticity. This is the brain's way of staying forever young, constantly reshaping itself in response to experiences, learning, and even injuries. It's like a never-ending renovation project, sculpting our brains according to life's blueprint. 🏗️💡

So, whether you're fascinated by the intricacies of embryogenesis, the enchanting dance of synapses, or the resilience of neuroplasticity, remember that our brains are living works of art in constant creation. 🧠✨

Feel free to dive into these references to explore the scientific wonders behind neurological development! 📖🤓 Got questions? Drop 'em in the comments! Let's unravel the mysteries of the brain together. 🌌🤝

References

Kostović, I., & Judaš, M. (2010). Embryonic and fetal development of the human cerebral cortex. Brain Structure and Function, 213(6), 111-128.

Huttenlocher, P. R., & Dabholkar, A. S. (1997). Regional differences in synaptogenesis in the human cerebral cortex. The Journal of Comparative Neurology, 387(2), 167-178.

Thompson, B. L., & Levitt, P. (2018). The clinical-radiological spectrum of perinatal hypoxic-ischemic encephalopathy. The Journal of Pediatrics, 192, 16-19.

[luna-rainbow]

I saw this great reference post recently about medical conditions. It has a lot of useful information about initial first aid. I wanted to add some comments about urgency because a lot of fics take place outside the hospital setting and it's helpful to know how quickly you've got to get your character to medical help before they die. I also wanted to add something about long term disability because I think fiction often doesn't address chronic illness and injuries, but it's useful to know about if your character doesn't have magic serum healing powers. (I didn't want to add directly onto that post because they had clearly spent a lot of effort on the research and I don't want to come across like I'm raining on their hard work)

Also got requested for stab wounds and falls from heights =) Going to start with a little spiel on brain injury because it will come up a lot.

Brain injury There are different types of brain injury and they present differently depending on the areas of the brain affected. Traumatic brain injury comes from acceleration-deceleration, and typically have issues with mood control, attention/concentration and decision-making/problem-solving. This is the type that comes with amnesia of events before, around and after the injury, but particularly after. Hypoxic brain injury is when the brain didn't get enough oxygen, and is typically associated with breathing issues (drowning, suffocating, hanging, anaphylaxis). Memory may be affected, but don't have the classic course that traumatic brain injury go through. Hypoperfusion brain injury is usually due to a blood supply problem, and is typically from heart issues or low blood volume. These often affect deep territories of the brain and can have a variety of very localised and sometimes unusual symptoms, but can also present like hypoxic brain injuries. There are also a bunch of other acquired brain injury syndromes from strokes, bleeds, tumour, inflammation, etc etc and they all affect the person in different ways.

Stab wounds - Deadly? - depends what you hit, how quickly that area bleeds, and how long it takes for them to get help. Fatal within seconds/minutes: hitting any major artery/organ that results in blood released outside the body: neck (carotids), groin/thigh (femoral), chest (aorta and heart). While veins usually bleed slower, hitting major veins (groin/abdomen/chest) can also kill quickly. Likely to be fatal within an hour or two: major organs with a lot of blood supply (e.g. liver, kidneys, spleen, lungs), the aorta - there is a buffer because they tend to bleed first into the body cavity. Depending on the cleanliness of the knife, environment and whether you perforate the gut, infection can kill them down the track (days). Stabbing into muscle and fat is not usually going to cause death by itself unless you hit a blood vessel. - Disability? - depends on what was hit. Not enough is said about lacerated muscles and tendons. Especially around the hands and wrist (e.g. when people hold up their hands for defensive wounds), this is not easy to repair and you may not regain all your hand function (screw all the samurai movies where people catch blades one-handed, don't do it!). If an organ is hit, part or all of it might need to be removed to stop the bleeding, which causes long term problems. If the gut was perforated and infection happens in the abdomen, this usually means lots of surgeries and lots of gut problems down the track. Scarring, disfigurement, pain, body image issues (and PTSD) can all happen.

Fall from height - Deadly? - really depends on the way a person falls and what they land on. People have died from getting punched and falling backwards onto the ground from standing height. The highest fall survived was 10km but the vast majority will not be this lucky. Statistically, the 50% survival rate is at about 4 storeys (15m) while heights above 18m (?about 6 storeys) are almost uniformly fatal. What usually kills them is either going to be massive internal bleeding or brain injury. - Injuries - determined by which part they land on first. Common injuries are: leg fractures (usually ankles and hips), pelvic fractures, spinal fractures, rib fractures and skull fractures. Arm fractures can also happen, especially if they land heavily on one side or they try to break their fall with their hand. In general, internal injuries are correlated with where the bony injuries are. So rib fractures will usually be associated with lung bleeding or pneumothorax (air in the space between lung and the lining), or liver bleeding (the lower ribs on the right side overly the liver). - Disability: apart from the issues with fractures and severe traumatic brain injury (discussed below), spinal fractures can (but doesn't always) cause spinal cord injury - i.e. damage to the nerves going from the brain to the rest of the body. Spinal injuries can be complete, or incomplete (and uh...it's like a massive topic by itself so I won't go into it), and comes with a huge laundry list of complications and life-changing challenges with breathing, blood pressure management, skin problems, bladder and bowel issues, and sexuality issues. Bad pelvic fractures can also come with a lot of bladder, rectal and genital issues.

Allergic reaction - Deadly? - no, unless it is anaphylaxis. It can be very annoying or even (temporarily) disfiguring from the swelling and redness - Disability? - most allergies recur (some get better with age some get worse), but allergic attacks alone do not usually leave permanent disability.

Traumatic Amputation - Deadly? - depends on the level and how long you take to get to medical help. Small appendages (fingers/toes) are okay unless they get infected in the coming days. The higher the amputation on a limb, the higher the risk of severe bleeding, and you'd need to get to medical attention within hours at most. Above knee amputations with femoral artery bleeds can pour out your entire volume within minutes. - Disability? - Yes. Even as small as fingers and toes will affect your ability, although humans are very good at adapting. Thumb amputations are a major problem because you will lose your grip. Losing the big toe will affect how your foot pushes off from the ground and can impact your walking. Lower limb prosthetics are much easier to adopt than upper limb prosthetics, and the higher the amputation, the harder it is for the prosthetic to be attached and used. Also...watch out for PTSD/psychological distress and phantom pain. - Notes: most fics wouldn't need to describe these in detail, but traumatic amputations are...for lack of a better word, traumatic and messy. They often do not amputate completely. They are often associated with multiple fractures along that limb. In hospital, the doctors will assess whether they can reattach the amputated part, but often there is extensive damage to the blood supply and nerves around the area, and a surgical amputation has to be done higher up.

Anaphylaxis - Deadly? - YES. Get that epinephrine/adrenaline in within minutes or they die. - Disability? They will need to be aware of their trigger and carry the Epi-Pen with them. If the anaphylaxis is treated quickly, there's usually no lasting effects. If the anaphylaxis is treated late and they lose consciousness or even, god forbid, arrest, they can have long-term effects from hypoxic brain injury.

Asthma - Deadly? - Potentially, depending on the severity. - Disability? - Yes. Apart from needing to carry their puffers, the severe asthmatics sometimes have to go on long-term steroids, which causes a whole host of problems with weight, appetite, bone health, skin health etc. If it's severe enough to need ICU (rare, but possible), then they might end up with hypoxic brain injury. - Notes: poor lungs is something that can permeate every aspect of life. Getting an attack when you go for a run in the cold, getting short of breath walking up the stairs, getting wheezy when you help move a couple of heavy furniture etc. In describing an asthma attack - a key is how much they can speak. The one holding a full conversation with you is going to be fine. Watch out for the one sitting silent on the edge of their bed, leaning forward with their arms propping them up by their sides (tripod position), their neck and chest muscles straining with every breath, who can only answer in single words.

Blood loss - Deadly? - Potentially - the previous post had a good rundown of the volumes involved. - Disability? - Potentially. Again, no blood for brain, brain sad. Mechanism is going to be different to anaphylaxis and asthma though, which are from low oxygen. With anaemia and shock, it can cause infarction (i.e. death of cells in area that didn't get blood supply) in deep parts of the brain. - Notes: people can tolerate horrendously low blood (haemoglobin) levels if it's from a chronic illness (e.g. lymphoma). In acute blood loss though - the person is going to get dizzy with standing up abruptly (might even faint), they might see black spots, feel short of breath and tired, start feeling cold more easily, walking unsteadily and probably trouble concentrating. Note that blood loss can occur internally! Also note that not everyone can receive blood transfusions for biological and for cultural reasons.

Broken bones - Deadly? - Trick question. The fracture is rarely going to kill you outright but the complications might. High impact pelvic fractures in particular can cause massive bleeding and kill (usually within hours). There are also other potentially deadly complications which I won't go into. - Disability? - Depends on severity, yes. A fracture where the bones are well aligned usually heals fairly well; poor alignment can come with visible physical abnormalities. Hardware across joints will restrict joint movements (common for ankle and spine fractures). A really bad compound or comminuted fracture may never heal properly and be a constant source of pain. Also the complications can cause lots of disability! - Notes: bad fractures will distort the anatomy around them, so it can affect the nerves or the muscles. Good young bones will usually take 6-12 weeks to heal enough for normal use. Old fragile bones will take much longer. In the immediate period, any force on the broken bone will hurt - so that's any attempted movement by the injured person, as well as gravity! Don't forget damn gravity! Also, in the first month it's common to get a lot of swelling and bruising in that limb.

Burns - Deadly? - Potentially, but you've got a bit of time (hours). In the early stage it's from the inflammatory reactions and severe fluid loss discussed in the original post. NOTE FOR SMOKE INHALATION IT CAN KILL RAPIDLY if the airways swell up (which might take a few hours, barring the issue with inhalation of toxic chemicals), so these people generally have to be monitored very closely for 24 hours. - Disability? - For the severe burns, potentially lots. Scarring across joints means a lot of movements get restricted, so anything involving hands and rest of limbs are going to be a problem. Large area burns also affects your ability to regulate temperature. Again, don't forget PTSD/psychological distress, particularly if scarring is highly visible.

Concussion/Traumatic Brain Injury - Deadly? - Potentially. Depends on where it's bleeding from. For some people it can kill them within minutes, for others within hours or days. - Disability? - Potentially. As the original post said in another section, head injury is divided into mild, moderate and severe. Most mild head injuries (aka concussion) recover completely within 3-6 months if not earlier. Moderate and severe traumatic brain injuries will often have long term effects on: mood, thinking skills, social skills, communication skills, seizures, headaches. - Notes: watch out for the person with a "blown pupil" (pupil/s not contracting) they will die within the hour if they don't get medical attention. Also watch out for the "lucid interval" for a particular type of head injury bleeds - these are the ones who walk around like normal after a hard knock to their head and are found dead in their beds the next morning.

CPR - the only thing I want to add for CPR is that for someone who needs CPR in the community (i.e. not a hospital setting), chance of getting their pulse back is 1 in 3, chance of them making it to hospital alive is 1 in 5, chance of them surviving the hospital stay is 1 in 10. (source) These are not great odds!

Dehydration - symptoms are very similar to blood loss (apart from the obvious lack of blood squirting out) but usually develop over a period of hours to days. Because it's a much slower process, it's more likely to kill you from kidney failure than from poor blood flow to the brain.

Heart attack - nitpick on the original post but heart attack is not cardiac arrest. Cardiac arrest is exactly as the words say: "heart" "stops". A heart attack is usually referring to myocardial ischaemia - i.e. low blood flow to the heart muscles. - Deadly? - a massive heart attack will cause the heart to stop so...yes. A smaller heart attack can kill within a few hours to days by causing heart failure (i.e. heart not pumping out blood properly), an even smaller one may not cause any obvious symptoms but will build up damage over time. - Disability? - yes. Just like with lungs, a bad heart will affect all aspects of your life. Walking around the house, having a shower, running up the stairs, going for a walk up the hill, having sex. If there is any period where the heart has stopped, it can also cause brain injury.

Loss of consciousness/syncope - Look. As much as fiction tends to depict people swooning all the time, it is not supposed to happen on the regular. Anyone who faints needs to be seen by a medical doctor. The only benign cause of loss of consciousness is a "vasovagal attack", which is where they (usually young women) drop their blood pressure because it's been a long hot day and they didn't have much to drink and they got excited and stood up too quickly. - Loss of consciousness happens because of 3 reasons: interruption of blood flow to the brain (strokes, heart attacks, heart rhythm problems, blood loss, massive clots in lungs), electrical problems within the brain (seizures), or crappy blood getting to the brain (toxins and medications) - The underlying cause will dictate whether it is likely to cause death or disability

Shock: This is when your entire body isn't getting good blood supply for whatever reason. This includes your brain, which means most people either become confused or lose consciousness by this stage. Will kill within the hour (depending on underlying cause) if not treated, and can still cause damage to multiple organs even if treatment started.

Stitches: erm...there are different types of stitches. The original post talked about interrupted stitches. There IS a type of suturing called continuous stitches, which is when you sew using one continuous thread and pull the wound close like you might fabric. NOT ALL WOUNDS ARE SUITABLE FOR THIS, but it is fairly common in some surgeries. Wounds can also be closed by staples.

[ae-azile]

So, I usually prefer AO3 for reading and writing, but decided to make a Wattpad account to post my stories across multiple platforms. Starting with Giant Dancing Hedgehogs are Nightmare Fuel!

Summary of Giant Dancing Hedgehogs are Nightmare Fuel:

There are several scenarios that Pete suspects to walk in on when he arrives back at the hospital:

Scenario 1: Vegas is still asleep and Macau and Tankhun have somehow managed to remain civil towards each other. This seems like the least likely scenario.

Scenario 2: Vegas is still asleep and Tankhun has tied Macau to a chair for the hell of it. While this would cause a great amount of trouble, it is almost comforting in its normalcy.

Scenario 3: Vegas has woken up and spilled every single secret that he has in his drugged up state, leaving him even more vulnerable than ever.

Scenario 4: Macau has killed Tankhun in a fit of grief stricken rage, which causes Arm, in turn, to kill Macau in a fit of grief stricken rage, since Arm and Tankhun are apparently in love and Pete can’t stop thinking about it.

Scenario 5: Tankhun has verbally attacked drugged up, pod person Vegas, which has caused him to burst into tears and pull out his IV, in hopes that he bleeds out.

It’s none of those things. Those things would be expected. Nothing happening right now is expected.

Some people love detailed spoilers and some people hate them. Stop reading now if you want to go in spoiler free.

SPOILERS BEYOND THIS POINT

Some themes of this story include:

1. Post-Canon: It accepts pretty much everything that happened up until the one month later epilogue in the finale.

2. Trauma: These characters are TRAUMATIZED. They are traumatized by the night of the attack, they are traumatized by their pasts and being abused/manipulated/gaslit, and they are all collectively traumatized by Korn. And Gun. But Korn is the real villain in this series.

3. Recovery: This primarily applies to Vegas, but also to other characters. Vegas is recovering from a coma and significant injuries. One is a hypoxic brain injury, which makes his autism a bit more apparent and something Macau eventually explains to Pete.

4. Autistic Vegas: In this story, Vegas has autism. He is low supports needs, intelligent, and his autism mainly becomes apparent with sensory processing, emotional regulation, and a little with social cues. His symptoms were more apparent when he was a child, but he learned how to mask. He struggles with masking more after coming out of his coma and pushes Pete away due to this, along with his guilt from his actions. Pete eventually talks to him bluntly and Vegas accepting his autism as part of his identity is something he works on through this fic.

5. Amnesia: Pete and Vegas have a history that goes much farther back than some funny run-ins and the safehouse. While Vegas has been pining for Pete for years, Pete forgets their friendship/sort of relationship due to being attacked on the job, resulting in a TBI and amnesia. This gets out when Vegas asks him if Pete remembers Vegas having a crush on him when they were young.

6. Cousin Reconciliation: Tankhun takes this first step in making amends with Vegas with Arm's support. Kim follows. Kinn gets there.

7. Side Couples: ArmKhun are the supporting lead couple. They are probably the healthiest couple in this series and have their own prequel story on AO3 that is longer than this story. Something to note: Tankhun protected Vegas during their kidnapping and was physically and sexually assaulted. His "hatred" for Vegas stemmed from resentment and trauma, which broke Vegas's heart because he genuinely loved and looked up to Tankhun as an older brother figure. Tankhun held onto that resentment for quite some time, but he also held onto a lot of guilt. When he saw Vegas shot over the security cameras, he was devastated. He - along with Arm and later Porsche - were the ones to get Vegas quick treatment and transferred to a good hospital. Arm is also a victim of abuse in this series. This is one of the main reasons why Tankhun chose him - along with Pete and Pol - as guards. They understand, they won't judge him, and he hopes they know he doesn't think less of them either. Arm is very aware of why Tankhun chose them and sees Vegas as a victim too (without knowing the abuse Vegas faced later on). He accepts and encourages the reconciliation because he loves Tankhun and knows it will bring him peace. Tankhun, Arm, and Kim are also discovering the kidnapping may have been ordered by someone close to them as damage control/retaliation.

KimChay are at odds but co-existing while Kim visits Vegas (+pines for Chay) and Chay hangs with his new bestie Macau (while holding a grudge against Kim). Kim is kind of going through it and arguably on the brink of a mental health crisis. He is also yearning for a connection with his brothers and cousins, especially after learning how much Korn put them all through. Chay has a bigger role in the sequel of this story, but he is forming a brotherly bond with Macau, is expressing how wronged he felt by both Porsche and Kim, yet is trying to support people in the ways he knows how. He also struggles with connecting to his mother, who can't communicate and doesn't seem to remember him.

KinnPorsche have a LOT on their plates in this series. Porsche has been thrusted into a role that he never expected or was trained for and is overwhelmed. He harbors hate for his boyfriend's father for keeping his mother away from him and for all of the lies. He is also worried about Kinn, who is feeling excluded from his brothers spending time together without him for unknown reasons. Kinn also carries a lot of confliction and resentment regarding his father's actions. He feels incredibly guilty and is going through mental health issues of his own.

8. Macau is very active in his brother's care and extremely protective of him. In turn, Pete protects Macau and is a good listening ear. Macau accepts Pete as family before Vegas even wakes up.

9. The Mothers: The mothers and how the boys' lost them are covered in this fic. Vegas was greatly impacted by the loss of his mother. She was his best friend and advocate. Losing his other parent and hearing of Porsche's mother bring up feelings of loss, sadness, and grief. He misses her terribly. Tankhun and Kim suspect that Korn had their own mother killed and are not surprised to hear that Vegas feels that Korn had something to do with his mother's death.

10. Crack!fic: These issues are covered seriously and treated with respect. That being said, this fic is a total crack and humor fic when it isn't doing that. Vegas says "I love you, Pete" 62 times within the first week of being awake because he can't stop saying it due to his brain injury and possible echolalia. Kim randomly starts calling Arm and Tankhun Pa and Dad, then never stops. He also tells fortunes by asking his friends and family to choose a Nintendo Switch and analyzes them by which color the choose, and his reads are extremely accurate. Due to obtaining Nintendo Switches, Arm and Tankhun run a farm together on Stardew Valley. Vegas has to be redirected away from Pokemon since he cries every time his Pokemon faint in battle. Kim tries to woo Chay by obtaining blue roses on Animal Crossing, all while Chay won't invite him to his island but will invite Vegas to give him starter crops and supplies. Pete buys Vegas a weighted blanket, something the whole family loves until it becomes sentient and starts hinting to a chosen few of their futures. Or, Pete's case, it gives him trippy dreams that always feature his boyfriend's mother.

This story is available both on AO3 (along with WIP companion stories). It is also now on Wattpad. Hope you enjoy and feel free to ask me any questions about this weird universe or for headcannons about it! Also open to prompts 🙂

[wandering-night19]

Just found your blog based on your new fic, which I loved! I was most excited by the medical accuracy knowledge. Do you have any old posts or thoughts about the medical accuracy for Danger Magnet Strand’s NDEs? I know the show is A Bit Not Good with that. I can’t find anything useful on recovery from severe hypothermia and it is driving me nuts.

I could literally write a dissertation on how terrible the medicine in this show is, but I will do my utmost to keep from doing that. Everyone at work makes fun of me, but I fell in love with these damn characters.

The shooting drives me absolutely crazy. “Well, it missed the subclavian artery, so he’s fine!” No. Absolutely not. He would at the very LEAST need physical therapy. It’s his shoulder! Do you know how much is happening up there??? Here have a picture... (under the cut because I am long winded)

TK would’ve come in as a trauma alert GSW to the chest. His chest!!! And he’s back at work in 10 days??? No!

I’m assuming they had him in a coma as a result of hypovolemic shock? I don’t know. It remains unclear. But that boy literally only had a nasal cannula the whole time? At the MINIMUM he would’ve come out of surgery with the following:

Art line

Central line

Temp sensing foley

NG/OG tube

AT THE MINIMUM 1 chest tube. Probs more tbh.

But I digress. You’re here for severe hypothermia. And boy do I have some THOUGHTS on this.

First of all, ECMO started in the back of a rig??? No, fucking way.

But this is supposed to be about TK, so…

You’re telling me this kid ran naked out into negative degree temperatures and rolled around on the frozen ground and there wasn’t any frostbite? Ha!

Let’s start from the beginning. So the call to the ER for TK would be traumatic arrest with ROSC achieved in the field. He should be intubated before he arrived, but this show doesn’t care about intubation. So let’s say they bag him all the way to the hospital.

When he arrives in the ER he’d be taken to the trauma room and 8 million things would happen at once. The first thing would be intubation. If a patient is intubated they need (at the very minimum) the following:

Sedation and paralytic medications

Central line

Art line

Temp sensing foley

OG tube

Because of the severe hypothermia his temperature would be monitored with a nifty esophageal thermometer. While the temp sensing foley gives bladder temp it’s behind until he’s warmed up enough.

He would also get warm IV fluids and peritoneal lavage, which is where we poke a hole in your tummy and introduce warm fluid that way. He’d also get the bair hugger which is a fun little plastic blanket type thing that inflates with warm air. (We break out the machine on night shift and put it at the nurses station. Best thing ever invented.)

Labs would be drawn and be all over the place because ice blood!! We’d probably be able to get him up to an ICU bed in an hour or two. I’d say he’d be a 1:1 for whatever ICU nurse gets him just because with all the monitoring for the first few hours it’s be impossible to get out of that room. If the nurse was 1:2 with a patient like TK the other patient would (re: should) be an easier patient. But in this post COVID world that ain’t happening. 😂

Recovery would be a verrrrrrry long road. With concern for arrhythmias and hypoxic brain injury and muscle atrophy. And then just soooo many other things. And the reason you can’t find anything useful is probably because TK would’ve died in the real world. Not a lot of people come back from that.

So this got away from me. I’m sorry. Here have some links.

This is a great article about hypothermia

And here’s a video of an actual hypothermic patient being treated in the ER so you can see all of the equipment that would be needed.

Obviously, I love to talk medicine. My inbox is always open for this. Just be prepared for me to go overboard. Sorry.

No idea if this helps or not. 🤷‍♀️

[daz4i]

You could also end up in a position with your neck cutting off blood flow to your brain but not enough to kill you and unable to wake from it because of the enhanced sedation until it wears off hours later and then you have a hypoxic brain injury and potentially lose the ability to walk again as well.

Source: had two patients over my career with some variation of this from benzo abuse or mixing benzos with another sedative. Both young people as well.

Please consider being careful.

too late 👍 i guess we'll see

[killed-by-choice]

Maria Santiago, 38 (USA 2013)

In 2013, 38-year-old Maria Santiago underwent a legal abortion in Baltimore. The abortionist was Iris E. Dominy, who later admitted to police that Maria lost consciousness and went into cardiac arrest during the abortion.

Maria was approximately 12.5 weeks pregnant when she and her baby were killed. The abortion facility was actually a space located in a residential condominium building. An inspection conducted by the Maryland Department of Health on February 20, 2013 discovered that Dominy left after the abortion and the unconscious Maria was alone with someone who was not medically trained and completely unqualified to monitor a patient.

After filling out paperwork for a while, the unqualified worker yelled for someone to come put clothes on the still-unresponsive Maria and mover her to the recovery area. The employee who answered the call noticed that Maria wasn’t breathing.

Not one single person at the entire facility had CPR training. The crash cart sat in the hallway and was not used. In fact, the defibrillator was broken. The abortionist propped Maria up and rubbed her sternum, which was not CPR and did not revive her.

Nobody even knew how much time had passed since Maria’s last breath because she was not given monitoring or medical support. She was taken to the hospital where she died. According to the death certificate, she was killed by severe pulmonary edema, Acute Respiratory Distress Syndrome, and hypoxic brain injury.

Dominy received a reprimand from the medical board and was placed on probation until 16 hours of continuing education classes in sedation and monitoring would be taken and verified. She was also prohibited from administering sedation until the board issues its specific approval, but is otherwise allowed to continue practicing medicine… if you could call what she did “medicine”. To many, it seemed like a slap on the wrist for the death of Maria.

(Dominy’s reprimand from the Medical Board)

(License suspension—Panah)

(license suspension—Basco)

(911 call and police report)

(Health inspection)

[bpod-bpod]

Natural Healing

Many of our best medical treatments are based on boosting the body’s natural capacity for recovery. So understanding the in-built responses activated during hard-to-treat conditions might point towards new approaches. Hypoxic-ischaemic brain injury is a common cause of disability in newborns that comes from a temporary block of the blood supply to the brain, and current treatments are limited to cooling babies down. Now researchers have investigated the role of lactate – produced by muscles during hard exercise when oxygen levels are low. They found that mice lacking a receptor that lactate binds to barely recovered any brain tissue following the injury, but those with the receptor enlisted the restorative action of immune cells (green in the recovering section pictured) and cell cycle to spark new brain cell growth (pink) and partly repopulate the damaged areas. Harnessing this mechanism could provide a route to improving prospects for babies with hypoxic-ischaemic brain injury.

Written by Anthony Lewis

Image from work by Lauritz Kennedy and Emilie R Glesaaen, and colleagues

Department of Microbiology, Oslo University Hospital and University of Oslo, Oslo, Norway

Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)

Published in eLife, August 2022

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