Tracheostomy

Ableism almost killed Stephen Hawking in the 80′s.

This is a casual reminder that Stephen Hawking was almost allowed to die due to ableism.

Stephen got so sick because the advance of his ALS made his larynx weak and it wasn’t doing the job of keeping spit and food out of his lungs when he swallowed. In the 80′s, he contracted aspiration pneumonia while at CERN. He got rushed to a hospital where he was placed in a medically induced coma and breathed via a ventilator. Doctors urged Jane (wife) to pull the plug because “he’s too far gone”. 

Think about it: Doctors put Stephen into a position where he couldn’t answer for himself, tried to tell his wife that he was too far gone and tried to tell her she should pull the plug as an act of mercy. 

I doubt that would have been said if Stephen wasn’t so visibly disabled by his ALS. It’s funny how people in the medical field tend to be so quick to give up on a patient if they already have a visible disability when they are brought in, but will throw all the medicine and machines they’ve got at somebody who isn’t visibly disabled. I don’t think doctors even realize they have this bias.

Thankfully, Jane stood up to the doctor. She said no, declared that Stephen must live and had him returned to Cambridge. She knew her husband better than the doctors. She saved his life.

Stephen had a tracheostomy done, which prevented him from speaking, and he spent some time on a ventilator while he recovered from the pneumonia. He initially communicated via a letter board by raising his eyebrows when the right letter was chosen. Then he went on to get the computer that gave him his famous voice. 

A little aside– Stephen has the option to get a new, more “human” sounding voice, and he refuses because he’s grown quite attached to the “robot” voice he’s so well-known for. He sees that as his voice now and identifies with it. (”Even though it gives me an American accent,” he once joked.)

Later, he had a laryngectomy because his larynx was causing a lot of trouble with swallowing food. Getting rid of it increased his quality of life. As far as I know he’s still swallowing just fine and eats and drinks by mouth with help from his assistants. A video of Stephen talking about the tracheostomy and laryngectomy can be found here. (No surgery images, but he describes medical tests and talks about the problems with eating.)

He communicates nonverbally with his caregivers using just facial gestures. One of them said Stephen can just look at him a certain way and he’ll know whether he’s saying he needs attention or everything’s fine. I read somewhere that Stephen grinds his teeth to express disapproval. (Yo, behavior is communication!) He communicates with more than his AAC device, it’s just a matter of learning to read him like his caregivers do.


‘No quality of life,’ the doctors said in the 80′s.


(Sarcasm) 

I guess this is ‘no quality of life’.

(/sarcasm)

[Stephen giving lectures at a university.]

[With the cast of The Big Bang Theory.]

[Experiencing zero gravity.]

[Looking sharp at the BAFTA’s!]

[In his office at Cambridge University, doing what he loves– trying to find the real theory of everything.]

(Sarcasm) 

Oh yes, his quality of life is just awful, isn’t it? 

(/sarcasm)


The only person allowed to determine Stephen Hawking’s quality of life is Stephen Hawking himself. And guess what? His life is great right now!

He almost wasn’t here. Ableism nearly ended his life in the 80′s.

Thankfully, he’s still around to sass people and keep us curious about the universe.

Here’s a documentary where Stephen tells his own story in his own words. CC’s are available for those with hearing or audio processing issues.

* * * WARNING: Video has flashing lights that may upset seizures or migraines.
* * * TRIGGERS: Dramatized hospital scenes, food consumption and alcohol consumption.

https://www.youtube.com/watch?v=hi8jMRMsEJo (not my video)

Btw the girl in the thumbnail is goofing off with him by making that face.

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Tracheostomy?
A tracheotomy or a tracheostomy is an opening surgically created through the neck into the trachea (windpipe) to allow direct access to the breathing tube and is commonly done in an operating room under general anesthesia. A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. Breathing is done through the tracheostomy tube rather than through the nose and mouth.

#video #instavideo #tracheostomy #trachea #surgery #surgeon #anesthesia #lungs #ent #pulmonology #usmle #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #nurse #nursing #hospital #hospitallife #patient #pathology #anatomy #physiology #mbbs #md #medicine #medlife #amc #plab @doctordconline

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All about Aurora!

Thank you to everyone that supported Aurora and helped her win $657 that will go toward her care!!! I realized I haven’t really shared much about Aurora’s story, so I wanted to post little snippets of her life for all those that wanted to know about her. And to show off how adorable she is!

A few of my classmates started fostering a pregnant cat around the beginning of the school year (we are all 1st year vet students) and she gave birth to six very sweet kittens. While five were able to nurse normally (and have since been adopted), Aurora had a visible facial deformity and couldn’t nurse. She has a small area on the side of her mouth that can open, so her foster owners had to tube feed her every 2 hours.

She’s much smaller than her litter mates in size, but not in spirit. Aurora is lively, loving, and just as naughty as any other kitten. Since she has grown, Aurora no longer needs tube feeding every 2 hours, which is lucky for my classmates, who were feeding her between classes. However, she does still need to be fed with the tube. Because of this, Aurora is at school quite often and visits during lunch and between classes. She was present after our recent endocrinology exam, wearing her little harness and greeting everyone. Seeing her never fails to lift all our spirits. I feel very lucky to be one of her lunch-time kitty sitters (AKA we get kitty play time while mom gets a break from shenanigans) so I’ve gotten the chance to get to know her and watch her grow.

That’s not how you walk on a leash…

Aurora has a visible cleft lip, but it was unclear beyond that how extensive the deformity is. In an attempt to find out, Aurora had dental x-rays taken that were reviewed by a boarded dental specialist. Unfortunately, the results were inconclusive due to structure overlap. Aurora also had a hard time coming out of anesthesia, which gave everyone a scare, but she recovered perfectly!

Much better!

The next step for Aurora was a CT scan. It took a lot of extra care, because she was high risk for anesthesia, but her foster mom reports she handled it really well! She is also now wearing a fashionable purple scarf, because she has stitches and staples from a tracheostomy tube (the only way to intubate her) and was messing with the site. Typical kitten! The results of the CT scan showed that her right mandible (lower jaw) is fused to her maxilla (upper jaw) and her temporomandibular joint is also fused, and she has a cleft palate. Now, Aurora’s vet and the rescue are discussing what is going to be done next. In the mean time, she’s busy being our unofficial class mascot and bringing smiles to all our faces!

How could you not love this face?

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The Obamacare provision that saved thousands from bankruptcy

Timmy Morrison was delivered by emergency C-section, weighing in at 3 pounds, 9 ounces. Doctors put him under anesthesia within a week and into surgery within a month. Some of the contents of his stomach sometimes made their way to his lungs. Workers in the intensive care unit frequently needed to resuscitate him.

He arrived seven weeks premature — but, in a way, just at the right time.

Six months before Timmy was born, President Barack Obama signed a sweeping health care law that would come to bear his name. Six days before Timmy’s birth, the Obama administration began to phase in a provision that banned insurance companies from limiting how much they would pay for any individual’s medical bills over his or her lifetime. At the time the Affordable Care Act passed, 91 million Americans had employer-sponsored plans that imposed those so-called lifetime limits.

That group included Timmy’s parents, whose plan previously included a $1 million lifetime limit. This Obamacare provision took effect September 23, 2010. Timmy was born September 29. On December 17, he surpassed $1 million worth of bills in the neonatal intensive care unit. He didn’t leave the NICU until he was 6 months old.

If Timmy had been born a week earlier, his medical benefits could have run out while he was still in the NICU. But that didn’t happen. His insurer covered everything. The NICU bills his parents save total just over $2 million (they come out to $2,070,146.94, to be exact).

“He would have lost his insurance at a million dollars,” his mom, Michelle Morrison, estimates, “which would have been about [halfway through] the NICU stay.”

Timmy still has significant and expensive medical needs. His rare genetic disease, called Opitz G/BBB Syndrome, causes abnormalities along the body’s midline. He is now 6 years old and has been under anesthesia 45 times. It happens so much, he and his mom have a routine: They sing the alphabet until he falls asleep.

Timmy breathes through a tracheostomy tube. A nurse accompanies him to school. But he’s still, in most ways, just a normal kindergartner. He climbs off his school bus wearing a backpack covered in cartoon dogs. He rides around his suburban Maryland neighborhood on a bright orange scooter with his little sister, Ivy, until they’re out of breath. He is obsessed with his collection of toy cars, which he zooms around the coffee table after school. He cannot decide whether he likes robots or pirates best.

Timmy’s parents switched insurance plans (and jobs) when Timmy was 8 months old and out of the NICU. On that new plan, he has run up $985,147.19 in medical bills. He will likely hit $1 million in the next few months.

Right now that doesn’t really matter. But if Republicans roll back this provision of the law — as some replacement plans do and some lobbyists are urging — it could drop a threat of bankruptcy onto Timmy’s family.

Timmy could find himself above the cap the moment the new law passed. Or he might have his old costs grandfathered in and the counting start anew. It would all “depend on the language of the statute that Congress passes,” says Nicholas Bagley, a health law expert at the University of Michigan. “I don’t think there’s any guarantee for the family of the 6-year-old boy. There’s just a lot of uncertainty.”

The Affordable Care Act is brimming with provisions like these: small parts of the law that are hugely consequential for the people who rely on them. These provisions complicate the matter of repeal and replace, because they all have constituencies that will show up for a lobbying battle in Washington — and their stories could tug at the heartstrings of voters who otherwise support the repeal effort.

The lifetime limits ban is a few paragraphs of a 1,300-page law. It isn’t crucial to making the coverage expansion work in the way that, for example, the individual mandate or insurance subsidies are. But the ban is absolutely crucial to making the Morrisons’ lives work.

“We don’t really know what to do right now,” Michelle Morrison says. “Should we start pressuring his doctors to do a surgery now so he can get it in time? That doesn’t feel right. Insurance is supposed to cover things that you can’t anticipate — and for us, this is one of them.”

Chapter Three: “POCKETS FULL OF POSEY”

AUTHORS: @2moms-0fucks @piecesofscully

RATING: Teen-Mature

WORD COUNT: ~8600

NOTES: Chapter One // Chapter Two 

Trigger Warning for potentially disturbing medical imagery related to children, and angst galore.

SUMMARY: “Tonight as he lay there in the guest bed with the old ratty comforter and lumpy pillows, he yawns as he listens to Dana and Mulder’s voices below him telling a story from their lifetime before.  It isn’t sadness he would rid himself of, he thinks to himself as his parents run through his sleepy mind.  It’s utter disappointment.”

Keep reading

Need some opinions.

I have a character who,through certain events,is no longer able to breathe through his nose or mouth due to a deformity. My question is would he be able to breathe solely through a trach tube without the use of a ventilating (after being properly weaned,that is)? Or at least go with out it while he was awake,because I’m sure it would be needed while sleeping. I’ve read several articles about trach tubes but none of them quite covered the information I’m after. The character is set on earth with technology equal to and in some cases above our own if that helps.

Medical facts and tips for your writing needs

Okay, guys. Here’s the deal. I have had too many fanfics and other stories just RUINED for me with terrible and painful inaccuracies having to do with basic medical processes and facts… and I just CAN’T anymore. Please, let me help you. PLEASE.

This is way too long, graphic at some points, and really, basically, please send me an ask if you want any basic info on what would happen in a certain situation. 

Keep reading

anonymous asked:

I once read a story (that claimed to be based on a true one but, well, grain of salt) where a character got hit in the throat by a rock and lost their voice permanently, thus becoming mute. Is that kind of thing possible? Could there be any injury/illness to the throat that would only damage the, I guess vocal chords, without screwing up everything else?

COMBINED WITH: 

Anonymous said:

Can someone permanently lose their voice if they have their throat slashed? Would that cause other permanent issues? 


Hey nonny. I’m getting a lot of questions on traumatic muteness, so let’s rap a bit. 

Yes, I would believe a blunt injury to the throat causing vocal cord damage. Here’s why. 

The vocal cords sit in a cage made of cartilage (specifically, the thyroid cartilage). 

That shield-looking  thing in the middle? That’s where the vocal cords hang out. It’s pretty well protected from slashing trauma. 

However, blunt trauma can crush, or at least partially damage, the thyroid cartilage – and thus alter the shape and length of the cords. It’s not impossible for the vocal cords to be damaged in such a way that they can no longer produce vocalizations, or at least, in the same ways that the character would use them before. 

With slashing it’s a little less likely, but still not at all impossible. 

Slashing the throat usually doesn’t affect the cartilaginous cage at all. Usually when someone gets their “throat” slashed, the affected area is the trachea below the level of the cords, meaning that the vocal cords themselves aren’t affected. 

But what often happens with that is that the trachea gets opened and breath comes out through the new hole rather than going through the mouth. Air will follow the shortest path of least resistance, which can mean “oh look new hole!”. Basically, the character has gotten a stoma from an unlicensed medical professional. 

What’s usually done in that case is that the unlicensed stoma just gets corrected into a full tracheostomy by the trauma team, so that they have someplace to breathe through. (I’m a BIG fan of just shoving an endotracheal tube into these injuries and rolling right along with them.) 

But having a trach in place still makes it hard to speak, because remember, the air still wants to come out of the hole in the front of the neck. So many (not all, but many) trach patients have to hold their finger over their trach, exhale, and then speak on the exhale. It takes more work and  more effort. 

Could a character lose their voice from a slashing injury? Yes, but it’s a lot more difficult. Could they lose it from a blunt injury? Absolutely. Would your audience likely believe either? I’m pretty sure they would. 

Best of luck to the both of you! 

xoxo, Aunt Scripty

(Samantha Keel)

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What Hide might have been up to since the sewer

Okay so I have this really weird Hide theory and I’m not gonna put pictures because it is 3am as of right now and I just need to say this. So there is this little theory that I have crafted, because of the way some of the major questions of the series can match up to each other. The major questions that im particularly looking at in this case is that of what happened to Hide after the sewer? Who was Touka visiting in the hospital? Also who is Scarecrow, and why does he seem to be hanging around important events in the manga? Well, all these theories have something in common as they all at some point have been pointed to Hide. Yet, when thinking about these all together I just thought of the most crackiest theory that actually makes a little bit of sense.

One of the major things about the sewer is that we know for a fact that Kaneki ate Hide by a couple of factors A. Kaneki tasted human when he was going to fight Arima, he was magically healed of his prior injuries. B. Hide was missing afterwards and C. Kaneki is convinced he killed him, yet I don’t think Kaneki was the most reliable in that moment, as in that moment he confused bodies for flowers when fighting Arima. Yet, there was at least one major group known to be there, and another I theorize was there the clowns keeping tabs on the Anteiku raid. Both of which could have and would have possibly brought him to Kanou as they were bringing him strong candidates to complete the ghoulification process on, and as Hide was in a ccg uniform and badly injured he could have been taken to Kanou. It’s very possible that he became a half ghoul, but one of Kanou’s failures, for not being the exact Kaneki replica. It’s very possible that between Kaneki snacking on him, and through Kanou’s less than stunning methods of trying to create Kaneki’s that he could have become disfigured or even just unrecognizable as Hideyoshi Nagachika.

Maybe during his escape he becomes incapacitated or in a clever attempt to not get recaptured he ends up in a hospital. Maybe pretending to be incapacitated in a coma or pretending to have ROS disease as a way to explain his high rc count. I mean sure Ros disease was introduced to show Shirazu’s motivation for joining the ccg and quinx, but to also alleviate a plot hole later. Maybe he is using a fake name, which is why Hide is still considered missing.

Also there have been theories that because of the way Scarecrow talks it’s reminiscent of someone with a Tracheostomy which is a breathing tube in the neck, which is common use if someone was in a coma, see where I am going with this.Also something that I have noticed with scarecrow is that with the few times we have seen him it’s always at night, and some of the things have been crazy helpful towards Kaneki, or it gives the impression he was trying to get information on Aogiri tree and the clowns. We saw him at the auction which had both the clowns and Aogiri tree, and he turned on the monitors that revealed to everyone that Haise was in trouble which brought both Hinami and Saiko to him to save him. Also when Mutsuki saw him in the Row boat it was at Rushima where Aogiri was hiding out. He also knew who Amon was and assisted with his escape.

So you might ask yourself well if Hide is in the hospital how can he be scarecrow, and to answer that question I just want you to remember how clever and sneaky Hide was. He was a human who was able to bug a ghoul and get away unscathed, and you’re telling me he can’t sneak out of a hospital. Know you might ask yourself how he gets out well something that I noticed something before the auction. You remember how Saiko and Shirazu visited Shinohara in the hospital right before the auction raid, and they ran into Touka. Touka who was visiting someone, well maybe Touka knew about Hide maybe he found a way to contact her or she helped him get into the hospital. But, maybe she acts as his decoy while he is away, and wears the monitors that would go off if Hide left. I mean even when scarecrow was at Rushima, it was weeks before Touka was in Cochlea.

This would also explain the common theme of Hide meta that Hide is the magician’s apprentice, which lead to the belief that Hide was working with Eto. Maybe it’s not intentional at all, maybe in his attempt at finding the truth he is doing what Eto wants. Through Marude and his admission that it was like Hide said the CCG was run by ghouls. We don’t know if that was from when Hide worked at the CCG or if he visited Marude since Eto’s book came out to finalize him on his side. I feel like Hide might have been pulled into Eto’s bidding just by his flaws his curiosity and his ability to put pieces together.

Well, that is my theory and you can either take it with a grain of salt of scream like I am for a little bit.

I may be in the USA, but I know it’s January 8th in the UK at the time I’m posting this, soooo... Happy 75th birthday, Stephen Hawking!

Stephen Hawking is not autistic, BUT…

If you took his computer away, he would fit into the category of a nonverbal person who needs lots of daily help and can’t make his communications understood*. He started out able-bodied and slowly became disabled as his ALS progressed. That means he was able to prove his competence long before he needed a wheelchair or AAC device.

Communication is a very slow process (one or two words a minute) for him because he has to compose what he wants to say letter by letter using the sensor on his glasses, which reads his cheek movements. Interviewers often send him their questions in advance so he can prepare his responses before the interview. Otherwise, it would take him all day. “Unscripted” things often edit the long periods between someone saying something and him responding.

A fun aside: Stephen’s cheek switch makes beeping noises when he’s typing. He spends a lot of time typing while being wheeled from place to place.

One of Stephen’s frustrations is he notices people are afraid to talk to him, or if they do they go off to something else while he’s trying to compose a response. Rude! I swear, if I ever met this man and someone tried to engage me when I’m waiting for him to compose a response, I will put my hand up and say “Excuse me, I’m talking to him right now” and return my attention to Stephen. I’m willing to be patient for him because I understand the frustration of feeling pressured to say something and not being able to say it fast enough.

Also, he has admitted that he’s shy and finds it hard to talk to people he doesn’t know. That’s gotta be hard when a lot of people ‘know’ him!

It’s kind of ironic that he popped up on the world’s radar because of his book A Brief History of Time. Suddenly the world knew the face of the really smart guy in the wheelchair with the robot voice. He’s as much of a pop culture icon as he is a physicist. He been in Star Trek: the Next Generation, The Simpsons and The Big Bang Theory. He even mentioned that he would love to play the big bad villain in a James Bond movie because he thinks the wheelchair and robot voice would fit the part XD!!

But consider this: what if Stephen Hawking was just a factory worker or store cashier? What if he was born disabled and unable to speak? Totally different picture, especially since he grew up in an era where disabled people were often institutionalized. 

Stephen’s visibility has done something else: it’s normalized his very visible disability. I don’t think a lot of people see him as “other” or “lesser”. His wheelchair and speech synthesizer voice are part of his persona, part of him. He’s adamant about keeping the voice he’s been using since the 80′s because it’s so distinctly him.

I dare you to try and picture modern-day Stephen Hawking without the wheelchair. It’s impossible, isn’t it? Seeing him sitting in his wheelchair with his computer screen mounted in front of him has become so normal that he looks tiny and vulnerable without it. 

Interestingly, one of the only occasions I’ve ever seen him photographed without his wheelchair (and sans glasses, too!) was when he experienced zero gravity. He absolutely did not need his AAC device to tell anyone he was having fun, it’s obvious by his expression.

(Above photos were before he started using a ventilator. The tube coming from his pantleg contained all the leads that monitored his vital signs. The apple was a nod to Isaac Newton. :D )

Stephen Hawking is probably one of the most famous disabled people in the world. Not everyone knows his name, but they know “that science guy in the wheelchair with the robot voice”. He is able to shine and show his knowledge because people worked with him to help him communicate effectively again when an emergency tracheostomy rendered him unable to speak. 

He can’t drive his wheelchair anymore due to his ALS. His current chair has two joysticks. One in the usual place and one behind his headrest. He currently uses a ventilator, but I don’t know for sure if it’s breathing for him or just assisting his natural breathing. He needs other people to do literally every physical task involved with taking care of himself. 

And you know what? You don’t see videos of Stephen Hawking’s caregivers helping him on or off the toilet. The man could be wearing a diaper for all we know. He might have a catheter and colostomy for all we know. But we don’t know because his caregivers don’t tell the entire internet about it. You don’t see videos of him being bathed or having his clothes put on. People respect his dignity and privacy for the most part.

While I am curious about how he gets taken care of in day to day situations, I understand that it’s none of my business unless he wants it to be.


So what’s the point of this post besides acknowledging Stephen Hawking’s birthday?

Why can’t the caregivers of nonverbal autistic people who need lots of daily help and can’t make their communications understood treat autistic people with the same amount of dignity offered to Stephen Hawking?


Stop making disabled people mere spectators in their own stories. Give us autism documentaries by autistic people.

Once again, Stephen Hawking shows us how it’s done. Here’s a documentary about his life, narrated by him. It was made in 2013.

* * * WARNING: Video has some flashing that may trigger seizures or migraines. 

* * * TW: Needles, food, alcohol and abortion mention.

https://www.youtube.com/watch?v=hi8jMRMsEJo




*He has some facial gestures that he uses to communicate with his closest caregivers, but I haven’t been able to see them clear enough to pick them out.

BTS: Save me (Gang AU)

Character profiles

Prologue

Chapter 1/ 2/3


Chapter 4
“Vacant room in darkness”

Medical room, 12.59AM

   You woke up and raised your hand to rub your tired eyes but hissed, when you lifted your arms. Memories of the gang fight came rushing back and you realised where you were, the medical room in the base. All you need to know was that taehyung was all right. All you could see was darkness, save for the flickering lamp on the table. All you could hear was silence, save for the occasional beep coming from the machine beside your bed. It was cold. The cold embraced you fully to the bone.

 You searched for your handphone and found it in the drawer of the table, you whipped out your handphone and quickly check the time, 13.07a.m. , you sighed in relief. Luckily, you weren’t out for long and it wouldn’t be too suspicious if you get back to work now. You checked your notifications, 4 missed calls, 2 messages from your second-in-command. It reads, “ Chief, you alrights?” and  “Call back soon.”

Your second-in-command, Jongsuk, knew what your were up to, knew you were helping BTS, but he didn’t mind and you trusted him.

   Yet you were hoping for something more, words or concern, words of encouragement from the man you love, or even BTS in general but none. You were hoping for someone to be here, holding your hand when you woke up, but none. Loneliness was everything you felt.

 You removed the tracheostomy from your nose and plucked the tube stucked to hand and get off the bed, changed and get back to work.


Police headquarters, Head inspector’s office

     You called Jongsuk, after a few rings, he picked up. He Inform you that he was all right and took care of the scene, and you thanked him and proceeded to complete the report and procedure work for the case that happened today. Double check to ensure that nothing was left out.

 You took a cab home and wanted to go DOPE, since it was on the way but the stinging pain below your shoulder and your teary eyes said no. You looked out the window, when you saw Taehyung arms around two women, too close for comfort. Walking out of DOPE, you knew where they were going, the hotel penthouse taehyung owned. Yet this time around, you felt a sharp pain, not from your wounds but close enough, not physically but mentally. Tears were threatening to spill and your vision blurred, as if to erased the image you just saw.

You knew didn’t you you?

Love hurts. A lot.


Author’s note: I was wondering if my fan fiction was bad? 

Sure thing! 

So a patient gets put on a ventilator when:

  • They have significant damage to the muscles that control respiration
  • They are paralyzed from a drug that prevents those muscles from working (like during surgery)
  • Their lungs are so damaged/full of fluid that the muscles aren’t strong enough (or have become too exhausted) to pull air in/keep fluid from building up further (this can be for many reasons, the most common being severe burns, pneumonia, bronchiolitis in children, cancer, and poorly controlled right-sided heart failure).

Scenarios where this might be applicable in fanfiction:

  • Character receives a gunshot/stab wound to the upper abdomen, where the diaphragm is pierced or otherwise badly damaged.
  • Character is envenomated by a blue-ring octopus or some other paralyzing neurotoxic venom.
  • Bow-and-Arrow-themed superhero ironically receives a typically lethal dose of curare (a personal fav).
  • Character sustains injuries involving multiple broken ribs, rendering breathing excessively difficult/painful.
  • Character sustains severe burns with suspected inhalation injuries (burns in the lung) and their lungs are swelling/filling with fluid.

I’m going to talk about ventilators for a second before getting into the meat of your question. There are two distinct types of mechanical ventilation. Positive Pressure (PP) Ventilation and Negative Pressure (NP) Ventilation

PP Ventilation is what most people think of when they think of a ventilator. This type of ventilator consists of a tube that either goes down a patient’s throat or through a hole in their windpipe called a tracheostomy. The tube is connected to a computerized and mechanized reservoir of air that pushes a set quantity of air through the tube into the patient’s lungs. Patients then (usually) breathe out passively. These can be set to “breathe” either a certain number of times per minute or to detect the beginning of a patient’s breath and only “assist” with the breath instead. 

Here is a video that demonstrates breathing and shows how this machine typically works. These machines look like this:

In NP ventilation there is no tube going into the patient’s lungs. This machine works by changing the air pressure around the patient’s body, causing the chest to expand and take in air. One familiar example of this is the iron lung. While these are not typically used today, one of their descendants, called the biphasic cuirass ventilator (BCV), is (link is to a video). This is like a wearable mini iron lung and looks like a turtle shell: 

It is possible for people to be on both types of ventilators while awake.

Trauma patients usually need to be on PP ventilation, and will be at least partially sedated during their time on a vent, on painkillers, and anti-anxiety drugs. This means they usually aren’t particularly “with it” during this time. The sedatives and anti-anxiety drugs are used with PP ventilation because the experience can be very scary and uncomfortable for patients (think of not being able to move while your brain is telling you you’re suffocating, even though you aren’t, combined with pain from other injuries, unfamiliar surroundings/noises from the machine/hospital in general). Most people wouldn’t want to experience/remember that.  Painkillers would be less for the ventilation itself and more for other injuries, but could still have a significant impact on consciousness.

That being said, the moment in a fanfic where a character wakes up on a PP vent and is told “Don’t fight it!” can be accurate in limited circumstances. In this situation, if the patient is fighting the ventilator, it may be time to change the vent setting to one where the patient initiates the breaths (see above). If the character’s breathing still needs to be entirely mechanically controlled for another reason, doses of sedative medication may need to be changed. Irl, it would be unacceptable to simply leave a patient in a condition where they were constantly fighting the ventilator. Even if the patient was calm and trying really, really hard not to fight it, it would likely still be a mentally and physically exhausting and uncomfortable experience for them. 

People who are more used to being on a ventilator (long term patients) may need fewer interventions/drugs to stay comfortable. It is possible to “get used to it” over time. Those who are conscious/calm enough to communicate typically can do so through writing or a book/board with pictures they can point to that help express their needs/answer questions. These patients can answer questions like “What is your name and birthday?” “What year is it?” and “Point to the picture of a dog” In order to determine mental status.

Measuring mental status with sedated patients is done through observational scales like this one: 

Patients on NP ventilation have no need for paralytic or sedative drugs to initiate or continue ventilation. They can talk and even eat normally while wearing a BCV, and movement is only slightly restricted. However, it is much less likely that a BCV would be used in a trauma situation because it requires an intact chest cavity to work, and because it does squeeze and pull at the chest, it could cause more pain and damage to injured bones and muscles..

Hope this answered your question!

PS, if you haven’t read this SGA fic, you may love it.

anonymous asked:

heya aunt scripty, i was wondering — if someone were to have their throat cut, is there a plausible circumstance in which they *almost* die, but ultimately end up surviving? and if so, would they face any sort of longterm repercussions aside from a scar? thanks a bunch in advance, and apologizes if this ask was worded weirdly 😅💙

Okay, so, this depends on exactly what you mean by “having their throat cut”. I’m not being facetious; the neck is a very complicated piece of anatomy, and exactly what happens makes a big difference.

For example, I once treated a man who tried to cut his own throat and failed. He had sliced – no, hacked through the musculature at the front of the neck, but he hadn’t damaged the airway or any of the large blood vessels. I mean, sure, he bled like hell, but he was sitting in his room, calmly talking to us. The cops had handcuffed him for safety, but he was able to walk, talk, have a real conversation. He just looked like an extra out of a bad Hollywood movie.

As for the almost dying part, well, your character could have had their trachea cut open but not their major blood vessels, and the medics simply put a breathing tube down the fresh hole. The character could have a lot of blood in their lungs (obvious reasons) but have a clear and patent airway that gets surgically converted into a tracheostomy, and they recover and eventually even lose the hole (but likely not the scars).

Alternative: the character could have the artery severed but manage to get the bleeding under control and get enough transfusions to keep them alive while the artery is surgically repaired.

Lots of things are possible! Best of luck with your story.

xoxo, Aunt Scripty

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I did a craniotomy the other day & I literally saw half a brain...

the whole frontal lobe was gone, it was so damaged from the patient’s accident that the brain tissue became necrotic & just died, and it literally deflated. Well, the patient had pneumocephalus hence why the patient needed a craniotomy. But wow! It was amazing that this patient was still alert even though the patient has a tracheostomy, and responsive. It was amazing

And, I actually worked with a very nice, and funny neurosurgeon who also loves to teach, so that was just a great evening even though I worked overtime…it was worth it

3

And now, for the worst makeover of the cycle/potentially ever:

1. THE MODEL MULLET

Go ahead and put the word “model” in front of mullet, Tyra, but that doesn’t make it remotely fashionable. Like, I could pretend “model tracheostomy” is a thing…

… but you’re not seeing it on a catwalk anytime soon. “Model mullet” might as well be an oxymoron.

I google image searched “famous mullet” to see if there was any kind of reasonable precedent that I’m forgetting about. Here’s who turns up:

Michael Bolton

Chuck Norris

MacGyver

John Stamos

Billy Ray Cyrus

Andre Agassi

and that kid from Home Improvement.

In fact, I scrolled through 100 photos of men before the first mulleted woman even made an appearance: 

Carol Brady. You know, a true fashion icon from the early ‘70s.

Searching specifically for modern-day models with mullets, most searches point me toward Lindsey Wixson. What websites are calling a “mullet” looks way more trendy and hipster-y than legitimately mullety, though. It’s a big contrast to Ava’s clumpy cut, which - for better or worse - seems more authentic to the trailer park. It’s as if they sewed roadkill to the back of her head.

Everything you need to know about Ava’s haircut can be read from her stylist’s bewildered facial expression:

You gotta give Ava credit. When Yu Tsai first reveals Ava’s mullet makeover, she barely flinches. She just sort of smiles and says, “Oh, okay.” Forget modeling, this girl needs to be an actress. “I’m ready to rock it,” she says post-cut. “I feel great in it, it’s easy, and it’s so fun.” She’s undoubtedly lying her ass off, but it’s fairly convincing, so good on her.

Instead of crying, Ava definitely knows how to keep things in perspective. Here, it seems like she’s reminding herself that it’s not like they gave her a mustache weave. Hey, don’t act like that wasn’t a possibility. Ava winds up thanking Tyra for the cut at panel, but it should be Tyra who’s thanking her for playing along.

Because this? This is sabotage. I already speculated that they fucked up Stefano’s hair for fun since he was already on his way out, but Ava’s haircut is meant to hinder her moving forward. So far, she’s kicked ass in every photoshoot and has to be considered a frontrunner. Four out of the last five winners have been blonde women, and Tyra isn’t trying to name another. At least Tyra gave Ava best photo once before eliminating her a few weeks from now for not looking “high fashion” enough despite being handicapped with a fucking mullet.

It’s a shame ‘cause I’ve really liked Ava so far. She’s fun, she’s kind, and she stands up for herself and her friends when warranted. She’s also not condescending or homophobic like we’ve come to expect from a lot of reality television Christians.

Mullets are said to be “business in the front, party in the back.” With this cut, though, no one’s going to want to conduct business or throw a party with Ava from either side. Even if you’re not as religious as Ava, do her a favor and pray for her. She needs it.

7 Funniest Moments of ANTM Cycle 22 Ep. 4