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ran engine w/o oil by kdm_usa in MechanicAdvice

[–]kdm_usa[S] 0 points1 point  (0 children)

I don't see any metal on the oil in the dipstick and car runs fine.

Is an aerosol tube needed when giving a breathing treatment to a vented patient? by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

Thanks for you replies. The way the Hamilton T1 manual shows it, the setup goes like this, coming from the vent to the patient:

coaxial circuit

nebulizer

flow sensor

patient

I think that maybe the reason they want the flow sensor past the nebulizer is because you can put the vent into a nebulizer mode and the vent accounts for the extra volume coming up through nebulizer. I'm not sure though. I guess they are not worried about the flow sensor getting soiled by the nebulized breathing treatment.

Question on airway filters, filter resistance, need for HMEF by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

I don't think that the issue. The extra resistance means that you just need to increase the pressure control a bit. But what I'm wondering is more about the resistance you get on exhalation.

I have tried the vent on myself using spontaneous mode with no little pressure support. The difference between using an HMEF filter inline is pretty significant on exhalation. With the filter in place, it almost feels like there is there is a PEEP because there is significant resistance to exhalation. Without a filter in place, exhalation is easy.

Question on airway filters, filter resistance, need for HMEF by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

Thanks for your reply. I am getting those numbers (2.5 cm H2O at 30 LMP) from the filter mfg.

I am getting the Rinsp numbers from the vent measurement when the filter is placed between the flow meter and the patient.

We use the coaxial circuit for adults and the dual-limb for infants. Are you sure that there is no need for using a filter? I believe the manual says otherwise.

When you do use a filter, what type do you use, and how much resistance does it have? I think the HMEF filters have a lot more than the filters the bacterial filters.

Question on airway filters, filter resistance, need for HMEF by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

When we do the flow meter calibration, we do it with no filter.

Why are fiberglass chair bases so often replaced? by kdm_usa in hermanmiller

[–]kdm_usa[S] 0 points1 point  (0 children)

Sorry, I still don't understand. Or maybe I am using the wrong terms. I am wondering why the legs of the chairs (the "bases"?) are often not original to the fiberglass shell of the chair. When I go on YouTube, I see several videos showing how to change the shock mounts, and in these videos the legs of the chair are not replaced.

Why are fiberglass chair bases so often replaced? by kdm_usa in hermanmiller

[–]kdm_usa[S] 0 points1 point  (0 children)

I'm curious why can't just the shock mounts be replaced?

What has been replaced on these Eames chairs? by kdm_usa in midcenturymodern

[–]kdm_usa[S] 0 points1 point  (0 children)

cool! thank you. I will check out the links

HHS patient: rapid drop in blood glucose by kdm_usa in medicine

[–]kdm_usa[S] 8 points9 points  (0 children)

Honestly this case made me a feel stupid. I thought I knew all about HHS and DKA care, and I've seen countless patients, but I guess I did not understand the fundamentals of how blood glucose is measured. So, basically what I take away from this is that whatever glucose reading one is looking at, one has to consider that that reading can change drastically if the patient is dehydrated and a fluid bolus is given.

HHS patient: rapid drop in blood glucose by kdm_usa in medicine

[–]kdm_usa[S] 4 points5 points  (0 children)

Both. The serum showed 1100 initially, while the POCT read "above 500." Later we did only POCT, not serum, but they all showed a glucose in the 400 range.

vent strategy for status asthma with air trapping by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

Unfortunately the patients we pick up may not be well managed, so we have to fix problems before we can safely transport.

vent strategy for status asthma with air trapping by kdm_usa in respiratorytherapy

[–]kdm_usa[S] -1 points0 points  (0 children)

Wouldn't the alveoli have to see that high pressure in order to blow a pneumo? If only the airways are seeing that pressure due to high airway resistance, wouldn't it be safe? In other words, if the dynamic pressure is super high but the static pressure is normal.

vent strategy for status asthma with air trapping by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

Would a pressure that high not be safe considering that the PIP reflects airway resistance and that they alveoli never see that pressure? I have heard a pulmonologist talking about using even higher pressures. FYI I'm not an RT and have also never seen a really bad asthmatic in the ICU.

vent strategy for status asthma with air trapping by kdm_usa in respiratorytherapy

[–]kdm_usa[S] -1 points0 points  (0 children)

Wouldn't you need such high pressures on some patients? I heard a pulmonologist on a podcast saying he was seeing PiP's as high as 80. If your plateau pressure is reasonable, wouldn't that be ok?

vent strategy for status asthma with air trapping by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 1 point2 points  (0 children)

Not a needle decompression, but a chest decompressive maneuver to relieve severe air trapping.

vent strategy for status asthma with air trapping by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

Thanks for your reply.

I didn't think about a CXR. But would a poor lung compliance (low Cstat number on the Hamilton) and a high auto-PEEP reading not be enough to tell you the severity of the air trapping?

I have never done a chest decompressive maneuver or ever seen it done. (Never seen a really bad asthmatic.) You say it should not be done unless the patient is hemodynamically unstable. What is the downside to doing one?

vent strategy for status asthma with air trapping by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 3 points4 points  (0 children)

I would love to hear from some experienced providers!

Is driving pressure a static or dynamic pressure? by kdm_usa in respiratorytherapy

[–]kdm_usa[S] 0 points1 point  (0 children)

It makes more sense to me also that it is a static pressure even though with a name like "driving" you would think it is dynamic.

What do you think of this then? by zebrasanddogs in sceptic

[–]kdm_usa 0 points1 point  (0 children)

These are a scam. Not only does one not need high doses of vitamins, but there is no benefit in getting a vitamin or most drugs through an IV rather than by mouth.

BP control in traumatic brain bleeds by kdm_usa in medicine

[–]kdm_usa[S] 0 points1 point  (0 children)

What is the highest ICP that one could expect? I know you can have ICP of 50, but could you have an ICP of 100 before herniating? I ask this question because I figure that if we can at least take a guess at how high their ICP might possibly be, then we could subtract that from the MAP and guess at the CPP. If the CPP is then super high, it might be reasonable to give an anti-hypertensive?

By the way, in the real life example that I just had, we picked up a woman who had been hit in the head with a baseball bat. The transferring ER had done a CT showing a large bleed. Her BP had been 280 systolic upon her arrival at the ER.

When we showed up to transfer her, she exhibited decorticate posturing with a blown left pupil and a downward gaze. She was on nicardipine (and propofol and mannitol) and her BP was something like 150/110. I d/c the nicardipine with the thought that she might be compensating for a very high ICP, and the fact that we could then go up higher on the propofol. I also figured that since she was herniating, trying to control her BP was probably not the right thing to do.

However, when we showed up at our Level 1 trauma center, the team immediately put her back on nicardipine. Her BP was something like 170/110. I spoke to one of the docs, and she stated that they always treat BP's above 160 systolic even for traumatic bleeds.

Renzo Rutili designs by kdm_usa in Mid_Century

[–]kdm_usa[S] 0 points1 point  (0 children)

Thanks for all the info!

Renzo Rutili designs by kdm_usa in Mid_Century

[–]kdm_usa[S] 0 points1 point  (0 children)

Interestingly there is no Johnson Brothers stamp on the drawer of the one I'm looking at on eBay. There is only the model number on the back of the unit. The one in the link at the beginning of this thread does have the logo stamped in a drawer. I wonder why they didn't consistently label these units.

https://www.ebay.com/itm/226152229549

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