#Respiratory Medicine

[aingopharma]

Introduction of Levosalbutamol Hydrochloride and Budesonide Inhalation Suspension

Managing respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD) often requires a multi-faceted approach. One such effective treatment option is the combination of Levosalbutamol Hydrochloride and Budesonide Inhalation Suspension. This blend of a bronchodilator and a corticosteroid provides relief from symptoms and helps control chronic inflammation. In this comprehensive guide, we’ll discuss the uses, benefits, dosage, and potential side effects of this inhalation suspension. Let’s explore how this combination can help improve respiratory health.

What is Levosalbutamol Hydrochloride and Budesonide Inhalation Suspension?

Levosalbutamol Hydrochloride and Budesonide Inhalation Suspension is a combination therapy used primarily for the management of asthma and COPD. The inhalation suspension combines two active ingredients:

Levosalbutamol Hydrochloride: Also known as levalbuterol, this is a short-acting beta-agonist (SABA) that acts as a bronchodilator. It helps relax the muscles in the airways, making it easier to breathe.

Budesonide: A corticosteroid that helps reduce inflammation and swelling in the airways, budesonide is essential for controlling chronic symptoms and preventing asthma attacks.

This dual-action approach offers both immediate and long-term relief, making it an effective treatment option for individuals with chronic respiratory conditions.

[ivflondon]

Anand Saggar | Expert Consultant in Clinical Genetics | IVF London

Discover expert genetic testing and treatment options with Consultant Clinical Geneticist Anand Saggar. Trust IVF London, the leading fertility clinic, for top-notch IVF treatments and personalized care.

[jtsmedicalcentre]

Unlock the secrets to healthy lungs! Dive into our latest blog where we unravel the complexities of lung infections, offering insights on treatment and prevention strategies.

Check out the Guide on lung infections, their causes, treatments, and preventive measures in this informative blog. Gain valuable knowledge on respiratory illnesses from expert perspectives. Meet best chest specialist, pulmonologist, ensuring access to top-notch care for your lung health.

[literaturepublishersjournal]

Clinical Images and Case Reports Journal 

About Journal

Clinical Images and Case Reports Journal (CICRJ) is a peer-reviewed indexed medical journal established Internationally which provides a platform to publish Clinical Images, Medical Case Reports, Clinical Case Reports, Case Series (series of 2 to 6 cases), Research and Clinical Videos in Medicine. Clinical image journal is a indexed journal accepting clinical images submission, journal of clinical images, journals publishing clinical images in medicine, clinical imaging submission journal and medical illustrations etc. Journal of clinical case reports publishes case reports in clinical medicine, clinical reports, journals accepting clinical case reports submission and journal of clinical cases. Journal of medical case reports publishing medical case reports, journals accepting medical case reports submission etc.

[daisiesonafield-blog]

Abstract:

Full article here

[mindblowingscience]

Researchers have witnessed two viruses – influenza A and respiratory syncytial virus – fuse together to form a single, hybrid virus.

While competition between viruses has been researched in some detail, this new finding provides researchers with an unusual example of one virus coopting another for its own benefits.

"This kind of hybrid virus has never been described before," virologist and senior author Pablo Murcia told The Guardian. "We are talking about viruses from two completely different families combining together with the genomes and the external proteins of both viruses. It is a new type of virus pathogen."

Continue Reading.

[science-lover33]

Exploring the Intricacies of the Respiratory System 🫁💨

Welcome to my Tumblr blog, where we embark on an exciting journey through the intricate world of human anatomy and physiology. Today, we're focusing our lens on the respiratory system – a wondrous network of organs and tissues that orchestrates the exchange of gases essential for our survival. So, fasten your seatbelts as we venture into the fascinating realm of respiration!

Anatomy of the Respiratory System: A Symphony of Structures

At its core, the respiratory system consists of a highly organized ensemble of organs and structures working together seamlessly. This symphony of components includes the nose, pharynx, larynx, trachea, bronchi, and, of course, the lungs. Each of these elements has a crucial role to play in the intricate process of breathing, ensuring our bodies receive a constant supply of life-sustaining oxygen while effectively eliminating carbon dioxide.

The Alveoli: Tiny Powerhouses of Gas Exchange

Now, let's zoom in on the alveoli, the star players in the respiratory system's performance. These microscopic air sacs, nestled deep within the lungs, are where the real magic happens. Through the process of diffusion, oxygen from inhaled air enters the bloodstream, while carbon dioxide, a waste product of metabolism, is expelled from the blood into the alveoli to be exhaled. It's here, at this cellular level, that the respiratory system's vital exchange takes place.

Breathing Mechanics: The Art of Inhalation and Exhalation

But how does it all come together? Breathing, a seemingly simple act, is a complex process guided by the contraction and relaxation of specialized muscles, primarily the diaphragm and intercostal muscles. These muscular movements manipulate the volume of the thoracic cavity, creating changes in pressure that facilitate the flow of air in and out of the lungs. Understanding the mechanics of breathing is fundamental to comprehending various respiratory disorders and their potential treatments.

Regulation of Respiration: A Symphony Conducted by the Brain

The respiratory system doesn't operate in isolation; it's under the watchful eye of our central nervous system. The medulla and pons, two regions of the brainstem, serve as the conductors in this symphony of breath. They continuously monitor factors like blood pH, carbon dioxide levels, and oxygen levels, adjusting our breathing rate and depth to maintain the delicate balance required for optimal body function.

Recommended Resources to Dive Deeper:

Book: "Principles of Anatomy and Physiology" by Gerard J. Tortora and Bryan H. Derrickson - This comprehensive textbook provides an in-depth exploration of the respiratory system, complete with detailed illustrations and accessible explanations for all levels of learners.

Article: "The Physiology of Respiration" by Stephen A. Ernst and John R. Helliwell - Published in the New England Journal of Medicine, this scholarly article offers an authoritative look into the physiological mechanisms of respiration, making it a valuable reference for those seeking in-depth knowledge.

Book: "Respiratory Physiology: The Essentials" by John B. West - For a concise yet informative journey through the key concepts of respiratory physiology, this book is an excellent resource, perfect for those looking to grasp the essentials of the subject quickly.

I hope this extended entry has sparked your curiosity about the intricate workings of the respiratory system. Feel free to reach out if you have any questions or if you'd like to explore another captivating topic in the realm of medicine and biology! 🌬📚

Here is my YouTube channel where you will find interesting videos, here is the anatomy and physiology of the respiratory system

Don’t forget to like, share and subscribe

[heardatmedschool]

“Sorry, we are going to have to steal him again. We’re having two intubations right now.”

Intermediate Care Unit doctor coming into med-surg to kidnap our respiratory therapist (again).

[help-im-a-medstudent]

You know you're in the right specialty when you spend a friday morning discussing and looking at the workings of an anaesthetics machine and drawing diagrams of sevofluorane vaporisers and that is a very enjoyable time

[bked0n-lorazepam]

"RSV"

The cold atmosphere surrounding the two men dampened the mood plenty, and the harsh coughs of the patient in front of them made it worse.

House had taken a case of a seven year old girl who hadn’t been able to walk since she was three. Whenever pressure was put on her left leg she would get a shooting pain all the way up to her spine.

No doctor knew why, other than that it was immovable and that she would probably never use it again. She and her mom had come into the clinic due to a respiratory infection, and House found her background ‘interesting.’ 

After a plethora of examinations and not-so-legal operations, he and his team found a tumor in her calf and in the middle of her spinal cord. How all of her other doctors missed them baffled the man, truly.

But that was how he was now sitting next to the girl showing her magic tricks as Wilson discussed with her mom possible treatments. 

“We could remove them and the dead tissue that surrounds the tumors, but it’s a tough and long operation that doesn’t have the highest chance of working.” Wilson stated lowly to the crying woman.

“How high?” She choked out, wiping her eyes with a tissue.

“A good, twenty-percent chance.” He estimated and thought about the severity of the girl's illness. “Her respiratory infection also doesn’t help much in the process, but if we don’t take those tumors out now, they might not be able to come out at all.”

The mother looked over at her daughter and watched as House pulled out a card from behind her ear, and then she saw him flick the girl’s forehead when she said it was the wrong card. Her mother laughed slightly, and then looked back at Wilson.

“Where do I sign?” Wilson smiled at her words and nodded to the door, “I’ll show you the reception.”

=======

The woman came back to the room and hugged her daughter, kissing her forehead. “Are you ready to get better, sweetie?”

The girl nodded her head and grinned, a tear falling from her eye.

Wilson walked in and snorted at House, who had fallen asleep in the chair with cards spread out all over him. 

“House.” He called out to the man, repeating it louder again. House still didn’t wake up, and Wilson scoffed before looking at the girl and the woman. 

“It’s about to get a little loud.” He warned them before he stood in front of the girl and offered his hand out. She took it, and he used his other to take off a cord that connected her to her heart monitor. It beeped loudly, repetitively, and House jolted awake. 

“Huh?”

“Welcome back, we almost lost you there.” Wilson said sarcastically, and House rolled his eyes. Wilson looked back at the girl, and he and House both grimaced when she coughed on his face. 

“I am so sorry.” The girl said and covered her mouth as she finished coughing. 

Wilson smiled tightly at her and connected her back to the heart monitor, “It’s all right, it happens more than you think.”

=======

“Where’s Wilson?” House barged into Cuddy’s office, completely ignoring the man she was with.

“House!” She scolded him, gesturing to the other man. “I’m in a meeting with someone. Knock next time.” 

“Oh, really? In that shirt I thought you were trying to proposition him a little something-something, if you catch my drift.” He raised his eyebrows to punctuate his sentence and grinned.

Cuddy gritted her teeth, and excused herself from the other man before walking out of the office with House trailing behind her.

“Wilson is at home sick with RSV. I told him to leave when I saw him this morning with eyebags heavier than yours and when I heard him cough his lungs out in his office from outside his door.” 

House looked at her and hummed before taking off without a word. The woman groaned and turned around, stopping one of the assistants. “Clock Dr. House out of work, please.”

=========

House lifted his cane up to Wilson’s door and knocked to the tune of ‘Shave and a Haircut’. He didn’t get a response, so he jiggled the handle and opened the door when he noticed it was unlocked. 

“You know, I could kill and rob you right now.” He shouted out as he walked into Wilson’s living room. It was eerily quiet, and he didn’t like it. The man thudded his cane on the ground three times and heard a faint cough as three other knocks followed from Wilson’s bedroom wall.

House’s eyebrows furrowed and he went to see the sick oncologist, roughly opening the door and turning on the lights. “Wakey wakey, eggs and bakey.”

Wilson groaned loudly and grabbed one of his pillows to cover his head with, coughing underneath it. He groaned even louder when House poked him with his cane, right before House jabbed it into his side.

“Ow! House!” Wilson uncovered his head and looked at the other man, holding up his hand to the light above them. He coughed a bit, and House let out a quick ‘yikes’ when he saw just how bad Wilson looked. 

The man in question had eyebags darker than his own hair, and his eyes were incredibly red and puffy. His lips were dry and cracked, and he had dried drool on his chin. His cheeks were red as well, and his hair was tousled like he just got thrown off a bull. 

“Jesus Christ.” House murmured, taking in the sight of his best friend. The said man had only grunted and thrown his face back into his pillow, coughing into it. 

“If you’re gonna gawk, at least turn the lights off.” His voice was muffled, but House understood it enough to flick the light switch and leave the room.

The man stood there for a second, staring at the door before going into the kitchen and grabbing Wilson’s keys from the glass bowl, and leaving to go to his own house.

=======

Wilson’s eyes opened when he heard his front door slam shut, and he inhaled deeply and sat up. He ran his hands through his tangled hair and carefully stood up, making his way to his bathroom. Washing his hands when he was finished with his business, he turned off the water and dried his hands while trying to sniff the air.

He couldn’t smell or breathe very well, but there was a slight smell of Thai food that caught his attention. He fixed his hair and left the bathroom, and wobbled to his kitchen, where he saw House sitting down on his sofa and eating noodles while watching ‘General Hospital.’

“Save any for me?” He croaked out and cleared his throat. 

“Fridge.” Was the only thing House said through a mouthful of noodles, and Wilson made his way to his fridge.

He pulled out a box of more noodles, and noticed the grocery bag on his counter. He reached out for it, and pulled out a bottle of Nyquill, Aspirin, Tylenol, allergy medications, and Motrin.

He opened the bottle of Tylenol and grabbed two, tossing them into his mouth and fitting his head under the sink to down them with the tap water. He grabbed the Thai noodles and sat down next to House, digging into his food. 

They both sat there in enjoyable silence until Wilson noticed all of the new pillows and blankets that sat on his reclinable sofa and spoke up.

“What’s all that for?” He mumbled through his noodles. 

“Doesn’t matter.” House said simply, pushing himself off the couch with his cane and taking his trash and bowl to the kitchen. Wilson stared at the cushions and shrugged, continuing to watch the TV. 

When he was finished, he got up and also took his bowl to the kitchen, and he coughed into his elbow as he placed his bowl in the sink. “Are you going to pay rent, at least?”

“Nope.” House popped the P and typed away on Wilson’s laptop, not bothering to look at the man. Wilson deadpanned at House until he decided to walk away and go back to his room, flopping onto his bed and falling asleep there.

The other man was searching for drug cocktails that he could inject his friend with to get him better, and he grinned devilishly when he found one that he had access to all of the drugs.

He leaned over slightly to see if Wilson’s door was open or not, and stood up and quickly made way to his bag when he saw it was closed. He pulled out what should have been a med-kit, and took out the drugs in it. He chose what he needed, and made sure all of the right ingredients were put into a syringe.

He slowly limped to Wilson’s room, opting out of using his cane so that he didn’t cause too much noise and wake him up. House opened his door carefully, and his nerves eased when he heard the loudest snore he’s ever heard in his life.

 He ticked his tongue and made his way to Wilson, pulling out a sanitisation packet from his pocket. He lifted the sleeping man’s shirt and carefully rubbed it onto his back, freezing when he stirred. Pulling out the other packet, he wiped down the needle slowly and injected Wilson with the cocktail quickly. 

He froze again, expecting Wilson to wake up and yell at him, but he didn’t. He was still fast asleep, and still snoring. House smiled in success and tossed the syringe into the trashcan by Wilson’s bed, and covered it up with crinkled tissues. He then left the room and closed the door, and went back into the kitchen where the laptop was. 

House re-skimmed over the article with the side effects and he stopped when he saw something slightly alarming.

“Patient may fall unconscious for any time ranging from 16 hours to 2 days. Watch closely and monitor all the time. Any illnesses that the patient may have when the cocktail is injected will dimishness.”

“Shit.”

=======

Wilson woke up after twenty-six hours with cotton mouth, a diaper on, and no idea where he was until he saw House sitting on a chair reading a magazine. 

“House?” He grumbled, lifting himself up to look at his clock. It was late, 1:24 in the morning to be exact. He looked back at House, and the man stood up and slapped the back of his hand onto Wilson’s forehead and held it there. 

“Feels fine.” The man said, and he grabbed his cane and left the confused Wilson to his own devices. 

Wilson didn’t know what happened, or what to do, so he chose to take a shower and freshen up. When he was done, he saw a glass of water on his bedside table and downed it immediately.

He sighed and stood there, unsure of what to do once again. That was until he noticed he felt much better than when he fell asleep.

He went to find House, and saw him in the kitchen again making what he assumed was an omelet. Staring into the back of House’s head, he felt that something was wrong.

He went to sleep with RSV and the worst headache and cough of his life, and now he felt like he could run a marathon.

“What did you do?” He questioned, and locked eyes with House when he turned around.

“What, no ‘thank you?’ No, ‘Oh my goodness, House. I feel so much better, thank you for your help and kindness?’” House mocked, tossing the omelet onto a plate and holding it out for Wilson.

Wilson felt iffy taking the food, but he still did and he sat down at the table as House served him a glass of orange juice. 

“It’s two in the morning-” “I don’t care, eat your food.”

“M’kay.” Wilson didn’t argue and he grabbed his fork and ate, huffing down all of it and drinking every drop in the glass. “So, what’d you do?”

“I drugged you with seven different drugs.” House told him, grabbing Wilson’s plate and putting it in the sink before filling his glass back up with more juice. Wilson sat there and stared at him in disbelief, no words could come out of his mouth. 

“Right.” Was the only word he could say, and he downed the drink in his glass. His mind was racing with many things he wanted to tell his friend.

He was in awe that he would put him so close to death, and that he would even think of doing such a thing that could one again, put him so close to death. It was insane of him to do, and he was flabbergasted. But what came out instead of yelling was, 

“You cared that much?” House turned on the water to the sink and grabbed a sponge and soap and started doing the dishes, ignoring Wilson’s question. 

That was the only answer Wilson needed, though, and he smiled at the back of House’s head. 

“I’m telling your team when I go into work.”

“No the hell you aren’t!”

“Oh, yes the hell I am!”

[xtruss]

We're Having A COVID Summer Surge. Should You Get The Updated Vaccines Now?

The FDA Just Approved an Updated Vaccines, and Officials Say Paxlovid is Still Effective in Preventing Severe Cases.

— By Sanjay Mishra | August 22, 2024

A Colorized Ccanning Electron Micrograph of a Cell (Blue) Infected with the Omicron Strain of the SARS-CoV-2 virus (Yellow). Micrograph By National Institute of Allergy and Infectious Diseases (NIAID)/National Institutes Of Health/Science Photo Library

The summer of 2024—the fifth since the COVID-19 pandemic began—is projected to be the biggest summer wave of COVID infections to date.

Since early May, COVID infections have steadily increased in the United States, Europe, Singapore, New Zealand, and Australia. The U.S. Centers for Disease Control and Prevention estimates that COVID-19 infections are currently increasing in 25 states based on data from emergency department visits. However, hospitalizations and deaths from COVID remain at their lowest levels.

Now, the U.S. Food and Drug Administration has approved updated vaccines to protect against current variants of the virus.

This recent surge has been driven mainly by a new group of closely related Covid subvariants, known collectively as "FLiRT."

As the summer winds down, students across the U.S. will return to school. Traditionally, this also coincides with the season of respiratory viruses, such as flu, RSV, and increasingly COVID.

"Not sure what will happen this fall and winter," says Kei Sato, a virologist at the University of Tokyo. While the FLiRT variants are likely to keep evolving after summer, entirely new subvariants cannot be ruled out. "An Omicron-like event” seems to have occurred every year in the fall since 2021, says Sato.

Here's what you need to know about the new variants and the new vaccines.

What Are FLiRT Variants?

The "FLiRT" variant family includes the majority of currently circulating variants, identified with the letters KP, JN, and the variant LB.1.

The unofficial name "FLiRT" is an acronym for a set of mutations on the spike protein of SARS-CoV-2, the virus that causes COVID-19. The virus uses spike protein to bind with ACE2 receptors in our nose and lung cells to cause infection.

All proteins are made up of amino acids that string together like beads. Mutations can change one amino acid to another, thereby altering the behavior of the protein and making the virus more or less infectious, or able to dodge immunity.

The FLiRT subvariant family members are descended from the JN.1 variant that was dominant in the U.S. in early 2024. JN.1 itself was highly unusual because it acquired 41 mutations that differentiated it from Omicron XBB.1.5, which is the variant upon which the current bivalent COVID booster is based.

Should You Get The New Vaccines?

The two updated mRNA vaccines, manufactured by Pfizer-BioNTech and Moderna, target a FLiRT variant called KP.2. Anyone over the age of 12 can get the new shots, as long as they haven't received a booster in the last two months.

“Vaccination continues to be the cornerstone of COVID-19 prevention,” Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research said in a statement.

Another vaccine targeting the variant JN.1 and manufactured by Novovax is also under review and could be approved soon.

Previous research also showed that older vaccines based on XBB.1.5, an earlier subvariant of Omicron, were still effective in preventing severe COVID-19. While this vaccine produces antibodies that still target the FLiRT variants, the efficiency is notably reduced. A recent infection from the JN.1 variant also seems to provide strong protection against all the FLiRT variants.

That said, the CDC recommends that everyone six months and older get a COVID vaccine. Those at high risk for serious COVID-19 should get vaccinated with the most recent versions available.

How Alarming Are FLiRT Variants?

Coronaviruses, such as SARS-CoV-2, frequently mutate to avoid recognition by antibodies. The two FLiRT mutations remove the sites on the virus where antibodies bind the SARS-CoV-2 virus.

Additional mutations on the FLiRT variants can either help the virus bind more efficiently to ACE2 receptors making it more infectious, help it evade previous immunity, or both, says Adrian Esterman, an epidemiologist at the University of South Australia, Allied Health & Human Performance in Adelaide, Australia

Early studies show that all existing FLiRT subvariants are very good at dodging previous immunity acquired through multiple COVID vaccinations—including the most recent COVID bivalent booster—or a breakthrough infection from a previous strain of Omicron.

But the good news is that by escaping the antibodies, the FLiRT variants have also seem to lost some ability to infect their target because the virus needed the original antibody-binding sites to bind the ACE2 receptor and enter cells.

"These variants are not yet particularly concerning, even with the new mutations that affect certain aspects of the virus's biology," says Shan-Lu Liu, a virologist at the Ohio State University.

It is common for viruses to acquire mutations that help them dodge immunity, which can affect their ability to infect cells, says Liu. "The viruses can quickly evolve new mutations to restore their infectivity."

But in the meantime, Sato thinks that waning immunity from previous vaccinations and infections, coupled with the FLiRT variant's ability to dodge remaining immunity, are probably the main reason for the recent surge in infections.

Liu also agrees that the currently rising numbers of COVID infections are mostly due to low booster uptake and increased summer travel.

Are COVID Medicines Still Effective?

Emergency department visits, hospitalizations, and deaths have all spiked during this summer but are still much lower compared to earlier waves of the pandemic.

There is no indication that these new FLiRT variants are more dangerous than other Omicron strains.

A study shows that Paxlovid is still effective against FLiRT variants. Other antiviral drugs such as molnupiravir and remdesivir are also expected to work since their mechanism of action is not affected by mutations in the spike protein.

[jtsmedicalcentre]

Dr. Suresh Puri, recognized as the trusted consultant pulmonologist in Dubai. With over 30 years’ experience, Dr. Puri has established himself as a highly experienced doctor in the field of respiratory medicine. From asthma management to advanced respiratory treatments, Book your Appointment with the best Pulmonologist in Dubai.

Visit Dr. Puri's clinic at JTS Medical Centre for diagnosing and treating various pulmonary diseases.

Book an appointment with us on +971562913634 or can email us at info@jtsmedicalcentre.com

[literaturepublishersjournal]

https://www.literaturepublishers.org/

Clinical Images and Case Reports Journal

Submit Manuscript or email at

editor.cicrj@literaturepublishers.org

imagecase@literaturepublishers.com

[faofinn]

DAY 10: difficulty breathing

@febuwhump

When Fao’s phone rang in the middle of the night, he startled awake, fumbling for it in the dark. He’d been out for dinner that night, definitely wasn’t sober, but the adrenaline was already doing a pretty good job of fixing that. They didn’t give him much information over the phone, just that they’d got a GSW and their rough location, in code so they’d be safe if anyone else happened to be listening. They were too far out to get back to the basement, and Fao would need to meet them halfway to treat. 

He woke Ely, gave her a quick update, and pulled on some clothes, the first thing he found on the floor, his shirt and trousers from the evening. He didn’t have time to go looking for anything else, and bolted out of the house. There was kit in his car, and he knew there was kit in the van. He wasn’t sure what he’d need, but between both he’d probably have everything he needed. He sped through the streets to the meet location he’d been given, ditched his car somewhere safe, and scrambled into the van. 

“What am I doing? Talk to me.” He asked breathlessly. 

Harrison had become combative as he deteriorated, struggling between conscious and not. It scared the men, and they'd all taken a step back, too uncomfortable to help.

Fao was a welcome sight, his reputation preceding him. 

"Uh, Harrison got shot. He won't let us near him, so we haven't."

Fao’s heart sank. Of course it was Harrison. “Oh, good. Just him bleed out all over the van, then.” He snapped, quickly throwing his hair up into a bun. “I need proper light, one of you sort that.” His voice was cold, commanding, rolling his sleeves up and quickly looking Harrison over. It wasn’t hard to see where the blood was coming from, and he shifted his weight to brace himself as he grabbed gauze and put as much pressure on it as he dared. “You. Come here, take over the pressure.”

“I, uh, I…” 

“Shut up, I don’t want to hear it. Cover my hands with yours and hold the pressure until I say otherwise. Unless you want to start an IV? No? Didn’t think so.” He snapped, as the other man took over. He wiped his bloody hands off on his shirt, and shifted over slightly to Harrison’s arm, eyes looking critically for a vein as he rifled through the kit. 

The pain somehow got worse. Harrison wasn't sure how, but it did. He cried out through gritted teeth, trying to arch away. It took a moment to coordinate, but he started swinging, trying to get away. 

Fao ducked out of the way, catching Harrison’s fist and gently forcing his arm back down. “Harrison? It’s okay, you’re okay. It’s Fao, I’ve got you. Try and relax, you’re safe now. I’m helping, alright? Let me help.”

"He's going to hit me!"

“He’s half unconscious, try harder to dodge him.” Fao shot back. “I’m working as fast as I can.” He gritted his teeth as he tried desperately to get a vein, struggling with poor light and Harrison’s struggling. He got one eventually, shouting triumphantly. It wasn’t enough, and he wanted more access, but he could at least get some pain relief in, hopefully settle him. 

Harrison twisted as Fao shouted, whining as he tried to get away. His chest heaved as he struggled to get his breath, the feeling he was drowning all too much. 

“Sorry, sorry.” Fao soothed. “You’re okay, I’ve got you. It’s gonna be okay, Hars. Just focus on doing that breathing, let me to do the rest. Giving you something for the pain, now, gonna make it easier.” He told him, quickly checking the drug before he gave it. 

His shouts died down into cries, quiet whimpering softly to himself. The pain had started to ease slightly, making it easier to focus. It made breathing more difficult, though, and he couldn't stop the panic coursing through him. 

“You’re okay, that’s it. Well done, keep breathing for me.”

He turned his head, looking towards Fao's voice. "Help."

“I’m helping, I promise.”

"It hurts." He managed, finally managing to focus on him. 

“I know, I know. I’ve given you some painkillers, they’ll work soon.” 

"'m dying."

“No you’re not. Just focus on your breathing for me, let me sort the rest.”

"I am." 

“That’s it, good.” Fao reassured. There was so much blood, and he was really struggling to properly control it. The van went over a bump and jolted, and Fao tried to brace himself on his knees. “Fucking hell.”

Harrison whined, trying to pull away from the pain. It was everywhere, though, and there was nothing he could do.

“Well done, that’s it.” He soothed. “I’ve got you.” He stretched for his kit, rifling through to try and find what he needed. He needed a trained someone, anyone who he could trust. Not Harrison’s little team. 

Frustrated and tired, he started fighting against the other man. He got a solid elbow in their ribs, the relief of pressure against his side just bliss. 

“I know, I know.” Fao murmured, moving to try and pack the wound. 

He twisted again, curling away from Fao. His scream died on his tongue, his hands pushing against Fao's. 

“I’m sorry, I know it hurts.” Fao muttered. He was happy enough with the packing, and moved to try and get a listen to Harrison’s chest. It was loud on the van, and he struggled to keep his balance as he listened, swearing to himself. 

Harrison could feel himself slipping, the ceiling of the van swimming in and out of focus. Even the pain couldn't keep him conscious, his head lolling.

Fao’s stomach twisted as Hars lost consciousness, but he was relieved in a way. At least he wasn’t in pain. He didn’t like what he was hearing at all from his chest, and dug in his kit to find what he needed for a chest drain. It certainly wouldn’t be perfect, but it would do. He didn’t even bother talking to the other men as he grabbed a scalpel, found his landmark, and made the cut. 

He definitely felt that, and he cried out again, but he wasn't with it any more. The men beside Fao retched, especially as blood quickly poured from the drain.

Fao rolled his eyes as the men retched. What he wouldn’t give for Steve or Finn or someone. Trying to manage this completely on his own wasn’t working. He took a set of obs as best he could, blood soaking his trousers and making them cling to him. The numbers he got back were more than a bit concerning, despite his interventions, and they weren’t getting any better. Fuck. 

Harrison coughed and choked, spots of blood on his lips. His resps were through the roof, his heart rate doing its best to compensate for his blood pressure circling, for his blood volume pooling on the floor. He managed to catch Fao's eye, and he met his gaze with panic and fear in his eyes. 

Fao locked eyes with Harrison. “I’ve got you, Tomcat. You’re gonna be okay.” He told him firmly. Things were just consistently getting worse, though, and Fao felt considerably out of control. He gave as much TXA as he felt he could, but it wasn’t close to enough to help the bleeding. 

“How far out are we?” He snapped, asking whoever cared to listen. 

"We've still got at least fifteen minutes."

“Fuck’s sake.” 

Hars could feel himself slipping again, missing parts of the conversation. He grabbed for Fao's top, his hand leaving more bloodied streaks across it. 

"I want Steve."

“We’re gonna be with him really soon, Hars.” Fao murmured. “He’s gonna be waiting for us at home.”

He shook his head. "I'm not gonna make it."

“As if I’m giving up on you. I’m gonna make sure you’re okay, alright? Hold on for me.”

He knew Fao was trying his best, and he’d continue to do nothing but. He trusted Fao with his life, and they unfortunately kept ending up in situations where it was tested. It didn’t take a genius to know he wasn’t okay, and the small bit or working brain he had left had worked out it probably wasn't going to end well. 

He forced his eyes open again, though he didn't remember closing them. "It's okay."

Fao’s repeat set of obs were no better. In fact, they were worse. He swallowed thickly, digging around in his pocket for his phone. He needed to talk to Steve, needed someone medical he could talk to, to reassure him he wasn’t completely out of his mind. 

He chucked it on the floor of the van on speaker as it rang, and he prayed he’d answer. 

"Fao, talk to me. I heard the call for medical."

“It’s Hars, and it’s bad. We’re still miles out, in the back of a shitty van, and all I have is my kit.”

Hars stirred again. "Steve?"

"Hey, Hars. You causing problems for Fao, eh?" He tried to sound light for him, but even he could hear the waver in his tone. He cleared his throat. "What's happened with him? Head to toe, obs, and what kit do you have?"

“GSW, it’s gone just under his vest, entry is the abdo but exit is further up into the chest. Haemothorax on the right. I’ve got a drain in but it’s putting out so much fucking blood. Pulse 138, BP 76/50, SpO2 94 on high flow, Resps sitting at 36, he's still not getting chest rise on the right. He's with it enough, but he's starting to pass out and stay out. I've given the TXA but it's just not stopping. The floor is covered, I'm covered. It’s my kit, it’s decent. Airway kit, ket, paralytics, TXA. I’m just out of my fucking depth here, nobody else knows a fucking thing and I feel like I’m going insane.”

Steve took a moment. Well, fuck. "Right. Take a breath. Reassess, keep going ABCs. You need to get on top of that bleeding. He's not going to be able to compensate forever. Have you got anything to give? Will they follow instructions?"

“I know he won’t compensate forever.” Fao snapped. “I’ve got saline but no blood. They’re fucking useless, hadn’t touched him at all when I showed up. Not even put pressure on.”

"Fucking hell. Okay. Fluid bolus, see if that helps his pressure at all. He's not going to hold his airway by himself if he goes, so just be careful."

Fao quickly set up the fluids, wiping his hands on his trousers as he struggled with the connectors. Fluids running, he forced himself to breathe. “Alright. Fluids in. I want to sort his airway before it becomes a problem.”

"If you're thinking RSI, you need to trust they can help." 

"Steve." Harrison interrupted again, apparently unaware of the conversation. 

“I don’t think I’m going to have a choice, Steve. I’m watching him deteriorate in front of me, and we’re still miles out.”

"You can see him, not me. Do what you think is best."

Unimpressed by Steve's lack of response, he shoved at Fao with a frustrated grunt. "Steve."

Fao huffed. “Thank you, Hars.” He muttered under his breath. “He’s very insistent that he wants you, Steve.”

"Hars, we're just trying to help you."

"No." He shook his head, though Steve couldn't see, and Fao wasn't sure he didn't realise that. 

“We are, I’m doing my best right now Hars. Focus on breathing like I said.” 

He sniffed, setting himself off coughing again. The pain exploded again, despite the morphine, and, once more, slipped under. 

God, it was just getting worse. He hated watching Harrison slip into unconsciousness again, powerless to stop it. 

"Fao, talk to me." Steve's tone was tense, and Fao could hear him pacing. 

“Unconscious again, I’m repeating obs.” Fao replied, his own tone similarly tense. 

"Come on, Hars. Don't do this." Steve murmured, wishing he was there with them. 

The blood pressure cycled, protesting at the numbers. It continued tightening, way into the two hundreds, and Harrison gave a whine. He tried to pull away from it, panicked. 

“Hey, hey, it’s okay. Just give it a minute, I know it’s uncomfy.” Fao murmured, but it wasn’t a good sign. He knew full well it wasn’t high enough to need that kind of pressure - it was just struggling for a read full stop. 

Harrison, of course, didn't listen. He twisted away, an unintelligible shout in both pain and frustration. 

"Hars, listen to Fao. He's looking after you."

“It’s alright, it’s okay.” Fao tried vainly to soothe. But sure enough the blood pressure gave up, failing to get a read, and Fao’s stomach dropped. “Fluids haven’t done shit. It won’t even read, just cycles until it gives up.”

"You're going to have to give more, you can't RSI that low. Has he got a radial?"

It took Fao a moment. “No. Nothing.” 

"Give him fluids."

“I might as well just pour them on the fucking floor.” Fao muttered, but swapped the bag over to give more. 

"Just try."

“Yeah, they’re running.”

Harrison screwed his face up, managing to squint at Fao. He was sure he'd heard Steve too, but the huddle of men behind Fao were too small to be him. 

“That’s it Hars, you’re alright.” Fao said softly, half as reassurance for himself. 

"Where's Steve?" He slurred, more of a mumble than anything. 

“On the phone with me.” Fao replied. 

"Right here, Hars."

“Both of us are looking after you.”

"Sorry."

“Don’t apologise.” Fao said firmly. 

Harrison lapsed back into silence, somewhere between conscious and not. As the blood pressure started again, he whined once more, but didn't pull away. 

Harrison’s blood was drying on his hands, as Fao waited for the machine to read, praying it would give him something. Just a number would be better than the endless cycling. 

Harrison's breath caught in his throat again, and his frown deepened. He knew Fao was looking after him, and Steve was there too, somewhere. He could see Fao leaning over him, doing things in slow motion. Which left Steve..

"Dad?"

Fao’s stomach twisted, and the noise Steve made over the crackled phone line was less than dignified. 

“I’m right here, Hars. I’m right here, I’ve got you.” He replied, his voice wavering. “You’re going to be okay.”

He seemed to have a sudden rush of energy, though his observations were still terrible, and his prognosis even worse. 

"Thank you." He muttered softly.

Fao sucked in another deep breath, forcing himself to re-focus. He had to keep doing this. “Blood pressure is a little less shit. I’ve at least got a number.”

"That's good." Steve managed. 

Harrison reached for Fao’s hand, for a moment of comfort in his desperation. 

Fao squeezed his fingers. “I’ve got you.” He murmured. He laid out his airway kit with the other hand, leaving smears of blood all over it, though he didn’t notice. He needed the blood pressure up a bit more before he could fully RSI, but it never hurt to prepare. 

The squeeze managed to help, a tiny hint of a smile gracing Harrison's blood-splattered lips. He tried his best, his fingers twitching in Fao's before his eyes rolled. It didn’t take long for things to go south, as Hars took a breath and then stopped. 

“Fuck.” Fao muttered, snatching up his kit. He couldn’t put this off any longer now, he needed control of his airway. Unsure just how conscious he was, having watched him flick in and out, Fao chatted away to him as he sorted it, half to keep himself from losing it. “Alright Hars. That’s you finding your limit, hmm? It’s okay, I’ll take over from here. Got some meds to get you off to sleep now, so you can have a nap whilst I do the hard work.” He quickly pushed the ket, watching him carefully. There were men clustered around Harrison’s head, and Fao snapped at them to move, which they did. Happy with his sedation, he pushed his roc, bagged until he was happy with it, and snatched up his tube and laryngoscope. He was rusty with his intubations, of course, so what better time to practice than in a dark, moving van covered in blood? But Harrison, for all he made Fao’s life difficult, apparently wasn’t a difficult airway, and Fao got it first time. He shouted triumphantly, checked his placement, and then secured it. 

“Tube’s in, airway’s secure.”

Steve let out a shaky breath. "Good. Well done."

Fao couldn’t breathe for Harrison forever, not if he was going to continue to manage the bleeding. “Which one of you lot is the most competent here? Who’s not a complete idiot?” He asked. 

They were all quiet, slightly afraid of Harrison and definitely afraid of Fao. After a moment, one of them stepped forward.

"I can help. What do you need?"

Fao looked up. “Are you capable of breathing?” 

"For him?"

Fao huffed. “Essentially, yes. Every time you take a breath, I want you to squeeze this to breathe for him, too. Can you do that?” He asked, demonstrating. “I can’t sit here and do it, I’ve got other stuff to do.”

Panic flashed across his face. "Okay. Yeah." He swallowed, taking a moment. It was Harrison. He'd got him out of shit so many times before, it was only fair to return the favour. "I can do that."

“Just whenever you breathe, breathe for him too. Just got to think about breathing. Okay?”

"Okay." He moved to take Fao's place. "I can do that."

“Shout if you get stuck.” Fao murmured, and moved away, to carefully take yet another set of obs, praying they were better than before. 

Steve hated being so far away, so unable to do anything. "Fao, talk to me."

“I’m taking obs.” Fao shot back. “I’ll tell you stuff when I know it.”

"You just went silent. I need to know what's happening."

“I’m trying to concentrate!”

"Fine, hurry up."

“Going as fast as I can.” He muttered. For once, Harrison’s obs had trended slightly upwards, and Fao was glad of it. “A bit better. SpO2 has come up, as has his BP.”

"Good. The tube will be helping with his sats."

“Yeah, that’s why I did it.” Fao said flatly. 

"I just mean that he's not going to be resping at fifty or some shite."

“Yeah.”

"How's the bleeding doing?"

“Still fucking bleeding.”

"I've put a call out for more blood, you just need to get back."

“I’ll need the whole trauma setup.” Fao muttered, doing his best to manage the bleeding. “Can you go up and wake Ely? I’m going to need her.”

"Everyone's up. They're just sorting the basement out."

“Good.” Fao was relieved he had a team waiting for him. 

"If the second lot of fluids helped, you can give him another 500 bolus."

“It’s helped, but I don’t know for how much longer. I’ve got no pressors, and limited fluids.”

"You just need to get him back. If he's still got pressure, give it."

“Giving it now.” He muttered, trying to push his hair out of his face. 

"Give me a run down of his obs once you've done that."

He finally got it connected and running, discarding the spent bag. His ‘assistant’ was doing well ventilating, surprisingly, and so he quickly started on obs. He hated having to do this in such an old fashioned manner, he missed his hospital conveniences and continuous monitoring. 

But as he started, he just knew it was wrong, and when he didn’t find a pulse, his stomach twisted. “Oh, fuck. Fuck, fuck, fuck.”

[theygender]

Why is it called a "common cold" when this is the worst hell I've experienced in my life. My nose and throat are burning like I snorted chili powder and gargled wasabi. My head feels like someone is inflating it with a tire pump and it's pushing all my brains out through my nose. This is worse than when I've had COVID, strep, flu, or pneumonia. What kind of hell are they putting in colds these days

[heardatmedschool]

“There’s no oxygen bomb, it’s all diffusion, baby.”