the future of ebooks

anonymous asked:

What would you consider to be the easiest way to get into vintage pulp stories? Are the magazines available in reprintings or collected volumes or something like that?

You are absolutely in luck, because in the past three years, it’s become incredibly easy to start reading old pulp stories because of kindle readers. Because publishing for e-readers is a gold rush now and it has very little overhead and zero per-unit cost, publishers are, for the first time, dipping into their back catalogs and even going into public domain materials. Seriously, the past few years are the best time in history to ever be a fan of old pulp fiction. It’s easier to get more old pulp stuff now than even in the 1920s-1950s.

The key thing to remember is this: don’t be afraid of exploring alternate formats. Leigh Brackett’s People of the Talisman is exactly the same, has exactly the same entertainment value, if you buy a vintage pulp magazine at $70 off ebay, than if you buy a $1 ebook or a 50 cent paperback from the 1970s! Remember that lot of pulp scifi was reissued in the 1960s-1980s during the paperback boom, so it’s not unusual to find it in paperback formats, and the thing about paperbacks is, there’s such a glut of them that used booksellers usually clear them off for under a dollar. Pay attention to the following old paperback publishers, because they specialize in reprints: Ace Books, Lancer, DAW (who had the best covers, maybe in paperback history) and Del Rey.

If you want to try kindle or ebooks, the best place to start would be collections of a single author or a single theme, what they call megapacks. It’s not unusual to see them selling for 99 cents or less on Amazon. The covers look very Mickey Mouse, with poser art that make them all seem vaguely like porno or fetish art, but most of the stories are pure gold. It’s possible to buy in bulk. 

If you want to read old pulp scifi, a lot of public domain materials are easily available. It’s possible to buy all 16 John Carter of Mars novels in one go for less than $5 for an e-reader, as is Ray Cummings’ Girl in the Gold Atom, the collected works of Stanley G. Weinbaum, including his best novel, the romance about immortals, The Black Flame. Hell, even Edmond Hamilton’s Captain Future is available in ebook form…where else can you get four novels in one?

If you want to roll the dice, there are even theme packs, with titles like “Golden Age Science Fiction Megapack,” but since most of them cost $1, you’re not gambling much, and they often contain pure gold. Since it’s ridiculously easy to get reprint rights, the ratio of hit to miss is higher than you’d think. 

If you want pulp horror-fantasy, try the ebooks for C.L. Moore’s Jirel of Joiry, about an amazon warrior lady in the middle ages - nearly everything by Moore is available in ebook form for peanuts. There is a great megapack for the oddly named Nictzin Dyalhis, containing everything he ever wrote in Weird Tales. And best of all, the entire life’s work of Abraham Merritt, who is surprisingly readable, including Dwellers in the Mirage, about a legendary world of squid-worshippers hidden behind an illusion, and the Moon Pool, about a portal on a lost island to a weird supernatural world. 

If you want lost-world adventure, Dian of Lost Land, about stone age men riding giant birds in Antarctica, is great, as is Thyra, Romance of the Polar Pit, about a lost kingdom of Vikings discovered by airship explorers. 

But here’s a quick piece of advice if you want to buy public domain e-books. You could save yourself a bit of time by searching for them on Project Gutenberg Australia, where you can get e-books for free. Project Gutenberg makes public domain materials available, but here’s an interesting quirk about copyright law: in the US and Europe, it’s been Life of the Author + 70 years, but in Australia, it’s life + 50. So you will always find more materials on Project Gutenberg Australia. (This is yet another indication of how copyright is totally unworkable in its present form in the internet age, but that’s a discussion for another time.)


Well, I didn’t read it, but I did turn my poem into an award winning short film where it gets read ;) 

“The Last Line”’s real name is “A Picture of Your Future” and it can also be found in my upcoming ebook “Water in a Wineglass” arriving in Kindle everywhere in the galaxy on April 1st! 

Ps, you can preorder it here . #shamelessselfpromotion 

Hey, everyone! How are you doing? Are you snowed in, looking for some entertainment? Well! This is a friendly reminder that my new book is out now! It’s available in paperback and ebook (just like all my future releases, yay!) wherever books are sold! Sofia Kennedy is a popular local news anchor who, three years earlier, had to report the death of her girlfriend live on-air. Marion Vogt is a caterer with a small but successful company. When they meet, sparks fly… by which I mean, they absolutely hate each other. They go from strangers to mortal enemies in a heartbeat, but fate keeps throwing them together until eventually they realize their feelings go deeper. It was written to give fans of ships like SwanQueen a chance to see a similar dynamic that didn’t toy with them. Hate turns to love and there are no bland boy characters taking up space. As it should be. ;)

“I was skeptical. I have a bias against men writing lesbian fiction. Geonn Cannon is the exception … I don’t know how he does it: he writes from an authentic female perspective. Some women authors aren’t able to do that as well as he does.”

“For believable characters, sensitive writing about grief, and good, steady pacing, this gets 4.5 stars.”

Getting Away From Amazon Kindle Lock-In

So I just found out that Google has an “archive” functionality that will allow you to move files from its services to your own hard drive and decouple from them at will. They don’t seem to yet have this for Google Play (and thus ebooks) but they are adding archive functionality for a lot of things, which means if they ever add it for Google Play you will not be locked in.

In case you are interested (as I am) in shifting from Kindle to Google Play without rebuying your ebooks over and over again, here’s how you do it.

  1. Visit this nice article to strip DRM from your Kindle books:
  2. Use the software mentioned there (calibre) to turn them books into EPUB books.
  3. Go to the Google Play store and click on “Books” and then on “Uploads”.
  4. Upload your new DRM-stripped EPUB books. They will now be synced across all your devices, including reading positions and any notes or annotations you make in the future.
  5. Download the Google Play ebook reader for your device of choice.

For those of us using the free Kobo reader available for iPhone/iPad devices, you can do the following additional steps to make it available for your Kobo reader as well (though without the syncing of position and annotations and stuff).

  1. Upload your new DRM-stripped EPUB books to Google Drive or Dropbox.
  2. On your iPhone or iPad go to the Google Drive or Dropbox app.
  3. For Google drive, click on the “i” icon and select “open in…” to open in your Kobo app.
  4. For Dropbox, click on the file, then when it can’t be read by Dropbox, click on the button that looks like a box with an up arrow to open in your Kobo app.


anonymous asked:

After finally saying enough is enough, I broke away from Christianity and decided to be a pagan. I've been interested in Egyptian dieties since I was a girl (but of course was punished for it). I haven't read a single book. I don't know what an altar is or how to make one in my home. I don't know how to "talk" to dieties or how to distinguish them. I only know of maybe 2 Egyptian dieties. :/ Oh and I'm white. What do you recommend for me, the blind beginner?

Hi anon.

Well, there are a lot of things to address in this ask, so let’s get started.


The race debate is one of those things that can get pretty hot and heavy when it comes to ancient Egypt. I am not going to get into it as much as I could, but I will leave you with this link so that you can get an idea as to what the controversy is about. A lot of people, mostly due to the ideological train of thought of Afrocentrism, have come to believe that Kemeticism is barred to anyone who is not of African descent. However, something that many people seem to forget is that the genome mapping project has begun and thus far, results are showing that, genetically, the ancient Egyptians are no different from those that are found there today. For anyone interested in the archaeogenetics of ancient Egypt, this should give you a general picture.

The ancient Egyptian religion was an open religion in antiquity. They readily and willingly accepted converts from other cultures and even added gods from other cultures it their own. As long as the convert was willing to live in ma’at, they were pretty much all set. Another sticking point is that the religion died out. It is not the national religion of the culturally Egyptian. In fact, modern-day Egyptians tend to look down upon their ancient heritage, in all honesty. The country is very devout, but to a single deity as opposed to the many of ancient Egypt. While some things have passed down to the modern populace, these are mostly superstitions carried out as opposed to any form of devotion to the ancient gods.


When it comes to learning about Kemeticism, there are a couple of different avenues that can be explored here. I recommend taking a look at my resource list as well as this information page by Devo. Devo’s page give a broad overview of what Kemeticism is about. She also provides forums, books, temples, and other information for your perusal. My resource list provides a list of books (historically based books for the most part) as well as a list of bloggers and webpages to peruse for information.

When it comes right down to it, when you first push off the yoke of a previous religious tradition, you’re going to have a lot of questions. And this is going to get scary. And this is going to be something where you end up feeling very out of your depth for a lot of the start. Just know that everyone felt that way. Everyone walked into a new religion, whether it is Kemeticism, Druidry, Hellenismos, etc. We all have no idea what we’re doing, what books to read, or where to even begin. I strongly recommend following the Kemetic and Kemeticism tags so that you can read others’ experiences, questions, worries, etc. And of course, every single one of us has our asks, which are open to anonymous questions.


Altars are usually one of the first place that new pagans go to because it’s something physical that they can do. And of course, I highly recommend creating one. I don’t recommend creating it in an effort to a single deity. Deities, in my experience, tend to make the choice as to who they will reach out to (or not) and there’s no point in forcing the issue. They may not respond to your entreaties and that may make you feel bad about what you’re doing. Even if you decide to ignore my advice, don’t feel bad if you don’t get any responses from the gods. They’re fickle and do what they want. You just keep doing whatever you feel like you need to do.

For a general altar, I recommend finding a flat surface that won’t be disturbed by others. This can be a nightstand or a bureau or a corner of a desk or a bookcase shelf – whatever you have handy. I recommend placing a small candle (either flamless or a tealight) in the center. This can be your focal point. As to what else you place on it, it’s really up to you. You can place flowers, pretty stones, jars, divination tools, or whatever you really want on it. It’s up to you. If you live in a place where incense is out, then you can always get one of those scented oil packs from the dollar store or one of those scented room cleaner things made by Glade or something to use instead of incense.

I recommend having a general altar to get you into a groove. This groove will help you to begin communicating, praying, or at least parsing out what you want to do when it comes to this religion stuff. By not having an altar dedicated to any deity, then you can reach out to all of the deities you feel like reaching out to, or not. I just recommend, honestly, at the start to get in the habit of spending, like, five minutes of your day in front of that space to build you up. If a deity shows up, then you can start adding things that you feel that deity would like to make it their altar. And if you’ve been doing the plunking down in front of the altar thing for five minutes a day, it won’t seem so strange when you start providing offerings to deities.


When it comes to talking to the gods, I honestly recommend just sitting down in front of whatever surface area will be your general altar and just start blabbering away. I don’t think any formality is really necessary. You can introduce yourself in a sort of general way: “Hi, my name is _______ and I’m interested in Kemeticism.” And then take it from there.

I tend to associate these conversations with conversations you would have with people you just meet. You’d want to introduce yourself. You’d want to tell them about who you are, why you are, and what’s going on in your life. From there, you can move on to talking about why Kemeticism interests you and why you think the netjeru (the gods) are the way to go.


Telling one netjer from the other can be difficult, especially for people who are new to all of this. There’s no discernment in the beginning. Every experience can be something new and exciting and possibly a sign from the gods. That’s not necessarily the case, but I think that new people look to things in that way because they want to feel a deep, personal, and powerful connection with the gods as quickly as possible. That’s not always going to be the case. As I said above, the gods are fickle beings and do whatever the heck they want when it comes to “picking up” new devotees.

Devo wrote this post about discernment and I strongly recommend you read it.

In order to distinguish once Kemetic god from another, I strongly recommend bookmarking the Henadology page for future reference. I also recommend finding either an eBook copy or a cheap copy of the following two books: The Gods and Goddesses of Ancient Egypt by Richard H Wilkinson and Egyptian Mythology by Geraldine Pinch. These two books, and that webpage, can give you clues that may help you to figure out what deity, if any, is reaching out to you. There are certain aspects to iconography and the myths that can provide those clues.


Take it easy.

Read all the historical resources you can.

Take it slow.

Have fun.

Go with the flow.

Ignore everything about Horus/Isis/Osiris being the blueprint for the Christian trinity.

Ask all of the questions.

E-stalk all the blogs.

Do not read anything by Wallis Budge.

Ignore everything you see about Atlantis and ancient Egypt.

Don’t let anyone tell you that you’re doing it wrong.

Be good to the community.

Don’t get scared off by the Afrocentrism in the tags.

Ignore everything about aliens in the tags.

Further Reading

My guides & 101s.

Devo’s starter guide.

Devo’s offering guide.

Kemetic Round Table.*

* The Kemetic Round Table (KRT) is a blogging project aimed at providing practical, useful information for modern Kemetic religious practitioners.

12 Classic Creepypasta and NoSleep Stories to Rot Your Soul.

Thanks to everyone who has bought my book “The Face of Fear”. I really appreciate it. It’s crammed with rewritten versions of some of my best stories and a brand new tale as well, which I think is one of my most frightening. By buying the book you’ll be helping support my work, allowing me to put more time into producing free stories for you all to enjoy, which is what I love doing the most. So, if you have enjoyed my stories over the past few years, please do consider picking up a copy and leaving a review. If you do, I promise to be even more terrifying in the future

~ Mike

delirieuse replied to your post

Would you think about sharing your six-semester program? I don’t have the money for actual study, I’m also a pretty self-directed student (I’ve had two people ask me how I know so much about two different topics, and I don’t really have a good answer other than, “Er, I read?”). It’d be nice to “join” you for a subject or two. Also I could really do with jiggling by creative writing around and getting a fresh perspective by challenging myself.

Sure, it’s not proprietary or anything :D It’s mostly “Read this article from JSTOR and react to it” and since I’m the one who picked the JSTOR articles it’ll be a lot of reflexive research too – reading the article, seeing what I learned from it, adjusting on the fly if it’s not what I needed, etc. (*waves at jstor*) Some of the articles I found, especially the super-old ones from the deep archives, were both hilarious and fantastic. 

The purpose was to fill in some gaps left in my education by being a theatre nerd rather than a lit geek, as well as strengthen areas that I’ll need in future writing/publishing endeavors, including stuff like ebook programming and cover design. Though some of the later classes may be replaced with marketing-themed courses depending on how things go. 

I designed it to be three classes plus a workshop per semester, with additional built in writing time; depending on how the first semester went I was going to adjust the time commitment up or down as needed. I put a copy of the class list below the cut, and if I end up actually doing the program I’ll definitely be sharing the full syllabus and documenting my work. 

Keep reading

anonymous asked:

Is being an emt traumatic? Like one must see so many awful accidents. Do people get flashbacks, nightmares or PTSD? If so how would someone minimalize these?

Hey there nonny! I’m going to talk about EMS in general and then

Yes, EMS workers suffer rather ridiculous rates of PTSD, though it’s worth noting that not all EMS employees have it. PTSD development isn’t my area of expertise – talk to @scriptshrink​ and particularly @scripttraumasurvivors​ about that one. But I’ll share my thoughts and observations from 10 years in the service:

PTSD is a significant issue in EMS. I’m fortunate enough not to have it, but the job scars us all in different ways. Dead kids, horrendous accidents and more. That said, a lot of it is in how you see things. For me, I think what increases my resilience is that I understand that I’m there to help. The awful thing that happened has happened – not my fault. But I can help, or at least try to help, or give someone the dignity of a sheet over their body. It’s an emergency, but it’s not my emergency. And the sense of being able to do something really helps.

PTSD is a problem, but it isn’t as big of an issue as burnout in our community. Compassion fatigue is a real thing. The job can be shockingly abusive to those attempting to work it.

PTSD is real and people get it. EMS has a particularly macho culture, with phrases like “suck it up, buttercup” getting thrown around a LOT. So once someone starts to struggle, they can run into significant problems trying to get support from their group. 

What’s interesting is this: one on one, we do pretty well. My friend Kelly Grayson calls this his Nachos And Beer therapy: take the coworker out, one on one, and talk, and eat nachos, and drink beer, and try to come to terms with what they’ve experienced.

If you want to read some stories from some real-life responders about their experiences and trauma, check out .

Also, if you can, send a little money their way. Code Green Campaign is literally trying to get us to call a metaphorical code on our mental health, because responders commit suicide in pretty drastic numbers.

It’s changing, but the culture around mental illness in EMS has been “repress, repress, it’s for the best.”

That said, my personal mental health issues don’t stem from work so much as they do from my natural disposition: I get depressed easily and often, and I’ve battled suicidal ideation from the time I was 6 years old. EMS isn’t responsible for that. In fact, it’s helped give me a sense of purpose and a sense that I get to do positive things in the world, that my contributions (and therefor my life) matter.

A terrible form of validation, but it helps me.

As for character construction, you’re dealing  with a group of characters that have Seen Some Shit™. Consider some coping mechanisms, like:

  • Swearing loudly and often
  • Very, very, very dark humor. I have been such a filter for you guys, you would not believe.
  • Lots of drinking, dancing, and partying, in order to “feel alive”
  • Talking things out quietly in corners
  • Partners making each other playlists to brighten their days
  • Finding someone outside of work to talk to in order to ground your character

One other note: things seem to actually get slightly better as medics  progress in their careers. That’s not saying us old-timers are jaded fucks (though some are), but rather, we have a different perspective. We see things less personally. We trade the crushing weight of individual tragedies for the crushing weight of The Broken System and our years of  clawing at the walls being unable to change it. As I said, it’s burnout, not PTSD (for a great many of us; your characters’ mileage may vary).

Good luck with your story!

xoxo, Aunt Scripty


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takestheweatherpersonally  asked:

Hello! I have a character who's five years old and I was wondering what difference that makes medically, if that makes sense? Both like how medical workers will act with her and explain things given she's very young and how that would factor into her medical care, like basic checkups or diagnosing illnesses and stuff like that. Sorry if this is too broad or vague, and thank you for all you do!

Hey there! Congrats on being Janey on the spot with the inbox and  being the first ask of June! 

So, one quick note. I come from EMS, and particularly now from a critical care service that handles a lot of kids. But I’m assuming for the purpose of this ask that this child is not and has never been critically ill. Okay? Okay! 

Pediatrics is its own specialty for a reason, and I have bundles to learn about it. There are all sorts of things that are different in pediatric medicine (and all sorts that of things that are shockingly similar!). 

First, let’s talk about “furniture.” As you’ll remember from having once been a child, peds doctors offices and clinics, and even ERs, are often bright, colorful and cheery places. Kids get offered toys and lollipops, they get to see special movies. Doc McStuffins is a very common sight in peds hospitals and waiting rooms. 

I’ve heard of peds hospitals that have different mural styles for different wards: one hallway that’s done all up in a baseball theme, another in a princesses and dragons theme, another in trains. 

Oh! When little kids get a nebulizer treatment, oftentimes now the mask they get the treatment through looks like a dragon and it’s awesome and I wish they came in adult sizes. 

Providers are also, by necessity, gentler with kids. You can’t argue with a kid and tell them to hold still; they’re going to squirm whether the shot is good for them or not. (Don’t get me started on vaccinations, please.) 

In terms of the medicine, as someone who works on a pediatric critical care unit, there are two ways you can look at kids. 

A) They’re just little adults. 

B) They are definitely not little adults. 

Both are true. They’re little adults in that they have the exact same functions as adults. They’re not little adults in that there are big social development changes that go on at various ages and there are some physiological changes (mostly that come up in very technical fields) that are different. 

For adults, a lot of the med doses are standardized; for kids, they’re almost all weight-based. A 5 year old should weigh roughly 20kg/45lbs (and there’s a really neat method called Handtevy that will give you the estimated weight of any kid up to 10 yrs old based just on their age; it’s stupendously cool and exactly the kind of thing pediatric critical care medics nerd out about!). 

IVs are almost always smaller in kids, but that’s because they’re little. I’ve also seen ERs use whole teams to get a single IV in a child, including someone singing happy songs while other people stab the child with needles. (It seemed seriously Clockwork Orange to me, but I have a feeling it’s data-driven with good outcomes, so who knows?) 

I get the feeling you’re asking about pediatrics in general and not pediatric critical care, so I’m going to try and focus on the general practice stuff, which is that kids who don’t get seriously ill tend to do pretty well. 

Some things they might have done at the doctor’s office if they’re not there for a specific illness: 

  • Vitals: blood pressure, pulse, oxygen saturation, temperature
  • Height/weight checks. 
  • Scoliosis checks. 
  • Vision and hearing checks. 
  • Immunization checks. (I’d say just check the immunization schedule recommended by your region; the CDC’s is here and is as good as any.) 
  • Allergy scratch-testing 

Common reasons a 5 y.o. will go to the doctor: 

  • Earaches and ear infections
  • Fever (usually the flu or an ear infection) 
  • Vomiting 
  • Asthma. This is incredibly common in some areas, and I’ve worked in a few. 
  • the snot. so much the snot. 
  • Something lost in the nose 
  • Something swallowed 
  • Mechanical injury (broken wrist, bumped head, etc.)  It’s common for good parents to be suspected of child abuse for having clumsy kids. 

Kids tend to bounce – both literally and figuratively. They’re little, but pretty tough and hard to injure, and when they do get hurt they heal pretty quickly. They’re still growing, so they do well. 

That’s all I can think of about pediatrics when it’s 2 in the morning and I worked a 14+ hour day! 

Congrats on getting there first and I hope this was what you needed. 

xoxo, Aunt Scripty 

(Samantha Keel) 


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anonymous asked:

What would happen if someone who was not diabetic was injected with insulin? Could a high dosage kill them and what would the consequences be if they were injected with too little to be fatal?

Hey nonny! Hoo boy howdy, yes, this could be fatal indeed!

So here’s the sitch with insulin. It’s a natural hormone, secreted by the beta cells in the pancreas. What it does is it pushes sugar from the bloodstream into the cells, where it will get burned for energy.

Diabetics use insulin because the beta cells stop making (enough/any) insulin, and without insulin, the sugar builds up in their blood, but because it can’t get into the cells, the cells start to metabolize muscle and fat for energy. This is, once things get bad, called diabetic ketoacidosis, or DKA.

That’s what happens when there’s no insulin. What happens when there’s too much insulin?

Essentially, the amount of sugar in the bloodstream drops to zero. The sugar is all pushed into the cells, but there’s none available in the bloodstream. The problem with this end of the blood sugar spectrum is that the brain runs preferentially on sugars, and it needs a steady supply. And when the blood is devoid of sugar, the brain can’t get any, and it will quickly burn through the supply it has.

This basically causes the brain to shut down / lose consciousness, though this is more a sliding-toward-unconsciousness than it is a lightswitch; characters who are hypoglycemic might develop slow, lethargic affects (the way they comport themselves), they may become very sleepy, or they may even lapse into a coma.

And this can indeed be fatal if left untreated. A significant insulin overdose could cause death, though of course it doesn’t have to!

If it doesn’t, the character could come out just fine – if it’s caught early, or medical staff arrive and quickly/correctly diagnose the problem, it’s easy to fix; any medical problem you can fix with a peanut-butter-and-jelly-sandwich is aces in my book. More severe cases where the person is too comatose to defend their airway (ie not to choke on water) will get an IV and a nice big blast of sugar water (D50; 50% dextrose in water; literal sugar-water), and will keep getting sugar until the sugar outweighs the effects of the insulin, and the character regains consciousness.

So your character could just get disoriented, dizzy, and very hungry, and instinctively drink a pint of juice and be fine. You could even have someone else – perhaps a diabetic character (hint hint!) who knows what hypoglycemia looks like – induces them to eat/drink/be merry.

Hope this helped and was useful/interesting!!

xoxo, Aunt Scripty


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anonymous asked:

Can you explain any additional side effects/effects of ketamine?

kicks down the door, dual-wielding syringes

Did somebody say KETAMINE?L!!?!?#$$@@!!!!!!?

…Shut it, Stethy.

Okay. Ketamine. My #1 all-time favorite pharmacological agent. (I have a feeling someone sent me this ask to cheer me up, which I’ve really needed this week, but I’m not sure so I’m going to answer it.)

There’s a phenomenal article about the “Ketamine Brain Continuum” from an amazing ER doc, which I’m going to summarize here,  but if you’re as fascinated as I am, is worth reading in its entirety.

In low doses, ketamine can relieve pain. It can also make people feel very “stoned”.

In  medium doses, it can cause hallucinations. This is what the drug using community refers to as “falling down the K-hole,” and ketamine is indeed known for its illicit uses. For example:

Then I entered an orange-brown-black space occupied by a giant inflated kiwi-bird with ruffled, long tassel-like feathers and a long curved slim black beak, and the beak curved off into infinity. The space was like a corridor, with undulating grasses at the top and bottom, and the kiwi somehow inside it, but the sides were open and the corridor stretched off into infinity and I moved toward the kiwi and it felt beautiful, amazing, with loud buzzing, ringing sounds accompanying the journey….

There are some fascinating first-hand accounts here:  

Note: I am in no way encouraging illicit uses of pharmacological agents. Any agent can be dangerous. But if you want to know what ketamine feels like, don’t ask the medical providers, ask the people who use it for fun, right? 

This is actually where medical people want patients not to be. The hallucinations can be distressful. To quote Dr. Reuben Strayer (above article):

If the patient develops distress shortly after an initial dose, the patient is not fully dissociated and the best maneuver is usually to give more ketamine.

Personally I think that’s the best maneuver for almost any situation.

In high doses, ketamine works as an anesthetic, specifically a dissociative anesthetic. It shuts the brain off from outside stimulus completely. Basically what ketamine does is it shuts the brain off from outside stimuli. That means that even though someone’s eyes are open (and possibly twitching, medically referred to as nystagmus) their brain isn’t processing information from them. As a doc whose lectures I love likes to say, “Think of a beach. Or think of a mountaintop. Or think of a beach on a mountaintop. Anything is possible with ketamine.”

Think of it like this: with most anesthetics, the brain is temporarily turned off. With ketamine, the brain isn’t turned off – it’s just disconnected from the outside world.

However, if someone is unprepared for it, those hallucinations can seem like a nightmare. And there is a portion of patients who get ketamine and, as it starts to wear off, they start screaming uncontrollably. This is called an “emergence reaction,” as they emerge from anesthesia and slip into the K-hole.

Someone who has been sedated/anosthetized with ketamine, especially if it’s against their will (used as a “knockout drug”), will likely have very negative hallucinations. To an outsider they’ll be lying on the floor, eyes open and blinking, unable to move or react to anything. It’s a great moment for a horror scene, or a horrific element to an action plot, especially if they have an emergence reaction and come back to reality screaming.

(Ketamine is also routinely used during veterinary euthanasia, at least where I live, and eyes stay open even after death, and that’s something a good vet warns their clients about. Ketamine isn’t the lethal agent, that’s a barbiturate, I think usually just a massive overdose of phenobarbital.)

Other uses:

  • ketamine helps open up constricted airways (acts as a broncholytic or bronchodilator). This means that it’s the optimal anesthetic for intubating – putting a breathing tube in – severe asthmatics who need to go on ventilators.
  • Ketamine, in high doses, can be used to subdue patient who are physically violent and psychotic.
  • Because ketamine acts on different receptors than typical sedatives, it can be used to stop seizures when benzodiazepines (Valium, Ativan, Versed…) have failed.
  • Low-dose, slow infusions of ketamine have seen great promise in depression that’s not responding to other approaches. There are ketamine clinics around for exactly this purpose.
  • Low-dose / analgesic ketamine is often used by EMS personnel during rescue scenarios where someone is trapped or pinned in a vehicle because ketamine, unlike most pain medications, doesn’t reduce blood pressure.
  • Ketamine is typically not used as an anesthetic in head injury patients because there is some (conflicting) data on whether or not it can increase intracranial pressure.

Originally posted by rightstufanime

So that’s ketamine. Thanks for the ask and thanks for listening to my madness!

xoxo, Aunt Scripty


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anonymous asked:

So, when my sister was hospitalized for severe pain (turned out to be cancer and she's in remission now), the doctors put her on Morphine. Turns out one of the side effects of Morphine is that it makes your nose itch and so I heard quite a few stories from my mom about how she was constantly scratching her nose. Are there any other weird/funny side effects of drugs that a doctor would give you like that? And what situations would they be for? Thanks!

There are quite a few strange side effects like this, and it would be an interesting idea for a post. One that I’m intimately familiar with (and you’ll get the pun in a second) is a side effect of the intravenous injection of a steroid called dexamethasone, which is useful in asthma, COPD, anaphylaxis, allergic reactions, etc.

If the medication is given too quickly, it causes an intense burning in the groin of females receiving it. (I’ve never seen it happen to males, but I’ve definitely seen women get it). The effect passes quickly, but it is noticeable.

Other side effects that I know exist but have not personally seen:

A great deal of medications can cause hallucinations (Lunesta [sleep aid], Lexapro [antidepressant]). Chantix / varencline (smoking cessation) has been known to cause really wild and vivid dreams, and Ambien / zolpidem is known to cause sleepwalking, sleep cooking, sleep driving, and sleep sex.

Some medications cause blue or green urine, such as amitryptiline (antidepressant) and indomethacin (analgesic). Metronidizole (antibiotic) can cause urine to come out black.

Many SSRIs can cause decreased sex drive and other issues.

Viagra / sildenafil (erectile dysfunction) can cause blue vision, while dangerously high doses of digoxin (antiarrhythmic) can cause yellow vision and “ghosts” when looking at lights.

Statins are a common class of cholesterol reducers (including Lipitor, Crestor, etc.), and can cause very strange memory issues due to demyelination in the brain – there was a former astronaut who went for a walk, came home, and didn’t recognize his wife as a side effect of Crestor.

GlaxoSmithKline, makers of Requip / ropinirole (treats Restless Leg Syndrome, Parkinson’s), say that their product may cause compulsive gambling and sex.

If you’re looking for your character to have some interesting side effects of a medication, there are a few options. First is to Google “Medication” + “side effects”. You could also try googling “Side effects” + “effect” and see what drugs might cause a given effect.

I’m sure my good friend @scriptpharmacist probably has a LOT to say about side effects, so make sure you check them out too!

I hope this was useful :)

xoxo, Aunt Scripty


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incompatibletype  asked:

How accurate is the "doctor stitches up their own wound" trope, assuming the wound is in a place they can reach and that will not quickly incapacitate them? I mean accurate in the sense that it's possible, not that it's common...

Hey there!

Given the fact that doctors have been known to operate on themselves if the need arises, I don’t see throwing a little suture as being a problem. In fact, many docs keep suture kits at home for themselves and loved ones (don’t tell…. wherever those suture kits came from).

Non-medical people have also been known to suture themselves with fishing line in remote areas. Really the only caveat is that you typically need both hands to throw a stitch.

The biggest issue is using an anesthetic like lidocaine (lignocaine if you’re in the UK and possibly Australia?), which is typically readily available wherever the character acquires the sutures.

xoxo, Aunt Scripty


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caramelmachete  asked:

My main character was slammed into a brick wall and hit his head. He lost consciousness briefly, was alert for a few minutes, and now has lost consciousness again. His partner rushes over to my MC. Assuming that his partner has a very good understanding of first aid, what should the partner do? Will my MC's pulse and breathing rate be slower or faster than normal? An ambulance has already been called. What other steps should the partner take?

Your character is dying.

The strike / loss of consciousness / brief period of lucidity / re-loss of consciousness is pathognomonic (read: One True Diagnosable Sign) for a traumatic subdural SUBARACHNOID hemorrhage, which is an arterial bleed inside the skull. That blood expands and puts pressure on the brain, which has nowhere to go… but it will go there anyway.

Your character’s breathing will likely ramp up and then decelerate, with periods of just… stopping. It’s called Cheyne-Stokes respirations, and it’s the body trying to manage cerebral bloodflow. His pupils will be uneven, with one bigger and the other constricted. His pulse will be normal and dip down to slow and then back up to normal; as he worsens, it will simply be slow.

Understand that what you’ve given your character is a catastrophic injury. A great many SAH patients don’t live, and he’s going to, he needs brain surgery basically yesterday.

As for first aid, keeping the character on his side isn’t a bad plan (but first they should feel the spine to make sure the neck hasn’t been broken). This will help when the injured character starts vomiting profusely.

If you want to make this a less lethal event, I would consider either a) simply extending the period in which the MC is unconscious the first time (and not putting them out a second), or b) have them lose consciousness and wake up a few minutes later but be very confused and lethargic.  Trust me, a few minutes is still enough to indicate plenty of brain damage, and plenty of drama and fear, because the seconds stretch into minutes in those situations.

For further reading I suggest you take a look at the head injury tag and the TBI tag!

Thanks for your ask and I hope I could help!

xoxo, Aunt Scripty


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anonymous asked:

Okay so let's say you're in a barn and you need to stitch up someone else's wound and you just happen to have everything you need to do this, what would be the absolute bare minimum of what you need to stitch up someone else?

Your characters will need the following:

  • Antiseptic (alcohol, iodine, whatever)
  • A needle (preferably curved)
  • Something to use as a suture (fishing line works fine if you don’t care about scars)
  • Gloves (the rubber kind – technically optional, but highly suggested)
  • Instructions to the patient character to HOLD GODSDAMNED STILL

Even the antiseptic is optional if your only goal is hemorrhage control and your characters are REALLY in a pinch, although your character will still have some things to say.

Might your barn have some rudimentary veterinary supplies hanging about?

Some lidocaine would be absolutely perfect to make the procedure painless, but what writer wants painless stitches?

Best of luck,

xoxo, Aunt Scripty


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anonymous asked:

I'm a big fan of the old show M*A*S*H, about a M*A*S*H unit in the Korean War. While a fair amount of the show takes place out of the OR, we see a lot of the OR, but it almost always involves the doctors quipping at each other from across the room, engaging in small talk, and lots of teasing and childish jokes, occasionally interrupted by requests for equipment from the nurses and fellow doctors. Do doctors ever have enough time/focus to spare for such a causal atmosphere in such situations?

So M*A*S*H is basically a sitcom, with the “situation” being “doctors in the Korean War.” It’s the same way House, MD is a detective show, with the “detective” being a medicalized Sherlock Holmes (Holmes = House), and the “criminal” being the disease du jour. Take its medical accuracy with a significantly enormous chunk of salt.

In fact, on MASH it’s basically played for irony. Here are these mangled teenagers coming back from war, with horrific wounds, and we’ve got doctors cracking wise to the sound of a laugh track.

That said, yes, sometimes surgeons goof around. Just the same way EMS and ER docs goof around, with the added benefit of the fact that the surgeon’s patient is unconscious and will not remember their antics.

Usually it’s restricted to bad jokes and talking about non-surgical things like vacations. It is also not unknown for anesthesiologists to read the paper during operations. 

The simple truth of the matter is this: most surgeries are routine, and medical staff have other things going on in their lives. And if the surgeon is comfortable with the procedure and they can have the headspace for the rest of  their lives to seep in, it will.

You’re also talking about a bunch of coworkers who are standing in a huddle, often for literally hours, many of whom will have little to do for the vast majority of the surgery. It can be extremely boring.

I’m going to argue that a little banter is not actually a bad thing. In the surgeries I’ve witnessed, it helps keep the mood relatively light, which is actually beneficial: it keeps everyone engaged. As long as the absolutely crucial moments are done seriously, such as the time-out and vascular surgeries, it’s typically not a problem.

(I’m not saying it’s never a problem, just that it isn’t a problem the vast majority of the time.)

I guess what I’m saying is: don’t judge it until you’ve been in it.

Good luck with your stories!

xoxo, Aunt Scripty


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anonymous asked:

I DESPISE the "a tap on the head leads to a prolonged blackout without problems" trope, but there's a part of my story where a character of mine gets roughed up and faints. I don't want to fall back on said trope, so I'm wondering if he'd pass out from pain and how long that'd last. the weapon is oblong & blunt (maybe one of those nasty barbed wire-wrapped baseball bats I've seen), and some injuries I'm considering are a shattered kneecap, broken ankle, dislocated shoulder and broken rib.

Have you considered ketamine?

This is my answer to pretty much every question. HOWEVER, you could also have a character use a “blood choke” to rapidly induce unconsciousness.

I actually have a post that may suit your needs….

Let me know if you need more! :D

xoxo, Aunt Scripty


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