chbare

Maxwell's Silver Hammer is an exceedingly violent song, but it's pretty catchy. Guess we better ban the Beatles while we are at it.

Solid question Dwayne!

True that. I absolutely appreciate all the great response I've received. I just want to be careful because I don't want to come of as being pretentious.

I'm certainly not here to intentionally zing anybody or get a one up, but a potentially teachable moment may have occurred. Maybe not for the OP, but others. If I can perhaps clear up some confusion and if the OP will listen, all the better.

What is a light molecule?

He was more than likely headed toward intubation regardless. Let's make some assumptions and create broad boundary conditions based on a "normal" patient since we do not have labs. Using perfectly normal gasses as my starting point, I have the following: PaCO2 40, HCO3- 24, Ph 7.4. Using Henderson Hasselbalch: Ph = pKa + log ( HCO3-/ PaCo2*0.03) log of 24/1.2--> log 20 --> 1.3 The coefficient of pKa in this case is 6.1 and that will apply throughout the bodynasnallmthe (EDIT: as all the) buffering systems are in equilibrium. 6.1+1.3= 7.4 Hopefully, you can accept what I did above as quantative proof for what I am about to do next. So, we look at this patient and we have an ETCO2 of 68. Being conservative, I will assume a gradient of 5 to give me a PaCO2 of 73. Let's see what the pH was at initial contact: Using the quantative method above without changing the HCO3-, you get a pH of 7.14. This is clearly much lower than the common cutoff of around 7.25 when considering respiratory failure and intubation. However, we can play around and assume this patient has metabolic compensation. Let's be generous and increase the HCO3- to 30. This still gives us a pH of 7.24. Even with metabolic compensation, this patient would clearly be in trouble. While I am not exactly sure of the patient's gasses, what I did above works as a good first approximation. Edit: phucking iPhone and it's phucking predictive entry!!!

Sounds reasonable. What were the results of the patient's gas and what did his lungs sound like? Also, did you manage to obtain history on this patient? What ventilator settings were you using?

I'm such a tool..,

Here is my take on the issue:

The biggest difference is still the large number of contractors. The contractor concept has really changed the face of modern conflict IMHO.

Except, thousands of contractors and "advisers" were not left behind in North Korea.

Meh, iPhones are retarded... Yeah, many services put their providers in situations where their providers are running medications under sub-optimal conditions. I simply will not work for a service that does not provide me with proper logistical support. However, I understand jobs are at a premium and I know that I am exceedingly luck to be in a position where I can discriminate somewhat.

This is what I do and this is what I teach. A simple formula with a wide variability in it's application. I do not teach or rely on shortcut methods such as the clock and so on. If you are presented with non-standard concentrations, you need to be able to properly administer medications without said shortcuts. On a side note, I would never transport a person on vasoactive mess without a pump or syringe driver. My personal bias.

I was curious if flaming had been to Afghanistan.

Have you ever been to Afghanistan, lived among the people of that country or experienced it's culture firsthand?

A certain amount of cultural relativism is needed when examining these issues IMHO. Anthropology 101 and all that.

Return of the living dead thread.

Understood, I'll keep it zipped.

That would be a bad move. Regardless of the flow, a non-rebreather delivers high FiO2 and you cannot titrate FiO2 with a non-rebreather mask. High FiO2 and subsequent elevations in SaO2/PaO2 will increase CaO2 and possibly lead to increased pulmonary blood flow, but compromised systemic perfusion. Is this a Sano modified procedure? An ominous possibility to consider with cyanosis in this case is proximal conduit obstruction.

Depending on your logistical support and comfort level, is a slit lamp a viable option?

That's the spirit!

How about a sexual pride day? That might be...interesting.

I dunno, I don't think it would be as colourful or interesting as it's counterpart. Now, a cougar/cub appreciation day...

Both heterosexual and homosexual couples use "toys," so this phenomena is not isolated by any means. Also, I believe you need to appreciate the anatomy of a female. It should become quite obvious why certain "toys" are used by both hetero and homo women. Regarding gay men and fake boobs, I would not write that one off. Sexual expression is complex and I do not believe we can make simple analogies or have linear hypotheses about said concept. I will say anecdotally however, as a relationship progresses and both parties become comfortable with each other, I would expect more shall we say playfulness. Clearly, this involves mutual love, respect and good communication. I'm not saying everybody will be like this, but a certain amount evolution of sexual expression is bound to occur. Some couples may "slow down" while others will want to explore their sexuality in unique and meaningful ways. Edit: "in"