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Everything posted by phillysailor

  1. phillysailor

    On This Season of Riots

    US Army and US Air Force are specifically prohibited from enforcing domestic laws by the Posse Comitatas Act. Coast Guard is a special case. Although not specifically mentioned, it is presumed that the marines and Navy aren’t eligible for service on our streets, either. Unless martial law, I suppose. Yikes
  2. We are not a banana dictatorship. No better way to destroy our grand experiment than encouraging this sort of malevolent street justice. sorry, CH, but you earned a downvote
  3. phillysailor

    Shameful, inexcusable behavior

    The OP is correct. The officers who killed Mr Floyd should have been arrested when aurhorites became aware of the video which exposed the nature of the murder and their lies. The riots may have been avoided if law and order was quickly enforced.
  4. phillysailor

    On This Season of Riots

    Not sure this would survive scrutiny without qualification. I think you are referring to European country and Aussie/NZ. Not sure income is guaranteed in all these countries, and I would be very interested to see the disparity of minority vs majority demographic killed by police in these countries.
  5. phillysailor

    So Much Cringe, So Little Time

    No. Way. the president of my nation tweeted that in the middle of an economic, social and healthcare debacle? Holy shit. We are fucked.
  6. The road to hell is paved with good intentions. These yahoos with guns thought they were protecting society, when in fact they were about to screw it up. Bearing arms while policing society is not easy, nor is it without risk. Academy training prepares most individuals for many interactions, daily exercise of these lessons combined with hashing out scenarios with colleagues and rigorous oversight through departmental oversight lead to application of laws and policing tenets becoming more and more likely. That's a system America can trust, despite it's flaws and mistakes. Vigilanteism, especially that tinged by racism, is to be viewed with arch skepticism. These self-appointed police did not know a crime was committed, yet felt the threat of deadly force was justified. Holding a gun while purposefully obstructing the movements of another creates a level of danger which needs to be justified, especially if that threat is carried out. The burden of proof that the threat of deadly force was necessary to conduct a citizen's arrest is on these men. If they cannot justify that threat, then the death of Aubrey was unnecessary, and therefore charges warranted. To do otherwise is to make America the land of the gun, by the gun and for the gun. People are just there to shoot, bleed and die. Sorry, but I like the original version of the Gettysburg Address.
  7. A continuation of the breakdown of law & order thanks to our amoral Republican leadership. Incompetent, juvenile judges nominated with ever increasing rapidity to lifetime posts. War criminals exonerated and brought along for campaign stops. Threats and bribes by our chief executive expressly for his own good. Gerrymandering and voter suppression used to prop up tyranny of minority rule and violating any number of traditions in the name of power. Torture, falsifying intelligence estimates to justify unnecessary wars, tax law used to benefit the rich. They are leading us down a path I don’t think is good for the nation.
  8. Talk softly & carry a big shtick
  9. phillysailor

    "intelligence is just an estimate" - McEnany

    I sincerely doubt it, but we’ve got to have standards. I humbly stand before you a sinner myself.
  10. phillysailor

    "intelligence is just an estimate" - McEnany

    Hey Steamers? Stop judging her like you would a piece of meat. Leave her body out of it. Goes for the rest of us, too. C’mon, this is bullshit.
  11. phillysailor

    Dominated by the left?

    Welcome to America, land of minority rule and those who are proud of it
  12. phillysailor

    CV-19 Scam

    The Justice Department has opened a criminal investigation into Blue Flame Medical, a firm created by two well-connected Republican operatives who started selling medical supplies this spring as the novel coronavirus spread across the country.
  13. I’ve got to agree with some of what Dog is braying. Trump gives himself enough cover when speaking, largely due to his word salad delivery, that you can find exculpatory statements amidst the damning near-racist tropes. Whats in his heart is clear, given his decades-long antipathy to black people as documented by his attitude towards his renters, the jogger killed in Central Park and the boys who didn’t touch her, the Detestable Birther bullshit, and his Muslim slurs from 9/11 and immigration comments, shithole countries. But his public statements have aspects which facilitate the denialism at which Dog excels. Sort of like the boilerplate fine print on credit card “agreements” and rapid delivery disclaimers at the end of gauzy medication ads. Talk long enough, and he could be anywhere & everywhere on an issue, although we all know what he means. @Dog has meager, but adequate grounds to defend his draft dodging hero.
  14. phillysailor

    The Tara Reade hoax falls apart.

    That Opinion hardly matches the headline it was given. The author goes through the many ways that women who claim assault are poor witnesses, how flawed their recounting may be, how they may vary their language and actions over time. Basically, #metoo is suffering growing pains. Al Franken wasnt given a fair hearing, and Democrats are learning that staking themselves on the cross doesn’t guarantee justice for women or men.
  15. phillysailor

    US ranked #1 to best deal with a disease outbreak

    The irony is that’s it’s Trumpaloos waving defeated flags and carrying their gunz who are cheering the demise of their fellow citizens as sacrificing the weak & ensuring our president become frustrated by “his numbers.” They are figuratively shooting themselves in the foot. The gunz must be unloaded, else we’d have heard of the literal version occurring by now.
  16. phillysailor

    How Covid-19 kills you

    From what I’ve seen, the Coronavirus doesn’t just kill those at deaths door. Marathon runners, subway workers, healthcare workers... anyone unlucky enough to get a lethal dose of virus, or to simply suffer a statistically likely collapse due to the vast numbers infected is at risk. Yes, nursing homes are supplying the greatest majority of patients coming in after 5-7 days of increasing symptoms, but healthier and younger ICU patients are showing up after the apparent worst of the disease is past, some 7-10 days after first symptoms. They felt like they were getting better when they suddenly worsen. We’ve seen a sudden jump in the last few days of patients being intubated. I really hope it’s not a trend which continues. We’ve only so much resources.
  17. phillysailor

    How Covid-19 kills you

    Buttressing your observation is a strong association of chilblains with Positive Coronavirus test results. Chilblains are an otherwise relatively uncommon inflammation of small blood vessels, most common in cold/damp environments, which cause itchy and painful toes. Lesions can develop, and sometimes those suffering cannot stand to wear socks or shoes. The underlying cause, however, seems to be either an inflammatory pathway, or via micro clots... leading me to believe that chaotic inflammation is the more likely route by which the virus does its damage.
  18. BTW, earlier there was much consternation over "minimally invasive intubation". My mind skipped right over that typo, assuming that what was meant was "minimally invasive ventilation" or "non-invasive ventilation" which is common jargon for BiPAP.
  19. The transportation of critically ill patients on ventilators, infusions and monitoring equipment isn't altogether without risk. There would have to be a very clear benefit to subject a patient to these risks and the risk of suffering an emergency in the chamber when at depth. The technicians along for the dive would have to be highly trained and capable of handling these emergencies, as well as for any other patients along for the ride. Terminal cleaning of CT scanners can put them down for hours after use on COVID patients, so a monoplace chamber wouldn't be efficient, it would have to be multiple. It is suspected that some patients on hi flow oxygen might be in a phase of disease where a bridge therapy such as hyperbaric chamber O2 could allow them to avoid intubation, helpfully during a phase when their mechanical accouterments are minimal. However, these patients are, by design, the very ones most likely to suffer cytokine storm or respiratory failure during an hours long dive, making trained personnel with intubation and critical care skills essential. These patients are all coughing freely, making the contamination of the environment exponentially worse than intubated patients, and posing risk to caregivers. Plus, the amount of oxygen which can be carried in blood stream during a few hours, even when PaO2 is raised as high as possible, will never achieve the oxygen delivery afforded by hemoglobin 24/7
  20. I’m remaining skeptical of any reports of treatments which proclaim 0 fatalities as a result of their therapy. So far, they haven’t borne scrutiny very well. YMMV
  21. phillysailor

    Armed gunmen storm Michigan statehouse

    Really? I’m not. We don’t need martyrs for “a movement.” We need rational behaviors from well armed idiots. Identify those breaking laws from video and stills, interview and consider charges.
  22. The coagulopathy is causing Heart-attack like conditions in folks with no atherosclerosis. Multiple PEs, and strokes, organ failure (kidneys, GI tract.) I think it’s some inflammatory cascade process side effect. Colleagues are describing severe body aches limiting movement, and many patients spend several days in bed. If they are smokers or have diabetes, they quickly rack up more reasons for excessive clotting.
  23. The way choking causes fluid to enter alveoli is somewhat interesting. Effortful inspiration against a blocked windpipe creates negative pressures (a vacuum) within the respiratory tree. Fluid is literally sucked from the interstitium (walls) of the lung passages into respiratory passages and alveoli. Even after relieving the mechanical or physiological obstruction, the patient may not be out of the woods due to the flash pulmonary edema with which they must contend. White or pink frothy sputum & noisy rattles when breathing returns may tell the tale. Care is supportive: oxygenation, suctioning, diuresis may help. For bonus points, what is the V/Q mismatch during such an episode?
  24. What appears to be happening, that Mikey is excited about, is how these patients with normal elastance “may” quickly decompensate, with extravasation of fluid and development of acute respiratory failure due to V/Q mismatch. V= Ventilation and Q= perfusion. Normally these are in balance, so you send air to parts of lung that are also getting blood supply. If you send air, but no blood supply goes past, (V>>Q) there is no gas exchange from/to hemoglobin in blood despite good ventilation... “dead space”. These parts of lung might as well be a longer trachea, for all the good they do a person. Think of a giraffe which has to pull a few liters of air in just to move the air in that looong windpipe before moving fresh air in/out of the lungs. This could be caused by a pulmonary embolism, which blocks blood supply through a portion of lung that’s being ventilated just fine. If perfusion >> ventilation there are parts of lung getting blood rushing past alveoli (the functional subunit of lung) that have no gas within... perhaps they are collapsed or they are full of fluid. This is called “shunt”, because it’s as if the right heart was shunting blood to the left without going through the lungs. There are many conditions which can rapidly fill lungs with fluid. Aspiration, flash pulmonary edema, allergic reactions, progressive pneumonia, choking can all cause interstitial fluid to rapidly fill alveoli and cause V/Q mismatch. The body can compensate to an impressive degree, altering local blood supply to restrict flow past non-ventilated segments. The authors surmise that some feature of this disease prevents this autoregulation, leading to widespread shunt, with concomitant low SaO2, since a percentage of blood entering their left heart never gets oxygenated. Intubating and sedating, perhaps paralyzing these patients and cautiously ventilating them can prevent harm from high pressures being applied to uninjured lung. When treating ARDS, high PEEP settings (the amount of pressure in the lungs at the end of an exhalation) are typically used in ARDS to “stent” (keep) alveoli open. High peak pressures “SNAP” open those alveoli. Minimizing these high pressures in early COVID patients may prevent damaging alveoli by not imposing high shear stresses on as-yet undamaged lung (the authors call it “baby lung.” This is a quick primer on some isolated features of lung physiology and vent strategies, not meant to be comprehensive or fully explanatory. I’m explicitly trying to give the impression that considering these forces, V/Q mismatch and lung pathology is what clinicians do all the time. Essentially, this isn’t ARDS, until it gets bad. Until it is, using ARDS vent strategies does more harm than good. That’s become clear over the last 6 weeks.