Love the book club idea. I am asking you (selfishly) to write about nurses and their paths in our current environment as our daughter is in a four year nursing program. We are flying blind as parents as we want her to hopefully get offered a job where she will be well trained, mentored at a responsible hospital.
On the book club idea - we could also share book titles that we found interesting. Wes Ely's Every Deep-Drawn Breath is one example relevant to your item about mechanical ventilation.
Final Item- book club...YES! But a month to read and discuss as I know that I'm an avid reader of non-fiction on variety of subjects, fiction, news publications, and guessing a lot of folks here are the same, let alone busy (like you) so time to read before discussion. Exchanging ideas in discussion really helps to impregnate what I read, on my brain, and give other important perspectives.
Hi Dr Faust, I'm a retired anesthesiologist and practised for ~40 years. It's my strong opinion that the intubator be well versed and prepared prior to instrumenting the airway. That includes low pressure oxygenation at high concentrations so as not insufflate the stomach, knowledge of the proper evaluation of the particular patient's airway, and making sure that all the appropriate, necessary equipment is readily available.
On the topic of PUBLIC HEALTH...yes, more funding for them all the way down to local municipalities! They, at all levels, are not just scientists, but the translators of the science of individual AND community healthcare and the overlays. Demographics and mapping so important in epidemiology especially as this pandemic was predicted with more in the future. Still blows my mind that we had the perfect opportunity to support the value of Public Health during COVID and in sharing info and compiling accurate stats and we let it become divisive and politicized. We need to address the "front end" needs of funding and ed of both medical staff and individuals to prepare for incoming pandemics and the one that STILL kills more people than flu...COVID. This virus should have been the Great Equalizer from which we understood that marginalized groups will fare much worse in a pandemic thus Public Health becomes even more important in providing equitable care and locating and treating, and educating those folks. Which is why the info on easing med students' interview process ties in. Though I've just perused that. I prefer face to face for important interactions like those but looks like some schools are offering virtual interviews followed by on location visits which sounds ideal to me. And being a disabled person, and thinking of those with socio-economic, racial, and distance challenges, a little flex is good.
Dr. Faust, once again, jam-packed with current and important issues. On making ER intubation safer...I have Progressive MS in "end stages". 7 years ago diagnosed w/weakened diaphragm due to MS (neuro). Started using power wheelchair. Pulmonologist versed us on potential for ER intubation and levels of function that necessitated it as in most cases this happened in an emergency situation. Stats/data still show MS patients most often die from pulmonary issues and/or comorbidities combined with MS. In 2020 during COVID, I was warned by a friend (administrator @ large hospital here) that I would not be prioritized for ventilators as there were not enough and not enough staff during COVID crisis. It was discouraging and frightening that even in looking at protocols for patients like myself at J Hopkins, Cleveland clinic, I would not be prioritized. It appears our healthcare system is at least better prepared with ventilators (I hope.) But staffing is still an issue in the system as a whole, in poorer hospitals, and more rural hospitals. I agree with the basic premise and now some backup data to support not rushing to intubation. In a hospital like yours with an ER doc like you, absolutely! But most hospital ERs and ER docs are not like you. I've been in quite a # around the country (small and large) in past 38 years due to my severely asthmatic child, my own multiple diseases/comorbidities since my 20's, responsible for my aging parents, now deceased. Will the hospitalists and ER docs have time to read this or even know it exists? Let alone have time to pay attention to complex health histories? I'm a bit concerned that this research could be used to delay a need for intubation if patient is not properly and quickly assessed, and the doc is not supported w/adequate staff and time for evauation.A really good subject to lead to Public Health...Thanks for bringing it up.
Thank you Lyn. We tend to think about "difficult intubations" in terms of difference categories. One is anatomical (say a patient with known esophageal cancer, or trauma to the face). Another is physiological--and MS can fall into that category.
The question of how fast will knowledge translate? Hard to say. In some ways, online dissemination of medical information has made changes happen much faster. But which changes are adopted quickly and which are not is really fickle. I think this will be taught in residency programs, which is a great thing.
Just here in the Holyoke/Springfield/Northampton medical area, I'm starting to see some different approaches for patients facing this potential procedure/issue that I find more comforting...better pulmonary monitoring and hopefully more specific to systemic disease before intubation, and better support for patients after intubation. But once again ed is so important for both patient and medical staff that seeks to help them. It's why your dedication to facts, data, compassion, education is so important. It goes beyond the classroom.
The impacts of climate change on mental health - what to know and what to take into consideration when making health decisions: https://www.prevention.com/health/a60986884/climate-change-causes-brain-changes/
Thank you for sharing!
Love the book club idea. I am asking you (selfishly) to write about nurses and their paths in our current environment as our daughter is in a four year nursing program. We are flying blind as parents as we want her to hopefully get offered a job where she will be well trained, mentored at a responsible hospital.
I'd love a good rec for books about nurses/nursing!
On the book club idea - we could also share book titles that we found interesting. Wes Ely's Every Deep-Drawn Breath is one example relevant to your item about mechanical ventilation.
Thank you for this. I met Wes last year. He's an inspirational guy (pun intended)!
Final Item- book club...YES! But a month to read and discuss as I know that I'm an avid reader of non-fiction on variety of subjects, fiction, news publications, and guessing a lot of folks here are the same, let alone busy (like you) so time to read before discussion. Exchanging ideas in discussion really helps to impregnate what I read, on my brain, and give other important perspectives.
Ah yes the TIMING was my next question. Thanks!
Please explain non-invasive ventilation? Is this impart explained above... low pressure oxygenation at high concentrations?
Thanks
Hi Dr Faust, I'm a retired anesthesiologist and practised for ~40 years. It's my strong opinion that the intubator be well versed and prepared prior to instrumenting the airway. That includes low pressure oxygenation at high concentrations so as not insufflate the stomach, knowledge of the proper evaluation of the particular patient's airway, and making sure that all the appropriate, necessary equipment is readily available.
Thank you for adding this. The nuance of course is that no two patients are alike. Are you referring to basically non-rebreathers?
I do see your point re: not over insufflating is an important goal. Ventilating against the pressure of an air-filled abdomen is...not fun!
On the topic of PUBLIC HEALTH...yes, more funding for them all the way down to local municipalities! They, at all levels, are not just scientists, but the translators of the science of individual AND community healthcare and the overlays. Demographics and mapping so important in epidemiology especially as this pandemic was predicted with more in the future. Still blows my mind that we had the perfect opportunity to support the value of Public Health during COVID and in sharing info and compiling accurate stats and we let it become divisive and politicized. We need to address the "front end" needs of funding and ed of both medical staff and individuals to prepare for incoming pandemics and the one that STILL kills more people than flu...COVID. This virus should have been the Great Equalizer from which we understood that marginalized groups will fare much worse in a pandemic thus Public Health becomes even more important in providing equitable care and locating and treating, and educating those folks. Which is why the info on easing med students' interview process ties in. Though I've just perused that. I prefer face to face for important interactions like those but looks like some schools are offering virtual interviews followed by on location visits which sounds ideal to me. And being a disabled person, and thinking of those with socio-economic, racial, and distance challenges, a little flex is good.
It keeps me up at night...and gets me up in the morning!
A huge yes from me on the book club!!!
L. H.
I was curious as to where & what Holyoke looked like, such a qualnt community. If I travel that way I most certainly will take a detour. All the best!
Very excited for the Inside Medicine book club!!
Dr. Faust, once again, jam-packed with current and important issues. On making ER intubation safer...I have Progressive MS in "end stages". 7 years ago diagnosed w/weakened diaphragm due to MS (neuro). Started using power wheelchair. Pulmonologist versed us on potential for ER intubation and levels of function that necessitated it as in most cases this happened in an emergency situation. Stats/data still show MS patients most often die from pulmonary issues and/or comorbidities combined with MS. In 2020 during COVID, I was warned by a friend (administrator @ large hospital here) that I would not be prioritized for ventilators as there were not enough and not enough staff during COVID crisis. It was discouraging and frightening that even in looking at protocols for patients like myself at J Hopkins, Cleveland clinic, I would not be prioritized. It appears our healthcare system is at least better prepared with ventilators (I hope.) But staffing is still an issue in the system as a whole, in poorer hospitals, and more rural hospitals. I agree with the basic premise and now some backup data to support not rushing to intubation. In a hospital like yours with an ER doc like you, absolutely! But most hospital ERs and ER docs are not like you. I've been in quite a # around the country (small and large) in past 38 years due to my severely asthmatic child, my own multiple diseases/comorbidities since my 20's, responsible for my aging parents, now deceased. Will the hospitalists and ER docs have time to read this or even know it exists? Let alone have time to pay attention to complex health histories? I'm a bit concerned that this research could be used to delay a need for intubation if patient is not properly and quickly assessed, and the doc is not supported w/adequate staff and time for evauation.A really good subject to lead to Public Health...Thanks for bringing it up.
Thank you Lyn. We tend to think about "difficult intubations" in terms of difference categories. One is anatomical (say a patient with known esophageal cancer, or trauma to the face). Another is physiological--and MS can fall into that category.
The question of how fast will knowledge translate? Hard to say. In some ways, online dissemination of medical information has made changes happen much faster. But which changes are adopted quickly and which are not is really fickle. I think this will be taught in residency programs, which is a great thing.
Just here in the Holyoke/Springfield/Northampton medical area, I'm starting to see some different approaches for patients facing this potential procedure/issue that I find more comforting...better pulmonary monitoring and hopefully more specific to systemic disease before intubation, and better support for patients after intubation. But once again ed is so important for both patient and medical staff that seeks to help them. It's why your dedication to facts, data, compassion, education is so important. It goes beyond the classroom.