endotracheal tube

Spirit in the House - Chap 4/10

Modern!AU Bucky Barnes x Reader

Summary: Reader is in a coma after a car accident. Bucky moves into your apartment and find your spirit still hanging around. (Based on Just like Heaven)

Word Count: 1,483

Warnings: Ghost!Reader, Coma, Language

A/n: I’m screaming, please scream with me! 
Happy Birthday @barnesndnobles Idk what’d do without you ♥ ILY!

[Part 1] [Part 2] [Part 3] [Part 4] [Part 5] [Part 6] [Part 7] [Part 8] [Part 9] [Part 10]

Originally posted by heartsandwheels

Bucky spent the next few days in complete silence. Every time he opened the wardrobe he expected to see you.

You used to hide in there and jump out at Bucky to scare him. Now that you were gone, he missed the excitement.

Bucky kept his promise and cleaned the apartment. He even decided to take care of himself. He sat down at the kitchen table and ate with gusto. It was the first home cooked meal he had eaten in a while.

On Saturday, he agreed to go out with Steve.

“What the hell happened to your face?” Steve smirked as Bucky approached the bar.

“I cut my hair, Steve. No big deal.” Bucky rolled his eyes. Steve took Bucky into a hug and patted his back.

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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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Day in the Life of my Anesthesia Rotation:

5:30 am: Alarm screaming. Ugh. Ugh. Ughhhh. Stumble around for coffee, change into scrubs.

6:50 am: Arrive at school. Check the anesthesia board. Looks like an extra orthopedic surgery for me today. Whoo?

7:05 am: Topic rounds. Something about capnographs and CO2? Or was it about inhalation anesthesia or the advantages and disadvantages of acepromazine? No one will ever know. 

7:30 am: Dismissed. Drop off my stuff at my locker and grab paperwork. Get pre-meds and induction meds ready for my first soft tissue surgery. Do a physical on my (very cute!!!) patient. 

8:01 am: Grab booties, cap, mask, etc. Chug last of coffee, it’s action time!

8:10 am: Place IV catheter (first stick HELL YES!), yell (nicely!) for tech, induce, place endotracheal tube, slide into OR, place all the right monitoring doo-hickies, and get this surgery show on the road!

8:56 am: All the vitals look good. Try not to doodle on clipboard. 

9:10 am: Try to wonder if, as the anesthetist, if you are truly invisible or the surgeons pretend you are unless something goes wrong. 

11:30 am: Cruising right along, though I am almost under general anesthesia myself. How is it, that anesthesia is either “OMG THIS THING IS CRASHING/WAKING UP!!” or “How many tiles can I count in this room for entertainment?” 

11:45 am: DONE. Wake up this cutie, take post-op physical, turn in anesthesia paperwork.

12:01 pm: Grab a granola bar while rushing to finish calculating drugs for the next surgery that is supposed to start.. well.. now.

12:10 pm: Rush around like a freaking manic, get drugs approved by Anesthesiologist, do physical, go go go go go don’t stop!

1:30 pm: Patient #2 in surgery and chugging along. Oh crap is my patient waking up? No they are just tugging on stuff relax…. Oh crap no he really is waking up! OH CRAP OH CRAP OH CRAP. 

1:35 pm: Crisis averted. Heart rate =180. My heart rate, that is. 

3:05 pm: Blood pressure is tanking, though drugs and fluids are great. 

4:08 pm: My butt is numb, along with my brain. I’ve stared at the ECG so long that I think I might be seeing arrhythmias that don’t exist.  

5:30 pm: Practically limb out of surgery, go to radiology for post-op x-rays, wake up patient.

6:00 pm: DONE DONE DONE DONE. GOODBYE! 

7:00 pm: Eat, drink, be merry! 

10:00 pm: Go to sleeeeep!

11:05 pm: Phone call. Phone call, at 11 pm? Wait……

11:08 pm: Emergency surgery. Got called in. Is this my life? This is my life…

4:00 am: Done! Sleep! Plan on waking up 5 years from now. If I’m lucky. 

daemoncrossing  asked:

Hey there, doctor! My kitten was neutered right about a week ago now, and I followed aftercare to a t and he healed very well. However, I noticed from the getgo when I got him back that he was quite... snorty. I assumed he had a raspy throat from being intubated but he got worse rather than better, so I made an emergency appointment. It turns out he contracted pneumonia, and the vet believed it was due to him inhaling fluid when he was in their care. I was just curious, about how common is that?

(Oops and to be clear he was put on antibiotics and is almost 100% better now!)

It’s not common, but inhaling fluid is a well documented risk of anesthesia, being more common in patients that have not fasted, and brachycephalic animals.

For a castration, it’s common for cats to be done without intubation (sticking the endotracheal tube into their airways) and to be done solely with intravenous anesthesia, because the procedure is so quick. Routine castration is something like a 3-5 minute procedure, so its anesthetic risks are quite low.

Regurgitation and inhalation of fluid can still happen though. It’s always a risk, even if significant care is taken to avoid it. Procedures like dentals, where lots of water is used in the mouth, are at relatively higher risk of fluid inhalation, so extra precautions are typically taken to prevent it.

I don’t have statistics for you on how common it is in practice, but it’s been common enough that there are multiple routine steps clinics take to minimize it.

Rotation 2: Emergency and Critical Care

I have never in my life been further from my comfort zone than I was during my week in emergency. Two hours into my first shift I was thrown into a consultation for a dog with suspected anaphylactic shock. It was my responsibility to triage the patient, collect a history from the owner and perform a full physical examination. I then assisted the vet with diagnostics and treatment, before heading to the student room to frantically type my patient record. The rest of the day passed with me running between ICU patient care and emergency consultations.

After my first 10 hour shift, my brain was fried and I was relieved to be heading home. I had just about reached the door when a dog in cardiopulmonary arrest (CPA) was rushed in. It was all hands on deck. Several minutes later it became evident that CPR wasn’t going to cut it, and the decision was made to try open chest compressions. This is when the thoracic wall is surgically opened to allow direct pumping of the heart. Amidst all the organised chaos, I managed to make myself useful by simultaneously squeezing fluids into the dog with one hand and feeling for a pulse with the other. After about half an hour of compressions with no improvement, the decision was made to stop. As all the endotracheal tubes, catheters and monitoring devices were pulled out or disconnected, the heart began to spontaneously beat again! Everything was reconnected and we recommenced compressions. After another 15 minutes and several attempts at defibrillation, the decision was made to let the dog go. What a day!

Day 2 was a brutal 13 hour overnight shift. We began with a CPR tutorial where we were given scenarios (such as ‘a 20 kg dog was hit by a car and you can’t hear a heart beat’) and had to act out our response on a dummy dog, including compressions, manual ventilation, fluids, drugs and defibrillation, while being timed. We then discussed what we did and how we could improve and tried again! It was difficult but invaluable practice. The remainder of the overnight shift was a challenge, both mentally and physically. It’s amazing how even the simplest of tasks can be become so difficult at 3am.

Throughout the week I got to work with some fascinating cases in ICU. The outcome for a dog with suspected snake envenomation was looking pretty grim after several days in ICU and no improvement after six vials of antivenom. Miraculously, the dog went from being unable to move and struggling to breathe, to walking around unaided within the space of a few hours! Another patient sustained severe burns and carbon monoxide poisoning after being caught in a house fire. As Christmas is fast approaching, we saw more than our fair share of naughty dogs who had helped themselves to chocolate puddings, fruit cakes and mince pies, all of which are toxic. Another dog swallowed an entire blowfish whole (see photo)!

About the time I was beginning to feel mildly confident with consultations, I had the misfortune of meeting a miserable old bag who I will name Margery Grouse, because it suits her. The conversation went a little something like this:

Me: “How much mince pie did Toby eat?”
Marge: "You saw the vomit didn’t you! You tell me!”

Me: “Has he had any history of medical problems?”
Marge: "Didn’t you read it on the computer?”

Vet: "I see Toby hasn’t eaten his chicken”
Marge: "Who would eat that? It looks revolting!”

By the time the end of my final shift rolled around, I was shattered and ready for bed. There is something fundamentally wrong with being at uni at 11pm on a Sunday. This week has been an incredible experience, yet extremely taxing. I’ve seen things I can’t un-see and performed procedures I never even knew existed. There were several occasions throughout the week, where I found myself wondering whether I was in shock myself. Most often I had enough adrenaline coursing through my own veins to supply the entire hospital for a week. As thrilling as this rotation has been, I’m definitely looking forward to the less chaotic weeks to follow.

What I Learned on My Anesthesiology Rotation:

-> A standard drug protocol is great to have, as you firmly understand your drugs, and you can easily predict how things will go. However, it’s important to be flexible, to readily change that protocol when necessary to fit the individual patient and their individual needs. 

-> Just because a patient is sedated, does NOT mean you can do anything you would like with a fractious/mean animal. Tons and tons of bites can result from thinking these guys are truly asleep when they are not. BE CAUTIOUS, my dear friends. 

-> There is a combination of drugs called “kitty magic” for those fractious and evil kitties, though injecting them can be extremely hazardous. Too bad you can’t just look at them and they would just fall asleep. That would be magical, indeed. 

-> There is no better feeling than intubating (placing an endotracheal tube) in a difficult patient/species, such as a cat or a pig. 

-> While monitoring anesthesia, you’re either as asleep as your patient, or you are scrambling around screaming as your patient tries to wake up or crash. There is no in between. 

3

Back to the grind! It feels absolutely incredible to finally be on HRT, out, and out at work, in public. I also got to use a military rescue device last Sunday morning called the bougie, to assist with the facilitation of establishing an advanced airway via endotracheal tube in a cardiac arrest. The device worked incredibly in a difficult airway scenario … look it up!

arlessiar  asked:

Thanks for your reply. I didn't quite know how to send you the Kingsman screenshots so I made a tumblr post with them, I'll send you the link in a second. Btw, one thing one cannot see in the caps is that the heart rate is actually changing in the scene where he wakes up, which is sth I don't see often on TV.

No problem!

(And thanks for your reminder! I know I haven’t done much on this blog recently… I have very little motivation for a lot of things as of late and this week in particular sucked pretty terribly, but I’m going to try to answer the best I can)

Disclaimer: I’m not an ICU nurse, nor have I seen (or read fanfic of) this movie. Everything is based on my critical care classes/clinicals in nursing school and my conjecture as to what happened based on what I’m seeing in these screen shots.

From what I’ve seen of ICU settings, this was pretty well done. They clearly did their research and/or hired a consultant when designing this set. Certain things I particularly appreciated were the presence of a central line (an IV that ends in a large, central vein- necessary for drugs that could injure smaller vessels, like many that would be used in an ICU setting), the not-overly-neat wires/tubes/hoses, and the changing vitals on the monitor screen.

(The following is mostly an explanation of what you’re seeing in the screenshots- nitpicks and a real-life pic for comparison at the end)

Here’s what’s present in a couple of those screenshots:

Monitor display: Showing two leads’ worth of ECG readings (green), heart rate (green), central venous pressure (the pressure in the vein that carries blood into the heart- yellow), oxygen saturation (blue), and non-invasive (cuff) blood pressure (purple).

  • The blood pressure cuff: Hooks up to the monitor display and will cycle (take a reading) at set intervals. While manual blood pressure is taken by listening to a pulse as the cuff slowly deflates, automatic cuffs sense vibration in the blood vessels as the cuff deflates, which can be interpreted by the computer.
  • Hardwire ECG leads: These are leads that go directly from the pt and physically plug into the monitor. They measure the electrical activity of the heart and present a graph of that electrical activity. They are common in ICU settings but mean the pt has to be physically disconnected if they ever want to get out of bed. 
  • Pulse-Ox/SpO2: This is a device that optically or physically measures pulse (which can be different than heart rate as measured electrically) and optically measures oxygen saturation. In this case, it would be helping to determine whether the ventilator settings were correct.

Syringe pumps: syringe pumps are used when only teeny-tiny volumes of medication are needed. They’re a lot more common in pediatric settings, but are definitely used in adult ICUs for very high potency drugs (especially drugs to increase blood pressure, sedatives, and painkillers). Syringe pumps are usually not the only pumps in the scene though- likely there would be at least a few “line pumps” controlling delivery of larger volumes of fluid like IV hydration, antibiotics, and electrolyte replacement fluids that come in hanging bags. Line pumps look like this:

(EEEP EEEP ………… EEEP EEEP<— that’s the sound they make. A lot.)

Endotracheal (ET) tube and securement: This is a tube that goes from just outside the pt’s mouth to their lungs, maintaining the pt’s airway and allowing the ventilator to deliver breaths while the person is paralyzed/sedated and unable to breathe for themself. The securement device keeps it from accidentally coming out or moving out of place. Missing is an NG or OG tube to deliver tube feedings, which would be necessary in this situation.

Central Line: This is an IV with a very long catheter (tube) that is placed in a vein (inserted surgically into the arm or upper chest) and that ends near the heart. This allows for administration of drugs/fluids at high pressure/volume and administration of drugs that could harm smaller peripheral veins. Simple versions (PICCs) may just provide reliable IV access to people who don’t have great veins, but they can be very advanced and include monitoring devices built in.

Because the monitor display is reading central venous pressure (CVP) (something that can only be measured by a sensor very near the heart), this guy’s central line is one of the more advanced ones (I’m still not seeing the external component to the CVP monitor but maybe its just hiding).

Also I’m going to guess that his injury has something to do with his chest and they’re monitoring for tamponade/pneumothorax? Because he seems a little young and healthy to be stricken with heart failure.

Peripheral IV: In addition to the central line, he’s also got a peripheral IV. These are much shorter catheters (about two inches at most) that can take IV fluids and many IV medicines that don’t need to go in a central line.

Miami-J collar: These are hard collars that do not allow movement of the neck (versus the soft foam ones that are for comfort only). Usually you see them in the field when injury is suspected, and they’re taken off once it’s ruled out in a hospital. The fact that he’s wearing one in this scene means that they’ve done the necessary imaging and determined that his neck was indeed injured in whatever happened to him. I’m guessing this guy was in a coma for a while (it would be arguably more important when he’s awake and moving around, so I’m guessing he had some time to heal and they took the collar off).

Ventilator: These devices breathe for pts who can’t breathe on their own, or assist for pts who find breathing prohibitively difficult. The screen shows a real-time graph of the breaths delivered and how much air was given with each breath.

There’s really not a whole lot that I’m downright “well that’s not realistic” about, but here are a couple nitpicks based mostly on ease of nursing care for him:

  • How would you suction that ET tube? (I’m sure there’s a way to do it but I’ve only ever used in-line suction before and it seems strange that this setup doesn’t have that given this movie came out so recently)
  • Why no line pumps? Why is EVERYTHING going through a syringe pump? That seems tedious…
  • Why are no lines labeled? That seems dangerous and confusing…
  • If they gave him a CVP monitor, why not also give him an arterial line? Especially since they’re probs going to need lots of arterial blood samples to make sure the vent settings are working right and it would be easier than sticking him that many times IN AN ARTERY…
  • Feeding tube- if he’s out as long as I’m guessing he’s out for (via the collar) and there’s no problem with his digestive tract, I’m gonna guess he’ll need some food (but tube feeds are rather icky for the whump community, so I get why they omitted it aesthetically).

Compare the screenshots you took with a similar scene from an actual ICU:

NOTE: I got this pic from a google image search, if you recognize it and would like it removed, let me know!

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Tracheal intubation , usually simply referred to as intubation , is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain
drugs.
*To begin the procedure,open the patient’s mouth by separating the lips and pulling on the upper jaw with the index finger.
*Holding a laryngoscope in the left hand, insert the curved blade into the mouth of the patient with the blade directed to the right tonsil.
*Once the right tonsil is reached, the laryngoscope is swept to the midline, keeping the tongue on the left to bring the epiglottis into view.
*The laryngoscope blade is then advanced until it reaches the angle between the base of the tongue and the epiglottis.
*Next, with the handle of the laryngoscope pointing away from you at 45°, the laryngoscope is lifted upwards towards the chest and away from the nose to bring the vocal cords into view.
*With the right hand, insert the endotracheal tube, made of flexible plastic, into the mouth directly between the cords to the point that the cuff rests just below the cords.
*The markings on the tube at the incisors will show between 21 and 24cm in the average sized adult when the tube is in position. Finally, remove the laryngoscope. The cuff is inflated to provide a minimal leak when the bag is squeezed.
*Using a stethoscope , the anesthesiologist listens for breathing sounds to ensure correct placement of the tube.

#anesthesia #trachealintubation #premed #anesthesiology #usmle #premedlife #premedstudent #university #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #nurse #nursing #video #instavideo #hospital #hospitallife #medicine #medlife #medstudent #mbbs #md #amc #plab @doctordconline

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kjierstisaysthis  asked:

Pardon the barrage of questions, but I have an OC who's studying to become a vet, and I'm prettyf pumped that this blog exists. Anyway, on to business: I know that vets run the risk of getting bitten by their patients while at work, but how often does that actually happen in practice? Have you (or maybe a colleage) ever been bitten badly enough that you required medical attention? Do most offices have a policy in place in case that happens?

Most clinics have a general policy that goes a bit like this:

  1. Make sure nobody else can be injured
  2. Secure the animal
  3. Seek immediate medical attention
  4. Fill out insurance forms later
  5. Meanwhile, someone else deals with the animal. Depending on circumstance may refuse to see it conscious ever again.

I haven’t been bitten, but I have had lacerations from nails and second degree friction burns on both hands thanks to a horse, which is the reason I don’t see horses anymore. A colleague got trampled by a cow and concussed. Sometimes we die. 

I’ve been ‘nipped’ by dogs on two occasions, not the patient’s fault in either case, and no blood drawn. For one dog I was examining their teeth, the dog sneezed, and smacked my hand with its canine teeth. For the other, it was being anesthetized and was a little too awake when I tried to place the endotracheal tube, and the jaw twitched strongly.

My boss and a nurse was badly bitten last year. A canine patient was waking up from anaesthesia, and still had an endotracheal tube in because it was brachycephalic and we needed to keep it alive. It woke up far too quickly, promptly went through an excitement phase and chomped down on the nurse’s hand as she removed the ET tube.

Boss came in to help nurse, dog is still freaking out and chomped down on his hand when he pried its jaws open. Boss then proceeds to sort of bear hug dog while it’s clamped on until it’s fully conscious and lets go.

(Dog apparently has no memory of this and since comes into the clinic sweet as pie)

Boss then stupidly scrubs into an orthopedic surgery he was scheduled to do (wouldn’t listen to me! Justified it by double gloving over the bandages and everything inside the glove was sterile anyway) and complains that the puncture wounds in his palm make it harder to do the surgery.

He sent the nurse straight to hospital, but fully intended to complete his working day before going. We rescheduled all his evening appointments and kicked him out straight after surgery anyway, but he intended to make a martyr of himself.

Now if you have an OC who’s studying to be a vet, I bet you’ll be thrilled to know there’s a whole vetblr tag on tumblr, filled with vet students. Despite the holiday season, many of them are probably still studying. You could consider following them to know what their lives are like in vet school.

Love and other Drugs

Okay, so… This is my second gift for the beautiful and amazing @lilousmustaches - if you haven't noticed yet, hon, I really do love you.
Well, this is my first time ever writing anything Supernatural-related, so I just hope it’s not total crap.
This is a Jensen Ackles x Reader fic, and it’s way bigger than I initially expected, so this is just the first part…
Hope you enjoy!

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anonymous asked:

DM Prompt: Soulmate AU where the world is black and white until you meet your soulmate and Abby meets her soulmate in the ER while operating, so she's almost dying

Also on Ao3

Abby looked up from her charts, stretched and left the nurses station to get food. The mountain of files weren’t going anywhere and her rounds started again in ten minutes. Most of the night’s intake roster was stable. The 36 hours on-call was brutal—on everyone—she watched her staff move through the rhythms of the ER. Exhausted or not, her team was some of the best.

Chief Trauma Surgeon came with a few perks and one was dibs on the last, ancient snickers bar in the secret stash in the break room. She’d been thinking about it all day and now she was halfway through it, sprawled on the couch cradling Marcus’s feet while he dozed. They lounged in a comforting landscape of old coffee cups and take-out containers when her pager went off. “Goddamnit. Fuck. Shit. Hell.” Her string of curses were practical, no-bullshit and concise; they got the point across. The others in the room, in various states of consciousness barely registered it. “Go get ‘em, tiger,” Marcus gave her the thumbs up without opening his eyes.

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Radiograph of an older man who was admitted to the intensive care unit postoperatively, note the right sided pneumothorax induced by the incorrectly positioned small-bowel feeding tube in the right sided bronchial tree, marked depression of the right hemidiaphragm is noted, and mediastinal shift is to the left side, suggestive of tension pneumothorax, the endotracheal tube is in a good position