There are lots of rapid infusion machines that claim to achieve 1000 mL/min or more. There are not a lot of IV's through which you can put 1000 mL/min without rupturing the vein, the IV catheter, or both.
Once you've bothered to tether them to a dialysis machine (and I'm not sure even they could handle this kind of volume), why not just put them on a real ECMO/CPB? Neither one is small enough to travel with you.
And in that ten minutes, in the field, do you have the kind of IV's that can put that kind of volume into a human body? Do you have access to a bunch of (properly stored!) bags of this fluid? No. You have neither. And saving that person for ten minutes is going to take between three and five liters of the stuff.
It is perhaps somewhat difficult for the average person to appreciate how abysmal our success is with coding people even when it happens in an operating room with monitoring equipment to tell us the moment something goes wrong. In the field? Ask any paramedic for stories of the places they've gotten called to, or any ER doctor who's worked small towns about the various degrees of rigor mortis that "found down" patients are known to exhibit. Now, if they get the density up, great, maybe this can have a role some time, but this is a long, long way from being clinically useful.
You have no choice but to use cardiopulmonary bypass for the reasons I outlined elsewhere - briefly, this method administers oxygen but cannot clear CO2, and in order to administer adequate O2 you're going to need a very, very, very high-volume venous access. Unless you can do a heart-lung transplant in 20 minutes of cross-clamp time, it's not getting you anywhere.
No. The volume requirements alone will rapidly render this useless. To supply an adult human, you would need 300-600 mL of infused volume per minute. Given that an adult has a blood volume of roughly 5 L, you can imagine that you're going to run into problems pretty quickly.
You can't turn CO2 + H2O into O2 + C(H2O) efficiently unless you're a plant, and you'd have to get the CO2 out of solution quickly (easy) and get more O2 back into solution quickly (hard).
Rebreathers just scrub CO2 from the atmosphere and lock it up as a carbonate. They need not be particularly large, though - the CO2 scrubber on the GE (Datex-Ohmeda) ADU Carestation is about the same size as a pint glass. The rest of the system is the bulky part, and in most situations could actually be done without.
The experimental solutions contained 50-90 mL of O2 per deciliter - to sustain an adult human, you need about 300 mL O2 per minute. At least 300 mL of IV fluid and as much as 600 mL per minute is going to have to go through one hell of an IV. I doubt you could achieve such infusion rates without specialized equipment (e.g., 8.5 French rapid infusion catheter + Level One pump) or multiple intraosseous needles.
Furthermore, this is temporizing just like any other O2 delivery method. Oxygen is essential for life, but eventually you have to clear the CO2, or it's pointless. As a bridge to a secure airway or crash on to cardiopulmonary bypass? Sure, it's not a bad idea, except that the only thing that matters in that kind of life-or-death situation is how long it takes to get it in the room. By the time you get this stuff out of the refrigerator in pharmacy and run it to the OR, ER, or ICU, you could have gotten a surgeon there to do the cricothyrotomy or even a proper tracheostomy.
I'm a practicing anesthesiologist in the United States. My first job out of residency was running a day surgery center that was over 50% orthopedics. I understand the treatment of surgical and postsurgical pain. I know how to create a proper balance of analgesia (pain relief) and anesthesia (loss of response to surgical stimulation) and amnesia (not remembering things you'd just as soon forget).
It sounds to me that you have been told about a very common method for dealing with pain after joint replacement and assumed that it was a generally good plan for most anesthetics. It's not. Here's why.
That "spinal for pain" is - when we're talking about joint replacements - usually 200 micrograms of morphine. It's not a "spinal anesthetic", which would be a local anesthetic agent like bupivacaine or lidocaine injected into the fluid around the spinal cord in order to make someone surgically numb; instead, it's there to work on the receptors in the spinal cord that prevent pain from being transmitted upward. As a downside, it does cause itching in the majority of people. You can't give them to people who are taking blood thinners (there's a risk of a hematoma developing in the epidural space and causing paralysis if it's not noticed and corrected in time). You can't use it for outpatients, because it does carry a risk of respiratory depression. Patients who get it can't have a patient-controlled-analgesia (the press-a-button-for-morphine pump) for the first 12-24 hours.
For those who are having arm/shoulder or foot/ankle surgery, a peripheral nerve block is by far the superior choice, but there are certain cases where it can't be used, and others where the risk-benefit balance means it's not worthwhile. In the military, they often leave catheters in place to pump local anesthetic into the peripheral nerve block for a couple of days, but they have the benefit of people who are under regulations and meet certain minimum standards. In private practice, most insurance companies won't pay for one, and I don't trust most people to use them correctly even if they were paid for - you can really, really mess someone up with one if it's not managed correctly, and my experience with epidurals (which are the most common place in which continuous infusions of local anesthetics are used) has shown me clearly that a large portion of people just don't understand the idea of not ever moving or disturbing the place where the catheter enters the skin.
BTW, most people who come out of surgery "changed" are those who have been on cardiopulmonary bypass. It's a known risk.
I can assure you that in my case, it's tax dollars. Even if it were cents, though, it's still leeching. Just because there are more than 300 million of us to split the bill doesn't mean that you're not taking someone else's money and spending it on yourself with no intention of giving ROI.
As for your job, it sounds to me like you didn't need a bachelor's degree to do it. (You might need one to get it, but that's a rant for another time.) So tell me why it was the job of your fellow Americans to subsidize you and your coworkers while you spent four or more years learning philosophy, art history, or sociology, just for you to turn around and start doing the kind of job you could have started doing straight out of high school. I'm sure that you enjoyed and benefited personally from college, but when applied to society as a whole, the question is: did you benefit from it enough to make it worthwhile? And that rapidly turns into: how much more money will you make?
If you're taking my tax dollars to study something that won't make you more productive, you're a leech. People who want to party for four to six years and major in something bullshit can either pay for it themselves or convince their parents (or someone else) to.
Just because schools operate as not-for-profit enterprises does not mean that people don't make money off them. Administrators like bigger budgets and paychecks.
Well, duh. They're giving away the stuff that's now much less valuable - the talk and text - and killing you on data charges. This is obviously not a good plan for you.
No, their requirements don't say that they make no exception for homeschooling. They don't say anything about homeschooling at all. At least, not on the pages you linked to.
He was nine at the time. You're going to be blazing a new trail when you do that no matter where. State universities get hung up by rules. Private ones can bend them.
Peds neuro is decently compensated, though it's definitely not up there with the surgical specialties. And some surprisingly small cities support pediatric hospitals - a friend of mine works in one in Temple, Texas.
Slashdot Mirror
There are lots of rapid infusion machines that claim to achieve 1000 mL/min or more. There are not a lot of IV's through which you can put 1000 mL/min without rupturing the vein, the IV catheter, or both.
There's nothing here to carry CO2, and the total volume starts to be a big problem.
Once you've bothered to tether them to a dialysis machine (and I'm not sure even they could handle this kind of volume), why not just put them on a real ECMO/CPB? Neither one is small enough to travel with you.
Planning to stick needles into both of their carotid arteries at the same time? If it were easy, we'd already be doing it.
And in that ten minutes, in the field, do you have the kind of IV's that can put that kind of volume into a human body? Do you have access to a bunch of (properly stored!) bags of this fluid? No. You have neither. And saving that person for ten minutes is going to take between three and five liters of the stuff.
It is perhaps somewhat difficult for the average person to appreciate how abysmal our success is with coding people even when it happens in an operating room with monitoring equipment to tell us the moment something goes wrong. In the field? Ask any paramedic for stories of the places they've gotten called to, or any ER doctor who's worked small towns about the various degrees of rigor mortis that "found down" patients are known to exhibit. Now, if they get the density up, great, maybe this can have a role some time, but this is a long, long way from being clinically useful.
You have no choice but to use cardiopulmonary bypass for the reasons I outlined elsewhere - briefly, this method administers oxygen but cannot clear CO2, and in order to administer adequate O2 you're going to need a very, very, very high-volume venous access. Unless you can do a heart-lung transplant in 20 minutes of cross-clamp time, it's not getting you anywhere.
No. The volume requirements alone will rapidly render this useless. To supply an adult human, you would need 300-600 mL of infused volume per minute. Given that an adult has a blood volume of roughly 5 L, you can imagine that you're going to run into problems pretty quickly.
You can't turn CO2 + H2O into O2 + C(H2O) efficiently unless you're a plant, and you'd have to get the CO2 out of solution quickly (easy) and get more O2 back into solution quickly (hard).
Rebreathers just scrub CO2 from the atmosphere and lock it up as a carbonate. They need not be particularly large, though - the CO2 scrubber on the GE (Datex-Ohmeda) ADU Carestation is about the same size as a pint glass. The rest of the system is the bulky part, and in most situations could actually be done without.
The experimental solutions contained 50-90 mL of O2 per deciliter - to sustain an adult human, you need about 300 mL O2 per minute. At least 300 mL of IV fluid and as much as 600 mL per minute is going to have to go through one hell of an IV. I doubt you could achieve such infusion rates without specialized equipment (e.g., 8.5 French rapid infusion catheter + Level One pump) or multiple intraosseous needles.
Furthermore, this is temporizing just like any other O2 delivery method. Oxygen is essential for life, but eventually you have to clear the CO2, or it's pointless. As a bridge to a secure airway or crash on to cardiopulmonary bypass? Sure, it's not a bad idea, except that the only thing that matters in that kind of life-or-death situation is how long it takes to get it in the room. By the time you get this stuff out of the refrigerator in pharmacy and run it to the OR, ER, or ICU, you could have gotten a surgeon there to do the cricothyrotomy or even a proper tracheostomy.
No, it's not useful for those. You already have an established airway for those. And in CF, the lungs aren't often the killer, these days.
Usenet certainly worked that way at a lot of sites for a long time.
I'm a practicing anesthesiologist in the United States. My first job out of residency was running a day surgery center that was over 50% orthopedics. I understand the treatment of surgical and postsurgical pain. I know how to create a proper balance of analgesia (pain relief) and anesthesia (loss of response to surgical stimulation) and amnesia (not remembering things you'd just as soon forget).
It sounds to me that you have been told about a very common method for dealing with pain after joint replacement and assumed that it was a generally good plan for most anesthetics. It's not. Here's why.
That "spinal for pain" is - when we're talking about joint replacements - usually 200 micrograms of morphine. It's not a "spinal anesthetic", which would be a local anesthetic agent like bupivacaine or lidocaine injected into the fluid around the spinal cord in order to make someone surgically numb; instead, it's there to work on the receptors in the spinal cord that prevent pain from being transmitted upward. As a downside, it does cause itching in the majority of people. You can't give them to people who are taking blood thinners (there's a risk of a hematoma developing in the epidural space and causing paralysis if it's not noticed and corrected in time). You can't use it for outpatients, because it does carry a risk of respiratory depression. Patients who get it can't have a patient-controlled-analgesia (the press-a-button-for-morphine pump) for the first 12-24 hours.
For those who are having arm/shoulder or foot/ankle surgery, a peripheral nerve block is by far the superior choice, but there are certain cases where it can't be used, and others where the risk-benefit balance means it's not worthwhile. In the military, they often leave catheters in place to pump local anesthetic into the peripheral nerve block for a couple of days, but they have the benefit of people who are under regulations and meet certain minimum standards. In private practice, most insurance companies won't pay for one, and I don't trust most people to use them correctly even if they were paid for - you can really, really mess someone up with one if it's not managed correctly, and my experience with epidurals (which are the most common place in which continuous infusions of local anesthetics are used) has shown me clearly that a large portion of people just don't understand the idea of not ever moving or disturbing the place where the catheter enters the skin.
BTW, most people who come out of surgery "changed" are those who have been on cardiopulmonary bypass. It's a known risk.
Bush went into Irak for oil
Since you write this, I'm going to assume you're a total fucking idiot. Price of oil on 9/10/2011 vs today? Yeah, we totally invaded Iraq for oil.
I can assure you that in my case, it's tax dollars. Even if it were cents, though, it's still leeching. Just because there are more than 300 million of us to split the bill doesn't mean that you're not taking someone else's money and spending it on yourself with no intention of giving ROI.
As for your job, it sounds to me like you didn't need a bachelor's degree to do it. (You might need one to get it, but that's a rant for another time.) So tell me why it was the job of your fellow Americans to subsidize you and your coworkers while you spent four or more years learning philosophy, art history, or sociology, just for you to turn around and start doing the kind of job you could have started doing straight out of high school. I'm sure that you enjoyed and benefited personally from college, but when applied to society as a whole, the question is: did you benefit from it enough to make it worthwhile? And that rapidly turns into: how much more money will you make?
If you're taking my tax dollars to study something that won't make you more productive, you're a leech. People who want to party for four to six years and major in something bullshit can either pay for it themselves or convince their parents (or someone else) to.
Just because schools operate as not-for-profit enterprises does not mean that people don't make money off them. Administrators like bigger budgets and paychecks.
Reread his comment. They already figured this out; they didn't need GWB to point it out to them.
Counter-example: Libya.
The "bath salts" are/were amphetamine/cocaine substitutes. Not cannabinoids.
Well, duh. They're giving away the stuff that's now much less valuable - the talk and text - and killing you on data charges. This is obviously not a good plan for you.
Yeah. It's a base price you can't escape.
With free unlimited talk and text. Don't forget that; it's what makes this pricing feasible.
No, their requirements don't say that they make no exception for homeschooling. They don't say anything about homeschooling at all. At least, not on the pages you linked to.
He was nine at the time. You're going to be blazing a new trail when you do that no matter where. State universities get hung up by rules. Private ones can bend them.
He went to a private university. They're not bound by (most) rules, certainly not ones like requiring a GED.
Peds neuro is decently compensated, though it's definitely not up there with the surgical specialties. And some surprisingly small cities support pediatric hospitals - a friend of mine works in one in Temple, Texas.