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Text of the page (random words):
hill country blogger hill country blogger from office monkey of a super mongoloid soul sucking mega computer company to fire fighter paramedic to teacher chronicles of the hill country blogger subscribe to hcb posts atom posts all comments atom all comments monday september 27 2021 picking out bedspreads i don t think that sleeping under an iguana having explosive diarrhea is my thing why did i get an annoyed look what the heck posted by hill country blogger at 11 26 pm no comments friday january 17 2020 eternity apart into my life and brought me my life you gave me so much and i will forever feel your loss our souls will never touch again infinity is a long time to be from my love posted by hill country blogger at 11 22 pm no comments lost my mind there for a bit can went a little sideways there heh heh but nothing to worry about back in the light whistles nervously posted by hill country blogger at 11 13 pm no comments thursday january 9 2020 seeing double it s weird that i see a stranger that looks like my love posted by hill country blogger at 10 47 pm no comments podcast challenge i ve been seeking help from youtube and podcasts don t laugh it s the more serious ones on how to deal with loss love breakups and life after i found several people that have nearly the identical experience i have had i m still hurting as if my insides had been scooped out faylene still cannot give me a straight answer and i ve stopped asking she wants someone else and i just need to process that didn t say agree but i do have to move past it or i will be consumed by jealousy anger and hatred which would all be legit considering but would it be the best for me i can t change the situation but i change how this situation changes me i m aiming for a better and emotionally healthier version posted by hill country blogger at 5 23 pm no comments monday january 6 2020 dealing but am i really find myself slightly less insane today instead of obsessing my everythought intoafullblownpanicattack i am able to break up my ride on the crazy train with some actual big people things like work and bills hizaah doesn t help that i come home and she is just as pretty as she was before it hurts that i fall in love with her the more i see her she says the 18th is her move out day deep breath posted by hill country blogger at 7 04 pm no comments sunday january 5 2020 totally solid it s like having your heart just blast you kilometers away onto a dark island the only lighthouse is her and she turned off her lamp she doesn t want to grant me safe harbor fay what s going on why does your body look foreign to me i m scared you re so far away now posted by hill country blogger at 10 08 pm no comments saturday january 4 2020 k now what me you said you wanted to do counciling her i did me all you had to do was call they won t accept an appointment until you call and confirm her i know me i m just frustrated i don t understand you said i check off all your boxes except romance we just had a baby we have maybe 10 minutes twice a week her it s not just that me i feel like i have two choices here one let you go and try our best to co parent two fight for you and our daughter i don t know what the right answer is but i know the wrong one her i want you to pick the first one and that s when i lost hope posted by hill country blogger at 8 44 pm no comments thursday january 2 2020 burned again 2020 i m sure the psychology trade publications will be writing about the surge of introspection that came with this year as i begin what a crazy period of my life i ve been in this over drive in the last five years to make things stable i was in a toxic to us relationship for 10 years a divorce and years of therapy got me stable i meet a ray beam of pure sunlight and fall head over heals of my future baby mamma then we split we didn t even try to save our relationship when i say we i mean as a team i tried i tried like a motherfucker drama breeds drama was in a staff meeting the other day one of the executives was talking about employee performance he was say that drama breeds drama and it needs to managed to so it s 2020 and i m single again and all i can think about is you posted by hill country blogger at 2 47 am no comments tuesday march 6 2018 when to stop cpr when to cease resuscitative efforts is a constant topic in the medical education and medical ethics communities while certain scenarios are usually cut and dry such as mortal wounds with significant destruction to vital organs other scenarios such as end stage disease generate uncertainty to the providers medical judgement so here we go the question and background presented to me 85 year old female patient in cardiac arrest with comorbidity simultaneous presence of two or more chronic diseases conditions in a patient of hcc hepatocellular carcinoma aka liver cancer hcv hepatitis c virus author note assumed to be the cause of hcc and large amounts exact volume unknown of hematemesis vomiting blood it was reported that cpr cardiopulmonary resuscitation and als advanced life support measures were immediately started progress the code for an unknown amount of time and the patient converts into rosc return of spontaneous circulation the goal of cpr and re arrested a reported four times secondary assumed to the hematemesis two units of packed rbc red blood cell were transfused to the patient without additional units being available per the blood center also note that the relative relation degree unknown of the patient asked for efforts to stop and let her die in peace on the fifth presentation of cardiac arrest the senor physician called for a vote to either continue or cease resuscitative efforts the vote resulted in the cessation of resuscitative efforts and the patient terminated several questions are asked as followed what are the guidelines for stopping cpr in cardiac arrest at this time 2018 the american heart association does offer guidelines to cease aha acls 2015 manual page 117 terminating resuscitative efforts resuscitative efforts for in hospital providers but no current algorithm exists that i know of currently specifically to this event the presentation of hematemesis requiring two units of rbc without additional units available from the network as questioned it was assumed the patient needed additional units the repeated arrests the almost certainty of severe secondary hypoxic brain injury and wishes of the family should be a strong indicator to lead a provider to cease resuscitative efforts it should be noted that the author is assuming that cardiac arrest means pea asystole over the wording of arrhythmia a poor prognosis on its own standing it is also assumed that peto2 is less than 10mmhg related to poor pulmonary perfusion secondary to hypovolemia also a cited reason is cease resuscitative efforts aha acls 2015 manual page 117 terminating resuscitative efforts is it right to exhaust all efforts to resuscitate without consideration of quality of life post event if this is the only aspect of the question without any consideration to other patients in the network without prior wishes from the patient and assumed resources at unlimited supply then we have to say yes however we do not provide in a vacuum and we do have to consider other patients as well as the resources dedicated as part of you care plan we also direct our efforts with the finite resources available i might suggest reading the aha journal article part 2 ethical aspects of cpr and ecc 2000 which i will link at the bottom i will say that for this scenario everything appears to be checked off on the list for ceasing supportive efforts also consult your bioethics office at your establishment for additional guidance what is the medicological response of the efforts for this patient i cannot speak to a full physician provider level but i can speak to the paramedic level and as an acls instructor immediate cpr is given followed in tandem to aggressive airway suctioning with efforts to ultimately provide an advanced airway i am applying a heightened focus on prevention of foreign substance aspiration given the ejection of total body blood volume route of exit and assumed subsequent drop in pulmonary perfusion to simplify the statement what is the point of making blood go round and round if i cannot get air to go in and out at the physician level i would suggest chest tubes if not already in place i need to note that i would require my team to place an iv io to provide large volume fluid bolus or ideally blood units if available i would continue to follow the established acls algorithm with two minutes of cpr cycles with 1mg of epi 1 10 000 each other two minute cycle i would withhold epi consider your h t s try not to eye roll which in this case should be going off like a billboard light in the dark hypoxia hypovolemia hemothorax i added that one and toxins suspect because of your lab statement comment secondary to the liver cancer if these supportive measure are not maintainable hypovolemia then working the arrest to the 20 minute mark with noted levels of your petco2 leads to the reasonable decision to cease cpr i hope this answers the questions you presented and i am happy to answer more if i cannot answer your question s i know which resources to contact to deliver appropriate answers american heart association 2015 guidelines 2018 terminating resuscitative efforts 117 american heart association 2000 part 2 ethical aspects of cpr and ecc retrieved 2018 http circ ahajournals org content 102 suppl_1 i 12 american thoracic society journal 2015 cease a guide for clinicians on how to stop resuscitation efforts retrieved 2018 https www atsjournals org doi full 10 1513 annalsats 201412 552ps whentostopcpr cpr aha posted by hill country blogger at 12 45 pm no comments older posts home subscribe to posts atom my bloghive 2021 1 september 1 picking out bedspreads 2020 8 january 8 2018 9 march 4 february 5 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