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wathe

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Everything posted by wathe

  1. 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:
  2. 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.
  3. 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. 🙂
  4. 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.
  5. 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.
  6. 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.
  7. Quoting mysellf because I used up the narcan tonight!!!!! I’m going to make a new thread about it.
  8. 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.
  9. 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.
  10. 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.
  11. It is formally indicated for acute covid illness. Prescribing for prevention of long covid is pretty far off-label, and would be a speculative practice. Also maybe not medicolegally defensible (outside of a clinical trial) if there is a poor outcome. I'n in a non-US healthcare environment though. We are prescribing a lot less paxlovid here than in the US, I think, with tighter qualifying criteria.
  12. Yes, acute covid. I think that the long covid data is still very mixed. I haven't seen anything that I would consider convincing. Lots of observational studies, mostly with self-reported data, with both positive and negative outcomes. To be fair, this will be near-impossible to get great data on -- PCC definition is very broad, and includes many subjective symptoms, with pathophysiology not yet well defined (and I think long covid/PCC term probably covers a number of different things, each not yet well defined, and perhaps with different underlying pathophysiology) -- it's still a bit of a messy basket of who knows what.
  13. Recent-ish evidence summary. I personally (50's, vaccinated, otherwise healthy) wouldn't take it.
  14. HHMI has a ton of free educational videos and interactive learning tools. They are meant for use in classrooms, but are available to anyone. " Your Inner Fish", "Your Inner Reptile" and "Your Inner Monkey" are interesting and very good, and not didactic. You can search the videos by topic (evolution, earth science, etc). Berkeley's Understanding Evolution materials are great BIg History Project has topics laid out nicely For a big picture summary, Bill Bryon's A Short History Of Nearly Everything covers history of life and history of the planet in an engaging way (library). Also, for big picture summaries, there is a surprising amount of good information about geological time on Wikipedia and Britannica Stephen Jay Gould's popular science essays/books are interesting and not at all didactic - a way to learn without feeling like you are studying . You might enjoy them? Not free, but sure to be at your public library. BBC In Our Time has done a lot of prehistory episodes.
  15. This happens all the time. You quickly learn to ask about medical conditions in at least 3 different ways when taking a history, and even then will miss some. People often say "no" when asked if they have any medical conditions, even when they clearly do. Then, when asked about medications, will produce a list of medications as long as my arm, with meds for at least 5 different chronic medical conditions. Which I will then guess at based on the meds, and the patient will then endorse. Or worse, when asked about meds, will say "Oh, yes, quite few," but not have brought them or be able to name them. Or will name medical conditions that they actually don't have (often occurs when pt uses medical vocabulary that means something different than the patient thinks it does - not blaming patients here, medical terminology can be complicated). All.the.time. Always believe the patient. But also, patients (and families) sometimes say things that are objectively wrong. It's not always easy to find the balance.
  16. Yes. I would be very, very surprised if there weren't one on board. More likely that they failed to find it, or there was miscommunication. Resusc in the air by volunteers is seriously stressful, and errors are inevitable. Volunteers don't know what equipment is on board, or where to find it. And are working in a seriously challenging environment, often well outside their usual scope of practice. I really do think that airlines need a better plan than relying on volunteers. I would love to see an airline medic type role, staffed on commercial flights - someone medically trained who can lay medical eyes on the medically distressed person, get a set of vitals, start an IV, do chest compressions, manage an airway, administer meds, and expertly communicate with base MD on the ground (both of whom know what resources are available equipment-wise and medication-wise, and are familiar with all the aviation angles - both practical and policy.procedural). Particularly on large overseas flights where diversion may not be possible. That would be so much better than hoping there is a medical professional on board with the right skills willing to step up (and then the flight staff having to trust to that -- that the person who steps up actually knows what they are doing. People who are pushed out-of-scope in emergencies sometimes do very dumb things, and bystanders will defer to their authority). There are probably a million legal and jurisdictional and financial reasons why this will never happen, and airlines will just continue to lean on the goodwill of volunteers instead.
  17. I am surprised that there wasn't an Ambubag or other BVM on-board. It's usually stored with the AED (NOT in the medical kit) Video of Air Canada medical kit. BVM is mentioned at the very end.
  18. @Eos I'm glad that your daughter stepped up to help, and I'm glad that there was a good outcome. I hope she is OK. Resuscitation can be traumatic for responders (both professional and lay-responders alike) and witnesses. Peel Regions's Lay-Responder and Bystander Resource Guide is excellent.
  19. I've volunteered to assist in on-board medical emergencies, and I know a bit about Canadian standards (apparently very similar if not identical to US), and no, and AED is not required. But most airlines carry one, as well as a lot of other medical equipment that's not required. Canadian standards require a Canadian standard emergency medical kit (section 725.91, copy-pasted at end of post) for flights with greater than 100 passengers. This is in addition to first-aid kits, which contain very basic supplies, required for all flights no matter how many passengers. Air Canada and West Jet have great kits (with both AED and glucometer). CMAJ ran a great article few years ago, with photo and table listing contents of the actual kits carried by these airlines. Which I happened to have read a few weeks before an international flight that had a medical emergency happen mid-flight over the Pacific. This is actually a thorny issue in the medical community. We have an ethical obligation to assist (but, interestingly, not a legal obligation in most jurisdictions). Airlines lean on our goodwill as part of their business model. Some believe it's exploitative. Their medical kits are loaded with drugs and equipment that can only be used by medical professionals (flight attendants cannot use), --- utilization depends entirely on chance and goodwill. Legal protection for volunteer responders is murky, especially on international flights. They do generally have a air-to-ground medical consulting service with and MD advising from the ground to advise and direct airline staff, which is better than nothing. 725.91 Emergency Medical Kit For aeroplanes with more than one hundred (100) passenger seats, an emergency medical kit must be carried and shall contain as a minimum, the following: ItemsQuantity a) Sphygmomanometer1 b) Stethoscope1 c) Syringes (sizes necessary to administer required drugs)4 d) Needles (sizes necessary to administer required drugs) and one safe disposal unit (amended 2005/06/01)6 e) 50% dextrose injection, 50cc1 f) Epinephrine/Adrenalin 1:1000, single dose ampoule or equivalent (amended 2005/06/01)4 (amended 2005/06/01) g) Diphenhydramine HCl injection, single dose ampoule or equivalent2 h) Nitroglycerin (amended 2000/12/01)10 tablets or equivalent (amended 2000/12/01) i) Protective non-permeable latex gloves or equivalent, disposable (amended 2005/06/01)2 pairs (amended 2005/06/01) j) Bronchodilator inhaler (metered dose or equivalent) (amended 2005/06/01)1 (amended 2005/06/01) k) Acetylsalicylic acid (ASA) (amended 2005/06/01)4 (amended 2005/06/01) l) (i) CPR mask with an oxygen port and (ii) valves (amended 2005/06/01)1 2 (amended 2005/06/01) m) Intravenous (IV) administration kit (incl. Alcohol sponges, tape, bandage scissors and tourniquet) (amended 2005/06/01)1 (amended 2005/06/01) n) appropriate intravenous (IV) solution (e.g. normal saline 0.9%(500cc) (amended 2005/06/01)1 (amended 2005/06/01) o) (i) Airways, oropharyngeal (3 sizes) or (ii) Ambu bag (amended 2005/06/01)1 set 1 (amended 2005/06/01) p) Atropine (0.4-0.6 mg per ml, single dose ampoule or equiv.) (amended 2005/06/01)1 (amended 2005/06/01) q) Basic instructions for use of the drugs in the kit. (amended 2005/06/01)1 (amended 2005/06/01)
  20. I expect it's like conditioning for any other cultural behavioural norm. Part imitation and part parental correction.
  21. Since we are discussing books on vaccination in general, I will put in a plug for my very favourite vaccine book: Your Child's Best Shot. It's superb. Also pre-covid. I really wish there were a more up-to-date edition (most recent edition is 2015)
  22. Science Based Medicine has posted a detailed unfavourable review. Anonymous author also gives me pause.
  23. It worked for me. This is standard first line treatment for NVP in Canada (Dilectin).
  24. We have a CO story with a happy ending. About 10 years ago our CO detector alarmed. I, foolishly, assumed it was a false alarm and re-set it. It alarmed again. I called the fire dept. They came and measured CO with their fancy detector. It was indeed elevated. Fire dept cleared the house, and called their gas guy, who condemned the furnace. This is when I learned that CO detectors (and smoke detectors) expire -- and that every single on in our house was beyond expiry. Fire department took all our expired ones and set us up with fresh loaners until we could get ours replaced. We were lucky that the CO detector still worked. Now we have 4 dual CO and smoke detectors, plus a wall plug in CO detector, and I check the expiry dates. The only one of us with any symptoms was me; I had a tiny bit of nausea. Enough to prompt me to take a pregnancy test, but not enough to otherwise get my attention. In retrospect, it was a symptom of mild CO poisoning.
  25. No quite snake oil, for NAC at least -- it's a drug with legitimate non-covid indications. Based on my quick search, the evidence to support NAC and berberine efficacy for covid seems very poor, and seems to gloss over risk. I, personally, wouldn't bother with them. I am an EBM person though; I am generally skeptical of supplements and alt-med.
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