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  • Hay George

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    George KG

    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.

  • I guess the Senate can refuse to seat him.

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    taiwan_girlT

    @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.

  • Fake picture of George Washington

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    89th8

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

  • Hamas attacks Israel

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    George KG

    https://www.nytimes.com/2024/11/18/world/middleeast/gaza-aid-convoy-looted-unrwa-israel.html

    A large convoy of trucks carrying aid was “violently looted” in the Gaza Strip over the weekend and its drivers forced at gunpoint to unload supplies, the main United Nations agency that helps Palestinians said on Monday, calling it one of the worst such incidents of the war.

    The agency, known as UNRWA, said in a statement on Monday that the convoy of 109 trucks had been driving from the Kerem Shalom border crossing in southern Gaza when it was looted on Saturday. Most of the trucks were lost, some of the drivers were reportedly shot, and some vehicles sustained extensive damage, the agency said.

    Only 11 trucks made it to their destination, said Louise Wateridge, an UNRWA spokeswoman currently in Gaza. Attackers shot the trucks’ tires out in order to stop and loot some of the vehicles, she said, and the agency is still waiting to hear how many casualties there were, and what types of injuries convoy members sustained.

    The incident highlighted the difficulties aid workers face bringing aid into Gaza, despite months of attempts to help it arrive safely. The need is urgent. Earlier this month, a U.N.-backed panel said that all of Gaza faced a risk of famine between now and April, with the north at particular risk.

    “People at the moment are absolutely desperate for anything,” Ms. Wateridge said. “We’re back at a stage where we’re seeing people literally fighting over a bag of flour.”

    She said: “Israeli authorities continue to restrict a huge amount of the humanitarian response. Everything here is being strangled — food, flour, water — everything.”

    The Israeli military did not immediately respond to a request for comment on the episode. It was not clear who was responsible for the looting. In the past, Israel has accused Hamas militants of robbing aid convoys to supply their own forces. Hamas also did not respond to a request for comment.

    The convoy had been scheduled to enter Gaza on Sunday, but the Israeli military instructed it to leave a day earlier “at short notice via an alternate, unfamiliar route,” he U.N. agency said.

    Ms. Wateridge told The New York Times that her agency was instructed a day before the scheduled transport that the convoy had to leave within 30 minutes — a huge logistical risk for drivers, who had little mobile data access to plan for the new routes safely.

    "In the past Israel has accused..."

    Well, NYT, who was responsible for the looting? C'mon gimme a wild-assed guess. Is it just possible that it was someone whose organization starts with "H"? It took you 7 paragraphs to even say the word.

  • Diversity is NOT our strength

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    Aqua LetiferA

    @Horace said in Diversity is NOT our strength:

    if you do think there is a lesser evil between the two majors.

    I did not.

  • Jon could still be in the running...

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    jon-nycJ

    I wish you were kidding.

  • Yeah, but he didn't play a snap on defense...

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    JollyJ

    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

  • Why did Harris !ose?

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    HoraceH

    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.

  • Hey Aqua - I got your Halloween planned out for next year.

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    No one has replied
  • It ain't all sunshine and roses.

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    JollyJ

    Bad actors.

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

  • What a difference three years makes

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    JollyJ

    To beat Harris, I don't care if he has cloven hooves and horns.

  • Pelvic floor and sexual dysfunctions after genital gender-affirming

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    JollyJ

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

  • Unvaccinated America in 5 charts

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    MikM

    @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.

  • Had a headache all weekend long…

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    George KG

    Naproxen vs Ibuprofen...any preference?

    (We used to give ibuprofen IV. Don't know if that's still being done)

  • Hay, 89th! You like soundtracks, right?

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    89th8

    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!

  • 4B-So let me get this straight…

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    89th8

    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.

  • "He's wrong, but actually right."

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    George KG

    "Editing error," my ass.

    Gcq-nIAWkAAJBms.jpeg

  • Maga’s war on the first amendment

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    HoraceH

    @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.

  • Lookalike in Chicago

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    MikM

    Um no.

  • Popular?

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    George KG