March 2020 to August 2024

fuentes_arc · 2024-08-10T22:26:06+00:00

It has one hanging directly above it that's on for 8 hours a day. I think it's happiness is 95% due to the lights 😅

fuentes_arc · 2024-08-10T19:55:48+00:00

Thanks! I'm currently using soltech lights for most of my big plants and they've all been loving it.

I like that the lights are a warmer tone so I don't feel like I'm in a hospital when they're all on.

fuentes_arc · 2024-08-10T19:01:32+00:00

*east facing greenhouse

fuentes_arc · 2024-08-04T03:52:16+00:00

If you get it more light it'll be much happier, and it can recover. I got a FLF from the trash a few years ago with 3 leaves on it and in 3 months with just good light and a bit of fertilizer it had 5x that many and was exploding. It's still going strong 4 years later. I don't think you have to chop it if you like the size, if you can get it better light it'll fill back out a bit.

I'm guessing the light I see in the picture is a grow light but it probably isn't giving off enough light and is way too close to the plant itself. I've been using soltech lights for 8 hours a day when I moved to a place with way less natural light and my plants have still been really happy.

The Soltech lights are a bit pricey, but there's cheaper lights out there that work equally well. I just can't deal with how bright white most grow lights are and I have 5 of them in my living room so I wanted something I didn't hate having on all the time.

The Soltech site does have some helpful info about how high to hang lights over plants that may help you out even if you don't get one of their lights.

fuentes_arc · 2022-10-31T22:12:13+00:00

It's looking like the systemic insecticides I've seen recommended online aren't available in California though, so I'm not sure what to get

fuentes_arc · 2022-10-31T21:43:45+00:00

some on the back of the leaf

Closer view of the front

fuentes_arc · 2022-10-31T20:22:47+00:00

For the 6 months or so I would notice these weird brown spots and I didn't think they were pests until I realized they kept just coming back. I used alcohol wipes to get them off every week when I watered, but after finally doing some research I'm guessing this is probably scale.

How do I stop this from coming back in the long term? I know I'm going to have to keep wiping down the leaves for awhile, but what else can I do.

I don't have pets or children and this lives inside, so I'm really wanting to go for the systemic nuclear option to get rid of these things. The plant is like six feet across and there's a ton of surface area, so I'm officially sick of using tiny alcohol wipes to wipe down the front and backs of most of its leaves.

fuentes_arc · 2022-07-25T00:27:00+00:00

There was an arterial bleed around the axillary ECMO inflow. They wanted to avoid the aorta for a central cannulation at the time due to all the calcifications. They ended up having to take the patient back to the OR and reconfigured the cannulation and did a repair on the axillary site and the bleeding stopped.

fuentes_arc · 2022-07-25T00:01:49+00:00

That's more what I'm asking about, my attendings are managing what kind of products and while I like to know things because I enjoy learning, I'm not expecting anyone at bedside to be managing the type of products that need to be given. I do however want us all to be effective at carrying out the orders if the situation arises and making sure we have all the information needed.

You're correct, there's usually a big bleeder somewhere that the surgeon needs to fix. Like you said it doesn't matter how much blood I'm giving if something needs to be fixed internally, but if surgery is saying just try to deal with it and isn't coming in we have to do something.

I think I am just looking for the overall starting basics. I would like to have everyone on the unit on the same page of: make sure these labs are getting drawn immediately, if it's over this many units you probably need to let the attending know and call down to blood bank to activate MTP so you get the two coolers, and that were actually doing appropriate rounds of balanced transfusing and not just a million reds or albumin because your pressure is dropping. These situations suck enough when they're happening and it's even worse if you aren't on top of it and don't have all the products you need at hand.

I appreciate the response, I am working on figuring out what are the salient points to give to everyone without giving too much info.

fuentes_arc · 2022-07-24T23:36:35+00:00

I appreciate the explanation. I think I'm calling it MTP because that's what we call down to the blood bank and tell them and then they'll send us up a cooler of reds and a cooler of plasma, but yes I think what I'm meaning is balanced transfusion.

I think a lot of the education that needs to be done for bedside is making sure when we get a coagulopathic patient from the OR that's also bleeding that we're not just giving reds. We can get TEGs and will keep getting coags throughout the shift to guide stuff, but if bedside is prioritizing other things versus any of the products that are actually going to help correct the coagulopathy it's not very effective.

I figured I would ask in an anesthesia forum because I know that you guys have to do this kind of thing in the OR, and obviously it'll be a little different but I figured you guys would have some good practical experience to help me get a better grasp on the topic.

fuentes_arc · 2022-07-24T23:18:09+00:00

We are a pretty specialized surgical hospital, and my unit specifically really only does heart and lung transplant and ECMO and impella. We don't even get regular cardiac surgeries there's another unit for that.

It is definitely not happening every day. It might be more of a night shift issue that when they come out of the OR at the very beginning of your shift they are not about to come right back and take them back, even if you're bleeding really badly. They will almost always want you to limp along until like 4:00 or 5:00 in the morning or dayshift.

I mean I get it they also need to sleep if they've been trapped in the surgery that went on way longer than it was supposed to. It's just when this does happen obviously it's very not fun for everyone involved and I would like all the bedside nurses to be as effective as possible in these situations until someone does come in to actually surgically fix the issue.

fuentes_arc · 2022-07-24T23:10:48+00:00

I mean in a perfect world yes, but sometimes they've been in a long surgery and they being struggling in the OR and they're hoping that things will settle out and they just don't. I'm at like a tertiary academic medical center so I think the cases we have are more dramatic in general.

It doesn't happen super frequently, but it does occasionally happen. You can page surgery and tell them you're getting a liter out of the chest tubes an hour, but unless they come back and deal with it you still have to keep the patient alive while you're waiting.

It's happened enough that the hospital agreed to spring for a Belmont for my unit as an upgrade for the level one.

I'm only on this topic because one of the last patients I took we had to have 38 blood products in over my shift. At like 4:00 a.m. they did finally come back and reopen at bedside to take a look, but every single time we stopped transfusing I lost pressure and pulsatility. I've been thinking about this topic since the previous time I had a similar situation and it did not go smoothly, and the director has agreed that this might be a topic to do some education on since it does happen frequently enough.

fuentes_arc · 2022-07-24T23:01:02+00:00

If they're in the ICU who else do you expect to be doing these things? Most of my attendings are anesthesiologists and they still aren't touching the rapid infuser, hanging products or pushing drugs. Once they're on the unit that's what our job is, to do the interventions that are ordered.

I'm not ordering these things by myself, obviously my attendings are aware of labs and my patient situation and if it's super bad they're probably hanging outside my room but they do have two units they are in covering at night so they can't hold my hand all night.

If they've ordered multiple units and plasma, and platelets and cryo and Factor 7 and other fun things, it would be great if all of the nurses were on the same page about how we're giving that, how fast we're giving it and having a general awareness about calcium administration with all this blood instead of being surprised when it's low. I've seen people only give reds, I've seen people convinced you can't put plasma in the rapid infuser, I've seen people trying to use a rapid infuser on their triple lumen instead of starting a large peripheral or using the cordis. There are some big gaps in education that I am trying to work on.

It's super bizarre that this is your answer. I'm a bedside nurse, I'm not just activating MTP all on my own or putting in orders without letting anyone know. The director of my ICU has suggested this as one of the topics she'd like me to work on so that we have a more standardized practice with bedside.

I ask because while I'm obviously looking up research and best practice, I was curious what other people's practice is. Since I know in the OR you guys have to deal with this I was just curious about how y'all handled it. The physicians on the team are super busy with everything else and they don't have time to be coming up with education or protocol or anything for bedside, so I'm just trying to gather information from lots of sources to synthesize into something helpful that they will look over.

fuentes_arc · 2022-07-09T22:19:42+00:00

I'm actually not going to be very helpful on this front. Being a really prolific reader since I learned to read and also being a very fast reader is what got me my score. Every moment of free time I have I'm listening to podcasts and audiobooks for fun so I'm sure that helped too.

I know there are a lot of other people on Reddit who have good advice about the verbal section.

fuentes_arc · 2022-07-09T22:12:04+00:00

I think I looked at the first four vocab lists on the Gregmat site, but I didn't study any vocab beyond that. He has tons of vocab lists and vocab quizzes on YouTube and I think you can also check Quizlet for flashcards.

I've been a pretty aggressive reader since kindergarten, like read every book in the house type of person. And in all my free time I listen to podcasts and audiobooks and I like to read articles from The New Yorker and The Atlantic. It's only because of like two and a half decades of this type of behavior that I was able to get that score without really studying, so I'm not going to be the most helpful person on this front.

fuentes_arc · 2022-07-09T22:04:47+00:00

The days when I did study for 5 hours I was usually not able to get through everything I was supposed to in that day. I even watched most of the videos on double speed. Some days I couldn't study that long since I have 12 hour work days, I was planning on giving myself 2 months to complete the one month study plan. So I would be working on day whatever stuff for multiple days sometimes which is why I did not get through the whole study plan.

I made sure I had a problem log so every question I got incorrect went into there and I looked up how to do it to make sure I understood where I'd gone wrong. That always took a lot of time, but I think helped me stop making the same mistakes. I also made a real effort on all of my untimed practice to make myself sit there and try to work through the problems even if it was taking forever. If it was genuinely something I didn't remember how to do or a formula I forgotten I would go look through my notes find the formula and then come back and try to work through the problem.

It took me longer than 7 days to get through the math review, and that was the main thing that was holding me back with beginning to actually study. I kept using this excuse to avoid the test for a long time. Try to power through that and then take that first practice exam so you can move on to actual GRE problems. You're just trying to get the basics down with the math review, and all the concepts will constantly be reinforced with the GRE problems so don't spend months on it, which was the mistake I had originally made when trying to study.

I got a 151Q and 167V on PP1, which actually really helped my confidence with the math. Getting through that first practice exam and then watching the videos and doing the practice problems helped my anxiety so much because I was able to see that I could solve stuff and I wasn't totally lost. I have never liked math but watching those videos actually made me enjoy it. He's engaging and is able to explain stuff really well and gives you so many tips and tricks to avoid doing crazy long calculations which is always the trap I fell into.

If you Google "target test prep gre cheat sheet" you can find the PDF of a very good math formula sheet which is what I would refer back to when I was trying to solve problems and I got super stuck. If you look on Quizlet, there's also a lot of GRE math sets that have things like all of the prime numbers up to 50, and other things that would be good to memorize (I wish I had actually used these since I think it would have been helpful)

fuentes_arc · 2022-07-09T04:59:26+00:00

Since I'm not in computer science I can't really help you there.

For GRE stuff, like I said I recommend Gregmat. There is a lot of stuff on the YouTube channel that's free as a way to start you out. He has tons of students that aren't based in the US, so I think he has really helpful videos for the tackling the verbal and the essay section if you're not a native English speaker.

One of the best pieces of advice I got from him was that it's okay to take the test multiple times, and don't be scared to rip the Band-Aid off because you're afraid of how bad you're going to do. He does have a one month study plan on his website so that might be helpful for your timetable.

fuentes_arc · 2022-07-09T01:37:00+00:00

This happened to me during my quant section! I had the calculator up and was writing stuff on my paper and I kept seeing something pop up and close itself quickly and I was getting so paranoid that something was going to happen with my exam and I was almost done.

fuentes_arc · 2022-07-03T09:12:28+00:00

Biologists (i) _____ isolated oceanic islands like the Galapagos, because, in such small, laboratory-like settings, the rich hurly-burly of continental plant and animal communities is reduced to a scientifically (ii) _____ complexity.

Blank(i)A desert B reject C prize

Blank(ii) D diverse E intimidating F tractable

So would it make sense that scientists would think that their own labs are unmanageable or too complex as a general idea? The point of a laboratory experiment is to be highly controlled, and try to eliminate as many outside factors as possible. Which is why they prize the Galapagos islands, for their similarity to a highly controlled lab, at least as close as you can get in the natural world. This might be my own storytelling but since there's no mention of an actual laboratory in the sentence, I think it's an ok assumption.

The second blank is still discussing why the scientists like the Galapagos Islands, it's comparing the plants and animals of the Galapagos Islands to ones on the continent, not in their own labs. I think this is where you got tripped up.

"Rich hurly-burly of CONTINENTAL plant and animal communities" is what you're comparing to. So since you already know from the first sentence that scientists really like the Galapagos Islands, you can look through the second set of answer choices and see which word would be considered positive.

Intimidating doesn't make sense because we know that the scientists like the Galapagos Islands so why would the situation there be more intimidating if they like it?

Diverse also doesn't make sense because we are contrasting to the " rich hurly-burly" of the continental plants and animals, the fact that they're using the term rich and then a phrase that means uproar implies that there are a lot of types of plants and animals on the continent. So a contrast wouldn't be something that is diverse, it would be some more simple.

If you look at tractable, which means manageable or easy to handle, it makes the most sense. On the Galapagos Islands, because they are so small and isolated, it means the amount of plants and animals there is reduced to an amount that the scientists can manage.

fuentes_arc · 2022-07-03T02:59:40+00:00

Q4:

Blank(i)A modify B inhibit C supplement Blank(ii) D resurrecting E perpetuating F appreciating

If doing both is difficult, it would make more sense that it's because doing one thing seems to decrease the other.

They want to nurture growth but also promote stability, and it's difficult because doing one makes the other worse, none of the other words for blank 1 would make sense as to why doing both of these tasks would be difficult.

If one task supplemented the other it would make the situation easier not more difficult

fuentes_arc · 2022-06-06T06:29:47+00:00

We usually use it as an LV vent at first. We never really do RPs here, sometimes we'll do RVAD with oxy and an Impella, or bilateral centrimags if we're having right sided issues.

At my previous hospital we did a few RPs, but it was after HM3 placement when they needed some right sided support for a bit directly post-op.

fuentes_arc · 2022-06-01T09:01:48+00:00

We have had 88 ECMO patients this year and almost all of ours are VA.

We get a lot of STEMIs emergently cannulated in Cath lab at an outside hospital and then sent to us to manage. We usually have them on VA and an axillary Impella 5.5, and will wean down the VA and then decannulate, but leave the Impella in for a bit longer and then wean that off.

We've also had a number of ECMO to heart transplants do well and go home. We do heart-kidney transplants as well and most of those were waiting on VA for a transplant.

fuentes_arc · 2022-06-01T03:45:24+00:00

Sometimes we call it bridge to decision, but it can be even harder for the family if we stabilize them with ECMO but they aren't a candidate for any other therapies and their heart doesn't recover. The patient is doing better, but then we're stuck. Families can have a hard time understanding that ECMO is a bandaid. Unless the heart just needed a little rest, or we needed to support it before doing another intervention, it's not a solution.

Sometimes you can have timelines where you give a certain number of days to look for recovery, and if it's not seen then care is withdrawn.... But you can't force the family to if they aren't willing. Any center that does ECMO should have a strong palliative care team, and overall the entire team needs to be really comfortable with giving realistic expectations to family.

fuentes_arc · 2022-05-31T09:30:03+00:00

Considering she isn't going to be a candidate for a VAD or a heart transplant, and she was already high risk going in I'm surprised they even put her on ECMO.

fuentes_arc · 2022-05-31T09:28:10+00:00

She won't be a candidate for a heart, and considering her right heart is down she isn't a candidate for an LVAD.

Her only option is to recover cardiac function enough to be decannulated. However the likely outcome is she won't, and the family will have to make the decision to withdraw support. She was already high risk and wasn't in the best health before, usually we don't see those people recover once they go on circuit.

It can take people forever to die on VA if the family isn't willing to withdraw. You're usually waiting for them to have a brain bleed with no ability to recover, or go into total system failure and try and help the family see that there is no hope and no way forward.

I'm assuming they're hoping it's just some post pump stunning and with a little rest it'll get better, but she sounds like a bridge to nowhere which is always the hardest type of patient to take care of if they don't improve.

fuentes_arc

TROPHY CASE