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Everything posted by GaryPinC
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Is there one key moment? I would say it's a series of them. "Assuming normal lung function" is not smart after a patient had an arrested heart, been defibrillated, had CPR and is on ventilator. To add to what Redtail Hawk posted, varying degrees of acute pulmonary edema is not uncommon in this situation. Oxygenation coupled with CO2 levels confirms whether or not the lungs are properly exchanging and functioning. That's pretty damn important. To take the patient off ventilator and see their breathing reflex (and autonomic nervous system) functioning normally is a huge moment in my little world. You're not wrong that assessing overall brain function is very important but if the autonomic nervous system is compromised, well I've never allowed an animal patient make it back to consciousness. There are different degrees to anoxic brain injury, many quite recoverable, but autonomic compromise is a dark indicator IMO.
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Thanks for all your input and feedback! I definitely appreciate your ambulance perspective, but as a former EMT would you want the mom in there if things go south? To answer your question, yes, but so, so much goes into it. Things like myocarditis/pericarditis temporarily changes ERPs and sensitivity of the heart to arrhythmia. In Hamlin's case, young and in top shape, with no significant risk factors you would anticipate restoring sinus rhythm quickly and minimal chance of rearrest. But we don't know what underlying genetic and environmental factors there were. Immediate CPR is a big help also, but the longer it takes to restore sinus rhythm the odds you can't bring the person back rise precipitously. My understanding from the docs is humans fall off the cliff of being able to resuscitate very quickly. Just happy they got him back, 8 minutes is a fairly long time but they were doing CPR for most of it.
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I work in cardiac research where we study rearrest and also reperfusion injury primarily to the brain. I am not a doctor or health professional, just a bench researcher. But a big part of our work involves animal models with clinical electrophysiologists and ER docs. I can offer some perspectives and hopefully will keep it from getting into the scientific weeds. The short answer to your question is the first cardiac arrest could cause multiple arrests, but it's truly an individual response. The second the heart stops, in some corners of the circulatory system blood begins to clot immediately raising the risk of stroke and a massive inflammatory reaction is initiated. The body quickly becomes hypoxic with reactive oxygen species (ROS) which damage DNA, RNA, proteins and can cause cell death. In Hamlin's case, one could easily surmise he quickly became hypoxic given the physical exertion of the game. Also keep in mind that just because you restore sinus (normal) rhythm doesn't mean the heart is beating normally. What usually happens post-arrest is despite the normal rhythm, electrical contraction(depolarization/QRS complex) is incrementally slowed(widened QRS complex) and relaxation (repolarization/T-wave) is usually a mess (ST elevation, elongated/elevated T-wave). At this point the patient can be very susceptible to rearrest. And this period can be as short as a couple minutes to nearly an hour in my animal model experiences. Anyways, from my perspective, putting an arrest survivor under therapeutic hypothermia is about mitigating and controlling the inflammatory damage while also slowing the metabolic processes and the heart to hopefully prevent more arrests. In terms of the brain, the inflammatory reaction compromises the blood/brain barrier, allowing blood and inflammatory cells into the brain to kill brain cells. The first 24 hours are critical as the damage and cell death will evolve over the next couple of subsequent days. Again, therapeutic hypothermia is crucial in arresting and limiting this damage. I was in disbelief that the ambulance waited even 1 minute to allow Damar's mother to ride along. Getting him to the medical center and started cooling is critical. I just thank God he didn't rearrest in that ambulance with his mom right there.
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Where was the best hamburger you’ve ever ate?
GaryPinC replied to Another Fan's topic in Off the Wall
I'd put Swenson's at the top of the "luxury fast food burgers" and that's it. Reasonably tasty with some brown sugar added to the beef, they have a large variety of burger and drink styles. And fried mushrooms as a side. Bonus points there! People around Akron swear by them though. But thanks, if I'm ever down around Dover I'll look Blazin Burgers up. Best burgers: Milt's out in Moab Utah: https://miltsstopandeat.com/ You can choose between buffalo or beef and he locally sources as much as possible. Built-in quality in a small Diner. Best restaurant burgers: Back in the '90s, I always felt Ruby Tuesday really did a great job with Burgers. Haven't been to one in at least 15 years as they've died out a bit here in Cleveland. But these days any place that'll cook a legit medium rare is a contender. -
I don't agree that Georgia brought their C game on defense, OSU was just that good. Kirby Smart even said post-game OSU probably should have won. Day was masterful at keeping them off-balance. OSU was equal to UGA last night, just unlucky. Michigan's performance (poor coaching and preparation) were more typical of why the Big10 under-performs and is disrespected. If Day moves forward coaching like this, I don't think Michigan wins 2 years in a row anymore. Harbaugh's coaching is not adaptable enough and lacks depth.
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Have to disagree with you on OSU. I thought Day called a great game against a loaded and always dangerous Georgia team. Stroud's lack of blitz recognition and being too content to kick from around the 30 were what killed them.
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No. Michigan was poorly coached, slow to adjust,and routinely made things worse with poor playcalling. They got what they deserved.
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Ball crossed the line before he hit out of bounds.
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That was a masterful drive to start the second half.
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OSU offense, most importantly the coaches, came to win. Now can the D stop the dogs and slow them down enough? Should be a classic if OSU doesn't get worn out.
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I live in Cleveland. Hue Jackson was a pathetic joke of a head coach long before Mayfield even arrived. You could be Hue's best friend in the entire world because he totally enjoys warping reality to deflect blame just like you.
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😂 Hue's record was 1-31 his first two years, 2-5-1 when he was fired (mid-point) and you blame Baker?😂
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A few observations from the opposing team fam
GaryPinC replied to PatsFanNH's topic in The Stadium Wall
Op, Thanks for your thoughts. The one clear thought about the Pats I had is Mac Jones is a strong backup and not your guy. He tries to execute the offense but displays no individual playmaking ability in crucial moments to carry his team. -
The Next Pandemic: SARS-CoV-2/COVID-19
GaryPinC replied to Hedge's topic in Politics, Polls, and Pundits
Ah. Well, there's your flaw. It is never definitively stated that any of them died, though I'm sure some did(maybe the 21?). And no, outside of far right circles most of the US does not believe deaths from Covid vs deaths with Covid are two VERY different numbers. Sorry, the evidence is not there. But happy to entertain evidence you feel proves your point. -
The Next Pandemic: SARS-CoV-2/COVID-19
GaryPinC replied to Hedge's topic in Politics, Polls, and Pundits
Help me out here, because I fail to follow your reasoning. The article seems to drive home the point: Out of 100% of Covid positive admitted patients, 40% were admitted for Covid (severe enough symptoms) while 60% were admitted for indirect injuries/symptoms but tested positive for Covid. It's worth noting these are not 100% of total patients admitted, just 100% of the Covid-positive admittees. And you are wondering if this ratio translates to how much they overstated the death ratio? 1. 40 and 60% are not death ratios in this context. They are admittances, plenty of patients admitted for covid symptoms survive, especially at this stage of an endemic virus. This is what Sundancer is alluding to, you don't know how many of these patients survived, especially in the context of 40 vs 60. If any deaths from this 100% group were all from the 40% would that really be applicable to your reasoning? Should you change your mind and decide deaths weren't overstated, why or why not? 2. Without digging too deep, at first glance it appears the CDC examines death certificates and applies criteria for who died primarily from Covid and who died with Covid. This may be separate from the hospital declaration to control for mis-attributed deaths. You're welcome to dig further, they discuss their criteria: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm Here's also their excess deaths graph (all causes) compared to historical data, which speaks volumes: Wherever you choose to attribute the deaths, the impact of the virus is clear. 3. Finally, these are medical professionals working hard to help people. There are very clear symptoms and progressions for most people who die from Covid. https://www.drugs.com/medical-answers/covid-19-symptoms-progress-death-3536264/ Obviously if someone has ongoing respiratory issues at the time of infection, it can get complex, but medical professionals are intimately familiar with what it looks like to die from Covid so while I believe there was some over-attribution of Covid deaths, I do believe it wasn't a large amount and may have been corrected for, even if the hospital got paid incorrectly. -
Ha! I don't think OSU is returning to the days of Cooper and Bruce anytime soon. Sorry about the loss. I'm not an OSU fan, but watching the game I can offer you this: OSU coaches are lazy due to the talent there. Edwards broke two touchdowns on the same exact play. No adjustments. I feel like Michigan's 2nd half deep balls were thrown looking more for the PI call than a completion. For as good a game as Harrison Jr. had, I felt like he was uncoverable and should have been used more. OSU has greatly qualified coaches on both sides of the ball. They need to take a page from Harbaugh and dedicate themselves more to coaching details and dictating identity on both sides of the ball. Including adjustments, which are generally unneeded for almost all their opponents. Almost all. It's why Harbaugh almost got fired and his improvements made all the difference today, just like last year. I think cutting Day loose would be a stupid move, but he does need to grow. Shoutout to TE Cade Stover, who went to my high school and has to be hurting from those important passes on his fingertips he just couldn't quite corral. Great player but those will torture him a long time.
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How is this any different than Trump getting his name put on the spring 2020 stimulus checks? In either instance no one directly asked for votes, just different tactics to make it clear who was responsible for the "free" money. Did any of you right wingers get outraged back then? However tasteless both times, I don't remember any legal repercussions for Trump, should there be some now for Biden?
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In my experience, people of any age, experience, and maturity tend to respond to how you approach/address them. There's a lot of wisdom in what you're saying, and key is the fact that both sides have to want to resolve it through compromise. I have to disagree with you that both sides are ready to resolve it. Further, even if both sides were to cease-fire right now to negotiate, I don't trust Putin to negotiate in good faith, instead using it to regroup. To avoid the initial conflict, his terms for the entirety of Eastern Europe were not remotely realistic, just insincere. Zelensky has been pretty consistent about Nato and even at August's end was open to negotiate the Donbas/Crimea region: https://www.google.com/amp/s/amp.france24.com/en/live-news/20220308-in-nod-to-russia-ukraine-says-no-longer-insisting-on-nato-membership This should have sparked mediation and I guarantee you mediating diplomats reached out and made the effort with the Russians. I think Putin's going to try a Stalingrad-style assault on Kviv from Belarus, if that fails then maybe he might negotiate if he doesn't nuke. He's simply not and has not been interested in peacefully resolving this dispute through compromise. I also disagree that rarely any dispute is solved without mediation. World War II in both theaters was enduringly resolved just fine without mediation. Nations have disputes all the time that they resolve without mediation. Disputes in personal lives, same. But both parties have to be interested in compromise and we just don't have that here yet. "All I Really Need to Learn, l Learned in Kindergarten" is a great essay about how to live your life but not much help with conflict resolution I'm afraid.