Divemedic

Permissive Hypertension

I am going to take this time to explain how strokes are treated in the hospital. I am going to make this understandable to the layman, so there will be some things that get simplified, or even omitted to make this easier to understand.

Strokes are the fifth leading cause of death in the US, so treating them is an absolute must. When people have signs of a stroke in the Emergency Department, the rules say that we have to get them a head CT within 10 minutes. The CT is looking for bleeding in the brain, which is called a hemorrhagic stroke. About one in eight strokes is caused by bleeding in the brain. The other seven are called ischemic strokes and are caused by blood clots.

Immediately after the CT scan is done (the patient is still in the CT imaging room), they are interviewed by a neurologist to see if they are showing signs of an ischemic stroke, meaning one caused by a blood clot cutting off oxygen to the brain. The nurse does the evaluation at the same time, and each of them come up with what is called an NIH score. They then compare scores and, if different, they discuss why. The idea is to give the score that is most advantageous to the patient. An NIH score measures the likelihood and severity of a stroke through a score that ranges from 0 to 42. The higher the score, the more severe is the stroke. A score of eight or higher means that the patient gets screened to see if they are a candidate for TPA administration.

TPA is a miracle drug. It breaks up blood clots, and allows blood to again flow, saving brain tissue from death. If administered within the first 4.5 hours of a stroke first beginning, the patient frequently leaves the hospital with no permanent disability. Sadly, many people with stroke symptoms wait too long to come in and are not candidates for this therapy.

If they are having a stroke, but are outside of that 4.5 hour window, they are admitted and we see just how much brain function they have lost. Then they are discharged to be rehabilitated and taught to live with their new disability.

In 84% of cases, patients who have just had a stroke will see their blood pressures greatly increase as the body tries to use this pressure to force blood past the clot that is cutting off blood to the brain. This process actually reduces the amount of damaged brain tissue in an ischemic stroke, reduces the amount of permanent disability, and decreases patient mortality due to ischemic brain tissue.

The risk of this is that the large increase in blood pressure greatly increases the chances that a blood vessel will rupture, causing a second, hemorrhagic stroke, and that second one is often fatal. I believe that a hemorrhagic stroke is what killed my mother last year.

Since 2019, the American Stroke Association and the American Heart Association both recommend that a patient with an ischemic stroke that isn’t a candidate for TPA administration be permitted to have high blood pressure for the first 24-72 hours after the stroke while being closely monitored. The only high blood pressure to be treated in these cases is a blood pressure higher than 220/120. In those cases, the patient should be medicated to reduce blood pressure by 15%. This is called permissive hypertension and is the current way that hypertension in stroke patients is being treated.

The problem is that this is not received well by older medical professionals, who have spent their lives thinking that “high blood pressure is bad” and want to reduce blood pressure no matter what. They just haven’t remained current in their clinical knowledge, and secure in their ignorance, will violently defend what they have always done, even when that has been shown to be the wrong thing to do.

I recently had a stroke patient with a BP of 263/152 and had formed a plan in conjunction with the doctor to lower her BP slightly to 220/110 using medication. Another nurse (who used to be a charge nurse) came over and started a loud shouting match, telling me that I was being dangerously lazy in not controlling the patient’s blood pressure. She accused me of being a shitty nurse and reported me for poor patient care.

I produced all sorts of studies showing that I was right, so I won’t be getting in trouble, even though the QA department agreed with her, trying to tell me that blood pressures of over 200 are too dangerous. They pointed out that the units on the floor have a policy of not accepting patients with a blood pressure that high. I told them that maybe the policy should be revisited in light of current literature.

Why? Because medicine is evidence based, and the evidence and current literature is on my side. I presented my nursing plan and the current literature to my department head, and she agreed that my treatment was in keeping with current AHA and ASA guidelines.

That required me writing a long dissertation to support my position. It wound up being a 460 word essay, complete with references to the AHA and ASA guidelines, as well as referencing multiple studies carried out since 2020, showing that patient outcomes are better under these guidelines.

It’s cases like this that show why good nurses make a lot of money for the level of education that they have. I’m probably going to present my case to the hospital’s clinical standards council (one of whom already spoke with me and thinks its a great idea) and try to get the policy changed. It’s a stupid policy that is likely killing people. The bonus is that, if I am successful in forcing the change, I get a raise and I also get published.

By Divemedic, ago

On the Seventh Day, He Rested

The reason that posting has been lacking a bit is that it’s been a busy week. Let me recap it for you:

There are seven days in a week, of course. Three of them were spent at work this week. The first day this week turned out being a 14.5 hour shift because of a stroke patient, a fellow nurse who used to be a supervisor trying to bulldoze me, and a little thing we will talk about in a future post called permissive hypertension.

The second day this week was a 14 hour shift because I had some relatively sick people and the nurse taking my patients was late doing so due to her trying to find a sitter for her Baker Act.

The third day, they cut me an hour early because the census was low and they didn’t want me to slide into overtime.

Then my days off wound up being filled with personal details- the house that we used to live in is now under contract. We first listed it for sale back in early March after replacing the floors and the air conditioner. We tried selling by owner, no luck, only one showing that never called us back. We tried one agent who didn’t even get us a single showing. The second agent had multiple showings, and we finally sold. Now I can use the money to get a pool, an outdoor kitchen, and pay off half of the mortgage on my current house. Speaking of mortgages-

We have been trying to refinance the house we live in, because our original loan was for 8%, and we got a refi offer for 4.8%. We close on that this week.

I have also been working on the network of the house. If you will remember, I wanted to put a UPS on the network. The one that’s in the house as built was supposed to have a 28 inch media panel. It didn’t- it had a 20 inch panel, and that was too small to fit all of the stuff I needed. So I pulled out the old one, put in a 30 inch panel, and wired the network in the house with a MOCA system. That 30 inch panel let me put in the modem, the MOCA converter, the master mesh node, a couple of network switches, and the UPS.

While installing the MOCA system, I had to use a cable tracer to see which cables went to which rooms. There are 8 cables coming into the house- one for each bedroom, one in the living room, one to the media panel, one to the bonus room upstairs, and one that I still don’t know where it goes. I put a cable tracer on the lines, and three of them were showing open circuit. I started investigating, and this is what I found:

The one in the master bedroom was hidden behind a phone jack:

The one in the upstairs bonus room was simply not connected. An inspection camera revealed that the cable was stapled to the studs above and below the box.

Still, I have it all done, and the MOCA system is now installed, so my mesh network now has an Ethernet backhaul, which increases network speed and reliability.

Then I spent a day this week going to my grandson’s soccer game.

All of those things have taken quite a bit of time, and left me quite sleep deprived. There was one night that I had to make do with only three hours’ sleep. So Sunday is a day off. I am going to get caught up on sleep, head to a diner and get a rib sticking breakfast, then spent the day with my bride doing nothing.

With all of that, there was precious little time for blogging or even reading the news. I am looking forward to vacation. I have a vacation coming up, where I am spending a week in Bimini for some well earned time off. Until then, life goes on.

By Divemedic, ago

Angry Rant

Xfinity can lick my taint.

I have been paying $40 per month for 300 mbps Internet since we moved in. I am lucky to get 60 mbps most of the time. So this morning, I saw a deal on their website to increase speed to 800 mbps for $60 per month. I took the plunge.

A couple of hours later, I got an email confirming that I was now on 1000 mbps for the low price of $127 per month. WTF. Even worse? I was still only getting 56 mbps. (The BS clause of “speeds of up to” means never actually hitting that speed, but you would think paying 3 times as much would get you SOME kind of speed increase)

I called the customer service number and got some middle eastern moron who couldn’t really speak English. I got up and drove 45 minutes to the nearest Xfinity location. When I got there, they told me that there was no 800 mbps plan offered, only 300, 500, or 1000. So I told them to put my account back the way it was before they did this.

They said that price is no longer available. I can have the 300 mbps for $60 a month if I sign a 2 year contract, or I can pay $80 a month without a contract. That’s it, and fuck you very much. So now I am paying DOUBLE what I was for the same shitty service. I have few choices- I can stay with Xfinity, or I can opt to pay for Tmobile 5G internet, or try Starlink. The thing that makes me leery of Starlink being my primary Internet provider, because of the service disruptions that happen during thunderstorms, which we all know happen virtually every afternoon here in Central Florida.

Here is the thing- I have proof that they sold me a plan that they had no intention of actually giving me before putting me on a different plan at double the price. I took a picture of the screen- proving that they DO offer 800 mbps.

On Monday, I am calling Florida’s Attorney General’s office to report this obvious “bait and switch” scheme.

By Divemedic, ago

Racist Left

The left thinks that blacks are too stupid to get on the Internet, and also think that blacks in Florida are all convicted felons and can’t vote.

But it’s the right that is racist.

By Divemedic, ago

On Amendment 3

Have you been to New York, Denver, or Las Vegas? The smell is absolutely pervasive. Even with only “medical” marijuana being legal here, we see a parade of people who are suffering from cannabinoid hyperemesis syndrome- a malady where they smoke so much weed that they spend a good chunk of time every day throwing up, yet they won’t take our advice and smoke less weed.

By Divemedic, ago

Christians Not Wanted

Kamala Harris loves herself some Islamists and thinks courting them is all important. The party that she represents says that hate has no home there, and uses a rainbow flag to show just how inclusive it is. That’s why people should be surprised that two young men in the crowd of her recent campaign rally yelling, “Jesus is Lord” were responded to like this:

So it seems that Christians are not to be included in the ‘big tent’ that is the Democratic party, but Muslims are. So are trannies, fags, atheists, child molesting pedophiles ‘minor attracted persons’, and all other sorts, but not Christians. They can just fuck right off.

This astounds me, because candidates are usually pretty adept at spouting a lot of words without actually saying anything. This one sentence emanating from the mouth of HOTUS says far more than anything she has said at the debates or mock interviews that she has participated in. It displays her inner self: she hates traditional America, and sees the beliefs of the 68% of Americans who identify as Christian as being a punchline, some sort of zinger to show what Bible thumping mouth breathing morons she believes them to be.

This should be a HUGE story, but the only play it is getting in the US is from Fox, the NY Post, and Forbes. Big media is a full on propaganda machine at this point.

The Republicans should be making campaign commercials using this clip, and should play them in the Bible belt at the top and bottom of every hour for the next 3 weeks.

Disclaimer: As those of you who read this blog already know, I am an atheist. I also share many of the same values that Christians do. I have more in common with Christians than I do Islam, the sexual deviants of the Democratic party, or the morons in the church of climate change. Just for full disclosure.

By Divemedic, ago

Rights Without Responsibility

Watch this video, then I will tell you my own story.

She claims to be an independent woman while at the same time wants her father to pay for her wedding, because she can’t. That doesn’t sound very independent to me.

When my daughter was 15 years old, she was dating this 20 year old loser who it turned out didn’t have a driver’s license because his had been suspended. When I told him that he couldn’t take her anywhere in a car since he had no driver’s license, he told me to mind my own business. I tried explaining to her that he was a loser who couldn’t date women his own age, so he was chasing younger girls, and all he wanted was to get laid. She told me that I was too old to understand how it is “nowadays” and that they were soulmates, and there was nothing I could do to keep them apart.

See, school taught her that she was a strong girlboss who wasn’t owned by anyone. She could decide for herself, thank you very much.

The young lad sent me an email telling me to mind my own business or he would come over with a bat and teach me a lesson. The next time he came over, I pulled a gun on his smarmy ass and told him that if I caught him coming over to my house again, I would kill his ass and produce the email as evidence in my trial.

I caught them once, having sex on my couch. I called the cops, who did exactly nothing.

Things degenerated to the point where she would just walk out whenever she pleased. Out of the house while I was taking a leak, out of school when he wanted to see her, nothing worked. I even tried getting a restraining order, but the courts denied granting it because she begged them not to. It turns out that the courts hold a teenage girl’s opinion in more regard than that of her parents.

On the day she turned 18, my daughter came out of her room and told me that she was now an adult and could do whatever she wanted. I pointed out to her that part of being an adult is understanding that adults have responsibilities, and one of those is to learn that there are consequences for every action you take, meaning that you can’t always do whatever you want.

She replied that she was done with my “bullshit rules” and she was going to live with her soulmate. I told her that, if she decided that she was an adult, then she needed to understand that, as an adult, she would have to provide everything on her own. Don’t come back here and ask for any handouts, not even a single dollar. She walked out.

I didn’t see her again for four years. That was when she came to me and asked for money for her wedding. It appears that she had broken up with her soulmate six months after moving in with him, and he stalked her to the point where she had to get a restraining order. She met this new guy, they were in love, and wanted to get married. She wanted me to pay for the wedding. I told her no.

My ex-wife (her mother) called me to tell me what an asshole I am, before telling me that I should pay for the wedding AND the honeymoon to Alaska, a bill that came to over $20,000. I said no. She is an adult, and I am not going to have her turn her back on me, only to come crawling back whenever she needed money.

The biggest lesson that she learned was just a few months after my grandson was born. Her husband ran off with an only fans porn actress, leaving my daughter and his kids high and dry. That was what she needed to grow up. The responsibility of having children of her own taught her lessons that she was unable to listen to when I tried to teach them.

Our relationship has never been the same as it once was, but we have slowly come to terms with what happened.

All because society and our kids’ schools fill these kids’ heads with ideas about the rights of being an adult, but don’t bother to teach them about the responsibilities that come with it.

You can’t be an independent adult if you need someone else’s money to pay for it.

By Divemedic, ago

Fire with Fire

The left is all butthurt because Trump apparently closed a McDonald’s so he could have a photo op of himself working there.

The thing is that they are conveniently ignoring the Astroturfing being done by the Harris campaign, where she stocked a closed restaurant with adoring fans before visiting it. The thing is that Trump is simply doing the “work an ordinary job” thing that was started by Florida’s Lawton Chiles back in 1970, then copied and repeated by Bob Graham beginning 1977. The basis of the plan was that Chiles (and later Graham) would spend a day performing the job of one of their constituents to show that they understood what ordinary working people were going through.

By Divemedic, ago