Comments

  • Coronavirus
    not the US. Canada. If you don't believe me feel free to look up manitoba headlines this last week. No nurses want their names mentioned and only speak to the news anonymously due to fear of being fired. Welcome to Canada eh! Don't get sick.
  • Coronavirus
    There ya go! You don't know where I work, but will certainly talk shit about how I am lying. You don't don't work health care, you friends do, but have no problem telling someone that does work healthcare the realities of their job. So you have strong opinions, and that's about it. Go for you. Now go tell your plumber he is doing it wrong because you read pamphlet somewhere...
  • Coronavirus
    People should always worry about going to a hospital to get help. It should be the last option used. There are all sorts of nasty bugs there and it is never clean enough. As anyone that actually works in one already knows. When there is no other option, go to the hospital. If there is any other choice, try that first.

    Interesting that you mention my speaking like a street thug yet you started swearing first and I am the most accepting of other peoples experiences. You don't actually work in a hospital do you? I have never actually heard any doctor mention the hippocratic oath, let alone worry about breaking it, unless in a theoretical discussion. You sound idealistic and very short on practical, actual experience.

    What is your prefered method for putting a body into a shroud?
  • Coronavirus
    I have no illusions: my job IS more important to me than saving lives. I do the best I can within the rules I have to play by, but I did not write the rules. You speak of whistle blower protection, however it is about as effective as a restraining order; ask a domestic violence victim how much that piece of paper protected them. I known people in my feild that have lost their jobs, or been fined $25,000, for saying "We can, and should, do better." So spare me your judgemental bullshit. Work under my conditions, then tell me all about how full of shit I am. At no point have I called you out for your experiences and yet you insist on calling mine a lie; because they upset your sensibilities. Your narrow minded sensibilities can go fuck themselves.
  • Coronavirus
    No thanks, I still need my job. Simple as it gets really. I am not in a position to change policy or order sets. I am in a position to lose my job or license, ergo, career, for telling of what I have seen and am expected to do. It has been like that for a number of years now. I advocate for my patients when I can, absolutely advise them not to blindly follow directions and to ask questions until they understand the answers. That's about all I can do.
  • False Analogies???: Drunk Driving vs Vaccine Mandate, Drunk Driving vs Abortions
    The analogy does not hold up.

    Drive drunk, more likely to injure the innocent, and increased risk to you.
    Don't drive drunk, less likely to injure the innocent and no potential increased risk to you.

    Get vaccine, maybe decreased risk of covid (you don't know if you were susceptable or goingvto catch it), maybe less transmission to others if you catch covid (although we din't know how much less transmission) and absolutely increased risks of side effects (immediate, short term, medium term, long term and potentially to offspring. We don't have any data in this area, just theory)
    No vaccine, maybe increased risk of catching covid (you don't know if you are susceptable), maybe decreased symptoms if you catch covid (80% of people are asymptomatic so they weren't going to notice anyway), maybe more chance of transmission (we din't know how much vaccine decreases transmission, we think ot does) and absolutely zero chance of any side effects from the vaccine you did not get. Not today, or next year, or two decades from now, and nothing extra for future generations.

    Because there is negilible negative consequences to not driving drunk but a very real potential of negative consequences from getting vaccinated; the analogy does not hold up.
  • A very expensive book.
    No worries there, I will find it eventually if it is worth finding. Not sure what you were expecting posting the OP though: people would either be interested in the book, regardless of price, or not interested. If you were expecting a horrified "That's too expensive!!" consider this: a single page from the Guttenberg Bible sells for $250,000.00 One page.

    Also, what is worth that kind of money to you?
  • Coronavirus
    Good for you. Your hospital seems to have had leadership move forward to do those things; must be nice. Ours did none of them, which is inline with our leadership. Every health region I have worked in cares very deeply about maintaining the image of caring very deeply. Actual patient care though, not so much.

    Notice that I did not jump up and call all the naysayers full of shit? I have no idea how accurate their information is. I assume, as they have said they work in the business, that their data is as accurate as mine as we all do it for a living.

    I also notice that no one has said anything about the Covid Resuscitation procedure...

    ...I guess that's another thing we aren't supposed to talk about?
  • Coronavirus
    Good for your neighbour. Clearly he doesn't work in my health region or he would be saying "Holy shit, someone is talking outside of work! That person might get fired!" I am glad that he works in a better place than I do. Although I am surprised that he would have such a narrow perspective as to instantly call bullshit, rather than saying that it is ridiculous practice. But hey, whatever helps you sleep at night eh!
  • Simone Biles and the Appeal to “Mental Health”
    My understanding is that she withdrew because she was no longer able to determine her body position relative to where it actually is. This is a legitimate reason to withdraw from such a high level competition, when she lands, if she lands poorly, it can have catastrophic and life long results. The only reason to go forward with this condition in this level of competition would be pride and stupidity. I am not saying she is brave to withdraw, merely pragmatic.

    What I find fundamentally racist about the current media narrative is that, for some unknown reason, the media insists on speaking of someone's colour, ethnic origins, or gender as if it is a barrier that they have also overcome.

    If I say Claire is an accomplished swimmer is that not enough? Does mentioning that she is also of mixed genetics add to, or demean her? I think it suggests that she is an accomplished swimmer
    DESPITE her mixed heritage. And to me, that is the epitome of racist.
  • Coronavirus
    The ventilation strategy they use is tailored to the patient's condition. Lung protection is the most important factor because the patient's lungs are being shredded by the virusfrank

    Nice thought, and wrong. Ordinarily I would say absolutely correct, but not for Covid. Your position presupposes that the patient is still the most important factor; it isn't. Controlling spread is. Which brings up your earlier points...


    The exit path for virus leaving the lung of an intubated patient would be into the ventilator circuit and splat onto the viral filter the protects the exhalation valve.



    Accurate, except for when we have to suction secretions to clear the airway for the patient and when the vent circuit opens accidentally, which does happen, hence circuit alarms. and when we have to change the circuit, or something goes sideways and we have to bag the patient while the vent gets fixed. Next point...


    frank
    because it's a negative pressure room.frank

    Maybe your ICU has negative pressure rooms. Mine generally have one, which isn't useful when the ICU is full of vented Covid patients. so no negative pressure rooms, although that would be nice. Also, ICU windows here don't open, controlled environment and all that. Perhaps your ICU's are different, I can't speak to your region.

    I did not write the algorithm for Vented Covid patients but it seems about as effective as the Covid Resuscitation algorithm for maintaining life.

    The advantage to telling what you have seen/done is that it is easy to recall and one can brush off anyone that says "I don't think so".
  • Coronavirus
    Aortic dissections are a rough go. He is lucky he made it through the corrective surgery. And yep ICU is where he would have been for a while to be kept in a "medically relaxed state" while his initial healing took place. Still, someone should have explained that, while he was sedated during intubation, the sedative would also help him avoid the DT's. The right IV meds and they wouldn't be a problem, since he was already out, no idea why they wouldn't give them, or inform family that he is being managed properly, not that "ride it out" crap.

    Not that I haven't heard and seen patient's get crappy treatment, I saw it all the time in the emergency department, and still do, but I never really understand why. I am able to still treat my patient properly, even if he is an asshole, although I won't stick around to chat if he is.
  • Coronavirus
    I can not speak directly to the treatment of only addicts in ICU with Covid. However (and this will raise a ton of naysayers who will refuse to believe me) the treatment protocols for Covid in the ICU for ventilated patients are designed primarily to reduce the number of viral particles expelled by the patient while ventilated. This is the first time I have ever seen a protocol for patient care that is based on fear of the infectious agent, rather than focused on patient recovery.

    When infected with Covid the inside of the lungs develop a relatively thick secretion which makes it more difficult to process oxygen and maintain reasonable tidal volumes, hence the shortness of breath associated with Covid. Ventilated patients are given medication treatments to dry up these secretions, thereby reducing the dampness, and viral load, of the exhaled breath. Initially it sounds like a reasonable step, until you consider what effect this will have on the lung tissue: We dry out the slightly thick secretion...and still need it to be permeable, and flexible, to allow for oxygen exchange and proper lung inflation. No wonder only 3% of ventilated patients survived initially. There have been some improvements since then ,but still based on reducing exhaled virus, not patient care.

    Changes to the resuscitation process are the same. Old approach: Patient down in cardiac arrest. Call for help, begin chest compressions, help arrives, attach defib pads, continue compressions, shock, etc. New Covid approach: Patient down with cardiac arrest. Leave room, go get isolation cart and place it at the door of patients room, call for help, get dressed in appropriate isolation gear, enter room, begin chest compressions, await other staff (who also must dress for isolation prior to entering room), when staff arrive and are dressed, run code as usual. Please remember, brain death begins at 4 minutes with no circulation. The old way wasn't that successful as the patient had usually been down a few minutes before someone noticed, but it had successes. The new way, which opens with LEAVE THE ROOM, means that the patient will have no one even attempting CPR for at least five minutes, likely closer to eight. So essentially the Covid resuscitation technique is: Patient in cardiac arrest, leave room, go for coffee, notify doctor that family needs to be made aware that patient died due to Covid.

    And no, I would not recommend treating the DT's in ICU. Not that ICU can't handle it, just that it is an inappropriate use of resources. Also, to avoid DT's the patient just needs the proper medications, all of which can be administered via IV, in the ICU, or any other floor. As far as "letting them ride them out", your buddy got a nasty ass care team. There is no reason to do that, not best practice, not even inconvenient to treat, just plain old mean.
  • Coronavirus
    Her level of safety remains the same. Whatever viral load that is taken up by the newcomer is countered by whatever additional load brought in by him, net effect: nothing changed.
  • The best argument for having children
    Eighteen years of payments for 18 minutes of entertainment seems tyrannical to me. It's not like there only one person involved eh.

    Kids from an actual decision to make them is different, but even then, if one parent takes the kids and cuts the other out of the kid's life, then the funding should also be cut off.
  • The best argument for having children
    Because kids are cool. Best reason to make one or two or more.
  • A very expensive book.
    I can learn Spanish easily enough. Language is not a problem. I would like to view a copy before breaking out the money though.
  • Anti-vaccination: Is it right?
    Pass. I answered your question. You changed the parameters after the fact.

    In response to the OP: Most people will have no symptoms of covid, and no long term effects. Those are the ones that get infected. Not everyone will get infected, so those people have zero need for a vaccine. The ones that will suffer zero symptoms also need not get the vaccine. So far, in this explanation, no one needs the protection offered by the vaccine. There are those who will experience symptoms, roughly 20% of the population. Most of those will benefit from vaccine protection. I say most because not everyone will get protection from it; for some it won't work. SO, lets say 95% of the 20% who need protection get protection. That's a good thing. And let's also say that 95% of the 80% who do not need protection also get protection...That's irrelevant, they were fine anyway. Since transmission after vaccination still exists, vaccination to end transmission is not a thing, so should not be considered into the discussion.

    Therefore, since 8/10 people get nothing from the vaccine, I say personal choice regarding to receive or not to receive is the correct path. I am not Anti-vaccine. I am pro personal autonomy.

    Bad life choices cause much more death and suffering than Covid. No one mandates 1 hour daily gym work outs, or no more takeout food, or smoking, or alcohol. All of which affect more than 80% of the population.
  • Anti-vaccination: Is it right?
    Populations, as a whole, do not feel the side effects that an individual feels, therefore, the decision to immunize or not should be from an individual perspective, not from the society perspective. From a "benefit to society" perspective I can justify all sorts of horrible things to the individual, for the betterment of the greater good. Society will not miss weeks of work with covid arm, the individual does. Society does not experience days of fever or rigors, the individual does. I could go on with this for hours. Thank you for demonstrating the intellectual diversity on this site, I had mistakenly thought that I would not need to be so specific in my explanations. My error.
  • Anti-vaccination: Is it right?
    notice your initial response had you packing a gun to potentially protect your family, and once I supported that position, with rationale, you suddenly shifted to your child packing a gun to school and began babbling as if the gun would protect him from covid, as if that were the initial threat the gun were supposed to protect from. Poor form changing the parameters because you are unable to defend your position without doing so.

    Also, and really the fundamental question, why is the school expected to protect your child from something his is just as likely to catch in the community, or bus, or simply by living? Covid is endemic now and should be treated as such.
  • Anti-vaccination: Is it right?
    you answered nothing. Thank you for a pointless response. Perhaps next time you could provide reasoning?
  • Anti-vaccination: Is it right?
    It's a simple risk/reward analysis, but it has to be made from the point of view of a population. Looking at it on an individual level is misleading.Cheshire

    But why? The population will not feel any side effects of the vaccination, but the individual will, therefore it is an individual decision.

    The "better for the population long term" argument should also support non-intervention for anyone that is suicidal as less individuals would mean more resources for others, less environmental damage, more job availability, etc. And yet, we are not advocating suicide, despite being able to spin the positive effects for society.
  • Anti-vaccination: Is it right?
    I have a family. Are they safer if I have and wear guns to protect them, or if I do not have guns. Safer? Not safer?tim wood

    Safer if you, and they, know how, and are willing, to use said weapons to defend themselves.

    If they are unable or unwilling, then they are not safer, you have provided a weapon to someone who is able and willing to use it.

    Now how does this apply to the vaccine issue?
  • An answer to The Problem of Evil
    It is a common argument that an all-loving all-powerful god is not compatible with the evils we find in the world e.g. people ravaged by disease, people beaten and tortured.Down The Rabbit Hole

    This argument precludes the concept of learning beyond a single lifetime, which is a self-defeating position for anyone that also believes in an afterlife.

    All experiences result in learning and therefore could be viewed as a positive experience when viewed from a long term perspective. From this perspective, evil, as defined, would become good, as it increases the knowledge and experience of those affected, in turn supporting the all-loving, all-powerful God that allows these to occur.
  • An answer to The Problem of Evil
    you are operating on a finite amount of evil. Why?

    Also, why an infinite amount of good?

    Lastly, why is evil a problem? Why not the problem with good?

    There is no dark without light, nor light without dark. The contrast is what creates the assignment of value.
  • Coronavirus
    We all have ultimately a right to defend ourselves against stupidity.tim wood

    Not usually, no. Usually stupidity is a mob rules kind of thing. And mobs are fairly easily led, provided you use the right tool. Fear is the best tool. As fear increases, rational thought decreases, and people are more easily led. We have fear by the truck load now, every t.v, every radio, and every newspaper is just spewing it all over. The internet is awash with it. Currently the touted solution to the fear, that which will save us all, is the vaccine. And woe unto any that dareth counter that claim. They are the heathen, the non-believer, to be vilified and reviled at every opportunity. Wait a year or two, then the non-believer will be placed into camps via the train load by the enlightened mob.

    There isn't much chance to defend oneself against that level of stupid. But everybody has to die sometime eh, so no worries. It'll all end the same way eventually.
  • Arguments for livable minimum wage.
    So where does the money come from? I did answer the thread. I said No to the living wage/ handouts. You came back with the sob story about all the poor non-working sods and how crappy their life would be without handouts and all that shite. Answer that eh. If everyone stops working where does the money come from for your handout supply?
  • Arguments for livable minimum wage.
    I don't have an issue with the poor having no money. I have an issue with the poor having a nicer cell phone than I have, better medical coverage, a nicer apartment, and larger tv, despite not actually working. Meanwhile I scrimp and save and my taxes pay for the stuff they have that I can't afford. Homeless people have better dental and pharmacy coverage than I do, and all of us have the same level of medical coverage. The street-walking crack addicted prostitute has better medical coverage than the nurse that treats her in the hospital. How exactly did that come about?
  • Arguments for livable minimum wage.
    As opposed to your "everyone gets a free ride" approach, wherein the main qualifier is the ability to breathe, with or without assistance. Apparently in your world no one ever has to actually think about where the money comes from, it just magically shows up, and will never result in decreased purchase power or any other economic side effects. You are smoking some really good drugs man! Carry on.
  • Arguments for livable minimum wage.
    bailouts, moral hazard. It makes a fool out of anyone who actually paid their debts. It incents people to be deadbeatsfishfry

    Exactly. In Alberta during the first six months of the lockdown people that apparently could not afford to pay their utilities were allowed to "defer" their payments until such time as they could afford to slowly pay back the balance owing, thanks to the government telling them it was not legal to cut off utilities during the lockdown, to defer instead. Now, 33% of deferred bills aren't being paid back. The solution, approved by the same government that created this program, is to apply an over charge to all the customers until the owing balance is paid. So I paid my bills the entire time, and now I get the joy of still paying my bills AND the deadbeats' bills because they stopped paying theirs. Just awesome.
  • Arguments for livable minimum wage.
    no research at all. I used your numbers so as not to skew any results with my own numbers. And still, you are angry. Not at my math, but that I simply disagree with you. I say if you don't work, you don't eat. Simple enough, really. Which violates your bizarre utopian ideal that everyone should have what they need, and possibly want, based on...breathing I guess. Seems totally ridiculous to me, but hey, you can't seem to understand my perspective either, so there it is eh, balance!
  • Arguments for livable minimum wage.
    you said jeff makes 800/hr. Based on your numbers, those that fill out the benefits and do nothing else make more hourly than he does. Deal with it. Work for a few minutes and get 300/wk. Good bloody deal! No way anyone makes that in the private sector. But hey, Maybe in the UK it takes 30+ hours a week to fill out the benefits paperwork, so 10/hr. Not so awesome then.

    It's ok though, you can keep on hating Jeff. And corporations. No worries eh!
  • Are emotions unnecessary now?
    Suffering is such an interesting thing. It is entirely individualized and almost entirely based on perspective. I am not sure how an increase in physical pain equates to an increase in suffering, again, perspective I guess. Not all pain is bad.
  • Arguments for livable minimum wage.
    Actually, with regards to energy expenditure compared to return, they likely make more than Jeff, per hour. Good system.
  • Arguments for livable minimum wage.
    I support the government through taxes. The government is not allowed to tell groups of it's citizens that they have no value, especially now when everyone is whining about the injustice of the world.

    My problem is that I do not want to support someone that elects to do nothing. Do nothing, get nothing.
  • Are emotions unnecessary now?
    Alright, so you hate corporations, for whatever reasons you think are valid. Never mind that every corporation started out with someone who wanted to improve their lot and busted their ass to get there, risked money and time and more. Forget all that shit. In your world the evil corporation just magically showed up; a fully functional monster just out to squish the innocent and plunder the world. Do you actually believe that shit? Next you will try and tell me that Satan runs all corporations and that God loves me.

    I am not donating to your cause.
  • Arguments for livable minimum wage.
    value is set by someone other than the worker. You might have a more valuable skill than I have, ergo, you make more when you use that skill. I may work 80 hours a week, so despite you earning more each hour that you work, I may take home more each week as I work longer hours. Bob might work longer than both of us, and have amazingly valuable skills, so he makes more than both of us combined.
    Whoever is paying us determines our value.

    In a world with no cars, mechanics have little value. If you are the only mechanic in the world and everyone has a car, you charge whatever you like.
  • Arguments for livable minimum wage.
    This is reminiscent of a debate I had 28 years ago with one of my girlfriend's Mother. She was angry because I was applying for a job that paid more than she made and I was 25 years younger than her. She apparently felt that my four years of education and specialty trade training was not relevant to how much I should be paid, nor should the fact that we did completely different jobs play into wage at all. As per her, everyone should make the same wage. It was perhaps one of the most ridiculous discussions I have been in. Her position amounted to "because".
  • Arguments for livable minimum wage.
    Sure. Equal value. I am not seeing that in your position