“We are so much accustomed nowadays to take it for granted that romantic love between the sexes is one of the most important and sacred things in life, that it is hard to believe that, before the twelfth century, such an idea never entered anybody’s head - and, if it had, it would have been considered not only immoral but also ridiculous. That human beings did in fact fall in love, with very disturbing effects, was of course a fact that nobody in any age could possibly overlook; but it had never been customary to admire them for it. On the contrary, passion, as distinct from a decent conjugal affection, had always been held to be a bad thing, both in men and in women - but especially in men, since it overthrew their sovereign reason, made them behave like lunatics, and (still worse) caused them to submit to the caprices of the inferior sex. On this point, pagan and Christian were agreed.”
- Letters to a Diminished Church, “The Writing and Reading of Allegory”
I’m only a little obsessed. I wonder who’s to blame?
Сильный яд (Strong Poison)
Где будет труп (Have his Carcase)
Возвращение в Оксфорд (Gaudy Night)
Медовый месяц в улье (Busman’s Honeymoon)
In Katharyn Powers’ original script, Kira and Tahna were to be lovers, but Michael Piller decided that this was a television cliché. Powers’ version also had Tahna turning his back on terrorism and attempt to forge peace with the Cardassians, before being killed by his own people. (Captains’ Logs Supplemental - The Unauthorized Guide to the New Trek Voyages, p 41)
How fleeting are all human passions compared with the massive continuity of ducks.
Why Is My Trauma Patient On Oxygen?
How many times has this happened to you? You walk into a young, healthy trauma patient’s room and discover that they have nasal prongs and oxygen in place. Or better yet, these items appear overnight on a patient who never needed them previously. And the reason? The pulse oximeter reading had been “low” at some point.
This phenomenon of treating numbers without forethought has been one of my pet peeves for years. Somehow, it is assumed that an oximetry value less than the standard “normal” requires therapy. This is not the case.
In young, healthy people the peripheral oxygen saturation values (O2 sat) are typically 96-100% on room air. As we age, the normal values slowly decline. If we abuse ourselves (smoking, working in toxic environments, etc), lung damage occurs and the values can be significantly lower. Patients with obstructive sleep apnea will have much lower numbers intermittently through the night.
So when does a trauma inpatient actually need supplemental oxygen? Unfortunately, the literature provides little guidance on what “normal” really is in older or less healthy patients. Probably because there is no norm. The key is that the patient must need oxygen therapy.
But how can you tell? Examine them! Talk to them! If the only abnormal finding is patient annoyance due to the persistent beeping of the machine, they don’t need oxygen. If they feel anxious, short of breath, or have new onset tachycardia, they probably do. Saturations in the low 90s or even upper 80s can be normal for the elderly and smokers.
Bottom line: Don’t get into the habit of treating numbers without thinking about them. There are lots of reasons for the oximeter to read artificially low. There are also many reasons for patients to have a low O2 sat reading which is not physiologically significant. So listen, talk, touch and observe. Set the alarm level to 90%, or even lower. And if your patient is comfortable and has no idea that their O2 sat is low, turn off the oxygen and toss the oximeter out the window.
looking forward to having enough free time to frantically draw egregiously fluffy shit again instead of just frantically reblogging posts
deepintheshadyglen