I've been preaching that for a while. In my career, I've had two patients aspirate gastric contents. One was a 12 (?) year old having foot surgery. He had been NPO for 8 hours, and I did the case without an endotracheal tube. It was within the standard of care. He coughed up last night's dinner. Spent the night in the hospital for a presumably outpatient procedure. No long-term sequelae. The other was a guy (I still remember his name, 30 years later) who had some ENT procedure. At the end of surgery, he coughed up last night's pizza. I remember the green peppers. He did not, AFAIK, aspirate, but it scared the crap out of me. Not my case, but there was a patient who I pre-oped who had a hiatal hernia. My partner put her to sleep, and before he could intubate her, all the stuff in her stomach came up and filled her oropharynx. A goodly amount ended up going into her lungs. She died about 10 days later - in the ICU on a ventilator. I was sued, as was my partner. I was dropped. He settled. Instead, the new ASA guidanceopens in a new tab or window states that most patients can continue their medication up until the day of surgery but should follow a liquid diet for 24 hours before the procedure, depending on specific circumstances. For decades we've been taught that pregnant women have delayed gastric emptying, and we should treat them all as having a full stomach. Now we're being told that it's probably OK. I disagree. Glad I'm retired and I don't have to make these decisions. I can't imagine going to the GI lab to give anesthesia for an endoscopy and, because the patient is on an GLP-1 agonist, arguing with the GI doc that I need to secure the airway because there's STILL STUFF IN THE STOMACH. Sorry for yelling. But, as they say, these days it's not my circus and not my monkeys. There are few things scarier for an anesthesiologist than opening the patient's mouth, inserting a laryngoscope and having half a liter of semi-solid gastric contents well up and fill the pharynx. As a former colleague of mine said (paraphrasing), "If you think the stomach might be full, you should treat it as if it definitely is." This is a hill I would have died on.

@89th said in I guess the Senate can refuse to seat him.: What is sad is each side would behave in the opposite manner if the roles were reversed. Yup.

I took the photo, it has embedded metadata in the file!

@Horace said in Diversity is NOT our strength: if you do think there is a lesser evil between the two majors. I did not.

I wish you were kidding.

As one wag referred to Taysom... TAYSOM THRILL VANILLA VICK THE MORMON MISSILE THE TERROR OF THE TABERNACLE THE LATTER-DAY LEGEND SWISS ARMY SAINT THE BAYOU BULLDOZER THE CRESCENT CITY CANNON

Lots of litigation of this question. The Democrat masses really don't want it to be the woke nonsense. Obviously the Trump campaign calculated that the trans stuff hurt Kamala. We know this because of the commercials. For those of us who would like more Maga after these four years, we want the Democrats to misdiagnose the issues. Might be optimal for them to amp up the woke, thinking it's not really an issue.

Bad actors. https://www.cbc.ca/news/politics/trudeau-immigration-changes-acted-faster-1.7386023

Some wise person said somewhere "First, do no harm."

@Horace said in Unvaccinated America in 5 charts: @loki said in Unvaccinated America in 5 charts: Say what you want about the righteousness of the vaccinated because at the end of the day all our masking, and the incredible work of the hospital employees is in service of keeping the unvaccinated alive. It would be strange to consider vaccinated people to be self righteous in general. Not self-righteous for me. Purely self-interest.

Naproxen vs Ibuprofen...any preference? (We used to give ibuprofen IV. Don't know if that's still being done)

Yeah I'm a big soundtrack guy. I spent an hour last night watching Hans Zimmer live. Cool use of chains in the video above!

The tantrums on the left aren't doing anything to bring in more voters. In retrospect, I'm not surprised the male ethnic (latino, black) vote is what propelled Trump to victory.

"Editing error," my ass. [image: 1731945556752-gcq-niawkaajbms.jpeg]

@jon-nyc said in Maga’s war on the first amendment: @Horace said in Maga’s war on the first amendment: TDS performance art. TDS (noun): (1) Trump Derangement Syndrome. (2) A handy epithet used to dismiss claims that offend one's sensibilities without having to go to the bother of providing any arguments. Trump said something about "fraud" rather than controlling the ability to express oneself. I am guessing he's wrong that the poll in question was "fraudulent", and I don't know the legal standards, if any, the honesty of a poll could even be held to. I will remain secure in my preference for a Trump administration and its attitude towards free speech, compared to a Harris administration in which Walz was saying that misinformation/disinformation is not free speech. As for the TDS, that will be the geyser of double standards that will come from you in this and other threads over the next four years.

Um no.

https://x.com/iowahawkblog/status/1858498028056752329 https://x.com/iowahawkblog/status/1858506873659420955

@Horace said in Pet Vet Corner: But saying "yes" costs them nothing, in fact they seem like they care. True - it costs "them" nothing. But I would guess that at least 10% of the people who post there regarding what might be a serious situation, having been advised to seek emergency care , go on to say, "I know I should take him in, but I'm in a horrible spot financially and I can't afford it."

@Jolly said in Pets For Dinner: Saw where some of the Haitians headed to Canada. How'd they get papers so fast? Remember that many are legal in that they have TPS status. Now that TPS status is kind of up to the discretion of the Administration…