Path's lead is shrinking..

[Jeff698]

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Here's a great reason to come to central Texas. This is about a 5 minute walk straight off of my back porch:

Take care,
Jeff

 

[DrMom]

Great picture, Jeff. Cute kiddos!

 

[Jeff698]

I know, I didn't realize. Taking them down.

Damn, they were cute pics too!

- H

Try www.smugmug.com. That's what I use to host my pictures. They allow posting links from forums. Unlimited storage.

I have no interest in them other than being a subscriber (less than $40 a year). Great for kid pics so you don't have to email the actual files to the grandparents.

Take care,
Jeff

 

[FoughtFyr]

Try www.smugmug.com. That's what I use to host my pictures. They allow posting links from forums. Unlimited storage.

I have no interest in them other than being a subscriber (less than $40 a year). Great for kid pics so you don't have to email the actual files to the grandparents.

Take care,
Jeff

See, we already have a .mac page set up with lots of pics for the grandparents. It just doesn't allow for links to individual pics from forums. I don't want to shell out for any others really.

Here is another one... sorry about the thumbnail!

- H

 

[DropkickMurphy]

Here's a great reason to come to central Texas. This is about a 5 minute walk straight off of my back porch:

Any good schools in that area Jeff? I'm looking for places to move to so I'm open to suggestions....and that goes for anyone. 👍

 

[DropkickMurphy]

Wait, I remember driving through Belton when I interviewed at Scott and White. The reason I turned down the job was because there wasn't a school close by so far as I could tell.

 

[DropkickMurphy]

See, we already have a .mac page set up with lots of pics for the grandparents. It just doesn't allow for links to individual pics from forums. I don't want to shell out for any others really.

Here is another one... sorry about the thumbnail!

- H

I recommend www.photobucket.com because that's what I use to put up all the pics I have put up on here. The best part is that it's free.

 

[SoCuteMD]

By the way, the management of ARDS has changed....we try to minimize using PEEP to help minimize iatrogenic trauma to the lungs.

As for dissecting, uh, ever tried embalming? Especially someone who has been autopsied....if you can stand that, an anatomical cadaver is nothing. Although I've helped pre-dissect a cadaver for a gross anatomy course (I got blind-sided into it by my professor- "Come here and help me....you know what you're doing" Great...... )

Ummm...from what I was told PEEP is the standard of care for ARDS (and has significantly reduced mortality from such) if the patient needs to be ventilated. Of course, they try to move them to CPAP ASAP b/c any ventilation is going to be tough on the lungs. And I doubt the prof would be lying - he's pretty much THE MAN when it comes to respiratory. But others, please correct me if I'm wrong.

And yes, that's exactly what I meant about you having an edge. You said you liked anatomy, but I was pointing out that you aren't exactly the average pre-medical student - most classmates will have a really rough time at some point in the semester!!!

 

[leviathan]

Well, you are going to have an edge in med school given your line of work. But trust me, when you are shoved in a room and told, "CUT!" and you are ready to vomit and pass out (knowing my luck it would be in the opposite order so that I could aspirate, get ARDS, and end up on PEEP) it's a very traumatic experience. I haven't known many people who liked med school gross anatomy.

I'm doing a gross anatomy class right now in my undergrad, and our first dissection lab is on Friday. What should I do to avoid vomiting inside someone's thoracic cavity? 😳

 

[EctopicFetus]

Where you flying to Ectopic?

Cali.. some interviews.. and hanging with my boy!

 

[EctopicFetus]

Any good schools in that area Jeff? I'm looking for places to move to so I'm open to suggestions....and that goes for anyone. 👍

Tucson has some great public schools... so I hear..

 

[EctopicFetus]

I'm doing a gross anatomy class right now in my undergrad, and our first dissection lab is on Friday. What should I do to avoid vomiting inside someone's thoracic cavity? 😳

If it smells bad put some Vicks Vapo run on your upper lip.. it helps with the smell I didnt need it but it helped others.

Nice ing today guys.. nice to see Jeff getting more involved.. esp since turtle is no longer on trauma.

 

[EctopicFetus]

If it smells bad put some Vicks Vapo run on your upper lip.. it helps with the smell I didnt need it but it helped others.

Nice ing today guys.. nice to see Jeff getting more involved.. esp since turtle is no longer on trauma.

2k is around the corner!

 

[EctopicFetus]

2k is around the corner!

Gonna eat some solid mexican out here.. and some sushi!

 

[EctopicFetus]

to update our stats..
Looks like another solid day.
Us - 32,067
Them - 34,936



The difference is 3077 Caught up by over 200 posts! today! 😱
Strong work Praetorian
The 3K mark FELL!

2500 is next!

 

[leviathan]

to update our stats..
Looks like another solid day.
Us - 32,067
Them - 34,936



The difference is 3077 Caught up by over 200 posts! today! 😱
Strong work Praetorian
The 3K mark FELL!

2500 is next!

I'm surprised they aren't trying to put up a fight against this attack!

 

[leviathan]

I could probably do this in my sleep. 😴

 

[basementbeastie]

aaaaaaahhhhhhhhh...............sleep..............

 

[DropkickMurphy]

Ummm...from what I was told PEEP is the standard of care for ARDS (and has significantly reduced mortality from such) if the patient needs to be ventilated. Of course, they try to move them to CPAP ASAP b/c any ventilation is going to be tough on the lungs. And I doubt the prof would be lying - he's pretty much THE MAN when it comes to respiratory. But others, please correct me if I'm wrong.

And yes, that's exactly what I meant about you having an edge. You said you liked anatomy, but I was pointing out that you aren't exactly the average pre-medical student - most classmates will have a really rough time at some point in the semester!!!

I didn't mean to imply the PEEP doesn't have a place or isn't used, just that it is used as aggressively as it once was (you'd be looked at if you were crazy if you cranked the PEEP as high as some of the "old school" RT's have told me was common back 15-20 years ago)

 

[DropkickMurphy]

Tucson has some great public schools... so I hear..

Well, I was thinking more along the lines of colleges, although you're right Tucson has a very good university.

 

[SoCuteMD]

I didn't mean to imply the PEEP doesn't have a place or isn't used, just that it is used as aggressively as it once was (you'd be looked at if you were crazy if you cranked the PEEP as high as some of the "old school" RT's have told me was common back 15-20 years ago)

Ah, yes, now I understand what you meant. I have no basis for comparison, as 20 years ago I was in preschool 😛.

 

[DropkickMurphy]

I was in Kindergarten so I'm just going off what I was told.....

 

[BKN]

duplicate, sorry

 

[BKN]

I was in Kindergarten so I'm just going off what I was told.....

Well, I was there at the time as a surgical intern. So called super peep was advocated by a series of Anesthesia intensivists at Wilford Hall (the big AF hospital) and Shands in the 70s. It required a patient with generalized ARDS and problems with oxygenating with FiO2 of >0.5 and conventional PEEP pressures. These patients are thankfully, relatively uncommon. They have very stiff lungs in which the airway pressures are not transmitted to pleura or right atrium.

It was carefully controlled and depended on taking matched Arterial and Pulmonary artery samples every hour to measure the shunt fraction. One then adjusted the PEEP about 3 mmHg an hour up or down, until the magic level where the shunt fraction dropped and the hypoxia cleared. It was important the the patient be on IMV rather than Assist-control so that the patient had a chance to decrease intrathoracic pressure to negative compared to atmmosphere, thus creating a pressure gradient for blood return to the heart. You had to continue to do the sampling hourly, for when the patient improved, the required PEEP went down and the high pressures were then transmitted to the pleural space and the right atrium.

Findings:

1. We could oxygenate anybody.
2.Incidence of barotrauma and hypotension were the same as anybody else's results, and this was a sicker subset of patients.
3. ECMO avoided, a good thing, since I don't think it was widely available, and I believe it was abandoned in adults as ineffective.

The point of this rant is that superPEEP worked well in the hands of careful people who could follow protocols. I'm not an intensivist, there may be better ways to handle such a patient today, but most of the bad results were from people who didn't follow the rules, sort of like tPA for stroke. 😉

 

[basementbeastie]

BKN: what were some of the superPEEP ranges that you were in? thanks.

 

[basementbeastie]

to update our stats..
Looks like another solid day.
Us - 32,067
Them - 34,936



The difference is 3077 Caught up by over 200 posts! today! 😱
Strong work Praetorian
The 3K mark FELL!

2500 is next!

if the difference is 3077 (i don't think it is), then how did 3k fall?

 

[basementbeastie]

perhaps several math checking post pads are in order...

 

[basementbeastie]

34,936

 

[basementbeastie]

minus

 

[basementbeastie]

32,067

 

[basementbeastie]

=

 

[basementbeastie]

2869

 

[basementbeastie]

2869<3k!!!!

 

[Jeff698]

Any good schools in that area Jeff? I'm looking for places to move to so I'm open to suggestions....and that goes for anyone. 👍

I gather from your later post you mean universities? We have a private undergraduate school in Belton, University of Mary Hardin Baylor. My wife got her BSN from here and thought it was a good school. The Univeristy of Central Texas is in Killeen about 20 minutes from here.

Texas A&M is about 1 1/2 hours and the University of Texas is about the same with traffic. Baylor University is about 30 minutes north of here on I35.

Take care,
Jeff

 

[basementbeastie]

happy king day...

 

[basementbeastie]

...or 'multi-cultural day' for those of you in arizona....

 

[basementbeastie]

and, of course, 2845 < 2869 .....

 

[Soup]

Any tips (besides the right shoes) for making twelve hours on your feet bearable? My feet, back, and knees get stiff, swollen, and angry with me after just a few hours.

 

[Annette]

I'm doing a gross anatomy class right now in my undergrad, and our first dissection lab is on Friday. What should I do to avoid vomiting inside someone's thoracic cavity? 😳

Turn your head?

Sorry, couldn't resist!

 

[EctopicFetus]

to update our stats..
Looks like another solid day.
Us - 32,097
Them - 34,939



The difference is 2842 Caught up by over 27 posts since yesterday! 😱
Strong work Praetorian
The 3K mark FELL!

2500 is next!

Sorry I screwed up yesterday thats what happens when you spend 10 hours traveling.

 

[EctopicFetus]

Any tips (besides the right shoes) for making twelve hours on your feet bearable? My feet, back, and knees get stiff, swollen, and angry with me after just a few hours.

Bend your knees some.. relieves back and knee pain.. Not much else to do. Perhaps you need some orthotics? Have you had this problem before?

Also this goes in the easier said than done file.. but exercise running etc can help in the longer term.

 

[EctopicFetus]

Man.. one day to relax before the interviews kick in..

 

[yaah]

I'm surprised they aren't trying to put up a fight against this attack!

Well, anyone can just keep posting one word posts and over and over again. Doesn't really mean anything. And as I have said before, numbers are meaningless. Meaningless, I says! You guys have more posters than path does anyway (I assume) so I would expect you to have more. When we started passing all the other forums it was really odd and I never thought it would happen. Path has a lot of lurkers that occasionally pop in to post something annoying like "Wht is job situation I am IMG thx" or "I want dermpath fellowship is competitive? What salary can I expect? Do they take IMGs?" etc etc.

 

[BKN]

BKN: what were some of the superPEEP ranges that you were in? thanks.

75 cm H2O is the highest that I remember. BN

 

[EctopicFetus]

Well, anyone can just keep posting one word posts and over and over again. Doesn't really mean anything. And as I have said before, numbers are meaningless. Meaningless, I says! You guys have more posters than path does anyway (I assume) so I would expect you to have more. When we started passing all the other forums it was really odd and I never thought it would happen. Path has a lot of lurkers that occasionally pop in to post something annoying like "Wht is job situation I am IMG thx" or "I want dermpath fellowship is competitive? What salary can I expect? Do they take IMGs?" etc etc.

So what are the answers? We demand answers in this forum!

For example.. we have learned..Socute had a date and she didnt like the guy.. she cant pick a sweater... Jeff love mid central texas and has cute kids.. Praetorian has cute kids too.

Not gonna get into what they know about me since I dont think it will reflect positively 🙂 😉

 

[Jambi]

Jeff love mid central texas and has cute kids.. Praetorian has cute kids too.

Hey I have cute kids too, so does roja and foughtfyr.

 

[basementbeastie]

75 mmHg .... that is much higher than i am used to...

 

[Jambi]

See, we're learnin' all kinds of stuff. 😛

 

[SoCuteMD]

So what are the answers? We demand answers in this forum!

For example.. we have learned..Socute had a date and she didnt like the guy.. she cant pick a sweater... Jeff love mid central texas and has cute kids.. Praetorian has cute kids too.

Not gonna get into what they know about me since I dont think it will reflect positively 🙂 😉

Um...you forgot that caffeine is apparently a candidate for "female viagra" but it apparently isn't effective for habitual users.

 

[basementbeastie]

learning all sorts of good stuff....too bad i got 'the habit'...