#2 Remember naloxone, glucose, and thiamine (NGT)
Original: Consider or give naloxone, glucose and thiamine
The number of patients presenting with opioid intoxication is growing, and the gentle reversal of patients without severe respiratory depression with naloxone is in the art of medicine – consider starting with 0.4mg and titrate to effect.
In contrast to empiric administration of glucose in the altered or ill patient, rapid assessment of glucose level with point-of-care testing is recommended.
Thiamine deficiency may be less prevalent than previously thought in intoxicated patients, but we now know that giving 100mg of IV thiamine can benefit other malnourished patients, including those with calorie-malnourishment from cancer, gastric bypass, hyperemesis gravidarum, and eating disorders. Personally, I use the ‘T’ of ‘NGT’ to remind myself not to miss alcohol withdrawal.Ten Commandments of Emergency Medicine Revisited — https://journalfeed.org/article-a-day/2021/ten-commandments-of-em-revisited
Why does this matter? I hear you thinking we underwrite life insurance, we’re not doctors. So true. But if we think like doctors we will get better at what we do by recognizing the subtleties buried within the medical charts we read. Here’s what my eyes/brain picked up.
The bold in the excerpt above are mine to illustrate how the mind of a mortality risk expert works. In Emergency Department records pay attention to the initial treatments provided which in some cases hints to a serious condition impacting mortality. Naloxone and opioids are obvious. But would you have associated the administration of IV thiamine to malnutrition or alcohol withdrawal? I thought so.
So read and research widely. You’ll always find little jewels to improve your skills and to impress your friends with. Or in my case to make Dr. Lee think his old man knows more than he actually does.
We all have difficult days and unfulfilled dreams and sometimes need a place of comfort. We have joyful days and want someone to celebrate with us, but if we’re not paying attention, significant moments can be overlooked.
So turn off the television, log off social media, pocket the mobile phone, and if you can’t mute the phone and ignore it, then leave it in the car when you go out to eat. Be present — not just with your ears, but your eyes, as well. Pay attention. Don’t interrupt. Say, “Tell me more or help me understand,” and just listen.
Charlotte Lankard is a licensed marriage and family therapist in private practice. Contact her at email@example.com.
Source: Lankard: Being present to the ones we love | Oklahoman.com
Daily Weigh-Ins Keep Dieters on Track – MedicineNet.
Journal of Obesity — An Open Access Journal.
A two-year Cornell University study found that tracking the results of daily weight checks on a chart helped people lose weight and keep it off.
Sometimes I forget but I try to weigh myself every day. I keep a log on a Google Sheet. It is a daily reminder of whether I’ve been good or bad. Bad behavior is not hard to recognize. Too many restaurant meals, too much animal protein, ice cream, pizza, beer, etc. Good behavior is harder but achievable. Grilled chicken on mixed greens, choosing the smaller burrito rather than the giant version, more plant based meals, less beer.
Periodic weigh-in’s work. It’s part of the routine ever since losing over 200 pounds. Boom.
99% of Networking Is a Waste of Time – HBR.
“Opportunities do not float like clouds in the sky. They are attached to people.”
Stupidity is worse for us than either sugar or saturated fat.
Read this article and you’ll encounter a well reasoned rant with lots of links for further reading enjoyment. My personal journey includes a significant weight loss experience in my early 20’s. Over the years I’ve gained back some of the 200 plus pounds lost. Over the years I’ve also gotten lazy with my dietary habits. Too many calories and an aging metabolism is not a combination for staying trim. So I got serious (again) and have dropped 12 pounds the past three months. I’ve always known what to do but failed to do what needed to be done.
And so it goes. Change. Adapt. Repeat.
Eating yogurt can reduce the risk of getting Type 2 diabetes by 28 percent, compared with consuming none, according to a study published today by Diabetologia. Higher consumption of low-fat fermented dairy products, such as yogurt and some cheeses, also lowered the relative risk of diabetes by 24 percent overall, the study showed.
via Yogurt May Be an Ally in Fight Against Diabetes: Study – Bloomberg.
I’ve started eating yogurt every day.
Your best bet is to have a system for acquiring new and complementary skills over your lifetime while always looking for better opportunities. It’s analogous to diversifying your investments.
via ‘Dilbert’ Creator Scott Adams: How to Fail Your Way to Success – US News and World Report.
People are becoming entrepreneurs. The mind-set of the employee is vanishing like the factory where it was born. It has to. We’ll all die if we wait for some force outside ourselves—business or government—to bring us jobs or teach us who we are or how we ought to live.
We have to invent our own ways, and that’s just what we’re doing.
via Writing Wednesdays: “Poof Goes the Middle Class”.
Poof goes the middle class – latimes.com.
A couple of weeks ago I caught up with my old college buddy on the phone. I asked how his son was doing after taking refuge in his parents’ basement post college graduation.
“Michael’s doing great. He moved out to Brooklyn and is doing project work. Very happy, very busy. Michael has four or five projects on the go.”
Call it what you want – freelancer, contract worker, portfolio careerist. The employee mindset is becoming a thing of the past.
Coursera courses are 6 to 10 weeks long, with an hour or two of videos per week. In addition to the snap quizzes, they feature weekly exercises, ranging from problem sets to spreadsheets to design projects or essays, and sometimes a final project or exam. For all quantitative courses, the platform uses artificial intelligence to evaluate each longer exercise, with instant results. Students can keep trying until they get the right answer. For humanities courses, Coursera is testing a form of peer grading.
via How Coursera, A Free Online Education Service, Will School Us All | Fast Company | Business + Innovation.
Great article about a MOOC (Massive Open Online Course). HT – Mish.
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