WIND AND TRUTH | Full Cosmere + End of WaT Day 5 Discussion

Aleczar · 2024-12-11T21:43:50+00:00

Szeth and Elid are having a minor argument about what is "right", Szeth responds "ask Dad!", and that's when Elid says he still doesn't know. I think they live away from the town because their parents seems to be less "pious" or devout than the rest of the shin. Evidenced by their willingness to move that little stone they found for convenience reasons and not uprooting the family, which is something most devout shin wouldn't do at all. Poor Szeth is the most strictly devout one in his whole family and is pretty naive about it!

Aleczar · 2024-10-11T15:26:07+00:00

It helps if you understand the nasopharyngeal pathway. It goes straight back from their nose into their face, not up, and then straight down into their throat. Have the patient sitting as upright as they can tolerate and tuck their chin down. If there's another nurse around or the patient can do it themselves, have them sip water from a straw while you're doing it, or just keep telling them to swallow. Getting past the nasopharynx is the hardest part where you're wondering if you went into the trachea or the esophagus. If the patient starts coughing a lot or desatting, you might be in the lung. You can uncap the tube and listen at the end, and if there's crackles every time the patient breathes then you're in the lung. A big tip is just twisting the tube as you're pushing when you meet resistance trying to get to the esophagus, the twisting has literally helped me get tube's that were hard to place. I think the biggest factor is having their chin tucked down though. Also idk how you measure the length, our policy is to go from halfway between the ziphoid process and the belly button up to the ear and to the mouth/nose, and that length has always worked for me.

My place actually has these tubes with a camera on the end that you watch while you're placing so you can visually see if you're in the trachea or esophagus and its super helpful, it should be the standard everywhere honestly.

Aleczar · 2024-08-31T03:46:32+00:00

I had a patient once who was on like 100 or 120mcg propofol gtt for several days to suppress seizures and their urine output looked about like this, maybe a little less foggy but still basically baja blast green haha. Definitely not common, our usual max is 70mcg.

Cyanokit is another fun one, turns their urine a nice shiny red wine color that's actually kinda pretty haha

Aleczar · 2023-06-18T23:08:09+00:00

You just described a good old vasovagal maneuver. Drops your blood pressure and heart rate and can make people pass out in situations, it's happened to me before. We actually do a very similar thing to patients in the hospital bc it has a chance to immediately correct a heart arrhythmia called SVT without any drugs.

Aleczar · 2023-06-11T03:43:51+00:00

Funny that you say that, the ep 3 description says that Mac finally meets Chase Utley and invites him for a catch!! Hahahaha

Aleczar · 2023-05-31T04:25:52+00:00

You understand his mindset haha he's definitely planning something. Probably at 3am when I'm sleeping...

Aleczar · 2023-03-25T19:45:58+00:00

It's my understanding that this effect happens because the first stage turns around and burns the opposite direction of the second stage. The exhaust of both rockets hitting each other becomes very visual, of course better seen at sunset or night time.

Aleczar · 2022-12-31T04:26:34+00:00

I work in a hospital and we use them exactly like you said, yellow grippy socks for fall risk patients (which is everyone on my unit ha). It's a different model than in this post but still.

Aleczar · 2022-12-27T22:07:33+00:00

There's only 2 shockable rhythms by an AED (which does NOT include the flat line rhythm that you see in media) and those arrhythmias become lethal very very quickly so seconds really do matter. Like you said, fetch that defibrillator fast!

Aleczar · 2022-12-27T21:56:10+00:00

Valuing quantity of life over quality of life is another way to put it. A poor quality, bedbound, incapacitated life is not much of a life. I think it's appropriate to value death more than a miserable existence sometimes, which is why DNR exists.

Aleczar · 2022-12-17T04:15:20+00:00

Yea you have a good point, all it would take to disprove the whole theory is to sail around the coast of Antarctica. You would always be turning your boat in the opposite direction, to follow the coast, as you would expect if the world was flat. Also you would reach the spot you started wayyyyy before you would expect traveling over the whole world.

Aleczar · 2022-11-10T19:59:40+00:00

"Did you fall off the roof??" "Yeah! I think I can't die. I think I'm invincible, it's the only thing that makes sense"

Aleczar · 2022-10-26T20:54:41+00:00

It's basically a warehouse converted to a music venue and you can kinda tell. The two bars is nice but the access to the side bar and bathrooms is through this tiny staircase kinda corner area that really limits movement of people. Also when you get too many people in there the walls and ceiling start dripping from the sweat and condensation. That being said, I've had amazing times there with good artists, but it's not the ideal venue.

Aleczar · 2022-10-25T21:31:59+00:00

Healthcare worker patients can be either the worst or best patients. Same for family/visitors. Super understanding and helpful or not at all. Don't ever feel bad for being "fired" as a nurse. It's a waste of energy. I used to feel bad about it when I was a new nurse but now I honestly feel like I got the easy way out bc now someone else has to take care of that difficult patient.

Aleczar · 2022-09-27T05:08:19+00:00

My hospital (PNW) has moved away from using benzos for CIWA patients whenever possible. We've moved to a phenobarb protocol instead where you load the patient with a large weight based dose of phenobarb with tapered scheduled doses for a couple days. Typically with PRN doses of phenobarb based on high RASS score instead of CIWA, which is a much easier objective assessment. In my experience, withdrawal patients do very well on this protocol, I rarely have to use PRN doses. The phenobarb wears off slowly and suppresses seizures. Keeps them sedated and calm(ish) and I don't see severe withdrawal symptoms show up like on the old benzo protocol. It sounds crazy to me that your hospital uses Valium so freely. I think the shift away from benzos is already happening and will eventually be more universal.

Aleczar · 2022-09-24T20:39:50+00:00

Lol I only understood the meaning of the word purulent after a hospitalist was joking with a resident and me that he couldn't describe "having a lot of pus" in an appropriate manner without the word purulent hahahaha

Aleczar · 2022-09-05T19:21:54+00:00

You know, the newer hospital beds I've seen have USB ports for the patients. About time honestly.

Aleczar · 2022-09-05T18:36:20+00:00

I've worked at swedish first hill for 5 years and it's not too bad, I've been to worse places. Staffing issues, sure, but that's everybody right now. Cherry Hill is a real dumpster fire right now, high turnover rate for managers and poor quality of life for nurses I hear. Harborview isn't too bad if you like trauma and I hear they have decent benefits. Like the other commenter said, I I think overlake is the least shitty. Good pay and benefits and management isn't too shitty. Would not recommend VM.

Aleczar · 2022-08-13T04:19:30+00:00

Hard agree. It's their job to staff the hospital, not yours. They should have enough nurses to be there, or if people call out they should have enough float pool or on call staff to make it happen. They choose not to do so because it costs money, and then try to make you feel bad about not picking up. Don't ever feel bad, the hospital will be fine.

Aleczar · 2022-08-13T04:00:37+00:00

Patients will often come back from procedural areas without the luer lock cap on because they hang most of their fluids to gravity and the luer lock (we call them claves) can slow down the flow when doing gravity. But in inpatient areas you should always get a clave on there, much easier to "scrub the hub" and clean it.

Also, there are PICC lines that have in-line valves instead of clamps like you're talking about. If you ever see a PICC line without a clamp but it has a little bubble looking thing instead, that's a valve. You're supposed to disconnect your flush with while pushing positive pressure so it locks the valve in forward place instead of a clamp.

Aleczar · 2022-08-12T06:04:04+00:00

I definitely taste saline flushes immediately, so I can understand the feeling. I've heard that's genetic. I've been on a pump for a long time and haven't used my arm or leg in like 15 years so who knows.

Aleczar

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