surgeryres

Not sure what you mean by over-eager. Patients are only intubated and placed on mechanical ventilation when they will die otherwise. There is a step wise increase in ventilatory support in these cases, starting at a nasal cannula, then increasing to face mask, then a positive pressure (CPAP) mask, and then if they are still hypoxic or hypercarbic - intubation is the next step.

VAP (ventilator associated pneumonia) is a known morbidity of mechanical ventilation. ICU protocols are much improved these days to combat it (oral hygiene, suctioning, early extubation protocols etc).

Doctors are done? Can the chat bot take out a colon or gall bladder or fix an aneurysm? Hilarity.

I am a vascular surgeon, and have many patients in the ICU constantaly. #6 confuses me - the original operating surgeon should be a constant through the patient’s stay. And while the ICU doctor might be the captain while the patient is in the ICU, the original surgeon is the general. He has complete control and should dominate the patient’s care. While the surgeon can not be bedside 24/7, they or someone from their team should “round” at least once daily on these ICU patients, talking to family, checking catheters and tubes, reviewing medicines, checking wounds.

At least that’s how it’s done in Texas.

Not getting the attention it deserves. CT scans with IV contrast are critical for trauma, cancer staging, emergency general surgery, orthopedics - everything. Having to ration it at all is a big deal. And IV contrast is used for more than just CT scans.

I am a vascular surgery trainee. Myself and others rely every day on IV contrast to do our jobs. We were told today the hospital has a two week supply left - and the production side could take 6 weeks to catch up. Scary stuff.

All your question marks makes brain hurt.

This study is not establishing a new treatment protocol by any means. It’s also a tiny number of people.

This study raises the question maybe we should design bigger trials to investigate treating long COVID with blood thinners.

The problem the paper is addressing is fibrin micro clots, which occurs in long Covid. This also occurs in acute Covid. The treatment is similar - anti coagulation. We (doctors) knew this from the beginning (1). Chill out bubba.

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378457/

Attached article was written during initial outbreak

Very interesting study.

I am an expert in the field of clotting mechanics (US NIH funded research / vascular surgery fellow). Not sure why they chose TEG to monitor coagulation status - it does not reflect well changes from any of the drugs used in the study.

It would be interesting to see the results broken down by gender - females respond much differently to aspirin and have less of a survival benefit than males (don’t get me started, many of the initial trials in the 60’s with aspirin were done with mostly males).

Also, in my own research - we have found that aspirin “softens” clots which allows platelets to squeeze pathological clots to smaller sizes, which allows more recannalization of thrombosed vessels and thus less ischemia - would be interesting to see if that same MOA happens here.

As an engineer the PCL seemed like foreign territory as it was in the other side of campus. Thus it was a nice place to go and think, especially in the map room, it was a magic place.

Fascinating.

They mention in the paper that the Dark Ages power spectrum would require a 100,000 dipole antenna array, seems like we are far from that.

Full disclosure brain fart - dark side of the moon still gets sun light (duh, right?), this basic fact had me scratching my head with regards to power source for an embarrassing amount of time.

Agree for Mars - this tech will translate well into other areas of need in hostile environments - like agriculture, mining, large scale manufacturing etc.

I think it’s a great idea to build mud huts on another planet where labor is scarce, machine energy is under different constraints, and certain resources are “unlimited”.

But this approach for building a house on Earth to house humans seems way off the bell curve of potential to scale.

Yes true, but brick and other base material like it is very strong and support fixtures to attach ducting, pipes, cables - I’m not sure you can drill brackets into this mud and safely secure an AC duct or conduit.

Yet another example of the over-hype of “3D Printing”. Yes it’s neat that they collected some local dirt, mixed it with some non-locally sourced water and binder, and poured it into an extruder run on some kind of non locally sourced energy, then sprayed it with some protective coating - it baffles me that people see this as a possible mainstream building technique. Running electrical, plumbing, air conditioning etc through this structure is doable but much harder, as the expectations of these niceties have evolved with modern construction and need easy access and hiding with things like dry wall.

This almost reads as an onion article with the headline “brilliant scientists figure out how to overcomplicate the construction of mud huts similar to our earliest human ancestors”.

I was a medical student with Cohn and Frazier in 2012 at Texas Heart - it was an awesome experience. Every day we would either do a heart transplant or peel a heart mate II out of a box and implant that. I remember sitting in Cohn’s office and him doing magic tricks, lighting things on fire, or making us laugh. Frazier would always have a book in his lab coat, usually something in Russian, to read at his leisure. Truly visionary people. They have a good TED talk where you can get a good idea of their personalities.

Y TU TAMBIEN

I wonder what these for profit companies do with the red cells and platelets? These are both heavily regulated with short shelf lives.

Anticoagulation normally, six months of pills or injections for the first vein clot (deep vein thrombosis or DVT) and then lifelong if you develop another one. If the clot travels to your lung and is big enough it can kill you (pulmonary embolism). For big life threatening clots to the lung there are invasive procedures to suck them out but these are risky.

No one likes to talk about the potential side effects of stem cell therapy. They express tissue factor, which increases after culture required for these treatments. Tissue factor is highly thrombogenic and can cause blood clots.

https://stemcellsjournals.onlinelibrary.wiley.com/doi/full/1...

Concerned about the decrease in meat, and ultimately protein in the diet. His meals only serve meat three times a week? For a surgical patient trying to heal their wounds, a decrease in protein content is the last thing they need.

Here is one paper from pub Med discussing NEC:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357630/

No, it is necrotizing enterocolitis (NEC). NEC is associated with formula feeds and accounts for up to 20% of NICU costs annually. Here is a pubmed link discussing:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357630/

At what point though must we consider that we, the American people, elected these people into office? They are there because we put them there.

To play my own devil's advocate, my perception is that the barrier to entry into politics, i.e. money, has risen substantially which prevents younger candidates from even running for office.

This post is one of the many reasons I love HN. In depth discussion of obscure (but very interesting) topics; and the personal websites that host them.

Another use would be 3D printed surgical instruments. There is already a proof of concept paper written on this topic:

https://www.ncbi.nlm.nih.gov/pubmed/27822724

Houston

It's been awesome the last few days to see stories like this. So many Houstonians serving one another after this terrible tragedy.