aceofwhump reblogged
You'll tell me everything I need to know.
aceofwhump reblogged
quick post about buck's canon (and non canon) injuries from the lightning strike
yes! i know i said i wouldn't do this today, but after the episode i can't just, shut up about everything. so this is a very quick, non citated version of a longer post i had in mind.
first of all, let's start with what we know: buck's canonical injuries.
- 30 year old male, struck by lightning, he was out three minutes before they started compressions.
lightning strikes have a mortality rate of around 10-30%, direct strike being the mechanism with the highest rate (30%), and also the highest morbility rates.
lightning strike can cause cardiac arrest- which is what happened to buck- and it's been proved that prolongated resucitation (CPR or shock) is very succesful, so the only determining factor could be the fact that he was in full arrest for three minutes. most case reports with good prognosis are the ones where CRP was administered within the minute. EVEN SO, cardiac arrest can lead to serious brain damage, as is often referenced in media (the 5 minute rule). what we know is that buck was in cardiac arrest for 3 minutes before CPR started, from which a fraction of the necessary oxigen starts mechanically flowing through to his brain, so this should definitively mean brain damage (in what degree is variable). now, we know that is not the case in canon. this will be further discussed in another post!
2. the lightning entered through his hand, all the way through his midline and out near his knee, could have (definitely has) some damage to major organs.
this means: burn scars!! we were all fixating over the lichtenberg figures, but these are temporary, now, burns from lightning tend to be superficial because of the short exposure to extreme heat, and being wet (like, rain or sweat) is actually a protective factor, but it's been reported that direct strike victims have enter and exit burns, around 2-3 inches in diameter, and they can look like big blisters, irritated skin, and even a bit of charred skin.
it also means, he didn't get hit though the head or anywhere near, so the potential electrical damage to his brain is less. in fact, respiratory arrest can happen if lightning goes through the brain stem, which has the respiratory center. so, good for buck! (also, since he was wearing a helmet, this could have also helped absorbe a lot of the impact, so the damage wouldn't have been as extensive. there is a case report on a football player who survived because of his helmet).
3. lung contusion.
from all the things they could have chosen, they went with one of the rarest ones! kudos for the writting team, they did their research! lung contusion happens because a lightning strike is very similar to being next to an exploding grenade. lightning causes a rapid increasse in pressure around the channel, creating a blast wave, which is responsible for most of the traumatic injuries, for example, it can throw a person several feet from where they were hit. it also can blast your shoes off.
in buck's case, the blast plus the fall caused great trauma on his chest, which explains the lung contusion. this is just like a giant bruise, but in very, very delicate tissue: the lung is like a big sponge, filled with tiny capillars in charge of sending oxygen though the body. when bruised, these capillars break massively, which leads to blood filling the lung. in this case, it caused respiratory failure because there was no space for the oxygen to even get to the capillars, because the holes of this sponge-like tissue were filled with blood.
(now, i had to laugh during the episode because they showed buck saturating 90mmHg, when respiratory failure is considered when the patient saturates less than 60mmHg.)
RESPIRATORY FAILURE CAN BE FATAL. case reports of direct strike victims with lung contusion are some of that 30% i was talking about before. in buck's case, he was treated in time, so it makes sense he could recover. but it's definitely not as easy, and it can also lead to other organ's failure.
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alright besties, this is all i can do right now, but this post will be continued! and as soon as i get my sources back i can link you to all the studies i referenced. this is all from the top of my head btw. i got classs early tomorrow, so enjoy!! i'll be back with more buck whump resources later!! stay tuned to hear me talk about all the heart issues and metaphors we can get from this.
aceofwhump reblogged
Anonymous asked:
Maybe a weird question, I have next to no experience with hospitals and so what I see on tv is where I get most of my knowledge, whether it's accurate or not. Does everyone who gets admitted have a heart rate monitor put on at all times? What other sensors are attached? Is an IV always inserted if they're admitted too?
Good question!
I'll answer the IV question first since it's the easiest. Almost all patients admitted to the hospital will have an IV unless they refuse. These are used to administer drugs and fluids, and also very helpful in an emergency. If the patient is getting continuous fluids, a blood transfusion, or IV medication over an extended period of time, they'll be attached to a pump. Otherwise the port will just be capped.
What monitoring equipment is used is based on what is wrong with the patient and what part of the hospital they are admitted to.
Typically, hospitals have 3 levels of acuity (how much care a patient needs): Critical Care, Telemetry, and Med-Surg. There may be multiple units/floors that fall under these categories, but their monitoring capabilities would be similar. Of these, I have worked med-surg and tele.
Med-Surg is typically the lowest level of acuity. This is where most patients are admitted. Think things like pneumonia, cellulitis, heart failure exacerbations, COPD or asthma exacerbations, as well as where someone might stay for a few days after most surgeries. Depending on the size of the hospital, there may be multiple specialized med-surg floors (say, one just for lung problems, one just for orthopedic surgeries, one just for trauma, etc...), or just one or two where all diagnoses end up.
Med-surg does not have heart monitors, but may have SpO2 (the amount of oxygen in the blood, measured with a probe on a finger or ear), EtCO2 (the amount of carbon dioxide in exhaled breath measured with a specialized nasal cannula), and apnea (whether the person is breathing and how many breaths per minute they are taking) monitors for overnight use in patients with sleep apnea or who have lung problems. These readings are displayed on tiny screens above the patient's bed or transmitted to the nursing station. When patients are up and walking around, they are typically not monitored.
Otherwise, vital signs (heart rate, respiratory rate, blood pressure, temperature, and SpO2) are taken about every 4-8 hours depending on the patient's condition.
Telemetry units are similar to med-surg units, but they have the additional ability to monitor continuous (3- or 5-lead) EKGs (heart rhythm waveforms). While they can take all higher-acuity med-surg patients, they can specifically also take patients who are admitted for heart rhythm problems. This is important to monitor how a new medication might be working to control a heart rhythm, or monitor for a dangerous heart rhythm.
Most tele units I've worked on have not had the patient monitors in the rooms. The patients carry little packs around in their gowns that connect to the leads on their chests. The packs transmit the EKG data (and optionally SpO2 data if that probe is also attached) to a computer screen at the nurses station and sometimes to a screen or two in the hallway for easy visibility.
Sometimes, if the hospital uses a communication system like Vocera (think little voice-activated cell phones that clip to your scrubs), the packs can also directly communicate to the Vocera and tell the patient's nurse if a heart rhythm changed (the lil computer voice hilariously mispronounces the names of heart rhythms. It's lovely). Or more frequently (like, waaaay more frequently) that the battery in the pack needs changed or that a lead fell off.
(Note- most alarms in med-surg and tele are "false" alarms and the system manufacturers know it. There's a system that has this quiet little "meep meep" sound for apnea (not breathing). Hilariously, it so infrequently actually detects apnea that the sound basically alerts you that the patient is probably breathing but the cannula fell off please help? But anyway, alarm fatigue (not being able to hear any alarms because there are just so many all the time) is a thing.)
Because this can get annoying, sometimes hospitals have people who's job it is to watch the monitors from a central location and call the associated nurses if they see something that looks actually wrong.
Critical Care includes all intensive care units, the emergency department, and any post anesthesia care units (PACU). This is where there are actual hardwired EKG, SpO2, automatic blood pressure, and other sensors that connect straight to a monitor behind the person's bed. They also transmit to the nurses station and Vocera systems if applicable.
In order to have this normal set of sensors (everything seen on the monitor screen below except the two yellow lines and second BP reading), the patient typically has 5 electrodes on their chest, a blood pressure cuff on their arm, a glowing red sticker on their finger or ear, and a cannula in their nose (both for providing oxygen and measuring respiratory rate). All of these require a separate cord to the monitor (or a box transmitting this to the monitor).
In addition to these, ICUs often have systems that can monitor continuous blood pressure via a little catheter in an artery, systems that can monitor pressure inside the skull with a sensor surgically placed in the brain, specific blood pressures in the lungs and heart with special sensors placed in the vasculature, and other invasive and non-invasive monitoring sensors.
Since people in ICU-level care more often have monitors both correctly placed and correctly maintained and since the patients are typically sicker and more likely to have a sudden change in condition, the alarms are statistically more reliable.
Hi @blue-flare10
This is also a good question!
Each hospital will be different on exactly who they will admit to each level of acuity. This is also not meant to be an exhaustive list- its just to get you started with a basic framework and some examples.
Med-Surg:
Admitted because one or more of the following is true due to a medical condition or recent surgery:
- Can’t take in enough oral fluids to stay hydrated and need IV fluids
- Require oxygen for a temporary reason (pneumonia, asthma attack, etc...)
- Need IV medication for pain or nausea that can’t be controlled any other way
- Need IV medication to reduce dangerously high blood pressure until they find an oral med that works
- Need IV medicine to make sure a blood clot doesn’t get bigger or break apart
- Need IV antibiotics to treat an infection
- Need monitoring for a condition that requires multiple serial assessments or might change in the next 8 hours
- Acutely confused for an unknown reason and unable to care for self
Med-Surg floors/nurses can provide/accommodate the following services:
- Take vital signs every 4-8 hours, including recording intake and output of fluids
- Nighttime SpO2 monitoring
- Administering oral medications within an hour of their due time
- Placing peripheral IVs
- IV fluids and many IV medications like antibiotics, pain meds, nausea meds, blood pressure meds, and blood thinners
- Placing and managing catheters
- Placing and managing NG tubes for gastrointestinal problems and feeding reasons
- Safety measures for those who are confused
Examples:
- Appendicitis/appendectomy
- Trauma surgery up to and including broken femurs/bowel resections
- Overdoses after initial resuscitation
- Severe asthma attacks that require medication and oxygen but not intubation
- New or breakthrough intermittent seizures (this could also be tele or crit care depending on severity)
- Infection requiring antibiotics
Telemetry:
Admitted because one or more of the above is true AND one or more of the following is true:
- Just had minor heart surgery or a vascular procedure that requires continuous EKG monitoring
- Came into the ED for a heart-related complaint (chest pain, palpitations, fainting in an older adult, etc...) that is either new or not being controlled on current medications, admitted to make sure nothing life threatening happens while trying to figure out what is wrong and what to do about it
- Need IV medicine for a heart rhythm problem or need an IV medicine that could cause heart rhythm problems
- Recent stroke or stroke-like symptoms
- Severe electrolyte problems (low or high sodium, potassium, etc...)
- Pacemaker’s not working right
- Have a condition that requires serial assessments and condition is expected to change within 4 hours
Tele floors/nurses can provide the following in addition to everything Med-Surg can:
- Interpret EKG waveforms
- Heart medication drips for rhythm problems
- IV heparin for blood clots that require rate changes periodically due to lab value changes
Examples:
- Severe dehydration
- Severe kidney infection
- Heart procedures that are performed through the femoral artery
- New pacemakers
- Not-great heart rhythms or new medication for heart rhythm problems
- Acutely high blood pressure
- Poisonings (though depending on the substance/how much/symptoms it might be another level of acuity)
- Blood clot in leg
Critical Care:
Admitted because one or more of the above are true, and also one or more of the below:
- Continued and significant problem maintaining their own airway and must be intubated
- Continued and significant problem breathing on their own and need a ventilator
- Continued and significant problem with level of consciousness (aren’t responsive to voice due to a recent illness or injury)
- Continued and significant problem keeping their heart beating in a rhythm compatible with life and/or their blood pressure high enough to get blood to their brain and need a constant IV medication to make this happen
- Constantly changing medical condition with the expectation that pt could rapidly deteriorate
- Need medications adjusted constantly to maintain their life (insulin drip and blood sugar checks every 15 mins, vasopressors to increase blood pressure that need dose changes frequently, etc..)
- The patient is sedated in a way that impacts their ability to maintain their airway
- Basically the patient would die or suffer lifelong disability if you didn’t do anything for them for 15 entire minutes
Critical Care floors/nurses can provide the following in addition to everything Med-Surg and Tele can:
- Ventilator Support for breathing
- Continuous non-invasive monitoring as mentioned on original post
- Invasive monitoring (continuous blood pressure and intracranial pressure monitoring)
- Temperature support (cooling blankets/warming pillows) and core temperature monitoring
- The ability to sedate patients with IV medication and titrate IV blood pressure modifying medication to pt response via an algorithm
- Physician on unit 24hr/day (not the case on other floors, though a nurse could call/page/message a physician 24hr/day on med-surg or tele)
- Bedside procedures like the placement of a central line
- ECMO (continuous heart-lung machine) (not all of them)
Examples:
- They showed up with CPR actively being done on them
- They coded (their heart stopped) on a med-surg or tele floor
- They are in shock due to a severe infection, neurological problem, or sometimes severe allergic reaction if they don’t respond well to initial resuscitation
- Post open-heart or lung surgery
- Severe chest trauma (multiple broken ribs/severely injured diaphragm) and can’t support the work of breathing
- Medically induced coma
- Actively life threatening heart rhythm
- Severe head trauma that requires intracranial pressure monitoring
aceofwhump reblogged
Stargate Universe S01E17 :)
aceofwhump reblogged
Hey um, does anyone know what kinds of plants one could use in medicinal healing. Specifically ones to slow bleeding and prevent an infection.
Ya know for....reasons....
Shepherd’s Purse - slows bleeding because of high vitamin K content, and you use it in a poultice.
Marsh Fivefinger - also used as a poultice/salve
Nettle, once dried and powdered - you can use the whole plant to help stop the bleeding, including internal bleeding.
Wintergreen/Pyrola - fresh as a spit poultice, since the juice has the properties to stop bleeding. The juice can also be drunk for internal bleeding
Oooh!!! THANK YOU!!! This is so cool! And so super useful! Thanks so much! I can definitely use this! How cool 😀👍
Here’s my dystopia/apocalypse medicine post, it’s not fully researched but I found some interesting info https://ivebeenmade.tumblr.com/post/190704998125/natural-pain-killers-dystopianpost-apocalyptic
AWESOME! Thank you!!! This is awesome! I have so many options to choose from now!
aceofwhump reblogged
Hey um, does anyone know what kinds of plants one could use in medicinal healing. Specifically ones to slow bleeding and prevent an infection.
Ya know for....reasons....
Shepherd’s Purse - slows bleeding because of high vitamin K content, and you use it in a poultice.
Marsh Fivefinger - also used as a poultice/salve
Nettle, once dried and powdered - you can use the whole plant to help stop the bleeding, including internal bleeding.
Wintergreen/Pyrola - fresh as a spit poultice, since the juice has the properties to stop bleeding. The juice can also be drunk for internal bleeding
Oooh!!! THANK YOU!!! This is so cool! And so super useful! Thanks so much! I can definitely use this! How cool 😀👍
aceofwhump reblogged
Last Patron COMMISSION ! Yeah I did it :) Thank you all for your support. Now I’ll think about opening my Ko-Fi commissions publicly. Depends on my schedule >//<
#shiro #muzzle #patreon #sai #fanart #voltron
aceofwhump reblogged
The Politician S01E06 + S01E07 (The Assassination Of Payton Hobart + The Assassination Of Payton Hobart Part 2)
aceofwhump reblogged
The amount of whump potential this has 😍
aceofwhump reblogged
To Supergirl anon ❤️
aceofwhump reblogged
“Give him to us. We can save him.”
Black Panther (2018)
aceofwhump reblogged
“Give him to us. We can save him.”
Black Panther (2018)