#complications and prognosis of stomach injury | Explore Tumblr Posts and Blogs

fuzzballsheltiepants · 2 years

Note

Do you have any medical information for realistic character injuries for drowning? I honestly don't even know how to search for the info I'm looking for any time I need background research, so if you had any links that would help too, and how you found them. Thank you. :)

Oh, this is an excellent question! (and the first request for follow up medical information for writers I’ve received after Fun With Wounds, so thank you for that!)

To make this as broadly useful to writers as possible, I’m going to discuss what happens when people drown—how they behave and what their body does—and then touch on some useful tips for showing a person being rescued and resuscitated, along with potential long-term complications and challenges to recovery.

PLEASE NOTE: THIS IS A WRITING GUIDE ONLY. DO NOT TAKE THIS AS MEDICAL OR FIRST AID ADVICE.

Drowning behavior:

Assuming that the character who is drowning is doing so in a larger body of water (pool, pond, lake, ocean), one of the hallmarks will be that their body will be vertical in the water, doing everything possible to keep their head up. Typically their head will be thrown back, trying to keep the mouth elevated above the surface as best as possible. Their arms will usually be held down against their body, trying to push themselves up out of the water. Their eyes may be closed. They can’t scream for help, as they don’t have enough air and opening their mouths makes them more vulnerable. They can’t wave for help, either.

All of this means that they typically are not visibly distressed, which makes it harder for others to pick up on it. A good lifeguard will watch for that, actually. The person splashing around violently may be at imminent risk, but they aren’t actively drowning. The person who seems frozen or suddenly calm, likely is.

From the perspective of the character that’s drowning, here’s what happens: First, as they start to truly struggle—with fatigue or cold or undertow or big waves or simply not knowing how to swim—they do panic and thrash (see above paragraph), which will expend a lot of energy and oxygen. As they start to go under, they will reflexively hold their breath, which is smart! But also causes an increase in carbon dioxide in the bloodstream.

So here’s a fun fact (fun if you’re a medical nerd): it’s not actually a decrease in blood oxygen levels that drives the desire to take a breath. It’s an increase in blood carbon dioxide. Remember, our lungs take in oxygen, and release carbon dioxide, and the body tries really hard to keep the blood levels within fairly narrow ranges. So your poor character is holding their breath, trying not to inhale water while fully surrounded by it, and meanwhile the body is positively screaming at them to take a breath because their CO2 levels are getting way too high. It’s a tough battle, which is why, eventually, if they can’t get above the water, they will end up inhaling it. Which, the body hates, so they then will cough, making them inhale even more water. Assuming they are still not able to break the surface to get to air, the larynx (opening into the trachea/airway) seals itself off, shunting water into the esophagus and stomach.

While all this is happening, the oxygen levels in the character’s bloodstream are continuing to drop, which means they are beginning to lose consciousness. Once they lose consciousness, that nice reflex keeping water out of the lungs goes away, and they will end up getting more water into their lungs, which now they can’t clear. This is basically the last moment where rescue and resuscitation is likely to be successful, because at this point, their heart is going to stop, and then the rescuers basically have 2 minutes to get the victim out of the water and their heart beating again.

Rescue:

Obviously, the earlier in the process the character is rescued, the better the prognosis. It’s also important in writing to figure out if the rescuers have training or prior experience in this area, as that will drastically impact how they handle this.

Let’s say the rescuer is experienced in the water, like has grown up on the water, or is an EMT, lifeguard, or the like. The number one object is to pull the victim from the water, and after that it’s the ABCs: Airway, Breathing, and Circulation. First, they will want to make sure the airway is clear of fluid, turning the head to the side or rolling the whole victim onto their side if possible, opening the mouth to allow fluid out. The next step is to determine if the victim is breathing. Is their chest moving? Are they moving air through their nostrils and/or mouth? You can test for this by hovering your palm above the nostrils, or even using something like a blade of grass or leaf or the like to look for movement. However, it may be hard to detect, especially if it’s windy, so when in doubt, assume they are not moving air. The third step is to determine if they have a pulse/heartbeat. The pulse can be checked most easily by pressing two fingers gently against the throat below the angle of the jaw. (Yes, you do it in that order because if they are breathing they definitely have a pulse, but if they’re not breathing they may or may not have a pulse.)

One thing to remember: it is possible for a victim to have movement to their chest/diaphragm, which should mean they’re breathing, but actually no air is moving through their nose or mouth. Remember that reflex where the larynx sealed over to keep water out? Sometimes it’s too spasmed down to remember to open up again. That is part of assessing the breathing bit, not just if their chest is moving but is air actually moving.

Assuming they aren’t breathing on their own, rescue breathing should be initiated. This is true whether they are in cardiac arrest (no pulse/heartbeat) or not. Five big, forceful breaths given via mouth-to-mouth (seal the nose, tilt the chin up to straighten out the airway, cover the victim’s mouth, and breathe out hard). If the larynx is spasmed down this may encourage it to open, and if it’s not it will help to force some oxygen into the victim’s lungs and potentially trigger a cough reflex, which we want! This step can be done while the victim is still in the water, once they get to a shallow enough area to be safe or get onto a stable surface (boat, surfboard, etc.). This may well be enough to get a drowning victim caught early back to responsive, coughing, conscious, etc.

The next step is chest compressions. This is necessary if there is no pulse or heartbeat, but should be done if the patient does not respond to those initial breaths even if a pulse is detected. While in some cases of CPR you can do chest compressions without rescue breathing, that is NOT true for drowning victims. They need oxygen! They have water interfering with the body’s ability to transfer oxygen and carbon dioxide in and out of the body, so breathing for them is critical. Here is where your EMT character will be wanting supplemental oxygen and an ambu bag, and one person managing breathing while another does compressions. Lacking that, it’s 30 chest compressions, 2 deep breaths, and repeat until they are breathing on their own.

When they do start to recover, they are going to cough up water, they are going to vomit up more water, it is going to be messy and gross. They will probably be crying involuntarily because of the burn of water in their nose, trachea (windpipe) and lungs. They may well have soiled themselves when they lost consciousness. Nearly dying is an ugly experience, and while you don’t need to dwell on that, acknowledging it will go a long way at enhancing realism as well as upping the emotional and physical toll of it all.

If the rescuer is inexperienced, chances are they’re going to be panicking a bit. It may not occur to them to clear out the airways, so they may open the mouth to do rescue breathing and find a bunch of water in there and panic further. They may try to do rescue breathing when they aren’t yet safe, and start to sink themselves. They may try things like hitting the victim on the back, or holding them upside down, or other things that seem irrational when we’re calm but seem like a good idea in the moment. Don’t assume your character with no background is going to behave in a clinical or rational way because they WON’T. They are going to be terrified and messy but that doesn’t mean they can’t still save a fictional life, damnit! It just may take a few frantic moments of struggling before they hit on the effective approach.

Things to keep in mind: the victim AND the rescuer are going to be wet. I know that’s a “duh” statement, but little details about that fact can make the writing feel more realistic. The rescuer may slip on a wet dock, for example; wet hands have trouble gripping or opening things; wet clothing is heavy and if it’s anything other than wool is going to worsen hypothermia, for another example. Which is another thing: the victim is going to be cold even if the weather is not, their abdomen will be distended with water, their lips and fingertips/nails will be blue due to the lack of oxygen, and in general the character may look dead even if they are not. Excellent for dramatic tension (and absolutely terrifying in real life).

Keep the environment in mind. Is it a tropical summer? Did someone fall through the ice in Canadian winter? Those immediate recovery situations are going to look quite different. Hypothermia may prevent the victim from resuscitating properly, and getting them—and the rescuer—warm will be important! It’s hard to give effective CPR if you’re also hypothermic, so the time frame you’ll have for resuscitation is going to be greatly reduced if it’s cold because the rescuer will be struggling, unless you have additional characters able to assist in both resuscitation and getting everyone warmer. Remember, a hypothermic victim isn’t dead until they’re warm and dead, so that can be another interesting thing to include: rewarming while continuing CPR.

Recovery:

Your character has made it out of the water, they’re breathing, their heart is beating, everybody’s happy, right?

In many cases, yes, BUT recovery from more significant water inhalation can be prolonged. Essentially, when a person goes without oxygen, it can cause a number of imbalances in the body. Their body pH can get too high (a condition called respiratory alkalosis), their blood glucose (sugar) can get too low, they can have muscle breakdown, and they can have damage to their brain. They can also end up with pneumonia as a result of inflammation or infection in the lungs following drowning.

In a modern setting, a drowning victim would be taken to an ER even if they seemed to recover. Essentially, you can seem okay initially, but still have enough water in your lungs that you can have what’s called “secondary” drowning hours later. Usually if you’re fine, the ER will take x-rays of your chest and put you in monitoring for about 8 hours, then repeat the x-rays. If everything is still okay, the victim is good to go!

If it’s more severe than that, they will be on oxygen, either flow-by (nasal cannula or mask) where they can talk, etc., or intubated and on a ventilator. They may need to have water pumped out of their stomach. Fluids and glucose (sugar) may be administered intravenously to help correct abnormalities. They will also be assessed for other injuries or complicating factors, which are common in especially adult drowning victims (more on that later).

Keep in mind: if a person gets to an ER still needing active resuscitation, the prognosis for full recovery goes way down. If they are still struggling to maintain their oxygen levels and their neurologic status after 24 hours, they have permanent damage. If you write a prolonged resuscitation, you should then also be planning to write ongoing disability of some sort (see below).

In an historical or fantasy setting, you will want to consider what alternatives there may be for this. You’re not going to have all the testing options or the fancy IV glucose to administer, and the victim may be having trouble swallowing, so consider what to do for that. Things like correcting hypothermia will be much harder too, and complications like frostbite will be both more likely and riskier due to potential infection. Pneumonia is more likely to be dangerous, debilitating, or fatal than in a modern setting (though, of course, it can be now too!).

If it’s a post-apocalyptic setting, consider what resources and training they might have access to. Even in an apocalypse, it’s not like all medical equipment will vanish, and likely there will still be some access to information as one would imagine that would be a priority for whatever remains of society. How would the rescuer(s) involved tap into those resources to better aid the victim in their recovery?

For long-term complications, the most common is zero, and the second most common is brain damage, from everything I could find. This can affect coordination/motor skills, speech, memory, even things like decision making and executive function. Children who have near-fatal drowning may have ADHD-type symptoms; people of all ages can require lasting mobility assistance; have decreased exercise tolerance due to lung, cardiac, or nerve damage; and may suffer permanent memory loss. Others may have that initially and slowly recover, partially or fully.

Don’t forget the psychological and emotional impacts too. PTSD, phobias, and anxiety would all be very reasonable, not just for the victim but for the rescuer(s) and onlookers as well! Particularly if the rescuer is not experienced, and if they have an emotional bond to the victim, their PTSD/anxiety may be as severe or more so than the victim. These impacts can be felt for years, so it is something that can be a plot point later in a story as well.

Other things to consider:

-There is a phenomenon incorrectly called delayed drowning. This usually occurs in children, but can occur in the elderly or adults with neurologic difficulties, or other conditions that affect their ability to cough. Essentially, the victim inhales water and doesn’t cough it out, doesn’t lose consciousness, and seems okay at first. However, they may seem excessively tired, disoriented, have trouble verbalizing how they feel, or have other behavior changes because they are, slowly, not getting enough oxygen to their brain. They may lose bowel or bladder control. This can be fatal, and in a modern setting would require oxygen supplementation and hospitalization.

-Consider what factors led to the character drowning. Do they not know how to swim? Were there dangerous currents/tides? Was it the result of a malicious action from another character? Are there other injuries or conditions associated with the drowning? In real life adults, drowning is often associated with alcohol or drug use (which can impair judgment in terms of overestimating abilities, underestimating risks, and not recognizing fatigue in time). Injuries such as head injuries or broken bones like broken necks, backs, or ribs caused by diving into too-shallow water or hitting an object beneath the water are also common.

-If you choose to write someone with long-term disability from drowning, great! There needs to be more disability rep in fiction, and this is a common and realistic outcome in real life. But please use caution and tact, and consider having a sensitivity reader or readers. Consider carefully what the disability will look like and feel like for the character, and how it will impact them and those around them, physically and emotionally. Do they require mobility aids, such as a cane or walker for improved balance? Do they have memory loss? Difficulty putting thoughts into words or other changes to their verbal abilities? Seizures? Trouble concentrating or with executive function? Changes in vision or hearing? How do they compensate? What tools are at their disposal that are appropriate for the universe? Use caution if you’re considering a magical recovery, whether in the literal sense in fantasy or in the metaphorical sense in non-fantasy settings. While people with major brain damage from oxygen loss may well improve, often a full recovery back to their pre-injury state would be unlikely, and depiction of such may be validly considered ableism. For example: rather than having a wizard magically cure a victim with hearing loss following drowning, consider them providing a magical hearing aid instead.

I hope this was enough information to help you in your endeavors!

Search parameters I used (note, I do not use Google, I use Duck-Duck-Go, and a lot of this was knowledge I already had):

-what happens when people drown?

-recovery from near-fatal drowning

-resuscitation for drowning

Some resources:

Drowning-specific:

Resuscitation of a drowning victim

Louisville Lectures - Drowning

Long-term impacts of non-fatal drowning

Let's be clear about drowning and nonfatal drowning

Writing about disability:

Writers block blog - disability rep in writing

Writing Disability and Neurodivergency by @writesistersociety

Writing disability in fantasy - adaptive magic by @owlsofstarlight

Do You Want to Write a Good Disabled Character? by @fernshawart

#writing #writing advice #writing tips #writing drowning #medical writing suggestions #ask me things

23 notes · View notes

fadingmiracledreamer · 3 years

Text

Best General Medicine Physician And Diabetes Specialist Doctor In Nagpur

Dr. Vina Bang, a renowned geriatrician, endocrinologist, diabetologist, and finest general physician in Nagpur, has 13 years of experience in the medical field. Her areas of expertise include diabetes, infectious disorders, hormonal issues such as thyroid and pituitary, delayed puberty, asthma, anemia diagnosis and treatment, cardiology, and hypertension. You can identify and address your health needs by meeting with Dr. Vina Bang.

A general physician is a highly trained professional who can diagnose, treat, and prognostic a wide range of diseases and health conditions. The majority of the non-surgical components of treating general to complex illnesses are handled by a general physician. Dr. Vina Bang is a general practitioner in Nagpur. She is well-known for her ability to efficiently diagnose and treat infectious illnesses. She treats viral fever, diarrhea/dysentery, or loose bowel motions, flu, weakness, low HB, gastrointestinal problems, and cold-cough.

Dr. Vina bang is the top diabetologist and general medicine physician in Nagpur, she specializes in various sorts of diabetes treatment in Nagpur. Dr. Vina Bang is a well-known diabetes doctor in Nagpur, having worked in the profession for over 13 years. If you require assistance with diabetes-related difficulties, you may schedule an appointment or contact us directly.

Why You Will Choose Dr.Vina Bang

Dr. Vina Bang is a top endocrinologist who is also well-known in the field of diabetes. She has over 13 years of experience in this profession and has a wealth of information. She earned a bachelor's degree in medicine and a certificate in evidence-based diabetes management from the Public Health Foundation of India (PHFI), as well as a Fellowship in Clinical Endocrinology – FICE (IMA-CGP) from the Indian Medical Association and an MD (Internal Medicine) from the Mahatma Gandhi Institute of Medical Sciences in Sevagram. Dr. Vina Bang has made major contributions to the field of endocrinology as a clinician and researcher. They work to improve patients' quality of life by providing attentive and genuine care for their medical problems.

Do you want to find the best General Medicine Physician in Nagpur?

Our Methods of Diagnosis and Treatment

For the past 12 years, Dr. Vina Bang was a general physician in Nagpur. She is noted for accurately diagnosing, prognosis, and treating disorders such as diabetes treatment in Nagpur, thyroid, blood pressure, viral fever, stomach infections, infectious diseases, gastric difficulties, anemia (low HB), and non-surgical injuries. Dr. Vina Bang, who practices on Nagpur's easily accessible Khamla Road, is one of the city's best general practitioners and is quite friendly and responsive.

Diabetes Treatment offered by Dr. Vina Bang in Nagpur

Dr. Vina Bang creates a treatment plan depending on the patient's symptoms and the severity of the illness. She is Nagpur's best diabetologist, and she is well-known for successfully recognizing diabetes complications with three tests:

Your case history is taken into consideration.

The HbA1c test is carried out.

Our in-house experts meet with the patient and explain the implications of the situation.

It has created a fitness program that is simple to follow and effective.

A suitable diet chart is created.

A constant glucose monitoring device (CGMC – 336 hours) is available if necessary.

Our experts will communicate with you on a frequent basis.

Conclusions

#diabetes doctor in Nagpur #thyroid doctor in nagpur #general physician in nagpur #diabetes treatment in Nagpur #Dr. Vina Bang

1 note · View note

a-theabrams · 4 years

Text

29 DAYS OF HEADCANONS

DAY 4 HEALTH

During his childhood and teenage years Artie never had one medical issue. Aside from the usual cold or stomach bug , he was always on top shape. Artie has never found to have any allergies - in fact to this date he jokes he’s lucky he isn’t allergic to any food or he’d be dead by now- and never broke a bone or even twisted an ankle.

And then at 21 he got into a massive car accident.

Artie was on his way back from his sister’s place when he got hit by a drunk driver. He was in a coma for a week and woke up with a heart breaking prognosis. He had broken his back in two different places and sustained spinal chord damage at T6 level.

Artie has a complete injury, meaning he can’t feel or move below his injury level. But there are other implications of his injury he never even comments with anyone: chronic pain in his back, the occasional pressure sore and urinary track infection, trouble regulating his body temperature ...and the worst of them the rare autonomic dysreflexia episodes.

Artie is pretty good at managing pain , and is very good at keeping his body in order, avoiding complications most of the time, but has had more than a couple of hospital stays from a bad UTI or AD episode.

But since he became more aware of his body than ever, even if he eats quite a lot, he takes great care of himself and goes to the gym daily . The fear of ever needing anyone or getting sick or hurt has became incredibly real in him and he makes absolutely sure to be in the best shape possible at all times.

#tw:car crash #tw: injury #sbtask #sbjulytask #headcanons

2 notes · View notes

crimsondomingo · 6 years

Text

Day 20: Hanahaki

For my July AU a Day Challenge

(Let me mention that I had never heard of this before, but I really love where I took it. Big thanks to @a-redharlequin for the help on this one! You are the best!)

“Are you trying to tell me you’re gay?”

“No. Well, yes, but… I mean a real faerie.”

Cisco laughed.

“I’m serious!”

“Sure, dude. I mean, that whole throwing up flowers thing is a neat magic trick and all, but I’m not an idiot. What’s the joke?”

In frustration, Barry tore his shirt over his head.

“Whoa, man, are you gay for me, coz I love you but…” Cisco trailed as Barry turned around to show off the wing pattered tattoos on his back that slowly began to unfurl into 3D, expanding until they were an impressive size clearly large enough to lift Barry, and delicately edged in the colors of a scarlet marigold.

“Holy shit. Can I touch them?”

“No.” Barry spun around before Cisco could get any close. “They’re sensitive.”

“Sensitive like…” He bobbed an eyebrow suggestively.

“Yes, that kind of sensitive.” Shifting his shoulder blades, Barry started to put them away.

“Wait! I want to see how they go back.”

Appreciating that Cisco was at least more curious than panicked, Barry turned around again so he could watch the way the wings shrank and folded in to lay flat against Barry’s back, then shimmer into place until they merely appeared like tattoos again.

“This is sick,” Cisco said while Barry put his shirt back on. “You’re really a faerie? Wait, like Tinkerbell, nice if a bit moody fairy, or steal children, trick people out of their names and souls for fun creepy kind of faerie?”

“The second one.” Barry glanced away. Then saw how Cisco’s eyes widened. “That’s why I left! I’m not like that. I wanted to be better, so I left to live among humans.”

“Among humans…” Cisco repeated, the full breadth of this finally hitting him. He paced a little around Barry’s apartment before slumping onto the sofa. “Do you have, like, magic powers?”

“Sort of.” Barry shrugged, sitting in the armchair opposite him. “I’m a faerie of springtime.”

“Which means…?”

“My clan is tied to new life and new beginnings.”

“Like how all the births you’ve helped with have zero complications?” It had sort of become a joke among the nurses and orderlies that Barry was a good luck charm, especially with births. “You really are lucky!”

“Fae always have a lot of luck, but with anything tied to our clans, we have an inordinate amount of it, so it would be pretty impossible for anything to go wrong when I assist a birth. I can also generally heal, but if I use my powers too much, people might suspect, so I try to only stick to the luck part. And I can also do this…” He held out his palm to show Cisco how he could also create life, but only springtime plants and flowers.

Cisco accepted the daffodil Barry handed him.

“Sweet. Wait, so why are you throwing up flowers?”

“That’s what I need your help with, or maybe some advice. It’s a curse. It happens when we fall in love.”

“Uhhh…” Cisco set the flower on the coffee table.

“Not with you.”

“Cool.” Cisco relaxed. “Cool. You’re just, like, my best friend, so it would be weird. But wait, falling in love makes you throw up flowers. That’s sucks.”

“It’s specific to falling in love with humans, especially if they don’t love us back. It’s considered a sign of weakness. It’s one thing if we fall in love after getting a human under our thrall first, but the other way around…” Oh no. Barry felt the purge coming again, but still, he could do nothing against it as he spewed a smattered of flower buds onto the coffee table. His apartment was covered in them.

Cisco grimaced, leaning further away now that he knew this wasn’t a trick.

“They’re not wet or anything,” Barry tried to defend himself. They were perfectly lovely, salvageable, and sweet-smelling flowers.

“Still, dude. Gross. But okay, moving on. Who is it?”

Glancing away as he pulled a stray petal from his mouth, Barry said very softly, “Len.”

“Len? Wait…Detective Snart? With the spine injury? Who…despite being shot and having a prognosis of never walking again, made a miraculous recovery—dude.”

“I couldn’t help myself! He’s…he’s amazing.” Before Barry had been able to stop himself once he got to know Len better, he’d poured every ounce of healing magic he had into the man until it was almost as if he’d never been shot in the back.

Cisco eventually relaxed again. “But he doesn’t love you back, huh?”

“Not yet. He doesn’t know me well enough. He doesn’t trust or open up to people easily. At least I know he likes me.”

“Yeah? He said so?”

“No, but I’m throwing up buttercups.” Barry flicked some of the petals across the table. “It means he finds me attractive.”

“Neat,” Cisco said, though his grimace said the opposite. “So what’s the problem, other than petals everywhere?”

“The problem is it’s going to keep getting worse. It started an hour apart, now it’s every twenty minutes, and it’ll keep shrinking if I don’t tell him how I feel, until it’s just constant, can’t stop, and then it kills me.”

“Kills you?!”

“I’m doomed.” Barry buried his face in his hands.

“Come on, man,” Cisco patted his back, “you’re not doomed. You just have to tell him how you feel.”

“I can’t,” Barry moaned into his hands. “If he rejects me, the same thing happens.”

“You choke on flowers and die? Shit. How long do you have?”

“Only another twenty-four hours at most.” Barry lifted up. “It’s not enough.”

“Well your curse hasn’t met me,” Cisco said firmly. “I’ll be your wingman. Hehe, even though you’re more my wingman, coz you have…” He cleared his throat when Barry looked at him miserably. “Sorry, this is serious.”

“Len checks out today. What am I gonna do?”

“You woo him, that’s what! I’m not gonna let you drown in flower petals, man. Snart’s the reserved type, that’s all, he’s just guarding his heart. But if he knows you like him, he’ll open up. If you can’t tell him straight-out, then you have to show him how much you care. Take him out to lunch. Invite him back to your place.”

“I’m not gonna sleep with him.”

“Not even to save your life? But you don’t have to sleep with him, I just meant spend as much time with him as possible so it clicks and he realizes how amazing you are. And if all else fails, maybe telling him as a last-ditch effort will push him over the edge.”

“I guess.” Barry sighed. Cisco was right. It was the only choice he had left.

Both of them had the day off, but Cisco, being amazing, promised to keep his cell phone on him if Barry needed help, while Barry headed in plainclothes to the hospital to intercept Len before he checked out.

He looked gorgeous as always, more so than Barry had ever seen him since for once he was dressed in normal clothes—dark jeans, long-sleeved T-shirt, leather jacket. Needing a cane for a while in no way diminished the view. In fact, it suited him well with his generally dramatic presence.

“Can I treat you to lunch?” Barry said before Len had even managed a greeting. “I’m off today, and you’re leaving, and I don’t want to miss the chance to…well.” He felt his face grow hot. He was a mostly immortal being who’d seen nations fall and met thousands of humans over his lifetime, but this man still reduced him to a fumbling child.

Len was just so…everything, and when he smirked in response, Barry felt weak in the knees.

“You’re on, Barry. Didn’t think you were the fraternizing type.”

“I’ve been known to be full of surprises.”

It sucked to have to duck away every twenty minutes to spew flowers, but during one such dash to the bathroom, Barry called Cisco.

“I think it’s working. I’m throwing up carnations now.”

“Yay?”

“Carnations mean fascination and new love, Cisco. He likes me.” Barry could hardly keep the smile from stretching his face, even as he spit leftover petals into the toilet.

“Congrats, man! Now, don’t let him go. Invite him back to your place so you can tell him how you feel.”

Barry was terrified, but he was also dying, so getting over his insecurities was the least of his problems. And amazingly enough, Len said yes.

“Something important to tell me?”

“Yeah. Not bad. I mean, I hope it’s not bad.”

When they arrived though, Barry felt another purge coming and excused himself to the bathroom.

“Sorry, nervous stomach.”

“Nervous of little ‘ol me.” Len grinned. Oh he was beautiful.

“I’ll be right back.” Barry ducked off. The flowers he spit up were still carnations, but Barry had hope that this would work—confessing to Len that he loved him, knowing that eventually he also had to admit he was fae. Maybe Len would react as well as Cisco had. There was always a chance.

Stepping back out into the living room to take the plunge, Barry instantly froze. Len had swiped a handful of peanut M&Ms from the bowl on Barry’s end table and was popping them into his mouth, eating them.

Barry buying Len lunch at a restaurant was one thing, but anything Barry had bought and brought to his home to just be his was, well, his. And the rules about humans eating fae food were very specific.

“Sorry, what a terrible house guest. They’re just a weakness of mine,” Len said.

Barry could only stare.

“Barry? Are you okay?”

Taking a breath, Barry wished Cisco was there to help him soften the blows he had coming, because he had no idea how to make this sound less terrifying. “I have several things I need to tell you, and at this point, I’m not sure which one is going to freak you out more.”

#coldflash #au a day challenge #hanahaki au #crimson's writing #barry is a faerie

161 notes · View notes

cbsmithpks · 5 years

Text

Every Parent’s Nightmare

We worry about our children from the day they are born or perhaps even from the day we find out that are we are pregnant. In September of this year, we had the scare of our lives as parents. After living through this nightmare, I was told by many parents that I should blog about our experience to help raise awareness of the symptoms of joint sepsis in children.

On a typical Thursday evening we thought our 11 year old daughter had the stomach bug that was going around the middle school. She had a fever of 103.4 and was throwing up. This lasted all of Thursday night and most of the day on Friday. But by Friday evening she felt somewhat better and the fever had dropped to 99.5. We thought we were out of the woods, but she was up much of Friday night with a fever and throwing up. I even told another mother on Saturday morning that this was the worst virus I had ever seen and I hoped other kids didn’t come down with it. Later Saturday morning, when our daughter tried to get up, she couldn’t walk. She was in severe pain. Even the weight of her leg hanging when we carried her was unbearable. We knew something was wrong. Fortunately for us, our good friend, Maureen is a Pediatric PA. She took a look at her and told us to go to the ER that she thought she had a septic hip. “A what!!” I exclaimed. How does a perfectly healthy child get sepsis?

We rushed to the ER and were there for over 4 hours. They did some blood work, an x-ray and we were told she had Transient Synovitis, which is when a viral infection moves into a joint. We were told it isn’t serious and that it will go away on its own. We were sent home with a child still unable to walk and in excruciating pain. That night things got even worse, she was up all night with a fever, throwing up and in unimaginable pain. In the morning, I called my friend, Maureen. She said she really felt like our daughter had sepsis and that the ER was incorrect. She reached out to our doctor (with whom she works.) He was not on call this particular weekend but lucky for us, he went ahead and met us at his office early on a Sunday morning. Within just a few minutes, he said, “I am pretty confident that this is a septic hip.” We were admitted to the local hospital where blood test and an ultrasound confirmed the diagnosis.

While my husband went home for the night to prepare for an oncoming hurricane (we live on a barrier island off the coast of NC,) my daughter and I were taken via a 3.5 hour ambulance ride to University of North Carolina (UNC) Children’s Hospital. We arrived in the middle of the night and within 5 hours of our arrival, I had already met with the Pediatric Team, the Infectious Disease Team, the Orthopedic Team, they had drawn their own labs, done an MRI and our daughter was in pre-op for a joint aspiration. After that surgery her pain was a bit better due to some pressure being relieved. That surgery along with the MRI and blood work confirmed the seriousness of her diagnosis and within 2 hours of waking up from the first surgery, she was back in surgery again. This time they had to open up her hip and go in and clean the infection out of her hip. A drain pump was inserted to remove the fluid. She was in excruciating pain after this surgery. To say that my heart was breaking for her is an understatement. She was put on very strong antibiotics while we stressfully awaited the 48 hours for cultures to grow to see if the bacteria was treatable with antibiotics (i.e. that it wasn’t antibiotic resistant.) She was given an echo-cardiogram to ensure that there had been no damage to the heart. “What!!! This was a possibility?” Another thing to worry about. Fortunately the results were excellent! We found out that the bacteria would respond to antibiotic treatment so next we moved into a “wait and see mode” as we waited for the antibiotics to do their thing.

To be considered free of bacteria, blood cultures have to be clean for at least 72 hours. Four days after surgery we had a big scare as the blood culture came back still positive for bacteria. They were getting her ready for a 3rd surgery when the orthopedic team came in and said that they thought that maybe pulling the pump the prior day could have caused bacteria to backwash into her blood stream and the blood test picked up on that. So the infectious disease team agreed to wait 24 hours for another blood sample. This was a huge relief as our daughter, who starting to get some relief, was terrified of having this clean-out surgery again as it caused her extreme pain the first time. Fortunately, the orthopedic team was correct and her blood was clean 24 hours later. So now we were 24 hours into our 72 hour wait before she could be considered for discharge. Once her blood was good, she went in for a minor surgery to have a PICC line installed to deliver IV antibiotics for several weeks before she could transition to oral antibiotics. She also started physical therapy to learn to walk with a walker.

She ended up in the hospital for 9 incredibly stressful days. It was difficult for my husband and I to see her in this kind of pain. We were physically and mental exhausted. We tried to shield her from the seriousness of her condition and it was very difficult to stay positive and not breakdown. I know any parent who has experienced a seriously ill child can relate. It was without a doubt the worst 9 days of my life. I swear that still today when I think about it - I have PTSD. It makes me almost nauseous.

While at UNC-Children’s Hospital we were educated on the ramifications of not getting timely treatment of sepsis in a joint. Because the hip is still growing, it is of utmost importance to protect the cartilage. Patients who sustain damage to their cartilage are risking permanent hip joint damage. These patients may require hip replacement later in life if the damage to the cartilage is severe. There can be complications such as osteomyelitis, bony erosions, damage to the heart and other organs and even death.

Until this, we had no idea that a perfectly healthy, very active, 11-year-old girl could get sepsis in her hip. Nor did we know how serious and how painful it could be. Once the antibiotic was working and she was out of immediate danger, we began asking questions about her long-term prognosis as she isn’t the sit around the house and watch TV or read kind of kid. She is a middle school cheerleader, plans to tryout for the track team, she bikes, surfs, swims, kneeboards and tubes. She never sits still. The thought of long-term damage, still weighs very heavily on me as I keep thinking --- “was there something else I could have done after the visit to ER with a misdiagnosis?” In my gut I knew something was wrong.

The delay caused by the misdiagnosis made it day 5 since first symptoms. After 5 days is when one can get into trouble with complications. We won’t know if her growth plate was damaged until we return to UNC Children’s Hospital early next summer. Her orthopedic surgeon feels pretty confident that all will be ok. Once she was in hospital, with the help of the doctors, we had traced back her symptoms. We learned that her hip hurt her on Wednesday during PE, but she thought she had pulled it in cheer practice and she wanted to cheer at the football game Wednesday night. I also recalled that on Friday, when we thought she had a stomach bug, she mentioned that her leg hurt. She didn’t say hip. I chalked it up to a sports injury. Because for the life of me I couldn’t imagine that fever, throwing up and joint pain could mean a septic joint. I had never heard of such thing. If it weren’t for our good friend, Maureen, being insistent on this being sepsis, I am not sure what we would have done. I shudder to think of the outcome.

At this point, I am sure you are all asking “how does a perfectly healthy child end up with sepsis in her hip???” What we learned is that she likely had a cut somewhere on her body and the bacteria got into her blood stream when she came in contact with it. The bacteria was Staphylococcus aureus which is a very common bacteria found everywhere. Typically your body fights it off but for some reason, unknown to the doctors, several thousand perfectly healthy kids a year don’t fight it off and it takes up residence in synovial fluid in a joint area. So we will never know how or where she picked this up or why her body didn’t fight it off.

While I hope you never have to experience anything like this in your lifetime, I do hope that by writing this article, others can learn more about sepsis in a joint and get quick treatment. While this is not very common (about 5 kids out of every 100,000 kids) it is scary when your kid is one of them. If your child has a fever and has severe joint pain --- shoulder, hip, knee, ankle, elbow or wrist - it is a medical emergency. Don’t make light of it. Insists on blood work, x-ray, ultra-sound and be sure to have them seen by a pediatrician, as this is more common in kids than adults. And from what we have learned septic joints are missed quite a bit by general ER docs that are not trained in pediatrics.

Finally, we would like to thank Maureen Young, our awesome Pediatric PA; Dr. Andy Kiluk, who is incredibly gifted at what he does, for rushing to office and giving up his Sunday to ensure that Peyton was diagnosed and transferred to UNC Children’s Hospital where she received exemplary care. And a HUGE thank you to the following groups at UNC Children’s Hospital (they were wonderful) - the Pediatric Team, the Orthopedic Team, the Infectious Disease Team, Radiologist, Cardiologist and Physical Therapy. So happy to have such a great resource in North Carolina!

Now..... go hug your kids because I learned that we are not promised a tomorrow. It can all be striped away in the blink of an eye. We were lucky, but it was way way way to close for comfort!!!

1 note · View note

number06fan · 4 years

Text

2019 Ecoli Romaine Lettuce Outbreak Has Everyone Fuming

Romaine lettuce is the culprit yet again in a 2019 Ecoli romaine lettuce outbreak that is giving people quite the pre-Thanksgiving holiday scare. E.coli infections are on the rise being linked to romaine and currently there are 102 reported cases involving 23 states. Of those cases, 58 people have been hospitalized, and 10 have developed hemolytic uremic syndrome – a severe form of kidney failure.

2019 Ecoli Romaine Lettuce Outbreak Update

Since the previous update on November 26, an additional 35 ill people have been reported. As of December 2, 2019, a total of 102 people infected with the outbreak strain of E. coli O157:H7 have been reported from 23 states.

StateIll PeopleArizona3California4Colorado6Florida1Idaho3Illinois1Iowa1Maryland4Michigan1Minnesota3Montana1Nebraska1New Jersey7New Mexico2North Carolina1Ohio12Oregon1Pennsylvania8South Dakota1Texas4Virginia4Washington2Wisconsin31Total102

Illnesses started on dates ranging from September 24, 2019, to November 18, 2019. Ill people range in age from less than 1 to 89 years, with a median age of 25. Sixty-five percent of ill people are female. Of 98 ill people with information available, 58 hospitalizations have been reported, including 10 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

History Repeats Itself with this 2019 Ecoli romaine lettuce outbreak

Last November you may remember being in the same boat. You are not dreaming as there was a similar outbreak about this time in 2018. You can read back through the romaine based articles on MakeFoodSafe and see for yourselves that there is definitely a long running history with E.coli and romaine lettuce.

All of the stories seem quite familiar and have similar characteristics, obviously all involving romaine lettuce as the cause. The November 2018 outbreak carried into the year 2019 and was considered over in early January so how long is the 2019 outbreak expected to last? Who knows really. The 2018 outbreak ended with 62 reported cases total and 25 hospitalizations involving 25 of our 50 states.

What To Do With Romaine Lettuce

Currently the CDC is telling everyone to not consume any romaine that was harvested from Salinas, California. This is a huge downer to me since I do dearly love a good Cesar salad, but health first. Retailers will also be pulling this romaine from their shelves and restaurants will stop using it as well.

The CDC Recommends:

Avoiding all types of romaine lettuce grown in Salinas, California, such as whole heads of romaine, organic romaine, hearts of romaine, romaine in salad wraps, and packages of precut lettuce and salad mixes which contain romaine, including baby romaine, spring mix, and Caesar salad.

Hydroponically- and greenhouse-grown romaine, which may be labeled as “indoor grown,” from any region does not appear to be related to the current outbreak.

More about the 2019 Romaine Lettuce Outbreak

Most romaine lettuce products are labeled with a harvest location showing where they were grown.

This advice includes all types of romaine lettuce harvested from Salinas, California such as whole heads of romaine, hearts of romaine, and packages of pre cut lettuce and salad mixes containing romaine, including baby romaine, spring mix, and Caesar salad.

If you have romaine lettuce at home:

Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.

If the label says “Salinas” (whether alone or with the name of another location), don’t eat it, and throw it away.

If it isn’t labeled with a growing region, don’t eat it, and throw it away.

If you don’t know if the lettuce is romaine or whether a salad mix contains romaine, don’t eat it, and throw it away.

Wash and sanitize drawers or shelves in refrigerators where romaine lettuce was stored. Follow these five steps to clean your refrigerator.

If you are buying romaine lettuce at a store:

Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.

If the label says “Salinas” (whether alone or with the name of another location), don’t buy it.

If it isn’t labeled with a growing region, don’t buy it.

Restaurants and retailers should check the label on bags or boxes of romaine lettuce, or ask their suppliers about the source of their romaine lettuce.

Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.

If the label says “Salinas” (whether alone or with the name of another location), don’t sell or serve it.

If it isn’t labeled with a growing region, don’t sell or serve it.

Suppliers, distributors, and others in the supply chain should not ship or sell romaine harvested in Salinas, California.

What Next?

The recalled salad products have “Use By” dates ranging from October 29, 2019, to November 1, 2019.

The recalled products have establishment number “EST. 18502B” inside the USDA mark of inspection.

Visit the USDA website for a full list of recalled products.

This recall includes salad products that contained contaminated romaine lettuce. The romaine lettuce was tested by the Maryland Department of Health as part of a foodborne illness outbreak in Maryland.

Take action if you have symptoms of an E. coli infection.

Talk to your healthcare provider.

Write down what you ate in the week before you started to get sick.

Report your illness to your local health department.

Assist public health investigators by answering questions about your illness.

Prevent infections in others by practicing proper hygiene, especially good handwashing.

Prevention is key, but knowledge is power and knowing the signs of an E.coli infection is highly important. Here are some tips to catch the infection early to hopefully avoid any serious or lasting effects:

First Early Symptoms

Nausea

Vomiting

Stomach cramps (abdominal pain)

Diarrhea that is often bloody

Fever of about 100 F to 101 F (37.7 C to 38.3 C)

Malaise

Loss of appetite

Mild dehydration

These symptoms can be seen in infected children and adults.

Later or late symptoms of E. coli infections may include:

Hemorrhagic diarrhea (large amounts of blood in the stools)

Anemia

Pale skin color

Severe dehydration

Little or no urine output

Severe abdominal pains

Easy bruising

Nosebleeds

Fatigue

Shortness of breath

Generalized swelling

Kidney failure

Jaundice

Excessive bleeding

Seizures

Mental changes

Death

For most people (about 90%), the infection clears and a good outcome and prognosis is good. However, if any of the previously mentioned complications occur, the prognosis may range from good to poor. The variable prognosis depends on the severity of the complication, the rapidity of diagnosis and treatment, the response of the individual to adequate treatment and the overall health of the individual. Children and the elderly are at higher risk for adverse outcomes.

With these outbreaks it is great to check on those who may be unaware of them and be helpful with letting them know. I know that when my grandparents were alive I was careful to help them be aware of recalls and even helping them to dispose of products involved in said recalls. It is often necessary to help care for our elderly loved ones.

If you suspect you have become ill with an E.coli infection, please consult your physician and be vigilant in your care.

Our E coli Lawyer is Here to Help You

If you believe you have developed an E coli infection from eating salads or in this 2019 Ecoli romaine lettuce outbreak, we want you to know that an E coli Lawyer at the Lange Law Firm, PLLC is currently investigating this matter and offering free legal consultations. Our lawyer, Jory Lange became a lawyer to help make our communities and families safer. Anyone who was infected with E coli from romaine lettuce may be entitled to compensation for their injuries. To learn more about this outbreak or making an E coli food poisoning claim, please visit The Lange Law Firm, PLLC’s website www.MakeFoodSafe.com.

If you or a loved one have become ill with E coli, you can call (833) 330-3663 for a free legal consultation or complete the form here.

By: Samantha Cooper, Contributing Writer (Non-Lawyer)

The post 2019 Ecoli Romaine Lettuce Outbreak Has Everyone Fuming appeared first on The Lange Law Firm.

0 notes

ignis-scientia-estrogen-brigade · 7 years

Link

Don’t let the goofy title fool you; as we’ve already established, the Episode Ignis teaser trailer absolutely gutted me, so I channeled my grief into this 5K word fic for all of my followers to suffer through. I don’t know why my word count keeps running away from me, but if it makes you feel any better, this canon-compliant imagining turned out marginally less angsty than I had originally envisioned it.

Takes place immediately after the events of the Hydraean catastrophe, but before Umbra returns the notebook to Noctis. There is mild language and imagery that some readers might find distressing, so be aware; full text can be found in the link above as well as below the cut. Gird your feels!

He isn’t in his bed when Gladio enters the dimly lit room; the big man’s eyes dart frantically from the empty sheets to the far wall, only allowing a small sigh of relief to escape him when he sees that the strategist’s lanky figure is neither tangled in a heap on the floor, nor dangling from the ceiling by a lamp cord, but settled into an ornate chair situated near a closed window.

The curtains are drawn slightly, enough to allow for a few paltry rays of sunshine from the otherwise grey and rainy Altissian skies outside to bleed through, but not so much as to overwhelm the strategist’s compromised senses. The doctors had said he might have some mild sensitivity to light, but that was before anyone knew the extent of his injuries; now that he was awake, it was clear mild sensitivity was a massive understatement—Ignis couldn’t even open his eyes properly, as helpless and feeble as a blind newborn Coeurl.

He might not be blind forever, Gladio thinks, as he strides across the luxurious throw rug blanketing the hardwood floor. It was too early to tell if the damage done to his friend’s sight was merely temporary, or whether his long-term prognosis was more grim; regardless, he makes it a point to drag his feet loud enough for Ignis to hear him approaching. “Made it out of bed by yourself without breaking your neck? That can’t be a bad sign.”

The strategist has no discernible reaction when Gladio stops beside him. “I suppose not.”

“Prompto took a stab at scrambling some eggs, if you’re feeling up for a bite. I can’t make any promises on the quality, though.”

“I’m fine.”

Gladio fights back the urge to bark at him; his friend hadn’t consumed so much as a single bread crumb since he’d regained consciousness, and he had enough of an uphill battle to face without the added complication of self-imposed famine. “You gotta eat, man. Those beauty marks of yours aren’t going to heal without a little help.”

The strategist’s gaze is directed toward some indiscernible point out the window, his voice an eruption of utter monotony. “I said I’m fine.”

The big man sucks in an irritable breath and grimaces. “Suit yourself.”

“Any news?”

They were the first words that had passed through his lips when he awoke two days ago, and the same inquiry he had made at the top of every hour since, regardless of whether he was confined to his bed or being helped to the restroom on two shaky feet; Gladio glances down at him, wincing slightly at the sight of exposed muscles visible beneath the gaping wound that mars the left side of his friend’s face, and ponders briefly whether Ignis Scientia’s unwavering loyalty to the crown isn’t actually a result of him being a secret bastard son of the Amicitia family.

“Still out cold,” he murmurs.

The strategist nods solemnly; after a moment, he drops his chin to his chest and leans forward in his chair, resting his elbows on his knees. “All right, then.”

A quiet lull descends on the room. There’s not much to say, really, and with Noct comatose in his own bed twenty yards down the hall—and Prompto choking back sobs at the slightest change in the weather—the lack of any meaningful developments serves only to agitate Gladio’s growing sense of apprehension. He shifts anxiously from foot to foot, peering out the window at the thick droplets streaming down the paned glass, until the silence becomes downright deafening and he attempts to make one last appeal.

“You sure you won’t try to eat something? It’ll probably give Prompto something happy to cry about, for once.” When the strategist responds only with a small shake of his head, Gladio flares his nostrils and moves to leave. “Then unless you need something else, I’ve got better things to do than to stand around and watch you starve yourself to death.”

“Could use a bath.”

Ignis’ quiet voice halts his exit mid-stride; Gladio returns his gaze to the slumped form in the chair, noticing that the stubble dotting his friend’s cheeks and jaw has grown out to an uncharacteristic length. “I bet you could,” he says. “I’ll get Prompto to draw one for you—wait right here for just a minute.”

The strategist fingers his rough chin absentmindedly. “Where else would I go?”

The big man ignores the dull ache in his chest and steps out of the room, scanning the long baroque hallways of the estate for any sign of the blond marksman. It’s only when he pokes his head into the extravagant suite Secretary Claustra had reserved for their private use that he spots Prompto, not blubbering into his overcooked eggs like he expects, but staring down at the screen of his cellular through dead eyes.

“Yo, Prompto,” he calls out from the doorway. “Iggy’s up. Says he wants a bath.”

Freckled features glance up from the phone, and Gladio can see the traces of tears that stain his younger friend’s cheeks. “That’s good,” Prompto says, setting his mobile aside and injecting some semblance of positivity into his voice. “What do you need me to do?”

“Figured you could get the hot water running while I strip him down.” Gladio then moves back out into the hallway, the sharpshooter hot on his heels. “The doc took his bandages off last night to let ‘em air out, so prepare your stomach accordingly.”

The expression of shock that crosses the marksman’s features when they return to their friend’s side matches the horror trickling into in his own gut; as the prince’s sworn shield, Gladio was no stranger to the sight of gruesome flesh wounds—his own included—but it was going to take some time to get used to the newest additions to the strategist’s face.

Mercifully, Prompto covers his surprise with a false smile and rests a hand on Ignis’ shoulder. “How’s it hanging, buddy? You’re looking better every day.”

The strategist lifts a weak hand in response, and Gladio sends the blond man off in the direction of the on-suite bathroom with a quick jerk of his head. When he can hear the sound of water splashing against the ceramic tiles of the tub, he reaches over and tugs on the back of his friend’s collar. “Ready to get out of those stinking clothes?”

The strategist is wearing the same loose pants and tunic the doctors had dressed him in the night they had dragged his battered and bloodied body back to the estate; if the smell of dried sweat plastered to his back for two days straight wasn’t overpowering enough, the stench of festering wounds was almost certainly driving the usually fastidious chamberlain slowly toward madness. He rises tentatively from his chair, swaying momentarily until he steadies himself against Gladio’s broad shoulders, and utters a painful groan as the big man peels the grimy fabric of his shirt up and over his head.

It’s not his friend’s nudity that gives Gladio pause when he helps him out of his pants—the brotherhood practically took sport in seeing who could withstand the glacial temperatures of Greyshire Grotto’s waterfall in the buff the longest before heading out to Altissia—but he is only now recognizing that Ignis’ wounds are not limited to his face. Removing his wardrobe takes with it the thin layer of crust protecting the lacerations that encircle his torso and thighs, and suddenly an eyeful of naked flesh is the least of Gladio’s troubles.

“Prompto!” he shouts. “We need a towel over here.”

The marksman immediately trots out of the bathroom armed with a pile of bath sheets, and the strategist stands in stoic silence as Gladio wipes at the blood trickling down his leg. But Ignis’ trembling knee betrays the true agony his body is almost assuredly in, and it takes all of the big man’s willpower not to throw his injured friend over his shoulder to save him from the misery of walking the twenty or so paces to the bathroom under his own strength.

Instead, he wraps a clean towel around the strategist’s waist and grips him gently by the elbow. “Take it easy,” he says. “It’s a marathon, not a race—Altissia ain’t gonna crumble any further just ‘cause it takes you two extra minutes to reach the tub.”

Ignis opens his mouth to speak, but words elude him; Prompto’s eyes widen at Gladio as he moves to the strategist’s other side, although whether it’s from shock or admonishment, the big man isn’t sure. He doesn’t spend much time mulling over his tasteless turn of phrase, however, because it’s clear from their friend’s pained expression that his stamina is failing with every one of his strides; Gladio’s heart winces at each agonizingly slow step, until his ribcage reaches nearly to the point of bursting before the three men finally reach the threshold of the bathroom and the strategist's kneecaps meet the edge of the ceramic vessel.

“It’s a clawfoot tub,” Gladio says. “About eighteen inches high. Watch your step.”

“As best I can,” Ignis replies sourly.

This time, there is no ambiguity in Prompto’s exasperated glare; Gladio brushes off the younger man’s disapproval as Ignis finds his footing, then helps lower his frail friend into the steaming water. “How’s that feel on your aching bones?”

For the first time in two days, the lines of suffering that furrow the strategist’s features relax into a small measure of tranquility. “A marked improvement, to be sure.”

Gladio then reaches for a washcloth hanging on a hook near the faucet and pushes it into Ignis’ palm. “Be careful with that gash on your face. In my experience, getting soap in an open wound feels about as good as pouring salt in it.”

“Hm. Noted.”

Prompto wrings a second washrag anxiously, the desire to be helpful clearly at odds with his fear of getting in the way. “Um, can we get you anything else?”

The strategist runs his hand across his coarse jawline, wincing slightly as his fingers meet the cut that splits his lower lip. “Perhaps just a razor.”

A look passes between the big man and his blond counterpart, their thoughts reaching the same dismal conclusion. “You’d better let one of us handle the sharp edges for a while,” Gladio says. “I’ll tackle your face for you, if you’re that desperate for a shave.”

“Yeah,” Prompto agrees. “Let us help you, Iggy.”

The strategist’s features crumple into a scowl. “I don’t see why I can’t do it myself.”

Because you can’t see anything, period, Gladio thinks, but bites his tongue. “Because it’ll give us something to do while we wait around for Sleeping Beauty to wake up from his nap,” he offers instead, and gestures to the sharpshooter. “Prompto, go find me a razor before I give his highness’ royal know-it-all something to really bitch about.”

Ignis’ scowl deepens, but he says nothing, and instead sinks farther down into the tub until the hot water is lapping around his shoulders. Prompto raids the nearest toiletry cabinet, returning to the big man’s side only when he’s located a bottle of shaving cream along with a questionably sharp blade. Gladio pours a generous amount of foam into his palm, then reaches for the strategist’s face—taking care not to gouge his grisly wound with his fingernails—and smirks. “Pucker up, gorgeous.”

But there is little humor to be found in this brief moment of indignity, because the exiled heir of Lucis was in a coma in the room adjacent to this one, oblivious that the world had changed irreversibly during his slumber and blissfully unaware that his bride had perished amidst the chaos. Scraping a few stubby hairs off a friend’s face was a minor inconvenience compared to the responsibility that lay ahead of whomever was ultimately tasked with delivering the devastating news to Noct; as he lathers the strategist’s jaw and drags the razor across one scarred cheek, Gladio woefully surmises there is only one man in this bathroom with enough tenacity of spirit to shoulder that terrible burden, and he’d need every ounce of strength to do so—even if he had to be force fed against his will.

He only gets partway through his task, however, before his hand slips—he hasn’t shaved his own face in years, much less anyone else’s—and the razor bites into his friend’s chin. Ignis flinches away, but he’s too late; the big man curses under his breath as he watches a drop of crimson blossom onto the strategist’s half-shaven jaw. “Shit.”

Prompto is already leaning over the tub, the rag in his hand moving quickly to stop the bleeding. “It’s fine,” Ignis says curtly, batting his assistance away and holding out a palm in the big man’s direction. “I’m sure I can manage the rest by feel—just hand me the razor, if you would.”

“No, no,” Gladio mutters, and reestablishes his grip over his friend's face. “I’m almost done—just sit still for another minute.”

The strategist grits his teeth in protest, but resigns himself to the inevitable and presses his lips together into a thin line. Gladio can feel Prompto’s anxious presence beside him, his nervous breath hot on his neck; he drives the younger man back with an elbow to his ribs, then returns his focus to Ignis’ bleeding jaw.

His confidence is already skating on thin ice, however, and his hand is trembling more than it was before; he only manages to get through two more passes with the razor before it snags on the strategist’s chiseled jawline yet again. “Goddamnit, Gladio,” Ignis snaps, recoiling angrily away to the end of the tub. “I told you to leave it.”

But the big man is already up, shoving the razor into a bewildered Prompto’s hand and swallowing the rage that is licking the insides of his throat. “You do this,” he shouts, then diverts his anger toward the figure floating in the water. “I’m not going to let myself be chewed out when all we were trying to do was help you.”

“I only asked you to draw me a bath,” Ignis counters. “I never asked to be treated like a bloody cripple.”

Had he been more in control of his turbulent emotions, Gladio might’ve picked up on the inkling of despair that laces the strategist’s voice; as it is, he can barely hear anything over the sound of his racing pulse screaming in his own ears. He stalks across the tiled floor and storms out of the bedroom, concluding on his way down the hall to the empty suite that Prompto was better at this whole nurturing thing, anyhow.

There’s little to distract him from his ire when he finally drops into a velvet sofa, so he returns almost immediately to his feet and paces the far wall. When treading a path nearly the depth of Pitioss Ruins does little to ease his agitation, he moves into the kitchenette and empties the last of the nigh inedible eggs Prompto scrambled from their skillet into a nearby wastebasket; as he dislodges the stubborn flakes from the frying pan with a dirty spatula, he takes a few deep breaths to quiet his roiling mind.

It’s only when he is no longer seeing red, and his heartbeat has returned to a more reasonable pace, that Gladio acknowledges to himself the real reason behind the strategist’s unusual display of impatience; comparatively speaking, a few minor nicks from a dull razor blade were drops in a bucket to the man who had survived having roughly half his face ripped clean off. But even without the use of his eyes, Ignis ought to have seen that his friends were merely looking out for one of their own—helping to pick up the pieces of his shattered existence in an effort to return some measure of normalcy and routine to their lives—and the big man isn’t quite sure whose pride is hurting more.

Half an hour goes by before Gladio catches a glimpse of blond hair strolling down the hall outside the suite; he darts over to the doorway and pokes his head out, flagging the marksman down. “Hey.”

“He’s fine,” Prompto says quickly, raising his palms to defend against any further berating. “I got his face all nice and shaved—he’s looking like a new man.”

Gladio punches him playfully in the shoulder to offset the panic in his friend’s eyes. “Took you long enough. After thirty minutes, it’s a wonder you even managed to figure out which end was the sharp one.”

Freckled features crumple into a frown. “My beard may not be as thick as yours, but I know how to get rid of a five o’clock shadow. We finished, like, twenty minutes ago.”

The hackles on Gladio’s neck stand up on end, and his pulse begins to pound once more. “Where is he now?”

“Still in the bath, I guess.”

“And you just left him there? By himself?”

Prompto’s eyes widen at the sudden heat in the big man’s voice. “I set a couple towels out for him—he said he could take care of the rest on his own.”

“Open your eyes, Prompto!” Gladio bellows. “Iggy can’t even take a piss without help—how’s he supposed to climb out of a two-foot bathtub without knowing where to put his feet?”

He doesn’t give Prompto any time to argue before he is grabbing him by the collar and dragging him down the corridor with him to the room at the end of the hallway. Only after the two men struggle to fit through the threshold at the same time does he finally release him, dashing across the throw rug and toward the closed door of the bathroom; when he opens it, his worst fears are realized as his eyes lock on to the jumble of wet limbs sprawled out on the tiled floor.

It’s not the first time Gladio has seen his friend take a tumble, and the strategist is already pushing himself to his knees when the big man drops to his side. It happened the first time he tried getting out bed by himself mere hours after regaining consciousness, and again in an effort to quench his thirst when no one was looking; it would’ve happened a third time after a misfortunate encounter with a wayward ottoman, but luckily Prompto was at the right place and time to help break his fall.

For a man with wet hair plastered to his forehead and wearing nothing save for the pewter skull pendant around his neck, Ignis remains remarkably dignified as he climbs to his feet. “Thank you,” he says, steadying himself against Gladio’s elbow as he gropes for the nearest towel. “It seems the walls of the tub were much slicker than I had anticipated.”

The big man is less restrained than his injured counterpart. “What the hell were you thinking?” he yells. “It would’ve taken you two seconds to call for one of us when you were ready to get out.”

“I’m fine,” Ignis retorts, the civility in his voice quickly being replaced by irritation. “You needn’t come running every time I blow my damn nose.”

“You’re not fine, so don’t act like everything is fine because your too vain to ask for a little help. Just look at yourself.”

“I can’t.” The ligaments surrounding the socket of the strategist’s right eye strain as he struggles to open it, and he finally manages to yank at the towel Prompto is holding out for him and cover his modesty. “I can’t look at myself, because I can’t look at anything. Or are you blind yourself?”

The tension in the air is as dense as the steam fogging up the mirrors of the bathroom, and the freckled marksman shifts uncomfortably between the two men. “C’mon, man,” he says to Gladio. “Maybe we should just give Ignis a minute—”

The big man cuts him off with a sharp glare, then takes a step toward the strategist and shoves a finger squarely against his wet sternum. “Listen to me,” he growls. “We’re helpless enough without you as it is, and I’m not about to let you crack your head open on the bathroom floor when your body is just starting to heal. Call one of us for help next time.”

The strategist has his face tilted vaguely in Gladio’s general direction; witnessing Ignis Scientia lose his everlasting composure was a sight even rarer than spotting an elusive Cactuar in the wild outskirts of Leide, but his expression is livid just the same. “I didn’t realize my own free will was under the jurisdiction of a committee. Or do I need your permission the next time I care to brush my teeth?”

It’s what the strategist is renown for, dishing out savage quips and pushing peoples’ buttons; Gladio would’ve been ashamed at himself for allowing Ignis to get under his skin so easily, if he was feeling anything other than pure, unadulterated rage in that moment. “Take that ego of yours and stick it where the sun don’t shine,” he snarls. “How’s that for permission?”

Then he’s pivoting on his heel and storming out of the humid bathroom; he can hear Promtpo’s footsteps squeak back and forth against the wet floor, evidently gauging his loyalty between the big man and the blind one, until the sharpshooter finally moves toward the threshold and calls out after him. “Gladio, wait—”

“Leave him,” he barks, wiping his damp fingers on his pant legs as he bursts out into the hall. “If he wants to choke on his own pride, who are we to stop him?”

The Pitioss path is about as useful at blowing off steam as his last pacing session—which is to say, not at all. But there’s no fitness center to be found in the secretary’s estate, no copious amounts of iron to pump that would help to soothe his wrath. So he gnashes his teeth together instead, marginally pleased that the marksman has trailed after him into the suite rather than indulge in the strategist’s thinly-veiled narcissism, although not enough to stop the taste of angry bile from flooding onto his tongue.

Gladio would’ve welcomed Prompto’s mournful silence in light of the alternative—the constant oscillation between incessant chatter and stifled sobs for two days straight was beginning to wear down on his last nerve—but the absence of conversation serves merely to heighten the suffocating ambience of the room, raindrops hitting the windows being the only sound coming from inside the suite at all. He stops at one of them and peers out at the increasingly ominous sky; it’s as black as his heart, the weather as fickle as the Hydraean when she unleashed her indiscriminate wrath upon both the corrupt and innocent alike, and as cold and wet as the dead civilian bodies he helped drag out of the sea with his own two hands.

When the haunting memory threatens to wrap itself around his throat and strangle him senseless, and he can see the expression of anguish on Prompto’s freckled face mirroring his own, Gladio finally breaks. “Spit it out.”

The marksman kicks a booted heel against the leg of the chair he is slumped in. “It’s nothing.”

“Spit it out before I make you.”

Prompto then gnaws on his lower lip, and Gladio waits for the tears he wholly expects to start pouring down his friend’s cheeks; the younger man surprises him, however, when he moves to fiddle with the studded bracelet on his right wrist instead. “I just think you’re being a little hard on Iggy, is all.”

“Why?” Gladio counters. “Because it’s easier to bring him a glass of water than it is to watch him eat shit every time he gets thirsty?”

“It’s not about that. You know it isn't.”

“In case you hadn’t noticed, we don’t exactly have a lot of time to sit around and act like each other’s personal therapists. Telling Noct what happened when he comes to is going to be hard enough without having a second head case on our hands to deal with.”

The fingers fidgeting with the bracelet tug more anxiously at it. “It just feels like you’re punishing him for something he can’t control. It’s, like, not even in his DNA to ask for help—you can’t force him to do it. The only thing you can do is be there for him when he does fall down.”

“Don’t you see? His life doesn’t belong to him anymore—none of ours does. And he’s only going to make it harder on everyone if he keeps hurting himself.” The vein in Gladio’s temple begins to throb, but he clamps down on his anger and blows out his breath. “Look—we’ve all got a job to do, and Ignis can’t do his effectively if he’s taking careless risks and slipping on banana peels. He of all people should recognize that.”

“What are you going to do, give him a sponge bath every day for the rest of his life?” Prompto finally drops his bracelet and offers a tired shrug. “If he wants to do something on his own terms, we should trust him. It’s not like he’s racing into battle with a Malboro without a hi-potion.”

“I can only hope not to run into any tentacled creatures for some time.”

The strategist’s clipped accent pierces the air; Gladio whips his head around nearly as quickly as Prompto, and he resists the urge to roll his eyes when he sees Ignis’ sopping wet figure hovering near the edge of the threshold.

“What happened to brushing your teeth?” he asks sarcastically.

“It seems the tube resting on the sink I thought was toothpaste was actually antibacterial ointment.” The strategist’s nose wrinkles as he clutches at the bath sheet wrapped around his waist. “Regardless, I only stumbled this far down the hall so that I might inquire into a clean set of clothes. I’d rather not toss a pair of trousers over my head, if I can help it.”

Gladio’s gaze shifts to Prompto, but the sharpshooter is already on his feet. “I’ll dig up something for you,” he says, and disappears into the corridor.

Ignis runs his hand along the doorframe, feeling the ground in front of him with his feet as he steps tentatively into the room. “You needn’t worry—I’ll be on my way soon enough and let you two get back to analyzing my inner psyche.”

This time, Gladio does roll his eyes, although this irritable gesture is lost on his blind friend. “Cut us some slack, will you? We’ve got bigger fish to fry with without having to dance around your feelings.”

“My feelings in the matter are irrelevant. This is logistics we’re talking about.”

The icy air surrounding the strategist is palpable, and a twinge of pain tightens around Gladio’s heart as he watches his friend lower himself dejectedly into a nearby chair. “Give it some time, man—it’s too early to know what you’re sight is going to end up like. You’d be less of a burden on everyone if you just sucked up your pride, at least for the time being.”

The lines on Ignis’ forehead furrow, and he drops his voice to nearly a whisper. “I should like to reach a point where I’m not a burden on anyone, period.”

It’s an understandable fear, especially among those who have devoted their life to a higher calling; the idea of being so weak as to require defaulting on the assistance of others leaves a bad taste in Gladio’s own mouth. But the big man isn’t in the habit of tiptoeing around the proverbial Sylleblossoms, and there was a more pressing issue in need of addressing besides, so he sets his jaw in preparation of the next difficult conversation. “Speaking of burdens,” he says grimly, “one of us is going to have to break the hard news to Noct when he wakes up.”

A small fracture appears in the strategist’s aloof facade, and Gladio can see the faintest hint of sorrow lacing his features. “I have admittedly given the notion some thought.”

“What’s the plan, then? We gonna tag-team him, or…?”

The fractures deepen, his melancholy growing more obvious as his eyes move rapidly beneath closed eyelids. “That’s not necessary. I’ll do it myself.”

Gladio frowns as he studies the planes of his friend’s scarred face. “You don’t have to do it alone. There’s no reason me or Prompto can’t be there with you.”

“Prompto has a good heart, but I foresee his own grief getting the better of him before he could even eke out a single word.” The strategist runs a hand through his damp hair and heaves a sigh. “As for you—don’t take this the wrong way, but your sensitivity meter could use some calibrating.”

It’s why the dynamic between the Crownsguard had worked so well in the past; Prompto was the heart and soul of the Brotherhood, his kind and gentle nature a breath of fresh air in a sea of masculinity, while Gladio was the shield and protector, ready and willing to exchange his life for one of his own at a moment’s notice and without hesitation. Ignis was somewhere between the two, amiable to the point of taking genuine pride in the culinary masterpieces he created specifically with his friends in mind, but with enough steel in his backbone to turn around and slit an enemy’s throat with the very same knife he used to dice his carrots.

How their bonds would fare going forward remained to be seen, and a humorless laugh escapes through Gladio’s clenched teeth. “That’s probably true.”

The sound of hesitant footsteps entering the suite draw the big man’s attention, and he watches as Prompto sets a pair of folded slacks and a tunic on the coffee table in front of Ignis. “I found your purple shirt,” he says, his voice wavering slightly. “You know—the one with the Coeurl print. Thought maybe you’d want to wear something else besides pajamas for a change.”

The momentary fractures in the strategist’s veneer seal themselves, and he offers as genial an expression as he can muster. “You have my thanks.”

The marksman’s lower lip trembles slightly, and he nods once before turning back toward the door. “I, um—I’m just gonna go hang out with Noct, I guess. Maybe playing some King’s Knight in his ear will wake him up faster.”

“Prompto.”

The freckled man glances down at the fingers Ignis suddenly has clutched around his hand. “What’s up?”

The strategist’s left eye was likely a lost cause, Gladio concedes, but he can see his friend struggling to open the eyelid of his right one. After a moment, Ignis gives up his futile effort, his shoulders slumping forward with the same sense of despair that plagues them all. “There is a rather troubling task that lies ahead of me I’m going to need to prepare myself for,” he says quietly, his fingers tightening around Prompto’s wrist. “Would you be so kind as to scramble a few eggs for me?”

#ffxv fanfiction #ffxv imagines #prompto argentum #gladiolus amicitia #ignis scientia #final fantasy xv #ffxv #ff15 #prompto #gladio #ignis #ignis stupeo scientia

44 notes · View notes

dratefahmed1 · 5 months

Text

1 Stomach Injury Types, Causes, and Consequences #stomachinjury #medicine #medicaleducation

#stomachinjury #medicine #medicaleducation #gastroenterology #surgery #criticalcare #emergencymedicine #gastritis #ulcers #gastriccancer #gastroparesis #celiacdisease #inflammatoryboweldisease #gerd #gastricperfo #uppergastrointestinalbleeding #endoscopy #laparotomy #gastricbypass #vagotomy #pyloroplasty #nutrition #diet #lifestylechanges #prevention #awareness #advocacy “Trauma Surgery:…

View On WordPress

#anatomy and physiology of the stomach #blunt stomach trauma #chemical stomach injury #classification of stomach injury #complications and prognosis of stomach injury #dratef #image of stomach anatomy #image of stomach injury types #management of stomach injury #mechanisms of stomach injury #motor vehicle accident stomach injury #no1doctor #Stomach injury #stomach injury imaging tests #stomach injury symptoms and signs #stomach injury treatment #stomach injury types #surgery #Trauma

0 notes

juniperpublishersanesthesia · 4 years

Text

Pulmonary Aspiration during Induction of General Anesthesia in a Patient with Chronic Inflammatory Demyelinating Polyneuropathy-Juniper Publishers

Abstract

Chronic inflammatory demyelinating polyneuropathy (CIDPJ-a rare immune-mediated disorder affecting the peripheral nervous system-is the most common treatable neuropathy. Its clinical features include progressive or relapsing muscle weakness and decreased motor ability and or sensation in the extremities. Patients with CIDP are not encountered frequently in the operating room; thus, there is insufficient knowledge regarding their anesthetic management. Here, we report a case of pulmonary aspiration during induction of general anesthesia in a 64-year-old man with CIDP undergoing emergency surgery for gastric ulcer perforation.

Keywords: Piriformospora indica; Pulmonary aspiration; Chronic inflammatory demyelinating polyneuropathy; General anesthesia

Abbreviations: CIDP: Chronic Inflammatory Demyelinating Polyneuropathy; MNGIE: Mitochondrial Neurogastrointestinal Encephalomyopathy; Fio2: Fraction of Inspired Oxygen; Hb: Hemoglobin; Paco2: Partial Pressure of Carbon Dioxide; Pao2: Partial Pressure of Oxygen; Spo2: Oxygen Saturation; POD: Post-Operation Day

Introduction

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare neurologic disorder of the peripheral nervous system. Clinically, it presents with gradual muscle weakness that is typically symmetric and characteristically involves the proximal and distal muscles. It usually develops over more than 2 months with relapse [1]. There are only a few articles regarding anesthetic management of patients with CIDP and there are no reports on the possible complications during induction of anesthesia in such patients. Here, we report a case of pulmonary aspiration during induction of general anesthesia in a patient with CIDP.

Case Report

A 64-year-old man (weight, 50kg) was hospitalized in the neurology department with a headache. His medical history included CIDP, chronic obstructive pulmonary disease, chronic hepatitis C, diabetes mellitus, and hypertension. He also had undergone subtotal gastrectomy (Billroth I) for gastric cancer approximately 4 years prior. On the fourth day of hospitalization, the patient complained of sudden abdominal pain. The air- fluid level was confirmed on chest radiography. Gastric ulcer perforation was suspected, and emergency surgery was scheduled.

The patient was not premedicated prior to induction of anesthesia, and he had fasted for over 14 hours. He received 100% oxygen for 3 minutes with spontaneous ventilation. Anesthesia was induced with 50mg propofol and 2mg/hr remifentanil intravenously, followed by 20mg cisatracurium. Immediately after administration of anesthetic drugs, the patient began projectile vomiting. Abundant blackish material was removed from the oral cavity and tracheal intubation was performed. After intubation, his oxygen saturation decreased to 55% and his right lung sounds also decreased. Suction through the endotracheal tube was performed quickly. Mechanical ventilation with 100% oxygen improved his oxygen saturation to 90%, but his blood pressure decreased to 70/40mmHg. Norepinephrine was administered, and his vital signs stabilized. Intraoperative anesthesia was maintained with 100% oxygen (2 L/min), sevoflurane (1.5-2 vol%), remifentanil (1-2mg/hr), and cisatracurium. Wedge resection of the stomach with feeding jejunostomy was performed successfully.

After surgery, the patient was transferred to the surgical intensive care unit. He was diagnosed as having aspiration pneumonia, and treatment with antibiotics, inotropic agents, mechanical ventilation, and supportive care was initiated. Arterial blood gas analysis was performed daily (Table 1).Despite this treatment, his aspiration pneumonia did not improve. On the second postoperative day, bronchoalveolar lavage via bronchoscopy was performed. Subsequently, pulmonary infiltrates tended to wax and wane, and his other vital signs and respiratory parameters remained stable. On the tenth postoperative day, chest radiography showed increased haziness over both lung fields (Figure 1). The patient's condition worsened, and he died the following day.

Postoperative days: 0a: immediately after pulmonary aspiration; 0b: 1 hour after pulmonary aspiration; 0c: immediately after intensive care unit arrival; 0d: 10 hours after intensive care unit arrival.

Abbreviations: Fio2: Fraction of Inspired Oxygen; Hb: Hemoglobin; Paco2: Partial Pressure of Carbon Dioxide; Pao2: Partial Pressure of Oxygen; Spo2: Oxygen Saturation

Discussion

Pulmonary aspiration is a well-known severe complication of anesthesia. Aspiration of gastric contents has been associated with acute lung injury characterized by pulmonary edema, severe diminished gas exchange, and progression to acute respiratory distress syndrome. In a recent review, prevalence of pulmonary aspiration was reported to be 1 in 8,600 anesthetic procedures [2]. Most cases occur during induction of anesthesia, or, less frequently, during extubation and recovery. The clinical manifestations of pulmonary aspiration depend on the nature, quantity, and distribution of the material aspirated, as well as the relative impact of the acidic, bacterial, and particulate content, and other patient-related factors. Major risk factors for pulmonary aspiration include pregnancy after the first trimester and acute gastrointestinal disease, particularly esophageal or gastric disease, decreased esophageal or gastric motility, small bowel obstruction, and ileus. Other risk factors for gastrointestinal stasis include trauma, diabetes, obesity, and administration of drugs that inhibit gastrointestinal function. Preoperative fasting for at least 6 hours after consumption of a light meal or nonhuman milk and 2 hours after clear liquids (e.g., water, clear tea, black coffee) is also important. If the patient is determined to have a high potential for pulmonary aspiration, nasogastric tube placement is useful for reducing aspiration during induction of anesthesia.

Our patient had fasted sufficiently (>14 hours), and a nasogastric tube was maintained. Despite these conditions, he aspirated gastric contents during induction of general anesthesia. Kim et al. reported that Billroth I reconstruction after subtotal gastrectomy was associated with delayed gastric emptying (12 of 378 patients (3.2%)) [3]. However, gastric motility returned in 3 to 6 weeks in most patients [4]. Our patient had undergone Billroth I surgery 4 years prior, which should have been sufficient time to improve delayed gastric emptying.

Patients with CIDP rarely exhibit decreased gastrointestinal motility. Progressive forms of CIDP carry a poorer prognosis than relapsing forms. For example, difficulty swallowing is a common symptom in progressive forms [5]. In the present case, the patient had progressive upper and lower limb weakness and difficulty swallowing for over 3 months prior to admission. He had been diagnosed as having CIDP based on his clinical forms [5]. In the present case, the patient had progressive upper and lower limb weakness and difficulty swallowing for over 3 months prior to admission. He had been diagnosed as having CIDP based on his clinical history and electrophysiologic studies. According to his history, he had difficulty swallowing, dysphagia, and occasionally aspirated food when eating. Therefore, we suggest that CIDP is a risk factor for pulmonary aspiration during induction of anesthesia.

There have been several reports of cranial nerve involvement in CIDP. Teramoto et al. [6] reported relapse with dysphagia in a patient with CIDP with involvement of the glossopharyngeal and/or vagus nerve [6]. They also showed that intravenous immunoglobulin was effective for CIDP with dysphagia. Our patient complained of dysphagia, difficulty swallowing, slurred speech, ptosis, and diplopia, which indicated cranial nerve involvement, but electrophysiologic studies showed normal values. Intravenous immunoglobulin may be effective for CIDP with dysphagia that does not resolve with steroid therapy; however, in our patient, we did not have the opportunity to administer this treatment.

Differential diagnosis of CIDP should include mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) [7]. Incidence of mitochondrial disease (1 in 500) is more frequent than that of CIDP (1.6 in 100,000) [8,9]. Gastrointestinal and neurologic symptoms are the most common findings in MNGIE. Pathology outside the peripheral nervous system and elevated serum lactate level are what differentiates MNGIE from CIDP Our patient had gastrointestinal symptoms, but he did not have an elevated serum lactate level. Although there is insufficient knowledge regarding anesthetic management of patients with CIDP, MNGIE is known to be associated with respiratory failure, cardiac depression, conduction defects, and dysphagia.

The manifestations of pulmonary aspiration include acute onset of dyspnea, tachypnea, bronchospasm, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome and death. These manifestations vary depending on the volume and nature of the material aspirated. Our patient had received treatment with antibiotics, inotropic agents, mechanical ventilation, bronchoalveolar lavage, and supportive care. Pulmonary infiltrates tended to wax and wane, but his aspiration pneumonia did not improve clearly. We had planned on weaning him from mechanical ventilation after tracheostomy. However, on the 11th postoperative day, his vital signs were unstable, his respiratory parameters worsened, and he eventually died. There is no clear reason for the clinical deterioration of this patient. We suggest that his aspiration pneumonia may have led to severe septic shock.

Currently, there are no anesthetic guidelines for patients with CIDP. There are only several case reports to use as guidance [10,11]. According to these case reports, regional anesthesia can be administered safely, and the effect of rocuronium can be prolonged in general anesthesia. However, ours is the first report of pulmonary aspiration during induction of anesthesia in a patient with CIDP. For safe anesthetic management of patients with CIDP, more research is required.

Conclusion

In conclusion, pulmonary aspiration may occur during induction of anesthesia in patients with CIDP. Recently, increased monitoring of anesthetic care outside the operating room has been suggested. Anesthesiologists and physicians should keep in mind the possibility of aspiration in patients with decreased gastrointestinal motility.

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com

For more articles in Journal of Anesthesia & Intensive Care Medicine please click on: https://juniperpublishers.com/jaicm/index.php

For more Open Access Journals please click on: https://juniperpublishers.com

#Piriformospora indica #Pulmonary aspiration #Chronic inflammatory #polyneuropathy #General anesthesia

0 notes

jansen82mcpherson-blog · 5 years

Text

Getting Difficulties With Acid Reflux? Try out These Guidelines

Anybody can get acid reflux. konopi semena is believed that up to 33 percent of Us citizens may endure from this problem. Even though acid reflux influences so several men and women, you might not know how to deal with it. In the subsequent few minutes, you are going to discover a handful of useful suggestions for battling reflux. Chew your foods. The a lot more you chew your meals, the considerably less perform your stomach will have to do. This also slows down the fee at which you are consuming, which enables your belly to hold up with its fullness level. As soon as you've eaten enough, your abdomen will inform your brain and you will really feel complete. Acid reflux can be a regular reaction of eating as well much or too rapidly! If you've been encountering the consequences of acid reflux currently, modify your ingesting behavior. Boost the content of your foods by incorporating more healthy choices and take the time to chew your foods well. Your digestive keep track of will appreciate it and you must not suffer with acid reflux so significantly High excess fat food items may be delicious, but that can be troublesome for anybody who suffers from acid reflux. Foodstuff that are substantial in unwanted fat result in the sphincter of the lower part of the esophagus to grow to be comfortable and enhance the time it normally takes for the abdomen to empty. Both of these circumstances make it feasible for acid reflux to arise. Consume a wholesome balanced diet plan of vegetables, fiber, grains, and lean protein. Change to aloe vera juice for a soothing way to heal the injury acid reflux can trigger. It minimizes swelling in the esophagus and the lining of the stomach by itself. All you need to have is a 50 percent a cup just before a food to help in your digestive regeneration, but keep in mind that it is also a laxative! If you have been encountering indicators of acid reflux, consider to cut down on the amount of alcohol you consume. Possessing some beverages tends to unwind the muscle tissue in the abdomen. When this transpires, men and women start off to encounter worsening of these symptoms. If you should have a consume, make confident to restrict by yourself to one or two drinks. It's time to shed some kilos. The most common situation leading to acid reflux is becoming over weight. You can lower the likelihood of acid reflux signs and symptoms by reducing your body excess weight by a mere ten%. You can use smaller sized meals to drop excess weight, since crash dieting is not the solution. If you suffer from acid reflux you can assist alleviate the signs and pain by watching what you try to eat. Consuming meals that are substantial in acidic content will drastically improve the volume of pain you feel from this condition. Try to avoid consuming foodstuff like tomatoes, corn, canned fruits, or any other of the 1000's of foods that are substantial in acidic articles. Acid reflux can be devastating in your lifestyle. Not only is the discomfort from heartburn a issue, but the danger of contracting gastroesophageal reflux disease is very high. If still left untreated, you could develop cancer of the esophagus. If you feel, you have problems with acid reflux, you need to have to check out a medical doctor before long. Take in smaller foods to aid manage your acid reflux difficulties. When you over stuff yourself in the course of a food, it can typically direct to not comfortable digestive upset, such as acid reflux. As an alternative, consider eating many modest meals a day, and usually stop consuming as soon as you get started to come to feel happy. Think about taking a proton pump inhibitor. Medications this kind of as omeprazole function to minimize the amount of acid your belly produces, stopping acid reflux at the source. Make positive you speak to your medical professional prior to starting up these varieties of medication, even individuals that can be obtained above-the-counter. You will need to have to make sure that as well significantly acid in the tummy is the trigger of your acid reflux. Chewing a adhere of cinnamon gum following your meals may help with acid reflux. Chewing some gum will trigger your glands to produce far more saliva, which can neutralize your abdomen acid. Chewing some gum also triggers most people to swallow with higher frequency. This performs to return abdomen acids to the appropriate area. A great way to eradicate your acid reflux is to change your diet in excess of to a plant based mostly diet plan. Meat is a large contributor to acid reflux. This appears to be contradictory simply because meats seem to be to be extremely alkaline when analyzed prior to consumption. The dilemma is that after meat is digested, it will leave a highly acidic residue within the entire body. Pregnancy may possibly trigger acid reflux indicators. Much more particularly, a link has been detected amongst pregnancy and chronic acid reflux. This generally stems from the simple fact that the weight of the baby is crowding the abdomen location. Most of time, the acid reflux signs and symptoms are relieved soon after the little one has been shipped. Understanding the indicators of acid reflux is the most essential information to have. If you discover you have upper body ache merged with soreness after taking in, burping, nausea, sore throat, bitter taste in your mouth and/or a persistent cough, you probably have acid reflux. Discuss to your doctor for a true prognosis. Make exercising a part of your healthy consuming prepare. Moderate workout can facilitate the approach concerned in digesting your meals properly, and it can also help you to get rid of excessive lbs. Equally of these items can have a optimistic effect on acid reflux problems. Make a stage to work out at a reasonable level at least 3 instances a week for very best results. Did you know that acid reflux, when untreated, can guide to ulcers? You can have perforations of equally the stomach and esophageal lining, leading to powerful ache. When your heartburn appears to have kicked up a notch, speak to your doctor to get the correct assessments accomplished to rule out this complication. So many folks experience from acid reflux in The united states. It is helpful to know that if you are one of them, you do not have to get it lying down! Set the suggestions earlier mentioned to great use and you will before long be residing a existence without having ache from acid reflux.

0 notes

casuallyimportantshark-blog · 7 years

Text

Vitamin D Benefits For Health

Step 1 towards healthy weight is correcting this diet. An incremental decline in your canine's consumption or changing the lower calorie or holistic food may be helpful. The prognosis of this kind of injury depends in regards to the severity for this tear, how quickly you get treatment, as well as your current bone and Joint Health. If a sprained thumb is treated promptly and properly, full normal function will be preserved and restored. Purchase delay management of skier's thumb, however, chronic weakness, instability, and/or arthritis could develop. These late complications can be repaired using a joint fusion procedure or ligament rebuilding procedure.

youtube

Thera bands have associated with workout routines and will all utilize different muscles within method. Some muscles you won't be aware of are there until you have completed an exercise routine. The resistance within these bands works your entire muscle at once, doesn't just in pieces as other free weights do. You also want to try to try as many repetitions as possible, using each repetition it are certain harder for that resistance that you may be using. Boresha not necessarily has its famous Skinny Coffee, within the has Nuvo Gene Tea which is yet another very intricate fat burning tea that attacks an obesity causing gene, and let me tell you from personal experience this teas are very good, it tastes like punch. Boresha hit it on the nail with the product for individual palate. Don't concentrate on only a person who or sporting activity. Make Shanti CBD Oil -training program to in avoiding the repetitive motion of one sporting activity that may joint problems over moments. If you're a swimmer, try to do some biking as extremely well. If you're into walking, rowing aid develop your upper stomach. By participating in a variety of physical activities, you avoid unnecessary strain on one part of your body while developing other locations your body to help stabilize and protect your joints. Get alternating. Exercise can help Reduce Joint Pain and stiffness and increases flexibility and muscle strength. Inflammed help with weight control, stress management, and cause you to feel better in total. The Arthritis Foundation also offers water exercise and other classes. So are able to be associated with where the oil comes from, like waters, also as, the species. A brandname that specifies where it gets the oil from, and also what type of fish is commonly employed is easily the best brand for taking.

0 notes

hollyrosemassage · 7 years

Link

Earlier than beginning my article I’ll prefer to say a couple of phrases about well being. “Each human being is the creator of his personal well being or illness.” “He, who has health, has hope. And he, who has hope, has all the things.” “It’s health that’s actual wealth and never items of gold and silver.” Article Abstract This text discusses the highest 10 well being points and dangers regarding ladies as we speak and affords some beneficial suggestions. The recommendation is meant to help ladies in dwelling longer and extra fulfilling lives. Key Well being Points for Ladies 1. Coronary heart Well being and Coronary heart Illness 2. Breast Most cancers three. Weight problems and Sort 2 Diabetes four. PMS and Menopause 5. Prenatal Well being 6. Osteoporosis and Arthritis 7. Growing old and Longevity Points eight. Kidney and Bladder Well being 9. HIV and Sexually-Transmitted Ailments 10. Nervousness and Sleep Problems Coronary heart Well being and Coronary heart Illness- Though many individuals are unaware of this difficulty, coronary heart illness is by far the primary killer of ladies within the U.S. Hypertension, excessive ldl cholesterol, extra weight, diabetes, menopause, smoking and bodily inactivity are key coronary heart illness dangers. Sustaining a wholesome coronary heart requires that we undertake a healthful weight-reduction plan low in saturated fat and excessive in soluble fiber. To scale back your dangers, stop smoking, preserve a wholesome weight, cut back stress ranges and be extra bodily energetic. Ideally, train in your coaching zone for 30-45 minutes every day. An influence-walk is among the greatest methods of getting sufficient train to fulfill this each day requirement. It is also simple in your joints relative to different workouts and it may be loved with a member of the family or good friend. Breast Most cancers – In line with Prevention Journal (March 2008), genetics play a task in figuring out general breast most cancers danger, nonetheless lower than 10% of breast most cancers instances are hereditary. Different danger components embrace rising age, private historical past of breast abnormalities, bodily inactivity, being chubby, taking hormone substitute remedy, early menstruation (earlier than the age of 12), late menopause (after age 55), age at your first reside start and household historical past of breast most cancers. To scale back your danger of most cancers usually, eat extra vegatables and fruits, cut back dietary fats, drink much less alcohol, stop smoking and train recurrently. To scale back your breast most cancers danger particularly, make sure you train recurrently and preserve a wholesome weight. Do your month-to-month breast self-examinations and have regularly-scheduled mammograms from age 40 onwards. If there’s a identified breast most cancers danger based mostly on genetics, surgical and non-surgical choices will likely be mentioned with you by your doctor. Weight problems and Sort 2 Diabetes- Sort 2 diabetes is a illness wherein your pancreas produces too little insulin or your physique is unable to correctly use the insulin that it produces. The result’s a build-up of glucose (sugar) in your blood. Weight problems is a key danger issue for kind 2 diabetes. If left uncontrolled, there are numerous critical problems related to kind 2 diabetes, resembling coronary heart illness, kidney issues and attainable blindness. Some signs of kind 2 diabetes are elevated thirst, starvation and urination, fatigue, weight reduction and blurred imaginative and prescient. With a view to cut back your danger of kind 2 diabetes, you need to attain a wholesome weight, be bodily energetic day-after-day and handle your blood strain ranges if in case you have hypertension. As well as, cut back your consumption of saturated fat and improve your consumption of soluble fiber to maintain your levels of cholesterol within the regular vary. PMS and Menopause- PMS is a quite common syndrome affecting an estimated four out of 10 ladies within the final two weeks of the menstrual cycle. It’s thought that altering hormone ranges and mind chemistry play a task in PMS. Many signs have been linked to PMS, together with irritability, bloating, weight achieve, fatigue, stomach ache, meals cravings and forgetfulness. Delicate or average PMS signs may be managed by consuming a weight-reduction plan wealthy in complicated carbohydrates resembling complete grain breads and greens, and together with 30 minutes of cardio train 3 times per week. Analysis signifies that calcium, magnesium, vitamin b6 and night primrose may assist cut back PMS signs. On the termination of menstruation, a ladies enters menopause after which should cope with one other set of signs. The signs of menopause embrace scorching flashes, urinary incontinence, vaginal dryness, breast adjustments, thinning of the pores and skin, bone loss, improve in LDL (dangerous) levels of cholesterol, improve in coronary heart illness danger, in addition to weight achieve. You’ll want to see your physician yearly for a breast examination, pelvic examination and mammogram. Train recurrently to take care of a wholesome weight, eat a weight-reduction plan low in saturated fat and excessive in soluble fiber, and make sure that your calcium and vitamin D consumption is satisfactory. You must also do common strength-training to assist strengthen your bones. Prenatal Well being- Even earlier than you grow to be pregnant, try to be consuming a nutritious weight-reduction plan and sustaining a wholesome weight throughout your childbearing years. This may put together your physique for the challenges of carrying a toddler and can set a strong basis for nourishing your little one throughout your being pregnant. Eat a weight-reduction plan wealthy in calcium (milk and yogurt for instance), excessive in folate (from complete grains and darkish inexperienced greens and legumes) and excessive in iron (rooster and fish primarily) previous to and through your being pregnant. A minimum of three months earlier than you grow to be pregnant, you need to start taking a folic acid complement as soon as each day to cut back the danger of neural tube defects in your child. A multivitamin with extra iron can also be suggested to make sure that you’re getting satisfactory quantities of important nutritional vitamins and iron. You’ll want to observe your physician’s recommendation all through your being pregnant and preserve your doctor knowledgeable of any and all dietary supplements you’re consuming each day. And, for the sake of your child’s well being, keep away from smoking, ingesting and medicines. Osteoporosis and Arthritis- As we age, the well being of our bones and joints turns into an rising concern. Osteoporosis is a bone illness that leads to lowering bone density and rising danger of bone fracture, significantly within the hips, backbone and wrists. Arthritis is a joint dysfunction that’s characterised by irritation within the joints. Danger components for osteoporosis embrace being 65 years of age or older, having a household historical past of osteoporotic fracture (particularly a mother who had a hip fracture), having a bent to fall, or early menopause (earlier than 45 years of age). Some minor danger components embrace low calcium consumption, low physique weight, extra caffeine and alcohol, and smoking. To scale back the danger of osteoporosis, do weight-bearing and strength-training workouts a minimum of three occasions per week to strengthen your bones, eat a weight-reduction plan wealthy in calcium and vitamin D, and take a calcium complement each day. Signs of arthritis embrace ache and joint stiffness, together with redness, swelling and heat. Relying on the type of arthritis, another signs might embrace fever, weight reduction, fatigue, gland swelling, and common malaise. Early prognosis and remedy by a rheumatologist is essential to make sure the absolute best final result and to assist stop everlasting incapacity. Many dietary supplements that assist help optimum bone and joint well being are additionally accessible available on the market as we speak. Growing old and Longevity Points – Genetics performs a key function in growing older with some people blessed with longevity genes that predispose them to dwelling an extended life. No matter the genes you’ve gotten inherited, it’s nonetheless attainable so that you can reside a protracted and fulfilling life. Free radicals are unstable molecules that may trigger injury to cells leading to coronary heart illness, most cancers and plenty of different well being points. Consuming meals wealthy in antioxidants resembling blueberries is one solution to combat free radicals earlier than they’ll injury cells. Not solely do free radicals reek havoc on the physique over time, however the physique’s techniques additionally begin to age (the guts, lungs, mind, kidneys, bladder, muscle tissues, bones, eyes, and so forth). To restrict the quantity of bone and muscle loss, you need to train recurrently and do strength-training workouts as talked about beforehand. To maintain your coronary heart and circulatory system in good working order, you’ll want to restrict saturated fat in your weight-reduction plan and preserve your LDL levels of cholesterol low by consuming meals excessive in soluble fiber resembling oatmeal. You too can preserve your thoughts sharp by doing psychological health workouts resembling phrase puzzles. As properly, there are numerous nice dietary supplements available on the market which might be particularly designed to deal with longevity points, leading to a extra lean and wholesome physique. Kidney and Bladder Well being- The 2 commonest circumstances affecting the kidneys and bladder are kidney stones and urinary tract infections (UTIs). The place ladies are involved, urinary tract infections are probably the most prevalent. Thousands and thousands of ladies yearly undergo from this kind of an infection, which is the second commonest kind of an infection within the physique. It isn’t identified why ladies are particularly liable to urinary tract infections. A UTI happens when micro organism (usually E.coli from the colon) will get into the urethra, which is the tube that carries urine from the bladder to outdoors the physique. If not handled, the micro organism can infect the bladder inflicting a bladder an infection. If once more left untreated, the micro organism can journey up the ureters to the kidneys, leading to a critical kidney an infection. Folks affected by kidney stones are liable to creating a UTI. Signs of a UTI embrace a frequent urge to urinate and burning sensations throughout urination. Antibacterial medicine are used to deal with UTIs. Many dietary supplements are additionally accessible to help bladder and kidney well being. HIV and Sexually-Transmitted Ailments- HIV an infection continues to develop steadily with heterosexual transmission making up the vast majority of all new instances. Within the U.S., African-American and Hispanic ladies have the best an infection charges amongst American ladies. Ladies are contaminated with HIV throughout intercourse or following injections of medication resembling heroin or cocaine utilizing HIV-infected syringes. Different sexually-transmitted ailments resembling genital herpes, syphilis and chancroid that trigger ulcerations of the vagina, improve a ladies’s danger of being contaminated with HIV throughout intercourse. Signs of HIV an infection embrace fevers, night time sweats, fatigue and weight reduction. Vaginal yeast infections are typically troublesome to deal with with ladies who’ve HIV and plenty of different vaginal infections might happen extra regularly and with extra severity, resembling gonorrhea, chlamydia, and trichomoniasis. HPV infections that trigger genital warts and might result in cervical most cancers are additionally extra widespread in HIV contaminated ladies. Early prognosis is essential to make sure that ladies may be handled with the antiretroviral medicine accessible as we speak. Constant use of latex condoms beneath all circumstances considerably reduces the danger of changing into contaminated with HIV, nonetheless it doesn’t cut back the danger of contracting a lot of the different sexually-transmitted ailments. The one means to make certain is to have you ever and your companion examined after which to stay monogamous. Nervousness and Sleep Problems – Nervousness problems are the commonest psychological sickness within the U.S. Nervousness problems embrace generalized anxiousness dysfunction, obsessive-compulsive dysfunction, panic dysfunction, post-traumatic stress dysfunction, social anxiousness dysfunction, and particular phobias. Nervousness problems are characterised by persistent, extreme and unreasonable ranges of hysteria, concern or fear. Sleep problems are characterised by irregular sleep patterns leading to impairment of bodily, psychological and emotional functioning. In some instances an anxiousness dysfunction can result in a sleep problem, however the reverse can also be attainable. Lack of sleep stimulates the a part of the mind most carefully linked to melancholy and anxiousness. In case you undergo from persistent insomnia, it’s probably that you just additionally undergo from one other well being situation, resembling anxiousness or a temper dysfunction. Whether or not it’s anxiousness or insomnia, you need to see your physician in both case in order that correct remedy may be prescribed. Therapy might contain remedy, leisure methods and/or remedy. a Bradford Massage Therapy | Holly Rose Massage Swedish MassageSports MassageDeep Tissue MassagePrenatal MassageAromatherapyTrigger Point Therapy The post Top 10 Women's Health Issues appeared first on Holly Rose Massage. http://ift.tt/2fBSloa

#IFTTT #Facebook

0 notes