Not sure what was specifically meant by C.difficile exposure. If it helps, know that most of us are exposed regularly. Approx 3% of healthy adults are carriers (and 8-10% of hospitalized and longterm care residents) , and the spores last a very long time in the environment (months and months). So, anyone who touches things that others have touched is likely to have had regular exposure -- pretty much everyone.

EPIC SR review post from First10EM (EBM FOAM-Ed site)

Long-term outcome data is harder to evaluate and will take time. It will come. I mean, insurance doesn't generally pay for expensive meds that maybe might work for a particular indication but haven't been evaluated. Especially in a publicly-funded system, where costs and adverse-events on a population level can be huge. In non-pandemic-emergency conditions, I don't think that Paxlovid would ever have been approved in the first place. I agree wholeheartedly that more research into long-term sequelae is needed.

It's true though that doctors don't have to accept a previous doctor's diagnosis. They usually do; because starting from scratch every time would be inefficient and wasteful and completely impractical. But each doctor is responsible for their own assessment and disposition, and that includes scrutinizing past medical history. Differences of opinion are common. EMR's are famously full of errors, and erroneous diagnosis have a way of being sticky and persisting through copy-pasting by rushed clinicians. "Trust no-one, believe nothing, not even the EHR". It's also true that misuse and diversion of prescribed stimulants is common, especially on college campuses; this is supported by the literature. In a litigious environment like the US, MD's really are stuck with defensive practice. From the other side of the gurney: One of my most awful career moments was getting a call from a coroner asking me about a Rx for a controlled ADHD med that I had written for a pt with a reasonable, believable story. It had been diverted, with a fatal outcome. The reasonable-sounding story was a set-up, and I got caught. I am now a controlled-medication defensive hard-a$$.

Adding: I don't see any food safety concern if re-brewing within a day or two. It's damp leaves. No different than any other plain cooked vegetable regarding food safety risk. Also, preparation involves submersion in boiling water, further decreasing risk.

The second brewing will be less delicious and less caffeinated. I sometimes re-brew loose leaf tea, but not teabags. I don't have a logical reason for why.

TC5 here, since the fall. Thread: Which Speed Queen Do I Want? I've been happy with it. It's super fast, and quieter than my old toploader. Clothes are clean. Works just fine on my non-slab floor. Much better balanced than my old one. Only drawback: It's not as flexible as my old completely analog 1990's era Maytag toploader that I could start at any point in any cycle or switch to a different program mid-cycle, or repeat bits of cycles by cranking the mechanical dials (usually would do this mid-wash when I wanted to add another forgotten item, and could restart the cycle without draining and refilling). The SQ runs complete programs that can't really be switched on-the-fly. But that's not a big deal.

It absolutely will. CBC article from today: Who needs Paxlovid now? New guidelines suggest only highest-risk groups should get COVID drug; Recommendations for provincial drug plans feature narrower definition of who should qualify Source document: CADTH Reimbursement Recommendation Thought I'm don't think that's a bad thing. It's a very expensive drug. If it doesn't work (and the evidence suggests it doesn't for standard risk people), then it isn't a good use of public money to pay for it. That money could be put to better use elsewhere.

WHO is attempting to redefine terminology for pathogens that transmit through the air: getting rid of the old "droplet" vs "airborne" IPAC categories, and replacing them with new terminology based on how infectious particles actually behave, rather than based on particle size. Also an attempt to standardize terminology across academic disciplines. This is long overdue. WHO Global Technical Consultation Report on Proposed Terminology for Pathogens that Transmit Through the Air CBC News summary, with some context.

Indeed.

2. Steady speed in the right lane, on the slow side, but with the flow of traffic, passing when necessary. I try to find the balance between not speeding and not being the cause of turbulent traffic flow. Husband has evolved from 3 to 2. He knows that I regularly deal with injured people from MVC's (ranging from minor to dead) at work, and respects that.

Paxlovid news: EPIC-SR was finally published in NEJM. Negative outcome. I haven't combed through it yet.

Another eclipse tangent: Niagara Falls, Ontario, has declared a state of emergency. They anticipate a million visitors

I think that it's worth noting that mass psychogenic illness is a very real thing, with very real symptoms, and causes very real suffering. I'm not so quick to dismiss it.

"Adrenal fatigue" is not recognized by mainstream evidence-based medicine as a legitimate medical condition and is not supported by best scientific evidence. It falls well within the realm of alternative/complementary/wellness med. You will likely get lots of advice recommending various pricey supplements of unproven value. Which is fine if that's an approach that works for you. I think that the best thing to do is tho see your own doctor first. (My biggest worry is that people who attribute symptoms to "adrenal fatigue" risk missing another underlying condition that may be treatable)

These are the kits that are available at pharmacies and public health units here. Contains intranasal narcan x 2, gloves, CPR face-shield with filter, and instructions:

This fellow woke up slowly and pleasantly. I felt much more threatened by street-buddy who showed up mid-way through. I think administration by bystanders is a little different to a professional context. As a bystander, I am free to leave at any time if I feel my safety is threatened. Much different that being in the back of an ambulance or in the ED where I have a duty of care (hence security staff ready with restraints if needed) It's true that some people wake up angry (not common) , but, IME with narcan in the hospital, it's very, very rare to go directly from blue and not breathing to swinging without an intermediate phase of breathing but still pretty snowed. I think it would very unlikely for a bystander who administered narcan to need to immediately jump out of the way --- you would get clues that the poisoned person is starting to wake up before they swing, and intranasal narcan takes a few minutes to work.

I had poutine (the real kind: fries topped with fresh cheese curds and gravy) for supper tonight! I have nothing else to add to this thread. Carry on. 🙂

Thanks for all the responses everyone. I was a bit wound up afterward about it having happened while the kids were with me. There was nothing heroic about it, really. No sacrifice, no putting myself in danger. Just wet knees from kneeling in snow. More serendipity than heroics: right place at the right time with the right training and the right stuff in my purse.

Here, it's publicly funded. Free for anyone to pick up a narcan kit at any pharmacy. No prescription, or even documentation, required. Good Samaritan laws apply. When someone is who unconscious or incapacitated requires life-saving emergency care, consent is generally presumed. ETA: intranasal narcan administration is super simple: just spray it up the nose. It's pretty impossible to mess it up. Risk of harm from administering to an unconscious person is zero.

As I noted in the what’s in your purse thread, I carry narcan and epinephrine in my purse. Until tonight, I have never used either in the community. We are staying in downtown Toronto for kids sports tournament. Stepped out of our hotel at about 9 PM tonight to get food. We’re situated right downtown, walkable to sports venue at a nearby university ,on a very busy main street with lots of pedestrian traffic. We didn’t even get 100 feet down the street before practically tripping over a guy laid out on the sidewalk, blue, not breathing. A few bystanders had arrived just before me, and had already called 911 but had not yet started first aid. He had a good pulse, but was blue and not breathing at all. Pinpoint pupils. Administered Narcan internasal x two and from my purse and did some very basic airway management. By the time the EMS arrived, he was breathing nicely, had much better color, and was starting to talk a little bit. I’m met a very nice tourist from Qatar and her two ? Daughters or ? Nieces who were the first bystanders to stop and call 911. We chatted a bit on the sidewalk afterward,. I didn’t get their contact information, which I regret. The most difficult part of the whole thing was redirecting an aggressive and apparently intoxicated bystander, who arrived later and kept shouting “he needs Narcan!” (which had already been administered and was starting to work), screaming he was going to “overheat and die” and kept trying to push a hat full of snow onto poor victim’s head. Maybe a buddy? I’m not sure.. Small chance of overheating, our guy was laid out on a sidewalk covered with snow at -5C. It was cold! I was with husband, and 14 and 16-year-old sons. Husband shooed the kids back to the hotel. 14-year-old was peeved; he had wanted to stay and help. I have mixed feelings about this; part of me is glad they have seen what an opioid overdose looks like, but I’m not sure I would have wanted them to have stayed to witnessed a poor outcome/death if it had gone that way. I’m going to need to restock my purse. ETA: this is the first time I have ever run across a not-breathing person in the community and the first time I have ever administered Narcan outside a hospital setting. I am very glad that it was in my purse.

Quoting mysellf because I used up the narcan tonight!!!!! I’m going to make a new thread about it.

I am your knife twin. I also used to carry a small swiss army knife, but stopped for the same reasons (including accidentally bringing it into the court house, but it got caught and and it got confiscated. Embarrassing!). My knife also now live in the car.

8x9 inch cross body bag. pen small notebook mask narcan kit epipen tissue packet ear buds CO2 monitor bandaids small amount of cash lip balm (ETA forgot about the hand sani! It's in there too.) Narcan and epipen get the least use, but I carry them on principle for emergency use. Tissue and cash get very little use, but when I need them I really need them, so they stay. Bandaids got more use when the kids are little. They could probably go, but a few bandaids take up negligible space, so they stay. Everything else gets used regularly. Wallet, phone, and keys go in pockets. There is room in the purse for these for rare circumstances when pockets don't work.

Is anyone aware of any prospective randomized trials of paxlovid for long covid/PCC? One of the problems with all the observational cohort studies that I'm seeing is that the selection bias is huge. People who seek paxlovid treatment may do better than those who don't, but that may have nothing to do with the paxlovid itself -- those who seek paxlovid were likely to have better outcomes regardless. Paxlovid seekers tend to be health-aware, and have the resources to get a test, see a provider, and fill a script, all within a 5 day window. Those seem like small things, but are indicators of social determinants of health that are tied to good outcomes, which is huge.