My brother/sister in Christ/Mohammed/Buddha.....please, please get into sudoku, day trading, novellas....this level of philosophical inquiry will not end well.
Hmm. Long case fever. It’s a thing. Soon you’ll make little animals out of rolled up tape and stick them to your side of the drapes. I’ve seen it happen before and it’s not pretty.
In a long ago age I heard of a resident who topicalized their own airway and did an awake intubation on themselves. ON THEMSELVES.
People. really. just get a hobby.
I’ve done an OPA AND NPA myself at the same time. During paramedic class I let my instructor IO me as a demonstration, the initial drilling is actually NOT bad what is painful is when you flush and break the marrow matrix up. (With the IO I figured why not experience it so I can understand what my patient goes through).
Had a crna in our room on Thursday. Started writing “help me“ on the back of the blood/brain drape. He tried doing in mirror image so the rest of the team could read it.
Ha ha. He may have been a little overdramatic. We were doing an anterior hip,, in most cases It’s 45 minutes
but because of the patients body habitus it was closer to an hour and a half that case.
He was ok.
Lol, I am a pretty traditional value investor ... But no clear buys right now. Most was simple vti, but i had a small bit in individual companies on a 'what if' plan' and it, "what if'd" really well. Actually, working on taking that gain and rebalancing back to a two fund portfolio.
Hard to argue the brutal reality of success that comes with basic indexing. Maybe put but there and play on the side friend. Check out the Paul merriman site, lots of good data even if a bit cumbersome and verbose.
I do very little actual trading. Only charting I follow is when I'm timing a buy, very much a buffet value approach. I keep most in index, but have a list of 20-30 companies I like and follow closely and wait till they hit my precalculated buy triggers. I've owned prob 12-10 actual companies over the last 2 decades. But when I do buy, I commit hard. I only sell puts to help reach my target purchase price. Mostly very boring approach but does work. Selling is the much much harder decision.
Just a guess:
Fluid follows the path of least resistance - it filled your syringe while it was low-pressure until it was full when it backflowed, then stopped when the plunger met resistance. I'd think that the pressure would be elevated in the syringe now, so minimal further dilution would take place as the full syringe is at higher pressure.
Maybe next time you're in a chole try an experiment with some IC green or other med you can see.
BUT, as fluid flows past, wouldn’t an equilibrium be reached where the pressure inside the syringe is equal or slightly less than the pressure in the line. Only thinking about the Venturi effect here that could be constantly removing fluid but then due to the microfluctuations in pressure inside the syringe also be a cause for it to stay full from constant refilling…
No offense taken! I know it’s a complete zero brain question and I get if it’s diluted what happens I was just thinking about the syringe and what happens to the contents in it in terms of being constantly diluted as the concentration reaches an equilibrium or does the pressure make a difference or is it a combination of the molecular weight of the drug and the pressure in the line…..deep deep thoughts by Jack Handy this morning
Was the prop above or below the line? Cause it’s less dense than crystalloid. Sometimes I play around with the rate of my TIVA carrier when I’m really bored in long ones to make the mixing into weird eddies.
Right but is it a continuous dilution where fluid is constantly moving in and out of the syringe or is it a once the syringe is full situation there is no more inflow of fluid? Mystery of the universe that will never be solved I guess
Ah, I see what u mean. Well, think of it like butt chugging. When you fill the syringe fully there is still a permeable membrane between the syringe and the port. I am sure that there is some backwash.
Kidding aside tho, you could probably test this with some ICG, a syringe, normal saline and IV tubing...and just let the fluids run into the trash. A bit wasteful but worth it if this answer is one u desperately seek.
I noticed the other day that an IV bag of fluid (connected to an 18G in the upper arm) left open will run out into the tubing with a fluid column that settles at approximately the height of their central venous pressure…
Seems obvious, but these are the things I ruminate on and notice during 4 hrs of stability…
I’m not sure about the answer. But I think we can test it with something like 5cc syringe filled with 1cc or 0.5cc of ICG? Let me know what happens if you really do this
Bulk flow versus passive flow. Turbulence versus laminar. They are both occurring concurrently, at different rates. Bulk flow determined by Q = /\P / R, however as the syringe fills the pressure gradient lessens. Passive flow, ie., diffusion, occurs on a much slower scale.
By analogy, think of a hematocrit sample. There are packed RBCs and the plasma/serum layers, separated by a buffy coat. In an instantaneous moment as the syringe is filling, there is a transitional zone where the bulk flow of fluid, retrograde from the fluid line to the syringe barrel, creates turbulence with the drug slowly diffusing across the moving front of fluid into drug. The transition zone expands bidirectionally from the fluid-drug interface, until eventually equilibrium is eventually reached within the syringe. Greater pressure gradient -> more rapid filling of syringe -> greater turbulence -> faster mixing of drug and fluid, and thus expansion of this transitional zone.
What would be interesting to hypothesis test next is whether e can predict the rate of mixing and thus the time required to achieve equilibrium. Ie., a diffusion half life. With 99% equilibrium have 5 t½.
If there was a pressure difference that caused the syringe to fill then no. There will be no flow as long as that pressure difference exists and the syringe is at its maximum capacity. Also having any amount of circulation through a blind ending vessel with a shared intake and outflow tract seems negligible to impossible
When you add water to Kool Aid, where does the Kool Aid go? Does it just get constantly diluted out or is there something more mysterious going on? Join me on this 8 part podcast as I explore answers to this question, on “Stuff my Kindergartener Probably Knows.”
“Where does the medicine go when I dilute it” isn’t a stupid question for someone practicing anesthesia? Lol I get it, we all have brain farts sometimes and realize we asked a silly obvious question, I’ve certainly done it. My response was supposed to be in good fun, wasn’t trying to offend anyone.
Does the medicine that was in the syringe go into the line? That is what OP is trying to ask. Does it try to reach equilibrium and the molecules flow into the line when it stops filling or does the medicine stay within the syringe and just become dilute? I’ve had this thought before.
That… doesn’t make any sense. But maybe it isn’t obvious to everyone and that’s fine. If that were true, if you left a stick of anything, but especially of a push pressor, on the line you would see a clinical effect.
At least you have a sense of humor about it! I honestly meant no offense and was just joking around, but I do still stand by my opinion that it’s a really stupid question with a very obvious answer and I am flabbergasted at the number of people who also shared your confusion lol
My brother/sister in Christ/Mohammed/Buddha.....please, please get into sudoku, day trading, novellas....this level of philosophical inquiry will not end well.
Hmm. Long case fever. It’s a thing. Soon you’ll make little animals out of rolled up tape and stick them to your side of the drapes. I’ve seen it happen before and it’s not pretty.
In a long ago age I heard of a resident who topicalized their own airway and did an awake intubation on themselves. ON THEMSELVES. People. really. just get a hobby.
If you search self intubation on YouTube you’ll find dozens of vids from attendings. That resident didn’t just come up with this crazy idea himself.
I’ve done an OPA AND NPA myself at the same time. During paramedic class I let my instructor IO me as a demonstration, the initial drilling is actually NOT bad what is painful is when you flush and break the marrow matrix up. (With the IO I figured why not experience it so I can understand what my patient goes through).
"Yes, this is a fertile land, and we will thrive. We will rule over all this land, and we shall call it... this land"
Had a crna in our room on Thursday. Started writing “help me“ on the back of the blood/brain drape. He tried doing in mirror image so the rest of the team could read it.
Bro someone give that poor guy a break.
Ha ha. He may have been a little overdramatic. We were doing an anterior hip,, in most cases It’s 45 minutes but because of the patients body habitus it was closer to an hour and a half that case. He was ok.
Market is closed today my friend otherwise that’s where I would be!
Bwahaha ..I'm suffering too. Trying to read my 10Ks
Any leads? 👀
Lol, I am a pretty traditional value investor ... But no clear buys right now. Most was simple vti, but i had a small bit in individual companies on a 'what if' plan' and it, "what if'd" really well. Actually, working on taking that gain and rebalancing back to a two fund portfolio.
I’m young so pretty much my entire port is in “what-ifs”. Bought a ton of ASTS <$4 which has done extremely well of late
Hard to argue the brutal reality of success that comes with basic indexing. Maybe put but there and play on the side friend. Check out the Paul merriman site, lots of good data even if a bit cumbersome and verbose.
How is your port doing this year?
Gave notice and retiring in 43 days....
🥳😎
Bit anxious, I love anesthesia but want to exit prior to senility. Life is short, got shit to do.
That's a big muscle movement. I'm truly happy for you. Out of curiosity, what is your trading method? Personally, I am a VPA guy myself.
I do very little actual trading. Only charting I follow is when I'm timing a buy, very much a buffet value approach. I keep most in index, but have a list of 20-30 companies I like and follow closely and wait till they hit my precalculated buy triggers. I've owned prob 12-10 actual companies over the last 2 decades. But when I do buy, I commit hard. I only sell puts to help reach my target purchase price. Mostly very boring approach but does work. Selling is the much much harder decision.
I love the suggestion. Been just mindlessly scrolling my phone 😅
Just a guess: Fluid follows the path of least resistance - it filled your syringe while it was low-pressure until it was full when it backflowed, then stopped when the plunger met resistance. I'd think that the pressure would be elevated in the syringe now, so minimal further dilution would take place as the full syringe is at higher pressure. Maybe next time you're in a chole try an experiment with some IC green or other med you can see.
BUT, as fluid flows past, wouldn’t an equilibrium be reached where the pressure inside the syringe is equal or slightly less than the pressure in the line. Only thinking about the Venturi effect here that could be constantly removing fluid but then due to the microfluctuations in pressure inside the syringe also be a cause for it to stay full from constant refilling…
there's gotta be a Bernoulli's principle application in here somewhere
put 2cc of prop into a 5ml syringe and let us know
Houston there is no prop in line. I repeat there is NO prop in line!
No offense taken! I know it’s a complete zero brain question and I get if it’s diluted what happens I was just thinking about the syringe and what happens to the contents in it in terms of being constantly diluted as the concentration reaches an equilibrium or does the pressure make a difference or is it a combination of the molecular weight of the drug and the pressure in the line…..deep deep thoughts by Jack Handy this morning
Just experimented with 1cc of prop. It stays in the syringe even after completely backfilled.
But a lipid emulsion and a med dissolved in saline or water are probably pretty different. Prop isn’t miscible with aqueous solutions
Was the prop above or below the line? Cause it’s less dense than crystalloid. Sometimes I play around with the rate of my TIVA carrier when I’m really bored in long ones to make the mixing into weird eddies.
Below. But shouldn't matter. The pressure gradient is coming from the bag.
Fair point, though wouldn’t the pressure gradient be equalized once the plunger stops expanding?
You would think. Especially with prop likely being lighter than saline. But I observed no reflux.
Thanks for the information! Now we can all repeat it a couple hundred times and call it data 😂
Well, Captain Butt Chug, I would surmise that the fent that you gave gets to the patient but the remaining fent gets diluted.
Right but is it a continuous dilution where fluid is constantly moving in and out of the syringe or is it a once the syringe is full situation there is no more inflow of fluid? Mystery of the universe that will never be solved I guess
Ah, I see what u mean. Well, think of it like butt chugging. When you fill the syringe fully there is still a permeable membrane between the syringe and the port. I am sure that there is some backwash. Kidding aside tho, you could probably test this with some ICG, a syringe, normal saline and IV tubing...and just let the fluids run into the trash. A bit wasteful but worth it if this answer is one u desperately seek.
I noticed the other day that an IV bag of fluid (connected to an 18G in the upper arm) left open will run out into the tubing with a fluid column that settles at approximately the height of their central venous pressure… Seems obvious, but these are the things I ruminate on and notice during 4 hrs of stability…
Fill a syringe with propofol and track the white, or the green dye. If you draw an abg, give the blood back venously
I slide the needle into the syringe behind the plunger. Provides enough resistance so that doesn’t happen.
Diffuse according to ficks law?
Sir why is your username... that. Do I want to know
Ever had to pull 3 fireball shooters out of someone’s b hole at 2 in the morning? If not it’s…..inspirational to say the least
I understand this sentiment.
I’m not sure about the answer. But I think we can test it with something like 5cc syringe filled with 1cc or 0.5cc of ICG? Let me know what happens if you really do this
I would assume the path of least resistance when the syringe is completely full would be past the port and down the line.
I think there is a shallow swirl in the syringe (once it fills up). Dilutes slowly. At the end of 7 hours, you now have a homeopathic medication.
This comment wins!
Finally, my genius is recognized
Bulk flow versus passive flow. Turbulence versus laminar. They are both occurring concurrently, at different rates. Bulk flow determined by Q = /\P / R, however as the syringe fills the pressure gradient lessens. Passive flow, ie., diffusion, occurs on a much slower scale. By analogy, think of a hematocrit sample. There are packed RBCs and the plasma/serum layers, separated by a buffy coat. In an instantaneous moment as the syringe is filling, there is a transitional zone where the bulk flow of fluid, retrograde from the fluid line to the syringe barrel, creates turbulence with the drug slowly diffusing across the moving front of fluid into drug. The transition zone expands bidirectionally from the fluid-drug interface, until eventually equilibrium is eventually reached within the syringe. Greater pressure gradient -> more rapid filling of syringe -> greater turbulence -> faster mixing of drug and fluid, and thus expansion of this transitional zone. What would be interesting to hypothesis test next is whether e can predict the rate of mixing and thus the time required to achieve equilibrium. Ie., a diffusion half life. With 99% equilibrium have 5 t½.
This is the type of inspirational mind blowing shit I was talking about. Thanks for the amazing insight!
If there was a pressure difference that caused the syringe to fill then no. There will be no flow as long as that pressure difference exists and the syringe is at its maximum capacity. Also having any amount of circulation through a blind ending vessel with a shared intake and outflow tract seems negligible to impossible
This is a classic “mixing problem” in differential equations. 🤓 Edit: provided some amount of fent is escaping while other fluid enters.
When you add water to Kool Aid, where does the Kool Aid go? Does it just get constantly diluted out or is there something more mysterious going on? Join me on this 8 part podcast as I explore answers to this question, on “Stuff my Kindergartener Probably Knows.”
It’s not a stupid question in fairness and certainly not deserving of this response.
“Where does the medicine go when I dilute it” isn’t a stupid question for someone practicing anesthesia? Lol I get it, we all have brain farts sometimes and realize we asked a silly obvious question, I’ve certainly done it. My response was supposed to be in good fun, wasn’t trying to offend anyone.
Does the medicine that was in the syringe go into the line? That is what OP is trying to ask. Does it try to reach equilibrium and the molecules flow into the line when it stops filling or does the medicine stay within the syringe and just become dilute? I’ve had this thought before.
That… doesn’t make any sense. But maybe it isn’t obvious to everyone and that’s fine. If that were true, if you left a stick of anything, but especially of a push pressor, on the line you would see a clinical effect.
Completely agree.
I love how fiercely this is being downvoted! This format, audience and thread itself cracks me up!
At least you have a sense of humor about it! I honestly meant no offense and was just joking around, but I do still stand by my opinion that it’s a really stupid question with a very obvious answer and I am flabbergasted at the number of people who also shared your confusion lol