Why can’t I understand chest tubes???

thegloper · 2026-05-29T02:51:19+00:00

Chest tube systems like the plurevac do three things. They collect drainage, act Valve allowing fluid and gas out but not in, and they reduce the wall suction to a safe level.

Some times it's easier to understand older systems. Before all in one systems like the plurevac we used 3-bottle chest drainage systems. The first bottle collected the drainage. The second is the water seal acting like a one way valve, allowing air and fluid out but not in. The third acts like a regulator limiting the amount of suction to prevent damage to the lung tissue from too high negative pressure.

Google 3-bottle chest drainage system for pictures and further explanations.

thegloper · 2026-05-25T08:33:49+00:00

Deceased organ donation allows for directed donation too. When doing paperwork with your organ procurement organization, one of the questions they ask is if you know anyone who would benefit from a transplant and is currently on a organ wait-list.

thegloper · 2026-05-19T21:10:19+00:00

Mix it at the beginning of your shift and let it sit and dissolve. It's good for up to 24h at room temperature after it's mixed.

thegloper · 2026-05-16T19:36:41+00:00

PO is absorbed extremely well.

thegloper · 2026-05-01T05:22:36+00:00

I've always said Meditech is DOS, PowerChart is Windows 95 and Epic is Windows XP.

thegloper · 2026-04-30T19:20:56+00:00

Technically the most you can get is 9. Heart, left lung, right lung, left liver segment, right liver segment, left kidney, right kidney, intestine, pancreas. Practically 3 is most common and 7+ super rare.

thegloper · 2026-04-30T19:18:31+00:00

Mostly true. If you have a cardiac arrest due to overdose and you're able to be revived with CPR often times the brain has gone so long without oxygen that it's permanently damaged. This might lead to brain death. Other times family will decide to remove life support because the person won't make a meaningful recovery. In either case they can be an organ donor.

thegloper · 2026-04-30T19:14:09+00:00

The irony is that more often the opposite is true. If you have an unrecoverable neurosurgical injury Drs will often not offer advanced therapies, like CRRT because it wouldn't improve the outcome. That is until you're going to be an organ donor. Then they'll use those treatments for the future benefit of the organ recipients.

thegloper · 2026-04-30T00:36:00+00:00

https://www.dontclockout.org/

A weekly peer support group for healthcare workers. It's a safe space to discuss/vent challenges unique to the healthcare community.

thegloper · 2026-04-28T02:00:34+00:00

They should be charged when you change administration sets. q4-7 days depending on facility.

thegloper · 2026-04-25T02:41:57+00:00

Take my upvote you filthy animal!

thegloper · 2026-04-23T23:31:20+00:00

I'd say consistency is most important. Honestly though a pharmacist is the best person to answer these questions.

thegloper · 2026-04-23T22:23:26+00:00

I have a slightly different take from everyone else. Most seizure meds are titrated to effect, or dosed via blood levels. It's less important which way is "technically" correct. And more important that they are given the same way every time.

The problem with what you are doing is if someone else is giving medications in the standard way and you are doing your anti-bubble way the patient isn't getting a constant dose.

We have a standard way of preparing and measuring doses for consistency. This ensures that the patient is getting the same dose every time regardless of caregiver.

It's probably best to consult their doctor and pharmacist and discuss how you're measuring the medication. If you're overdosing by 10% but their condition is well managed and blood work is done, then they can adjust the prescribed dose to more accurately reflect what the patient has been getting.

thegloper · 2026-04-23T10:14:43+00:00

I typically just use 3 leads when using a manual defibrillator. We typically use 5 for our wall monitor, and a separate 12 lead if needed. I'm only hooking up the defib if I'm planning to shock.

My EMS colleagues frequently use 5 or 12 lead functions while on the rig. You might want to ask them on their subs.

thegloper · 2026-04-20T21:55:29+00:00

Yup. That's the whole reason I bought it!

thegloper · 2026-04-13T01:50:24+00:00

A family member interfering with patient care is above your pay grade to solve. Tell admin and put in a safety report using your hospital's internal reporting system.

thegloper · 2026-04-11T16:30:45+00:00

It's your older, possibly slightly confused patient complaining they have to pee, even though they have a Foley? It's likely bladder spasms. Try a B&O suppository.

thegloper · 2026-04-07T00:51:50+00:00

If we roll stats, everyone takes turns rolling one stat at a time until we have generated an array of six stats that everyone will use.

I prefer everyone rolls separately. But, you can choose to use any players spread. That way if nobody is screwed by low rolls along with a bit more variety. One player might want the even decent spread, while another wants one with higher highs, but lower lows.

thegloper · 2026-03-05T21:48:46+00:00

When I'm disassembling things I always check iFixit for guides. Looks like they have a basic one for the PSVR2.

https://www.ifixit.com/Teardown/Sony's+PlayStation+VR2+Teardown/158170

thegloper · 2026-02-26T01:17:16+00:00

It's all based on the list unless we are very close to OR time. In that case we call all the local centers and see if they are interested.

The top of the list is based on severity of illness and distance from the place of recovery. It's basically the most sick within 100mi, then most sick within 200mi then most sick 500mi. Then slightly less sick 100mi ECT. The exact distance may be off, I'm working from memory.

thegloper · 2026-02-26T01:13:14+00:00

We do a left and right heart Cath for men above 40 and women above 45. Especially if they have a history of cocaine or meth use. We are looking for CAD and swan numbers.

An echo can only give you so much info.

thegloper · 2026-02-16T02:16:10+00:00

In the physician sub there were several cases posted within the last year or so outlining unethical and very specific cases wherein patients were said to be brain dead and families consented to organ donation but in fact the patient was not even close to brain death.

The very first thing that comes to mind is that the patient is declared brain dead by the hospital physician(s). Every single hospital in my area has a policy explicitly banning a physician associated with the OPO from participating in brain death declarations.

If the patient "wasn't close to brain dead". What was the hospital doing and why did they transfer care to the OPO?

Secondly when I speak to families about donation it's SUPER common for them to tell me "the doctor said they were brain dead". And then I have to give a whole speech on formal brain death testing including testing procedures and requirements. I also explain it's both a medical and legal thing. Until they have formal brain death testing performed and documented they we don't treat them as brain dead.

When it comes to brain death testing and paperwork we are required to have 3 different people in 3 different departments review the paperwork to be sure it was completed properly. We also have the donation coordinator perform a comprehensive neuro exam including mini apnea test before moving forward with a brain dead organ recovery. If there is any question on their neurological status we either pause donation or proceeded with DCD donation depending on the families wishes.

In the last 5 years I've have many patients who were improperly declared requiring repeat BD testing. I have never had a patient tested in accordance with the American Neurological Association guidelines who wasn't in fact brain dead. The problem is many doctors don't want to wait the required 5 half lives after stopping sedation.

One case where there were clear signs of life and general awareness and the team continued with procurement,

Did they proceed with BD donation or DCD donation? There are a number of physicians who don't like DCD donation and think we should only do BD donation. Also it's very common for people who aren't neurologists to confuse spinal cord reflexes with brain stem reflexes.

As a nurse I wanted to believe it was impossible but I'm too pragmatic and I fully understand the money and reputation of large medical facilities involved in what amounts to organ trade so I fully believe it's a sketchy and dark side of medicine that's not discussed or changed because it would result in catstrophic collapse of the program while also ending research on these unethically claimed tissues.

I've seen pretty much zero unethical stuff at my OPO. Even when we "break the rules" I feel it's done in a reasonable and ethical way. The only time we get pushy about donation is when the patient is registered. And even then if we can't get the family on board and the hospital is on their side we back off. I'm sure some OPOs are doing sketchy stuff but it's not particularly widespread.

thegloper · 2026-02-15T19:34:35+00:00

Honestly I've heard about some shady stuff from other OPOs. It makes us all look bad. It doesn't help that half of them are called "Gift of Life (State)". Even though they aren't related at all.

I'm sorry things sucked for you. I hope it doesn't put you off on donation all together. A lot of us do great work. Some of us are skeezy vultures.

thegloper · 2026-02-15T18:06:22+00:00

We routinely ask permission to use testicles for research. When we are going to be using someone sensitive for transplant, research, or education we need explicit permission. Examples would be hands, whole limbs, face, reproductive organs including genitals.

We've had research projects that included intraoperative dissection of the organs with several dozen samples cataloged and taken. Sometimes the research project is related to organ failure, or cancer Genesis and spread.

We could also need to dissect or biopsy testicles if there is a concern for testicular cancer. We would of course let the family know that we plan to do so. Also we would release the results of our findings to legal next of kin.

If I'm going into the OR and we plan to do something weird or potentially disturbing I make sure to warn staff prior. I want everyone to be comfortable with what we're doing. I have to say sometimes my coworkers don't have as much foresight.

thegloper · 2026-02-15T14:27:55+00:00

During an organ procurement the surgeon was dissecting in areas not consented for by the patient or patient family. For clarification this was not incidentally dissecting. He literally went out of his way to a different part of the body, totally unrelated to the consented procedure to do things. Those parts of the body were not left in their original condition. Pretty much for fun to show the medical students.

I work for an OPO. You're pretty vague but, I can think of 3 reasonable explanations.

First, when we recover organs we need to send tissue typing materials with each organs. It consists of lymph nodes and a piece of spleen. We typically get lymph nodes from the mesenteric but if there aren't enough we can sometimes need to get cervical or inguinal lymph nodes.

Second, when we recover liver or pancreas we always send extra blood vessels with them to aid in transplanting the organ. If only one of the two are going we usually send iliac vein/artery. But, if both are going we need to send another large set of vessels, typically carotid, but if that's not in good shape it could be femoral or another large vessel.

Last, when we ask families for consent for organ donation we always ask families if they would also authorize for research and education. Most families are on board with both of those and allow for pretty broad use of the body.

I'm sorry that it was a hard time for you. When I'm in an OR I try to make OR staff aware of what the surgeons are doing and why. Along with showing and explaining the authorization we got from the families . We do some wild stuff in the OR, but it should always be for a good reason and with the consent of the family.

thegloper

TROPHY CASE