What’s Eating Our Kids? Fears About ‘Bad’ Foods – NYTimes.com

What’s Eating Our Kids? Fears About ‘Bad’ Foods – NYTimes.com

I’m all for trying to eat healthy.  Low fat, low sodium, easy on the processed food and trying to keep white sugar to a minimum.  I’m not exactly successful some days.  Others, not so bad.  It’s sad though when kids  get so fixated as displayed in the article.  On the flip side, my wife once took care of a child who would only eat chicken tenders and ramen, the complete opposite of healthy.

I think this quote sums up the article best though:

“It’s a tragedy that we’ve developed this moralistic, restrictive and unhappy relationship” with eating, she said. “I think it is making kids nutty, it’s sucking the life out of our relationship with food.”

Bon appetit!

Ventricular Bi & Trigeminy

PVCs are a fairly normal thing.  Sitting right here typing this out, I felt one, it’s kind of like your heart skips a beat.  Usually they are benign, but when you have sustained bursts of sequential runs of PVCs as a nurse we need to do some research and know the reasons why your patient is having these.

First, ventricular bigeminy

click for largerIn ventricular bigeminy, every other beat is a PVC.  This is usually caused by an irritable foci within the ventricle firing early, in this case, over and over again.

Second, ventricular trigeminy.

click for largerAs you can see, every third beat is a PVC followed by a compensatory pause and then the cycle starts again.  Once again, an irritable foci within the ventricle is firing off early.

In both cases above, the PVC is followed by a compensatory pause that allows the SA node to rest the cycle.  Also, it appears that in each case, it is a single irritable foci that is firing as the complexes are the same in each strip.  Among the causes of PVCs are:  ischemia, hypoxia, hypokalemia, hypomagnesemia, hypercalcemia, digoxin, cocaine, alcohol, tobacco, cardiomyopathy, MI, mitral valve prolapse and several others.   One of the old school nurses I worked with was saying how back in the day, anytime a patient had more than 6 PVCs a minute, they got started on a lidocaine drip.  Not so much anymore.

If this were my patient, I would double check to make sure they’re maintaining a blood pressure and feeling OK, then make sure their electrolytes get checked.   That is assuming there wasn’t some sort of event, like an MI, occurring.  Typically treatment is either treat the underlying problem, like repleting electrolytes, or do nothing.  Antiarrhythmic medications typically are not used as the side effects can be worse than the problem they are trying to treat!  (See info on the CAST trial for a good illustration.)

The key comes down to this:  how does your patient look?  As with many arrhythmias, sometimes the true measure of what the squiggly lines are saying about your patient is what you patient is telling you.  If they’re doing just fine, then no worries, if not, you need to do some digging!

eMedicine: Prematue Ventricular Contraction

Wikipedia: Premature Ventricular Contraction

Ah, memories

I was looking through my saved pics on my hard drive and came upon a couple old gems from the days when I worked as loadmaster.  Our motto was, “Whaddya’ mean it won’t fit?!”  We had skills to go with the swagger too.

980530-004

Oilfield Equipment Bound for SE Asia

If memory serves, this hung about 7 foot off of each end making the whole thing about 35 foot long.  But that’s why you can raise the nose on a 747!

Got Turbine?

Got Turbines?

These were gimball mounted thrusters going onto a ship of some variety.

The Easy Part

The Easy Part

The hard part was the tail boom and rotor section on this Huey.

By the Dawn's Early Light

By the Dawn's Early Light (click to enlarge)

In spite of everything that I hated about that job, long odd hours, way too much responsibility (I signed off that the load was correctly balanced and loaded), too much stress and no opportunity for advancement, this is why I loved that job.  There is nothing like the full-throated roar of a fully loaded 747 at lift-off.  Just thinking about it still gives me chills.

Evolution

We don’t often get to see evolving MIs.  Usually they go to cath lab and the ICU so serial EKGs are not available.  In this case, intervention had already been attempted but due to the nature and type of lesion no intervention was possible.  In a case such as this, surgical revascuarlization was the primary modality, but due to multiple co-morbid conditions including age, severe aortic stenosis (valve area in range of 0.55 cm²) and general deconditioning none of our surgeons would touch them.  Notice the subtle changes especially through the precordials.

20:00, Day 1

Click for larger image

So, what do we see? First, Q-waves in leads V1, V2 and V3.  Second, ST-elevation in V1 and V2.  Third, ST-depression in V4 (slight), V5, V6 and flipped T-waves in Leads I and aVL.  Also present is probable left atrial enlargement and  Left Axis Deviation with an axis of around -30°.  Based on this you could theorize that the LAD and Circumflex arteries have some sort of lesion.  The patient is actually hemodynamically stable at the moment.  Previous to this, they had been in atrial flutter with a rate of 110-130’s with some instability.  The cardiologist who was on the floor at the time decided to cardiovert the patient, but as we were prepping to do so they spontaneously converted back to sinus rhythm.  Teetering on the knife edge of stability they enjoyed a nice nap thanks to the Versed we had pushed while prepping for the cardioversion.  It was a reminder to follow the checklist, including ensuring that the patient is still in the rhythm you’re going to shock them out of prior to giving drugs and shocking.  The cardiologist in the last rhythm  check notices that it looks different and at that very moment the tele tech comes running in saying, “They’re in sinus!  They’re back in sinus!”

Next, 24:00 Day 1, patient c/o 5/10 substernal chest pain.

click for larger image

Nothing too different, although you could say that there is a slight elevation in V3.  The other leads actually look a little better, especially the lateral leads.  No change to axis.  This was after one SL nitro though, so that dilation may have helped, one reason we try to get a 12-Lead prior to giving nitro.

06:00, Day 2

click for larger image

Now there appears to be ST-elevation in V3.  The lateral leads have calmed down, with just a touch of depression in V5, V6 and I, with flipped T-waves in aVL.

14:00, Day2

click fo larger image

Kind of ugly now, eh?  Now we have questionable Q-waves in V1-V4 (there is a pip right before the wave drops), but fairly significant ST-elevation in the precordials.  Depression and inverted T’s in the lateral leads has returned.  Again this was during an episode of chest pain.

Later that night the patient started to decompensate fairly rapidly.  They had a drop in LOC accompanied by a drop in SPO2 to the low 80’s on 15L non-rebreather.  Lungs we very wet, obviously filling with fluid.  The nurse called the on-call cardiologist who ordered 80mg of Lasix IV, in addition to the 60mg given previously during the day that only got an output of 200ml.  Everything was starting to shut down.  We ended up calling a RRT to get a doc at the bedside, if nothing more than to see if there was anything within the patient’s advanced directive to help.

About a week prior to this, the patient had gone to the cath lab in the failed attempt mentioned above.  Angiography show a 99% occlusion of the left main and distal disease in the RCA, LAD and circumflex arteries.  The left main lesion was so bad that they interventionalist was unable to even pass a wire through, which means it was very, very tight.  They minimal blood flow the heart and absolutely no reserve.  With that in mind, the doc on the RRT realized that we could not fix the underlying problem that was causing the distress.  She spoke with the patient’s family who in the end realized that the patient didn’t have much longer, and made the patient comfort care.  They ended up expiring about an hour later.

Looking at these EKGs one could argue that the ST-elevation is actually LVH with a strain pattern. It certainly fits the criteria, especially when considering the patient had endured previous infarctions and had aortic stenosis, but I’m not completely convinced.  I’m no cardiologist, so I’m going with what I know.  But I am open to other suggestions.  It’s a sad case, especially as the family was still saying how they wanted to talk to the surgeon about open heart surgery the morning of Day 2.  Luckily, we were able to use the means available, notably medication, to give some comfort at the end for the patient, even if we couldn’t’ fix what was wrong.

Voodoo Medicine Man: An Excellent Email Thingy

Voodoo Medicine Man: An Excellent Email Thingy

I’m sure many have seen this, but it needs to be shared.

While I do have liberal tendencies, the stimulus plan scares the hell out of me.  History has shown that stimulus plans don’t work.  As much as many liberals point to FDR’s New Deal as the force that pulled us out of the Great Depression, the truth is that it wasn’t until we entered the war that our Depression truly came to an end.  Yes, the New Deal did a great many things that helped us along the way, as does the stimulus package, but there were failures along the way as well.  We’re mortgaging our children’s children’s futures to help us now and you can only borrow from Peter to pay Paul for so long before something comes due.

For some interesting reading check out:

From the Wilderness and Act 2.

I don’t necessarily agree with many of the opinions contained in the former (mostly their 9/11 analysis) but it has some good stuff, but the analysis in the latter is really the better of the two and has some pretty good with some good food for thought.  I have a decent understanding of economics and geopolitics, at least enough to get me in trouble, but these guys have it nailed down fairly well, from certain point of view.

No more politics.  Back to EKGs and nursing stuff.

JFS: Government-oversight of healthcare — End of discussion?

Junkfood Science: Government-oversight of healthcare — End of discussion?

Sandy over at JFS examines in great detail the language and some aspects of health care directives inserted into the stimulus package that just passed through Congress.  TPTB (the powers that be) were able to insert these directives with a minimum of public discussion as they were attached the stimulus package.

To my brief read of this one analysis it seems that the foundations of both health care rationing and governmental control of our health are being laid within this bill.  There are ominous terms in here like “biosurveillance”, EMR integration into a federal database, evidenced based practices for community health, all of which seem like they “good” things when looking at it with a naive eye as it sounds like a good thing to do:  surveil those with chronic conditions to enhance their health, share medical records electronicaly across providers, but in reality these start to restrict our freedom as every move is tracked.

Maybe I need to adjust my tinfoil hat, but I have grave misgivings about this kind of federal oversight.  On the other hand, “I welcome our new electronic overlords.”

Just go read it.