The Fall of Hospitals

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erqueen75

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I had some experience with catheters a long time ago in a galaxy far far away, LOL. I was a hospital orderly before going back to college.
Hospital got bought out and the new administration (Humana, if I recall correctly) only allowed me one cheap plastic glove (kind of like the ones used in food service) to use for catheterization.

I fought it and won.
CHEAP BASTARDS
 

DrJenner

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The normal saline lactated ringers debate-
I think if you are an ICU person you tend to go LR while ER peeps like NS.
Cautious with dumping in large amounts of NS - would say more than 3L as you can cause hyperchloremic metabolic acidosis- would switch to LR after about 3L of NS
 

Kevin L

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The normal saline lactated ringers debate-
I think if you are an ICU person you tend to go LR while ER peeps like NS.
Cautious with dumping in large amounts of NS - would say more than 3L as you can cause hyperchloremic metabolic acidosis- would switch to LR after about 3L of NS
Got it. Thank you.

There can be too much of a good thing.

As a medic, I often encountered hypovolemic shock, and our policy (at the time, many years ago) was to go ahead and dump crystalloid fluids into the patient very quickly. We even had this thing called a RIC catheter, which had a larger diameter lumen than even a 14 guage over-the-needle catheter.

As I said, it was many years ago.
 

DrJenner

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Got it. Thank you.

There can be too much of a good thing.

As a medic, I often encountered hypovolemic shock, and our policy (at the time, many years ago) was to go ahead and dump crystalloid fluids into the patient very quickly. We even had this thing called a RIC catheter, which had a larger diameter lumen than even a 14 guage over-the-needle catheter.

As I said, it was many years ago.
Oh yeah, I mean if it’s all you have- that’s what you have to do.
Just think it would be beneficial to have both on hand. Also caution in using LR in acute kidney failure due to hyperkalemia (too much potassium)- can make that worse.
Although if you’re that on the brink in a SHTF situation and you need dialysis you’re probably screwed anyway
 

Kevin L

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Oh yeah, I mean if it’s all you have- that’s what you have to do.
Just think it would be beneficial to have both on hand. Also caution in using LR in acute kidney failure due to hyperkalemia (too much potassium)- can make that worse.
Although if you’re that on the brink in a SHTF situation and you need dialysis you’re probably screwed anyway
Scewed with a pinecone.

I sometimes have to bite my tounge when I read about people using and stockpiling things like antibiotics, IV fluids, and so forth . . . with the idea of using them without any experience or formal training.

I intend to store such things, but I plan on having regular contact with a physician and an advance-practice nurse practitioner, so I'll have real-time direction and guidance on how to properly administer these things.

I understand that--in a true crisis--doing something is better than nothing . . . yet a lot of people want to learn about antibiotics, but not proper aseptic technique . . . or how to administer IV fluids, but not how to properly use an Ambu bag or airway adjuncts like a nasopharyngeal airway, or how to use a laryngiscope to visualize the chords and put in an endotracheal tube. How many laypeople have obtained a suction unit with Yankauer tips to clear an airway of emesis . . . and know how to use it? Or that once someone develops aspiration pneumonia under austere conditions, that all of the IV fluids and antibiotics in world won't--in all probability--do any good?

Partial measures without imaging and/or diagnostic lab results may--on many occasions--be worse than doing nothing at all.

I'm not trying to be a troll, but can you guys see my concerns even if you disagree with me?
 
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DrJenner

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Scewed with a pinecone.

I sometimes have to bite my tounge when I read about people using and stockpiling things like antibiotics, IV fluids, and so forth . . . with the idea of using them without any experience or formal training.

I intend to store such things, but I plan on having regular contact with a physician and an advance-practice nurse practitioner, so I'll have real-time direction and guidance on how to properly administer these things.

I understand that--in a true crisis--doing something is better than nothing . . . yet a lot of people want to learn about antibiotics, but not proper aseptic technique . . . or how to administer IV fluids, but not how to properly use an Ambu bag or airway adjuncts like a nasopharyngeal airway, or how to use a laryngiscope to visualize the chords and put in an endotracheal tube. How many laypeople have obtained a suction unit with Yankauer tips to clear an airway of emesis . . . and know how to use it? Or that once someone develops aspiration pneumonia under austere conditions, that all of the IV fluids and antibiotics in world won't--in all probability--do any good?

Partial measures without imaging and/or diagnostic lab results may--on many occasions--be worse than doing nothing at all.

I'm not trying to be a troll, but can you guys see my concerns even if you disagree with me?
Absolutely
the stockpiles should be used carefully- and in partnership with someone who has some medical knowledge - be it a paramedic, RN, nurse practitioner, PA, physician whatever.
You can definitely do more harm than good- such as med reactions and even crystallization of the meds (ceftriaxone and LR can cause reaction).
 

Kevin L

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Absolutely
the stockpiles should be used carefully- and in partnership with someone who has some medical knowledge - be it a paramedic, RN, nurse practitioner, PA, physician whatever.
You can definitely do more harm than good- such as med reactions and even crystallization of the meds (ceftriaxone and LR can cause reaction).
Thank you.

I sometimes encounter a lot of hostility when I tell people that certain meds are by prescription and managed by a doctor for very good reasons.
 

erqueen75

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Absolutely
the stockpiles should be used carefully- and in partnership with someone who has some medical knowledge - be it a paramedic, RN, nurse practitioner, PA, physician whatever.
You can definitely do more harm than good- such as med reactions and even crystallization of the meds (ceftriaxone and LR can cause reaction).
Thank you, Doctor.
Gotta remember those IV Fluid/I.V. Medication incapabilities...
Need to get a copy of one of those HUGE charts in the MED Room that shows the compatible/non-compatible combinations...

1632751164526.png

Erqueen75 :USA:
 

erqueen75

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Got it. Thank you.

There can be too much of a good thing.

As a medic, I often encountered hypovolemic shock, and our policy (at the time, many years ago) was to go ahead and dump crystalloid fluids into the patient very quickly. We even had this thing called a RIC catheter, which had a larger diameter lumen than even a 14 guage over-the-needle catheter.

As I said, it was many years ago.
Kevin, you made my mouth water when you mentioned 14-gauge!!!
We used to say just shove a pencil in his arm!!!

God we're sick, but in a "I want to help you," good way. :)
Erqueen75:USA:
 

bigpaul

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as far away from "civilisation" as i can get.
Although if you’re that on the brink in a SHTF situation and you need dialysis you’re probably screwed anyway
Dialysis, Cancer treatment, any kind of life saving treatment and the person wont be around for long post SHTF.
mind you neither will the doctors and nurses in a full blown SHTF event.
 
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jontte

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I think this could be a bigger disaster than COVID itself.
And it is all man-made.
we have the same crap here, even without a covid mandate, so many RN's,PN's are so utterly fedup about the pay, treatment from the upper management, short staffing etc...the new ones we get, are....
below any standard, some didn't even grasp the meaning of the ABCDE protocol,don't have a clue about CPR, but as immigrants they get the job, despit that I like my boss,I hate that she likes to play the game of kumbayaa...
 

DrJenner

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we have the same crap here, even without a covid mandate, so many RN's,PN's are so utterly fedup about the pay, treatment from the upper management, short staffing etc...the new ones we get, are....
below any standard, some didn't even grasp the meaning of the ABCDE protocol,don't have a clue about CPR, but as immigrants they get the job, despit that I like my boss,I hate that she likes to play the game of kumbayaa...
Yep its sad and everywhere. People are leaving in droves, has nothing to do with mandate yet.
Everyone burned out and over it.
 

Kevin L

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Kevin, you made my mouth water when you mentioned 14-gauge!!!
We used to say just shove a pencil in his arm!!!

God we're sick, but in a "I want to help you," good way. :)
Erqueen75:USA:
I agree.

I could always tell who the new nurses were . . . because during lunch, the veterans were eating lunch while talking about secretions, pus, maggot-infested decubitis from low-end SNF facilities, and colostomy bags.

The new nurses were the ones whom weren't eating and looking pale and/or green around the gills.

I had few issues with this, as I could run on a 4 car pile-up with multiple fatalities, and have spaghetti when I got back to the station.
 

radiogoon

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Scewed with a pinecone.

I sometimes have to bite my tounge when I read about people using and stockpiling things like antibiotics, IV fluids, and so forth . . . with the idea of using them without any experience or formal training.

I intend to store such things, but I plan on having regular contact with a physician and an advance-practice nurse practitioner, so I'll have real-time direction and guidance on how to properly administer these things.

I understand that--in a true crisis--doing something is better than nothing . . . yet a lot of people want to learn about antibiotics, but not proper aseptic technique . . . or how to administer IV fluids, but not how to properly use an Ambu bag or airway adjuncts like a nasopharyngeal airway, or how to use a laryngiscope to visualize the chords and put in an endotracheal tube. How many laypeople have obtained a suction unit with Yankauer tips to clear an airway of emesis . . . and know how to use it? Or that once someone develops aspiration pneumonia under austere conditions, that all of the IV fluids and antibiotics in world won't--in all probability--do any good?

Partial measures without imaging and/or diagnostic lab results may--on many occasions--be worse than doing nothing at all.

I'm not trying to be a troll, but can you guys see my concerns even if you disagree with me?
He's not wrong guys....a little internet knowledge is a dangerous thing.
 

DrHenley

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