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.”

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.

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 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.

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

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.

jannock-jess  asked:

Hi! I just found this blog and I have a couple of questions that I've been harboring for some time now. 1) If someone's throat was slit how long would it realistically take for them to die? Also would it be possible for them to talk at all? 2) Where/how would someone need to be injured to become paralyzed from the waist down? 3) How would birthing a child work if the mother dies mid-birth? Thank you so much!

Oh wow, a threefer! Okay! I can do this! Let’s go! *cracks knuckles*  

Re throats, and the slitting: I have seen several lacerations to the neck that would very much count as “getting your throat slit” (or, in one case, “cutting your own throat”, much like Mr. Dibbler.) None of them have been fatal. So you will not necessarily die from someone slitting your throat.

The reason for that is that there is a lot of muscle between your skin and the most vulnerable parts of the neck, especially the arteries. It takes a lot of force to actually cut through and cut the artery, because they’re well-protected behind the strap (sternocleidomastoid, or SCM) muscle. As for the trachea (windpipe), it’s actually a very hard structure that’s hard to cut through. It’s why when we do surgical airways, we aim for a very specific membrane called the cricothyroid membrane. (This is why the procedure is known as a “surgical cric”).

 Now, can your character get killed by a throat-cut? Absolutely! But the attacker should be very skilled. Time to dying will vary, depending on how exactly this is accomplished; simply cutting the airway isn’t necessarily effective, because…. Well, the lungs still work, and you have a breathing hole low. You’ve basically just moved the air-exchange-hole from the mouth to the throat. (This can be done surgically as a tracheostomy). So if the victim can manage to keep that hole open and get some help, they will do very, very well.

 Let’s pretendsies, though, that the airway was crushed—maybe they got hit in the throat with an axe or something with some weight behind it. Assuming no other trauma (which is unlikely), they still have a good 3-4 minutes of oxygen to circulate. Maybe a little less, and they’re not exactly useful minutes, but they’ll be awake for a bit.

However, if the carotid artery or -ries get cut, it is game over. While I don’t have any human data on bleedout times (I would LOVE to meet the IRB that would approve that study, except that I wouldn’t), my best guess is 1-3 minutes, and they’re not going to be very functional for those 1-3 minutes, because they will have exactly one goal, which is not bleeding to death.

OKAY! RIGHT ON! QUESTION 2!!

 Paralyzed from the waste down, huh? Let’s see. Here we have a shiny map of dermatomes, which i sa map of what level of the spine innervates…..

…and right nyah. The purple is innervation for the legs. So a spinal cord injury anywhere between C5 (which controls respiratory muscles, very important) down to T12 will cause paralysis below the waist. If you want the character to have full use of the arms, I suggest below T2. So somewhere in the lower thoracic spine should do well.

TWO DOWN, BABY!!! *and the crowd goes wild!!!*

Okay. Number 3. Need some pump-up music.

*Plays Eye of the Tiger*

 Hoooo boy. The procedure you’re looking at is called the Peri-Mortem C-section. It is difficult, not in the skills it takes to do it but in the mentality it takes to make the decision to cut the mom’s belly open to deliver the neonate. That’s a hard decision, done under one of the most stressful moments a doctor could ever face.

 Here’s the thing: mom’s body is very, very sick. Usually this is done because of trauma, but it could also just be a garden-variety medical cardiac arrest. Either way, the #1 thing mom’s body want to do to feel better is jettison the baby.

 Picture a cardiac arrest: CPR, intubation, ventilation. Now add a baby bump, and someone whose literal job it is to only push that baby bump to the left side so that it doesn’t compress the inferior vena cava (great vein). Now picture, during all of that, a doctor performing a C-section. This is madness. This is crazy madness pants-soiling terrorsauce.

 The incision in the abdomen is going to be big, because they want to do it once. Then they dissect down to the uterus, and cut, and deliver the neonate, and the placenta, and clamp and cut the cord.

 Depending on how long mom was in distress before someone decided to do this, baby may be dead, and not come back; baby may be in cardiac arrest and need resuscitated and extensive time in the NICU, or baby may come out relatively healthy and just need some time in the NICU for observation, but this is a baby who has just come out of a BAD situation, very quickly.

 As for mom…. Her day just got a lot better. She’s only trying to circulate blood for one now, not two. A perimortem C-section is a lifesaving operation not just for baby, but for mom, too. Sometimes mom gets lucky, and she lives. Sometimes mom does not. She might die, she might live; as a writer, the decision is in your hands. Both outcomes are possible.

 I hope this helps you!  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

Even If It Kills Me

A/N: I’ve had a few requests for a fic about the surgeon and how Chat got his scars. I didn’t expect it to turn out like this…this is way more brutal than I originally intended it to be.

Fandom: Miraculous Ladybug

Pairing(s): Ladynoir, Adrienette

Rating: M - for graphic violence and swearing. 

Word Count: 3756

Original Fic: Finding You

Summary: How did Chat get his scars?

Days before finding Hawkmoth, Ladybug and Chat face off against The Surgeon—a brutal akuma who manages to knock Chat out and try to get a good ‘slice’ of information out of him.

After saving him from the akuma’s clutches, Ladybug is unable to leave his side and tends to his wounds before watching over him as Marinette. Companion piece to 'Finding You.’

On Ao3

On FF.net

Chat hated hospitals.

Well, technically Adrien hated hospitals. But Chat was Adrien so by proxy Chat didn’t like hospitals either.

But that was beside the point.

Aside from the fact that hospitals were full of sick people, the overall atmosphere was what got to him most. The walls were white and bland, the halls were huge.

It just felt so haunted and empty. How anyone could be here all the time and not have a breakdown baffled him.

Until today.

It was only a matter of time he figured until he and Ladybug had to show up to a hospital to get rid of an akuma—in fact, he was surprised it hadn’t happened years earlier when this whole thing with Hawkmoth first started—but now that it was happening…

Chat was having a hard time focusing.

They’d successfully evacuated the East wing of the hospital as Chat distracted The Surgeon, and now Chat was jumping around the halls, and desks. The walls and doors that separated patient rooms had been blown away, so the Eastern wing was now one large indoor area with carnage everywhere.

Chat was ducked down behind a toppled table when Ladybug silently rolled in next to him.

“Where’d he go?” she asked.

Chat smirked, “Nice of you to drip on in, m’Lady.”

Ladybug’s brow furrowed, “Is that supposed to be an IV reference?”

Chat’s grin just grew wider.

Ladybug shook her head and sighed, “C’mon, Chat. Focus here, okay?”

The blond nodded, peeking over the top of the table. The Surgeon had disappeared a minute or so ago after trying and failing to plunge a needle into Chat’s neck. He threw the syringes like darts, and it was only sheer luck that kept the black cat from getting stuck.

It was bound to run out eventually.

Chat gestured toward the doors that lead to the West wing of the hospital.

“I think he was trying to head to one of the other wings. I’ve blocked the door, so he’s definitely in here.”

Ladybug nodded, “I’m gunna go check over there.”

Ladybug kept low to the ground, crawling over obstacles and keeping behind large bits of wood, creeping ever so slowly toward the door. Once she was out of his direct line of sight, Chat went to move when a sound pricked his hears, catching his attention.

His head snapped around to see The Surgeon hiding behind a wall divider, watching where Ladybug had just ventured off to.

Not on my watch you don’t.

Silently, Chat circled around, never taking his eyes off The Surgeon. He didn’t question how his hands and feet knew just where to go to avoid the bits of metal on the floor. He didn’t even think about the aching in his joints from where debris had fell on or was whipped at him. He just kept his eyes on the akuma.

The sound of a loud crash and Ladybug’s yell diverted his attention for only a second, but it was enough that when he looked back, The Surgeon was gone.

“Fuck.”

Chat sprinted over to where he last was and then around the corner, following the sound of the falling footsteps. He knew his partner was down the hall and there was no way he was letting his Lady get hurt.

Silently he advanced, closing the distance between him and the akuma. His feet moved silently on the ground until he was close enough to leap on the doctors back and wrap an arm around his throat.

He had to keep in mind that this person was a victim that was taken advantage of by Hawkmoth, so he had to immobilize him while at the same time keeping him alive. The more ruthless the akuma was when it came to attacking his partner, the harder it was for Chat to remember that.

In this case, cutting off oxygen to his brain and getting him to pass out was the best option.

Tightening the hold of his legs around the man’s waist, Chat wrapped his right arm around his neck and kept it secured with his left hand hanging onto his right wrist. His grip tightened as The Surgeon struggled, trying to throw Chat off.

Stars burst across Chat’s vision as he was backed into a brick wall and he hissed under his breath, but his grip didn’t waver. His head felt dizzy as the man spun, but again, he didn’t waver.

It was only when The Surgeon jumped and fell on his back—and in turn Chat’s back since he was holding onto him—that another blow to his head had him falter. With the wind knocked out of him, the blond found it hard to breathe and The Surgeon took this moment to break free from him.

“Shit!”

Chat snickered as he watched the man look back to where Ladybug had been, and obviously see nothing.

Not this time, Hawkmoth.

At the sound of his chuckles, The Surgeon turned back to him and stalked over, pulling him up by his collar.

“You know where she went, and you’re gonna tell me.”

A cocky grin spread its way over Chat’s face as he stared at the pink butterfly mask that was currently hovering over the akuma’s face.

“Not a chance you basta—”

In a flash, a sharp pain in his neck caused his breath to hitch. Glancing down, the presence of The Surgeon’s hand registered as his fingers fell way to reveal an empty syringe plunged into his neck.

“Mother…fuck..er,” he slurred as gravity claimed his body and his vision faded.

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Case scenarios: When you don't give patients 100% O2 and why

Clinical scenario #1: Chronic lung disease patient.

The ventilatory drive of patients with chronic lung disease is primary due to their hypoxemia, rather than CO2 levels. This is because pCO2 receptors are adaptive. Chronically elevated pCO2 makes central receptors unresponsive in COPD patients. Administration of a high O2 mixture to relieve the hypoxemia is contraindicated because this removes the hypoxic drive, leading to severe hypoventilation.

Clinical scenario #2: Drug overdose where central receptors are blocked.

In morphine or heroine overdosed patients, central receptors are knocked out and the hypoxic drive is what keeps them breathing. Administration of a 100%  O2 mixture to relieve the hypoxemia is contraindicated too because this removes the hypoxic drive which kept them breathing.

Clinical scenario #3: Tracheostomy following prolonged respiratory obstruction.

Apnea in patients is due to washing out of CO2 which was acting as a respiratory stimulus. Treatment is to administer 5% CO2 in oxygen or assisted ventilation.

I know there are many such scenarios but I can’t think of any more at the moment. The basic concept in such cases is the same - understanding which receptor acts as a drive for respiration and not messing with it! Lemme know if you recall any more and we’ll add more scenarios here =)

OMG. When in the hell did a total thyroidectomy with a pectoralis flap & PEG become a fckn emergency case?!

Well it happened on Saturday, some fckn resident decided to add on a case when we are only 3 nurses in the OR and we had to delay the case a bit bc we only had 2 techs and we had to call back the “on call” tech. Oh goodness. The patient was fckn stable. She just wanted the surgery done to “get it over with.” Hence why they decided to add the case. 

So background, the patient has a history of cancer & she’s stage 4 - & now she’s having dysphagia bc of the mass in her thyroid. So her consent literally said this: 

Total thyroidectomy, possible partial laryngectomy, possible tracheostomy, possible partial esophagectomy, with pectoralis flap. Percutaneous endoscopic gastrostomy tube placement. 

Keep reading

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

anonymous asked:

I read worst family meeting ever I felt compelled to say This was my family 1 week ago deciding if our grandmother should sign a DNR and the decision fell on my mother who completely lost control. This person is usually picked because they were the most loved by the person so it is even harder for them to decide not to help they loved one live. I wasn't there for you situation so I can't say but you should respect people's beliefs and understand this is one of the worst times of their lives

Okay, you don’t know me so I understand why you might think that I’m an asshole doctor who is laughing at the expense of a family’s grief.

So I’m just gonna share: I have been on BOTH sides of the end-of-life conversation. That is why I took the results of my patient’s conversation so personally, why I am so upset.

Yes, I have! Shocking, isn’t it! I, a cruel, rude, evil doctor who has no soul, has been the grieving family member. I have been there for those family meetings, when doctors told us the prognosis.

I was there when we extubated my paternal grandmother. The decision fell to my father, because “he’s a doctor, he can make the right choice.” Well, he stilled wept and broke down. I didn’t even like my paternal grandmother very much, but it was a heartbreaking decision.

I was there when my parents received a call, at 2AM in the morning, that my maternal grandmother had suffered a stroke. I was there for the family meetings, when the neurologists and the neurosurgeons told us she would never really recover. My grandfather and my whole family knew she would never want to have a tracheostomy, to live out her life bed-bound. But my grandfather couldn’t imagine life without her. He asked for the tracheostomy. He goes to her nursing home every day, from the moment visiting hours start to when they end. His decision has caused deep, deep emotional rifts in my family. My mother and aunts cry EVERY SINGLE TIME they goes to see my grandmother, bed-bound. 

So don’t think I don’t understand and I don’t respect. Because I have seen it happen, I have seen both results. I am an adult; I can respect and disagree with someone simultaneously.

Don’t you dare assume I don’t know the pain and anguish my patients feel. I know all too well. I AM the patient’s family. And I’m the physician, too. I’m both.