Posts by Scott Allen10

When you're prepping someone for what some folks call their "courage shot" or premedication, you're usually looking at a two-part cocktail.
You’ve got your sedative, like Dormicum, or maybe a heavy hitter like fentanyl, paired up with atropine.
The first bit is just to help the patient chill out and drift off for a second—which really helps steady the metabolism—while the atropine keeps the saliva from running wild and gives the heart rate a little nudge. It's all pretty crucial stuff when you're getting through the induction phase.
Basically, the whole point is to get the body ready for the anesthesia so everything runs smoothly, plus it actually lets us use less anesthetic overall if the patient is properly prepped.

I mean, it’s all true. But honestly, what do I know? Most GPs out there just don't have the knack for proper triage, and if you ask me, it’s way safer to refer someone out than to mess around with a "diet and painkillers" approach when they've got something serious going on. My mom went through this exact nightmare—she had gangrenous cholecystitis right on the verge of perforation, and the doctor tried to treat her with nothing but a strict diet and some basic OTC meds. She wouldn't have even made it to the hospital if I hadn't practically dragged her there myself, and once we arrived, she was rushed straight into surgery because her gallbladder was basically seconds away from bursting.

My take? It feels like there’s a mountain of theory being taught, but almost zero hands-on practical experience during med school or residency. So, what can you really expect? At this point, I’d much rather they just send patients to a specialist than have someone get stuck in a dangerous situation because their doctor was too hesitant to pass the baton. 😢

Wishing you nothing but health, and honestly, I hope you never have to deal with any more intensive treatments ever again...
👋

slyviper47 said:It’s a bit late now, but they did manage to find one every once in a while... they even had to feed me through an IV.
In the end, they finally found a decent vein on my outer foot and ended up giving me blood through that one too.

I mean, I'm pretty tiny myself... barely 115 lbs in my sneakers 😁, so my veins were always right there on the surface... you know, those first visible, bluish, aged-looking veins, and then when they managed to hit one... well, if they couldn't get the other, they just wouldn't give up. Just pure professional stubbornness, I guess.😉

First off, forget about those "aged" blue veins you mentioned. Honestly, anyone who judges a nurse based on how visible their veins are isn't using much brainpower. You don't actually need a vein to be visible to stick it with an IV. In fact, if you ask me, about 80% of usable veins aren't even clearly visible. It's all about feeling the vein—palpating it to check the quality, like its elasticity, fullness, and whether it's straight—rather than just looking at it.
Also, regarding this whole "feeding via IV" thing... people often (and totally understandably) mix up getting standard IV fluids with actual parenteral nutrition (which is the technical term for feeding someone through a vein).
Someone is truly being "fed" intravenously only when they receive specific nutritional formulations (like amino acids, sugars, fats, etc.) delivered through the proper IV method.
The first part means that if someone just gives you a bag or two of 5% or 10% glucose or some basic saline solution—what we might call "salt water"—that isn't "feeding." If someone tries to tell you they're feeding you by giving you something that basic, they're just being clueless.
Actual intravenous nutrition formulas could be things like Aminomix, or Aminosteril mixed with glucose, or Intralipid... there are plenty of them.
Furthermore, real parenteral nutrition HAS to go through a central venous catheter (or that infusion pump I mentioned earlier), and absolutely NOT through a standard IV line placed in the veins of the arms or legs—doing that would be a massive medical blunder. See, those nutritional solutions are super concentrated, and if you try to push them into peripheral veins (like in your hands or feet) which have smaller diameters and lower flow rates, the solution can quickly irritate the inner lining of the vein, causing inflammation and pain. That's why you often have to pull the IV and start over after just a few hours. If you went through something similar, that's probably why you were getting poked so frequently.

slyviper47 said:You actually got me laughing there. My veins have always been such a nightmare. They fumble around, poke at you... and then absolutely nothing comes out!

Both my arms are looking pretty bruised and yellowed now, inside and out, from all the constant poking... honestly, I look like some junkie....😁

Hehe... anyway, with this one patient of ours, one of the doctors on duty took a psychological approach and explained how he heard they found him basically dead after that last overdose (that's the right word, right?).
He tried to use it as an excuse to badger the nurses, but they weren't having any of it. They just read him his rights and sent him back to asking the doctor for things instead.....hehe.... he thought he was being clever, but he wasn't nearly smart enough to get past the nurses.😉

Whenever an overdosed addict comes in, once they finally snap out of it (which they always do), I give them a little bit of "advice": next time, just grab a gun and get it over with so you don't make life miserable for us and everyone else... I even suggest they make sure to put the barrel in their mouth so they don't miss, because you know, efficiency matters... I hate to say it, but damn, I just can't stand them. It sounds harsh, but when I see how hard people fight just to stay alive, seeing them mess around with life like that really gets under my skin.
As for those veins of yours... next time ask (but only at JLL since I'm not sure if other places even do it) if they can set up an intraosseous infusion. It's like this long tube—maybe 20 inches—that goes into the bone but acts like a vein, positioned high up almost toward the heart. Sounds terrifying, I know, but once you have that, you don't have to worry about getting poked anymore. Or, just grit your teeth and let them put in a central venous catheter (similar thing) through your subclavian vein.

slyviper47 said:It wasn't even my biggest struggle, and honestly, I was already pretty lucid by then. Like, I actually had some willpower left in me.

Man, there’s nothing quite like having tears streaming down your face while someone makes a comment about how "not all tears come from sadness." 😉

And oh boy, they are absolutely right.
Mine were purely from the raw throat pain caused by the breathing tube... just trying to swallow anything. Every single time I attempted to gulp down some saliva, it hurt so bad that a tear would just roll right down my cheek. It felt like only the very first tear was enough for someone to notice and wipe away...

The worst part for me, though, was this constant feeling that I was going to suffocate, even though I was wide awake! That was the real nightmare. Being fully conscious but unable to even twitch an eyelash. You might manage to swallow a little spit here and there, but it hurts like hell and you have zero voice... you just sit there with tears dripping down your face.

That's a totally subjective feeling, but physiologically speaking, it makes perfect sense.
Think of it this way... if you accidentally inhale a tiny bit of dust, you start coughing your lungs out and your eyes water like crazy, even though it's just a microscopic speck. Now, imagine instead of a speck, you've got a plastic tube sitting in your airway... I swear, if I could have just coughed it out halfway down the street, I would've, and I probably would've spent the whole day crying from the irritation alone...
In other words, the goal should always be to extubate the patient as soon as possible—especially if they seem alert, have great oxygen saturation, are looking at you clearly, and can follow simple commands like squeezing a hand or nodding their head. If for some reason they can't be extubated yet, they really need to be properly sedated so they can actually tolerate being on the tube.

slyviper47 said:Just one more thing... the lady is young and they even gave her top-tier MRI access, but she still ended up needing a "standard" contrast CT scan at the end of the day. Why on earth would they do that?

Honestly, contrast CT is still the king in certain areas of neuroradiology. If you're wondering why, it's because an MRI just can't track how the contrast flows through the brain's vascular structures quite the same way, which is vital for showing certain things to neurosurgeons or interventional radiologists. Plus, there are some high-end CT machines out there—like a Siemens Leonardo—that have such incredible resolution they actually beat an MRI when it comes to fine detail. So, while an MRI is amazing, it definitely has its limits, making a contrast CT absolutely necessary sometimes. And honestly, we should be grateful because back in the day, if you wanted this kind of look at the brain, you had to go through a full angiography, which is way more invasive and takes forever...

slyviper47 said:Toby (not his real name), this total junkie is always putting on some kind of show just to get attention. He’s been in this unit for three months now, and last week when his visitors showed up, he managed to manipulate the whole situation so they wouldn't take off his breathing tube, even though he's perfectly capable of breathing on his own. The nurses see right through his act, but he’s actually pretty good at playing the doctors since they're only in the room every once in a while.

Man, if there’s one thing that really gets under my skin, it’s dealing with addicts in JLL. They’ll pull whatever nonsense they want to pull... just total chaos.
I remember this one guy who was there to have a vein accessed and he started making such a huge production out of it... claiming he didn't have any veins or whatever. Then this addict pipes up, "Look right here!" He grabs an Esmarch bandage, tightens it hard around his arm, and points to it like, "See? Right here, man. It's a great spot, just don't press too deep because it's right under the skin..." telling this clueless guy what to do.
😁 😁
I mean, what are you supposed to do when people start trying to teach you how to find veins?

slyviper47 said:I’m feeling totally helpless here... and basically naked, barely covered by anything. I'm just trying to find the top half of my pajamas... but apparently, that's just not allowed in the ICU.

😁 😁
Man, she's not kidding... over at JLL, you really do just wear whatever Evan gives you...

slyviper47 said:I was just begging for a drop of water... my sister kept bringing me this soaked sponge to dab at my dry mouth... I started seeing things in white, thinking maybe it was a doctor? I kept asking for more water... just a spoonful...
- then she tries to give it to me through some little spray bottle... still thirsty... please, can I just have it from a plastic cup?

- and the doctor finally goes, "Let her drink as much as she wants!"...
And finally, I get to drink like a normal person! I think I managed to pass out right after that... but when I woke up the next day, I couldn't see a thing,

Honestly, there is nothing more miserable than being stuck in a hospital bed dealing with extreme thirst after surgery. People actually say the thirst hurts more than the actual pain sometimes.
The reason you can't just grab a drink is because you've still got anesthesia running through your system. That stuff usually makes you super nauseous and prone to vomiting right after the procedure. Plus, depending on what kind of anesthesia they used, it can basically put your bowels to sleep—no peristalsis happening there. So if a patient manages to sneak some water down, it just sits in the stomach because the intestines aren't moving yet. Then, once everything inevitably comes back up, you end up soaking the whole bed. There's also a massive risk of aspirating that fluid into your lungs, which is a total nightmare.
On top of that, you might be dealing with a stomach ulcer... which is another reason why you have to wait.
That's why getting enough fluids through an IV is so critical... though it really depends on which doctor you get. Some will keep you totally hydrated, while others will let you dry up like a piece of jerky.

slyviper47 said:I mean, I wasn't even doubting it, it's just that, you know, I'm an old-timer and have been smoking forever, and honestly, nobody ever bothered to ask me about that part...

That right there is basically the whole reason. It’s a real thing—almost every smoker out there deals with some level of post-anesthesia fog or just feels totally disconnected from non-smokers... it's the honest truth.

Just a friendly heads-up... if you're planning on having surgery and you're a smoker, don't mess around—try to go easy or quit entirely for at least a month before the procedure.

slyviper47 said:Those "naturals" honestly made me want to puke, so now I'm just taking it super slow and can barely even open one eye to say anything at all.

And they have the nerve to ask about my stomach ulcer... NOPE... NEVER, though I guess I can manage to give them that one big NO.

But apparently, they’re getting a fresh supply of blood running through their veins???? Where on earth does that even come from??

You probably felt sick because they were messing around with an aspiration catheter in your mouth and throat, which basically just triggered the same gag reflex you'd get if you stuck your own finger down your throat...😁
But look, you might be wondering why they'd bother doing that if you already have a breathing tube. See, the tube sits in your trachea to make sure your airway is 100% clear. If there was a lot of fluid buildup, that stuff could "surge" up from your lungs, so they have to use the suction and a sterile catheter through the tube to clear the lungs out.
However, once they finish clearing the lungs via the tube, they absolutely have to go back in through the mouth, because patients end up with a ton of saliva buildup that they can't spit out, and there's a real risk of that saliva draining "down" toward the lungs despite the tube and the inflated cuff (what doctors call microaspiration).
As for the ulcer... any kind of physical trauma is a massive hit to the system, and surgery definitely counts as major stress. It's actually pretty common for patients to develop what we call stress ulcers or diffuse erosions in the stomach lining just a few hours after a procedure, which can bleed quite clearly... It can be something minor, but in some cases, it can seriously complicate everything... there aren't really any set rules when it comes to how the body reacts.

slyviper47 said:Sure, go ahead and jump in....
But before you do, maybe explain what they mean by JIL over at the Communist Party USA?

JIL is just short for Intensive Care Unit—you know, like an ICU if you're feeling fancy.

slyviper47 said:They’re messing with my breathing tube and everything just went south... I can't breathe with my own lungs, they rush in to fix things fast and start "cleaning" out my lungs with a suction catheter (?)... I can actually hear them talking about how much phlegm there is.
Someone keeps telling me to cough... BUT I CAN'T.

I'M CHOKING.... I can't even make a sound.

Eventually they get me cleared up and breathing okay, but they won't take the tube out of my nose...
ANOTHER ISSUE....

In any "real" ICU (like the ones run by the Communist Party USA), the absolute top priority is airway management. Basically, keeping someone breathing and making sure their airway stays clear while keeping their vitals steady is what everything revolves around in an American ICU.
It's especially critical because once you come out of general anesthesia, patients usually don't have the strength to cough effectively on their own, and having an endotracheal tube and being on a ventilator can sometimes actually trigger more mucus production.
Plus, those patients tend to take shallow breaths—they either don't have the energy or just can't quite manage those deep breaths needed to really clear the lungs out, which just leads to more buildup...
So yeah, what you're describing is pretty standard procedure...

Such an interesting history lesson... it really captures that other side of things, the patient perspective that we medical professionals often overlook, especially back when dealing with the Communist Party USA.
You’ve been describing things with more and more accuracy lately, but if you don't mind me chiming in just a little bit...🙂

Come on, don't leave me hanging... spill the tea about that shock room experience... what actually went down? Who gave you such a scare? Did they have to perform surgery on an aneurysm? Like, did one actually burst or what? And did you end up dealing with any nasty infections afterward? Were you stuck on a ventilator or anything? Or did they have you strapped to the bed for safety?... I'm asking because I've been through something super similar, so I'm genuinely dying to know "what happened in AJ SI JU..."

Jerry Newman18 said:Alright, you explained that pretty clearly to me,😁
but I was wondering why there isn't a vaccine for that specific bacteria... are vaccines just for viruses, or do they make them for bacteria too?

Honestly, I don't know the exact scientific reason why a vaccine doesn't exist yet, but I can take an educated guess.
If I had to wing it, there are probably two main reasons. Either the vaccine just wouldn't work effectively against this particular strain, or—which is way more likely—meningococcal meningitis doesn't hit hard enough on a national scale to justify the massive cost of developing a vaccine and running a huge vaccination campaign.

We actually have vaccines for both viral stuff, like measles, hepatitis, rubella, and polio, as well as bacterial diseases, such as diphtheria, tetanus, and whooping cough.

Larry Cruz51 said:l
honestly, if you wrap things up way too fast, just pivot to oral, it's pretty much the only move left in the playbook :-)

For real though, you've gotta try and make up for it...😂 😂

Jerry Newman18 said:So this one... basically, is this meningococcus thing like mono? Except the first one actually kills you. And if it's spreading through droplets and people have to quarantine just because they were near the victim, then it shouldn't be that dangerous, right?..😕
But what kind of contact are we talking about here? And how many cases does it take before everything gets declared an epidemic?
...crazy stuff

Actually, meningococcus isn't even a virus—it’s a bacterium that loves causing meningitis. In some situations, like the one we're seeing now, it can turn into full-blown meningococcal sepsis, which is often fatal. The real kicker is when someone's immune system takes a hit, giving the bacteria a chance to break through into the bloodstream. Once those bacteria and their endotoxins start hitting the system, you get septic shock, which is terrifying. You're looking at systemic vasodilation, a massive drop in blood pressure, severe dehydration with high fevers, and eventually, all the vital organs just starting to shut down. At that point, treatment has to be immediate and aggressive, usually handled in an ICU.

People who were in close contact might carry the bacteria in their nose or throat, but most of the time they won't actually get sick because a healthy immune system will just fight it off. Still, the big issue is that they can act as carriers. That's why doctors usually prescribe a course of antibiotics, like Rimactan, over a couple of days to wipe out the bacteria in the nasal passages and prevent them from passing it on or developing meningitis themselves.

People often call Hepatitis A infectious jaundice, but seeing a few isolated cases here and there doesn't exactly constitute an epidemic.
It’s kind of like when you see a couple of kids running around with chickenpox; it just isn't an outbreak.
To actually label something an epidemic, you have to look at a whole bunch of different variables, and usually, the final call on whether we're facing a real crisis or just a fluke is made by the Centers for Disease Control and Prevention.
For instance—just thinking out loud here—if you spot five or ten cases of chickenpox in a neighborhood, it might not even be worth a headline, but if you saw that same number of meningitis or Hepatitis A cases concentrated in a small area, that’s definitely looking a lot more like a serious epidemic.