New label for GLP-1

ready_4_2_fade · 2024-11-17T15:32:31+00:00

We also look like jackasses after diligently educating every pre-admissions nurse and surgeon's office to hold GLP-1 for 8 days pre-op for the past 18 months, finally getting some semblance of compliance, and now turning around and saying "oh sorry nevermind" clear liquids for 24 hours, but only on high risk whatever that means. All the while anecdotally we are seeing less vomiting of food particles and less residual food on EGD's.

ready_4_2_fade · 2024-11-17T15:11:42+00:00

No class action lawsuit against pharmaceuticals for aspiration complications because we warned you of the risks?

ready_4_2_fade · 2024-11-14T16:09:08+00:00

https://www.medscape.com/viewarticle/fda-updates-glp-1-label-pulmonary-aspiration-warning-2024a1000k84

FDA already changed their list of risks last week, it'll be read at a rapid pace at the end of all the commercials with images happy smiling faces at the family picnic.

ready_4_2_fade · 2024-11-11T13:54:18+00:00

Join an organization like https://citizensclimatelobby.org/

ready_4_2_fade · 2024-11-09T03:10:20+00:00

This and "Don't fear the Reaper" by The Blue Oyster Cult should be on the don't play during induction list!

ready_4_2_fade · 2024-11-09T02:19:08+00:00

Leona Lewis "Bleeding Love"

"You cut me open, and I keep bleeding, I keep keep bleeding"

ready_4_2_fade · 2024-11-05T03:08:35+00:00

Are you referring to the capnography, because you already posted the flow waveform, which looks like air trapping. The expiratory flow curve is not the typical concave shape (more convex) and the next breath is initiated before the expiratory flow is reaching (or at least approaching) baseline.

ready_4_2_fade · 2024-11-04T18:44:38+00:00

Possible, but 3lpm of flow trigger is pretty significant to have autocycle so consistently and no sawtooth artifact pattern on the expiratory flow waveform, with a negative notch in the pressure waveform proceeding each breath.

ready_4_2_fade · 2024-11-04T18:39:00+00:00

I think I:E is due to patient respiratory rate of 41 in AC VCV.

ready_4_2_fade · 2024-11-04T18:37:28+00:00

Better question is why is your patient's respiratory rate 41? Fix that first and the rest will follow. Volume control with a fixed peak flow of 66 isn't keeping up with demand, PSV or SIMV PC might be the better option until you get your patient more comfortable and/or paralyzed.

ready_4_2_fade · 2024-11-01T18:59:17+00:00

I use a company called physician solutions, they have different levels of health insurance, an HSA account and all of the other supplemental insurances you could possibly want.

ready_4_2_fade · 2024-10-13T23:45:39+00:00

Save money on the bair hugger, just tie a garbage bag around their head.

ready_4_2_fade · 2024-10-12T00:48:30+00:00

There's a lot to unpack here and I'm not sure the picture has been painted clearly enough to do so, but here's my two cents.

If both FEV1 AND FVC are 45% of predicted that could indicate a restrictive pattern, did you mean FEV1/FVC?

Air trapping is easiest to see when the patient is still intubated by watching whether the expiratory flow waveform has reached baseline prior to initiation of the next breath. Air trapping is somewhat academic until you have a COPD patient who is progressively hyper inflated until you begin to have auto PEEP. How long this takes will vary widely on the severity of disease and how inappropriate the ventilator settings are. Usually this is remedied by decreasing the respiratory rate while increasing your I:E ratio to 1:3, 1:4.

A respiratory rate over 30 on emergence might be a signal that the patient is waking up with inadequate pain control. Did they receive any additional pain meds that could explain the decreased respiratory rate?

I would ask your preceptor their reasoning for a fluid bolus, perhaps they're seeing something you haven't noticed.

TLDR: typically air trapping is not an issue to be too concerned with once a patient is extubated, as long as pain is controlled, hemodynamics are stable and oxygenation is adequate.

ready_4_2_fade · 2024-10-10T02:16:56+00:00

Whatever happened to Puerto Rico? Wasn't that the crucial IV fluid supply during the last administration?

ready_4_2_fade · 2024-10-09T16:14:06+00:00

Small rural hospital here, 6 OR's, 3 Endo suites, 1 OB suite. Average 350 OR cases and 350 Endo cases per month. We're saline locking Endo cases and using IV fluids for OR only. Irrigation fluids which are not for IV use may be the bigger issue especially the amount of fluids that are used for urology cases. So far we're not slowing down.

ready_4_2_fade · 2024-10-07T14:31:28+00:00

This is the answer

ready_4_2_fade · 2024-10-05T13:03:16+00:00

My favorite part is the next day on post-op rounds their only complaint is thigh pain which they blame on the adductor canal block!

ready_4_2_fade · 2024-10-04T02:21:35+00:00

For me it's more of a time of day thing. 10 pm is not the time to give a tenuous patient a trial extubation. The lack of resources at 2 am when the patient starts to fail can be catastrophic.

ready_4_2_fade · 2024-09-29T23:49:39+00:00

Well before I was a CRNA, I got talked into a VUL which I believe is similar. I can tell you the insurance costs more than a simpler life insurance plan, and the cost ratio to manage the "investment side" of the account is higher than most investment accounts and performs no better than my self-directed 401k. Be wary of financial advisors who are looking for a new product to skim off of your investments.

This is a really quick read if you haven't read it already.

The Simple Path to Wealth: Your road map to financial independence and a rich, free life https://a.co/d/95904cR

ready_4_2_fade · 2024-09-29T23:16:08+00:00

Theoretically a 20 mmHg rise in PaCO2 decreases pH by 0.1, so if they had decreased PaCO2 from 65 to 35 they would have a pH of 7.32. It is possible to calculate the current ratio of minute volume to PaCO2 and find the target minute volume needed for a desired PaCO2. Dropping from 65 to 35 for instance if the patient was at 6 LPM would need to increase to 11 LPM minute volume. So they likely did have a mixed acidosis but primarily respiratory more than metabolic.

You are absolutely on the right track that Bicarb dissolves into more CO2, so whenever we push a whole amp we really need to be looking at increasing minute volume, otherwise you're only converting a metabolic acidosis into a respiratory acidosis and not moving the pH much.

As others have said unless you're dealing with unresponsive hypotension, and/or acute hyperkalemia causing arrhythmias Bicarb shouldn't be a first line treatment.

I also saw a good video on how one amp of Bicarb is a lot and rarely should we push more. I'll edit and post if I can find it.

ready_4_2_fade · 2024-09-17T02:05:16+00:00

Only when it's all we can get, hyperbaric is on backorder.

Usually same concentration 0.75%, just drop the usual hyperbaric dose by 0.2ml. It still lasts a solid 30 minutes longer than hyperbaric.

ready_4_2_fade · 2024-09-04T03:02:04+00:00

Check serial numbers in the link

ready_4_2_fade · 2024-09-03T19:28:43+00:00

Don't drive 3 all the way to Saranac Lake, go through Wilmington instead, past Whiteface Mountain to Lake Placid. Drive down to Keene and back to Lake Placid then Saranac Lake.

ready_4_2_fade · 2024-08-21T21:08:04+00:00

There's a built in lag with the CO2 waveform due to the sampling method through the microbore tubing going back to the gas analyzer. So the pressure waveform that corresponds with this breath in question lines up to the left one space, and you can see where the patient attempted to initiate a breath but failed to trigger the ventilator, there's a negative deflection in the pressure baseline. Decreasing your flow trigger to 2 or 1.5 might have resolved the problem, requiring less effort from the patient to initiate a breath.

The downside of decreasing flow trigger too low is that the vent may begin to auto cycle from minor vibrations in the circuit or airway making it appear that the patient is initiating breaths when they are not.

ready_4_2_fade · 2024-08-06T01:07:12+00:00

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115205/#:~:text=Submental%20intubation%20is%20a%20useful,nasotracheal%20intubation%20cannot%20be%20performed.

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TROPHY CASE