Briefly, @walterlekh and others in the #OSINT community. Question about usage of #nerve agents (more likely than blister or irritant) and how to protect oneself. Carbon filters are essentially the best barriers available on the ground (car air filters for example).
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#Organophosphate poisoning is punctuated by “excessive parasympathetic” nerve tone - think the “rest and digest” but in overdrive. This causes excessive salivation, bronchoconstriction (wheezing), lacrimation (tearful), airway secretions, flushing, diarrhea, vomiting, …
…muscle tremors, constricted pupils, sweating, and confusion. The first symptoms are usually salivation (makes sense; quickest to react). Treatment is atropine and 2-PAM Chloride (see Mark I Kit).
How can you protect yourself? Honestly, we don’t know how effective these are in this day and age with ubiquitous mask usage (it’s AT LEAST a barrier). My homemade masks have a pocket to put in a carbon filter if needed. I had this made since I was one of our first COVID docs.
Carbon filters, if not available, can be cut from car air filters, maybe some central air units, or frankly purchased in bulk. It’s more effective than nothing.
Some enterprising individuals might consider crushing up some charcoal and pancaking non-carbon filters in these to at least provide some absorption (like, maybe a shirt, mask, whatever). You can even purify water with charcoal 🤷🏻♂️!
If you want to purify water with charcoal, here we go.
Most nerve agents are heavier than air and will layer towards the ground, possibly going into bomb shelters, basements, etc. Good ventilation is always necessary (also for general hygiene and prevention of respiratory pathogens).
Well, @TheCurbsiders, it’s been over a week since I’ve posted here… but it seems like it’s been mere days. #COVID19 has not necessarily overwhelmed our hospital system, but has absorbed our lives.
Furthermore, @SCCM released some guidelines that can be helpful; however, as this information is ridiculously fast moving, these guidelines may be approaching obsolescence as time goes on.
Well @TheCurbsiders, thought I forgot about following up on this tweet?! Well, I did. I'm on the inpatient Hospitalist Service. Nevertheless, let's go down this rabid hole together...
So the question remains - what is the best pharmacologic intervention to reduce post-operative VTE after orthopedic surgery. A prior EBM presentation that I routinely give compares Apixaban vs Enoxaparin which finds that the NNT to prevent one major VTE of 166.
Great, so Apixaban may be better than Enoxaparin (with questionable cost benefit). Apparently, oral anticoagulants, in general, are likely more efficacious than Enoxaparin.
Effective teamwork, like relationships, isn’t defined by the absence of conflict; if fact, without conflict, there can be no authentic growth. No, these are defined by the ability to resolve conflict, allowing divergent positions to mature into something greater. @thecurbsiders
Similarly, you will constantly find yourself in conflict, both internal and external, when dealing with, among other things, your patients and colleagues.
For your patients, seek first to understand before being understood. A “difficult” patient presents an opportunity to grow, build rapport, and develop an authentic patient-caregiver relationship that is more meaningful than just “refilling meds.”
Answer will be given in 8-hours in a new tweetorial! Yay!
I didn’t include Benzonatate, Codeine, Steroids (that’s also in the literature from Iran), Albuterol, Nasal Atrovent, or many others, mostly because of poll limitations.