chbare

Don't forget, we've made it to the top and have earned the right to spew said hubris.

Naw, the baby boomers and their hippie ways are to blame for our nation's sense of entitlement. In fact, I pretty much blame the boomers for pretty much all our social and fiscal issues. j/k btw

Typical gen xer.

A "South Park Republican" eh? I pretty much identify with fiscal conservativism and social libertarianism.

Let us not forget the United States has just a itty bitty debt problem. We are likely looking at raising taxes and cutting college funding (already occurred in my state) as a band aid for our insolvent debt problem, biggest economy or not. Also, many of the "socialised" countries in this world are doing a financial downward spiral. Look at Europe: Insolvent debt, several countries potentially facing default, and a Euro that is on the brink.

Not at all. As an adult, you are better able to think abstractly. This can lead to an exciting and almost child like fascination with exploring the physical world. For example, I remember a chemistry lecture involving something called a p orbital. Basically, a volume of space with a high probability of finding an electron that is in a certain state with a certain energy in a Hydrogen atom. One of the orbitals is dumbbell shaped with something called a node that separates the lobes. You have probability density in one lobe and the other, but none at the node. So if the electron is in one lobe, how can it be in the other if it cannot exist between the lobes? That's the wave like behaviour of an electron. Made the hair on the back of my neck stand up. There are so many fascinating and mind blowing things to learn about the world.

Solid Dwayne: I agree on your point of view. It seems we as humans experience a special type of delight when we can crush a person's spirit. I see religious zealots and hard core atheists try to do this all the time. Ruff: At the end of the day, any faith based conclusion you make is still one based on, well...faith. You are ultimately trying to define things that are not defined. Personally, I am am good with whatever conclusion you reach so long as you don't berate me with your beliefs. Of course, the same should also be true for me. Herbie: It is quite possible. At a certain point, I think many people at least come to a realisation that the concept of an interventional, divine mechanism does not really fit into what we know of the physical world. This does not mean I lack faith per se however.

Faith comes into play when we attempt to explain the philosophical and non-physical aspects of the universe such as what was before "everything" and what made "everything" occur and so on. These are concepts that are not explained by science. A scientific theory has to be falsifiable, in that I mean it should make predictions that can be tested and potentially falsified. Faith, by it's very nature, is not falsifiable and does not make physical predictions that can be tested. Therefore, faith is great for making qualitative sense of the "unknown." Of course, faith is not needed for many people. Also, I have never seen anything that defies logic. I have seen people survive that were most certainly not viable. However, this does not defy logic as this world is still non-deterministic and probabilistic. Therefore, highly improbable things can occur, it's just not all that probable to have them occur.

No worries, my name is just as pitiful as yours and Mike's.

Again, I do not see homosexual couples having children as being an issue.

That depends somewhat on the context. For example, developed countries in fact have rather low birthrates among their populations. Many of these countries have a rapidly aging population. This is particularly significant in techhnologically developed countries such as Japan where the birth rate is nearing stagnation. Countries where overpopulation and resource limitations are a significant problem include undeveloped or developing nations. I do not see homosexual couples who undergo non-traditional forms of conception as a significant source or problem when considering the potential population issues on this planet.

I would argue, no. As part of this physical system known as the universe, we must also play by the rules. Therefore, we cannot "play God" per se because, ultimately we are part of the system and subject to it's rules. Regarding any tweaking that led humanity to it's current state: The most fundamental aspects of the physical world are probabilistic. Intelligent life may or may not be a statistical outlier, but with enough time, pretty much anything is possible even if not likely. I am not convinced anything is particularly special about us because it's a big, old universe. Processes have been occurring for a long time and I'm not surprised that we are here if we simply consider all the probabilities and all the processes that occur.

Actually, the role of sex in humans is much more complicated than simply being about procreation.

The only secular argument that I've seen used with any amount of consistency is that allowing gay marriage will open the door for legal expression of deviant behaviour such as polygamy and so on. Please don't lecture me on how this line of logic fails as I've not stated I agree with it, just that it exists. I am quite the libertarian when it comes to what two consenting adults want to do with their free time. I'm also not opposed to gay marriage. I can even empathise somewhat as I've been on the receiving end of a bit of hate regarding my choice of lifestyle. Apparently, it's only acceptable for old fart guys to marry young woman, but a cougar-cub relationship is taboo in some circles. My biggest issue is related to the fact that marriage offers certain legal protections if you will. Being married can make things such as health care decisions, health benefits and even banking much easier between two people. This was a big issue when I was working overseas. Much easier being married because my wife had access to all my personal finances and information. She could easily make decisions and so on. I would hate to see somebody in a homosexual relationship not have access to the same benefits.

I am a bit confused by the resurrection here? The last post was in April. Unfortunately, much has happened since April.

So they say. I was very light weight in my 20's ( 6'1" and 148 pounds) and generally felt horrible. Currently a bit overweight ( around 200 pounds and a bit shorter) but feel much better and I don't get sick as often. So, I pretty much maintain. My n=1 experience in any event.

Cardio at the gym for 35 minutes twice a day followed by a 25 minute cardio before I go to bed. Lift light free weights for about 10 minutes a day and try to walk 30 minutes a day. Also do 10 minutes of abs and stretching before going to bed at night. Unfortunately, I am still a bit of a plumpkin...

Why do you feel guilty? We often allow people to treat us badly. Is hanging out with some other dude's family at the ice rink in your job description? If it is, sorry for you. Otherwise, you are under no obligation to do this. While its hard, you are going to have to stop being a piece of carpet, learn to assert yourself and set boundaries. You may ruffle some feathers, but few if any people get through life without rubbing people the wrong way from time to time.

I would call it a "potential" alternative because I am not appreciating loads of evidence other than a few case studies regarding it's efficacy. If you are really wanting to implement modalities other than parenteral, your best bet is to push for IN administration. You can find a fair amount of evidence regarding it's use and several states not to mention numerous services are using this modality effectively. EDIT: "find"

There exist many different types of hand guns with sometimes exotic methods of clearing. A Ruger Vaquero for example, has a different method of "clearing" than say a Sig P226. Clearly, we have different methods of dealing with this situation based on policy, comfort level, and so on. I would likely initiate transport and treatment, remove the holstered weapon and keep it in the holster, secure it in a compartment where we have constant eyes on, call for a law enforcement intercept at the hospital and let the officers take the weapon upon arrival.

I am on board with the intranasal spray; however, the conversation is not about IN delivery. In fact, the person does not have IN capabilities and is looking at literally adding it to a small volume nebuliser and administering it by mask or by bagging the nebulised medication into the patient. I am not convinced that this is a superior method at this point in time. Again, I agree with you on the IN delivery. My state has guidelines that specifically allow this via the MAD device.

I'm still not convinced. Bagging a patient can be difficult without adding in the time and logistics of bagging naloxone in a patient with an already compromised airway. Is there a good base of evidence to support this? This has been discussed here before and I'm still not won over by the evidence that I've seen. This may be a more effective and safer way to do things; however, I have not seen anything to convince me it's safer or better than current methods.

ET administeration is not the same as nebulised. If you have an apneic, unresponsive patient, I do not think they will have a respiratory pattern that permits good absorption and bioavailability. If the patient has a good respiratory pattern, I would question the need to even give naloxone. I'm not arguing against this route per se, but if we have a patient that is apneic, I'm not sure of the efficacy of administering it via this route. I have seen a few case studies involving lethargic, methadone overdoses that were successfully treated; however, I am not sure that this route would be appropriate to use universally. Special cases perhaps. Of course I must admit my bias about reversal agents such as naloxone. I like to give small doses and titrate carefully for effect. I'm not sure how easily I could do that in certain patients via the nebulised route. Perhaps a consideration in certain cases, but I'm not sure it would be successful in all cases. I guess you could intubate and bag the neb in, but the whole point is to prevent intubation if possible?

If you have a patient with a depressed respiratory drive, I assume optimal inertial impaction and deposition of nebulised naloxone would be compromised. I would also have concerns about the potentially wide range of bioavailability when given via the nebulised route. Of course, the IN route appears to have good efficacy. What does the literature say about administering naloxone this way?

Going strictly off of lab assessments DKA is characterised by a sugar over 300 mg/dl, presence of ketones in the urine and elevated ketones in the blood, a Ph less than 7.3 and a low bicarbonate. The acidosis is most often going to be an elevated anion gap acidosis. Anecdotally, I've seen very sick patients in the 500's and rather unremarkable patients in the 500's. Again, anecdotally, the sickest DKA patients that I have seen were newly diagnosed children with sugars in the 600's/ Once, I have a critically ill patient who had sugars in the 400's, but she was a well known, non-compliant type I patient with other co-morbid factors. An elevated blood sugar is not particularly sensitive or specific on it's own. In fact, an elevated sugar is not it's own problem per se, it's an indication of more complex pathology occurring. Perhaps it is related to illness, stress, DKA, or even steroids. It is rather difficult to differentiate in this situation because the OP still has not provided us with additional information. If we are treating something like DKA, it would not be uncommon to administer one, two or even three litres of isotonic fluid in the first hour. As sugars and the anion gap close, you often see a change to D5-10% in 1/2 NS or transition to some other related solution. Often, we will add Potassium as well because the total body stores of potassium are actually low even though the serum potassium will often be elevated. The fear of renal issues is real; however, fluids will be helpful. Yes, you may have a patient with co-existing CHF; however, these patients are still going to be dehydrated and will need fluid replacement. Also, many CHF patients are in fact fluid depleted in many cases, but that is for a different discussion.