#Causes of COPD

[diginerve]

Respiratory Medicine: Current Trends in Asthma and COPD Management

Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory conditions that are very common, not just in people of one country but worldwide.

Though both problems are distinct, sometimes COPD is mistaken as asthma because the two have almost the same symptoms.

Below is the information that will help you differentiate both: 

Asthma is a chronic inflammatory disease that affects the airways at both a cellular and molecular level. Asthmatics often suffer from allergies, and their symptoms begin in childhood.

COPD, on the other hand, is characterized by impaired airflow that cannot be reversed. It usually develops later in life.

After gaining some insight into the impact of both diseases on health, you might get concerned about the situation. But the good news is that with the increasing number of asthma and COPD patients, awareness and research for better treatment for these conditions have also increased. To ease the lives of people suffering from these issues, our scientists work day and night to create Oral and intravenous corticosteroids. Additionally, students pursuing an MD in medicine put in their 100% effort so that in the future, they can do more advanced-level research and invent new drugs. 

The following are the current Asthma and COPD Management trends that you should be aware of!

Current Trends in Asthma & COPD Management 

Asthma & COPD management aims to control symptoms, prevent exacerbations, and minimize the risk of persistent airflow limitation and asthma-related death.

The following are the current trends in management that you should be aware of if you are interested in studying Respiratory Medicine:

Inhalers and Nebulizers: Inhalable medications such as Fasenra, Dupixent, Ventolin, salbutamol, and terbutaline are the first-line treatments for respiratory diseases. With the advancement of medical science, the market has seen a surge in the development of more efficient and user-friendly inhaler devices, which ensure better compliance and improved drug delivery.

Despite the initial treatment, if you still struggle with the issue, consult with your doctor to pursue a second line of action.

For Asthma, second-line drugs include heliox, magnesium sulfate, ketamine, and inhalational anesthetics.

For COPD,second-line options include tiotropium, salmeterol (Serevent), formoterol (Foradil), ipratropium, albuterol/ipratropium (Combivent), and levalbuterol (Xopenex).

Biologics Medicine: The emerging trends in therapies for lung diseases have pointed toward the use of monoclonal humanized antibodies, which are referred to as biologics.

These therapies target the specific immune system components responsible for asthma and COPD, increasing the chances of better outcomes.

Digital Health Solutions: The digital revolution is not only uplifting our lifestyle but also playing a critical role in improving our health. Now, with the invention of wearable devices that can track respiratory health, patients can help themselves escape serious respiratory conditions where they have to rush to the hospital.

Personalized medicine: Another prominent trend is treatment tailored to the patient's unique genetic and molecular profile. Because every person might have different causes of problems, symptoms, and responses toward particular drugs, this approach should become more common in the coming years. 

Apart from the treatment listed above, for people suffering from asthma and COPD, it is possible to manage their condition before the problem gets out of hand.

The following are the steps they can take:

Identify and avoid triggers like allergens, irritants like smoke and pollution, and respiratory infections.

Get regular vaccinations for influenza and pneumonia.

Quit Smoking

Control weight

Summary: We hope you found the above information helpful. Though the information in the article was basic, if you want in depth knowledge of the Clinical manifestation for COPD and the management of Asthma attack, enroll in our medicine md online course now!

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This course is designed to address the gaps in clinical skills and help students grasp the subject fully.

The course covers various medical specialties, including Neurology, Cardiology, Gastrointestinal Surgery, Hepatology, Pulmonary and Chest Medicine, and rheumatology. 

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[drsheetusingh-blog]

Meet  Dr. Sheetu Singh, a COPD Specialist in Jaipur

Are you struggling with COPD? Meet Dr. Sheetu Singh, a COPD specialist based in Jaipur. With years of experience and expertise in the field, Dr. Singh is dedicated to providing personalized care to help manage and improve COPD symptoms. Book an appointment with her today and take control of your respiratory health.

More Info: https://www.drsheetusingh.com/copd-specialist

Website:  https://www.drsheetusingh.com

[sleep-safe]

shout-out to anyone with a preventable disability. shout-out to the frustration and the pain and the grief and the rage. if your disability was caused by ignorance or negligence or malice or chance i see you. if someone else had made a difference choice or if you could have made different choices i see you. i see your pain. you are no less entitled to feel that grief even if you could have done something. you shouldn’t be in pain even if you caused it. i forgive you, i see you. if someone else caused your disability i see you. you’re entitled to rage and grief and confusion. to everyone who sees people ignoring the same advice that could have prevented your own suffering, i see you. i see your sorrow, your indignation, your desperation. It’s frustrating when people don’t take your advice because they can’t see the looming outcome. Even when you’re right there.

[mythicalcoolkid]

After too many years here I've final what hornets' nests I am not brave enough to kick

[scientia-rex]

A lot of younger people have no idea what aging actually looks and feels like, and the reasons behind it. That ignorance is so dangerous. If you don’t want to “be old,” you aren’t talking about a number of years. I have patients in their late 80s who could still handily beat me in a race—one couple still runs marathons together, in their late 80s—and I lost someone who was in her early 60s to COPD last year. What you want is not youth, it is health.

If you want to still be able to enjoy doing things in your 60s and 70s and 80s and even 90s, what you want to do, right now, is quit smoking, get some activity on a regular basis (a couple of walks a week is WAY better for you than nothing; increasing from 1 hour a day of cardio to 1.5 will buy you very little), and eat some plants. That’s it. No magic to it. No secret weird tricks. Don’t poison yourself, move around so your body doesn’t forget how, and eat plants.

If you have trouble moving around now because of mobility limitations, bad news: you still need to move around, not because it’s immoral not to, but because that’s still the best advice we have. I highly recommend looking up the Sit and Be Fit series; it is freely available and has exercises that can be done in a chair, which are suitable for people with limited mobility or poor balance. POTS sufferers, I’m looking at you.

If you have trouble eating plants because of dietary issues (they cause gas, etc.) or just because they’re bitter (super taster with texture issues here!), bad news. You still want to find a way to get some plants into your body on a regular basis. I know. It sucks. The only way I can do it is restaurants—they can make salads taste like food. I can also tolerate some bagged salads. On bad weeks, the OCD with contamination focus gets so bad I just can’t. However, canned beans always seem “safe,” and they taste a bit like candy, so they’re a good fallback.

If you smoke and you have tried quitting a million times and you’re just not ready to, bad news. You still need to quit. Your body needs you to try and keep trying. Your brain needs it, too. Damaging small blood vessels racks up cumulative damage over time that your body can start trying to reverse as soon as you quit. I know it’s insanely, absurdly addictive. You still need to.

You cannot rules lawyer your way past your body’s basic needs. It needs food, sleep, activity, and the absence of poison. Those are both small things and big asks. You cannot sustain a routine based on punishment, so don’t punish your body. Find ways to include these things that are enjoyable and rewarding instead. Experiment. There is no reason not to experiment—you don’t have to know instantly what’s going to work for you and what won’t, you just need to be willing to try things and make changes when things aren’t working for you.

You will still age. Your body will stop making collagen and elastin. Tissues you can see and tissues you can’t see will both sag. Cushioning tissues under your skin will get thinner. You’ll bruise more easily. Skin will tear more easily. Accumulated sun damage will start to show more and more. Joints will begin to show arthritis. Tendons and ligaments will get weaker and get injured more easily, as will muscles. Bones will lose mass and get easier to break. You’ll get tired more easily.

But you know what makes the difference between being dead, or as good as, in your 60s vs your 90s? Activity, plants, and quitting smoking. And don’t do meth. Saw a 58-year-old guy this week who is going to have a heart attack if he doesn’t quit whatever stimulant he’s on. I pretended to believe it was just the cigarettes, and maybe it is, but meth and cocaine will kill you quicker. Stop poisoning yourself.

Baby steps; take it one step at a time; you don’t need to have everything figured out right now. But you do need to be working on figuring things out.

[hemanthsworld]

Ultimate Guide to Respiratory Tract Infections: Symptoms, Diagnosis, and Evidence-Based Treatments for URTIs and LRTIs

Upper Respiratory Tract Infections (URTIs) Introduction Respiratory tract infections (RTIs) encompass a wide range of conditions affecting the upper and lower respiratory tracts. They are common ailments that cause significant global morbidity and economic loss. This comprehensive guide covers everything you need to know about RTIs, from symptoms and diagnosis to evidence-based treatments and…

[xtrablak674]

Death Certificates

I have become a reluctant collector of death certificates. I am trying to remember why this was even on my spirit this morning, maybe something that was said on the Ear Hustle podcast. Yes, it was one of the silly questions asked in one of their magazine segments, what kind of pizza would you be? My answer was a simple cheese pizza with a single topping pepperoni, and the reason was this was same order my mom made when she treated me and my siblings to pizza.

When I order pizza as an adult if I am ordering a topping it is usually pepperoni, I am not saying I haven't tried other toppings but my go-to is plain cheese with pepperoni. This then lead me to think I had mis-remembered her date of death because it made for a better story saying she died four days before my eleventh birthday. Something in my head was saying that was just a story and not the actual date of death. I searched my tablet and couldn't find a picture of her death certificate which was odd because my fathers and his mothers were right there.

This lead me to my safe to get out my copy of her death certificate which I scanned and photographed to fix the previous oversight. Her date of death was actually April 4th, 19XX, which is actually a week before my eleventh birthday once again even in my storytelling my bad math was at play. So I wasn't lying, she died right before my birthday. Happy Birthday. #🥳

Since I had her certificate out this was a good time to look at the comparisons between hers, my fathers and my grandmothers. Michael, who I guess was indeed real, is the one who reported our mom's death. It has been forty years since I had seen this "older brother" that I had been to doubt that he existed, but here he was right on this official document, so I guess I did/do have an older brother, how much older isn't clear to me and probably never will be.

My father's certificate was reported by his mother, I guess this was appropriate since his parents after prodding by his aunt were the ones to discover him dead in his Harlem apartment. Now I also had to verify another piece of information about his death, I have always told the story that my parents died at the same age nine years apart. Officially he died a month before his birthday which would indeed make him forty-three years old, the same age his youngest son would follow him in death. But I have a tendency to round up and he would have been forty-four if he had survived another month. I like the repetitive numbers, 84, 44, 40. And my favorite superhero team is the Fantastic Four so all these fours line up with mystic numerology.

Curiously since both of my parents died at forty-four I didn't feel great about getting past that number myself, its and odd feeling to be older than your parents ever were, but I am not the one who should have been worried, my late younger brother who basically smoked himself to-death followed his dad at the exact same age. I think my late brother was born in nineteen eighty, which means he was thirteen when he lost our father. But four when I lost my moms, another four. He died two year after our grandmother, I think our shared last grandparent.

Causes of death were quite different, my moms carcinoma of breast with metastasis, dads undetermined, but the family assumption is something related to his exposure to agent orange during the Vietnam war. Not sure if there is a thing as a good death, but my grandmother's cause is listed as hypertensive cardiovascular disease, probably related to the congestive heart failure she was diagnosed with, but it was old age. I am curious where do they get cause of death from? I don't recall ever using the term "hypertensive cardiovascular disease" as cause of death. I also don't remember giving out doctors information. I guess its all moot now.

Too bad I won't ever know what my death certificate says or who will be my informant. I feel a way having this much hands-on experience with death certificates, with my moms it was about being able to cash in the payable-upon-death bonds she had purchased for me. My father I think it was just information because he had no discernible estate and made no kind of preparations for his progeny, pretty typical to how he lived. My grandmothers was tied to an inheritance, a word frankly I wasn't really involved with until her death. It was curious that during her life she thought someone was studying her wealth, when frankly I know I wasn't, but as I even told her sister regardless of that, I was no fool and I wouldn't leave a penny on the table and I didn't.

I would love to say I am indifferent to death, having had so much during my lifetime. I can say definitively that when my time comes I will be ready to go, no kicking and screaming here. My preference would be to die like my moms or grandmother at home. But we know like in life our preferences aren't usually honored especially in the last preference we will ever have.

[Photo by Brown Estate]

[emed123]

Explore cutting-edge COPD treatment options. Stay informed with new developments in COPD care.

[ecomehdi]

Unveiling the Silent Killer: Exploring the Link Between Lung Cancer and an Undiagnosed Lung Disease

Our lungs play a vital role in keeping us healthy and alive. They are responsible for the exchange of oxygen and carbon dioxide, ensuring that our bodies receive the vital oxygen needed for proper functioning. However, when our lungs are compromised by disease, the consequences can be severe, leading to health issues such as lung cancer. In this article, we will delve into the connection between…

[queertransetc]

Shout out to people with breathing related disabilities because this shit sucks

People who need inhalers and nebulizers. People who use ox tanks. People who can’t stand or walk too much because it makes breathing harder. People who have given up important parts of their life because of their breathing issues. People who need assistance and caregivers. Especially huge shoutout to people whose breathing problems don’t have any treatments and/or are getting worse with time

In my experience, we are often left out of the disabled community, either implicitly or explicitly. Needing assistance with chores and errands is so common for disabled people yet when it’s a lung or airway issue that causes us to need that assistance, we’re left out of the convo. Conditions like cystic fibrosis, COPD, lung cancer, VCD, asthma, anaphylaxis, and more can all be seriously disabling. We deserve a voice

Anyways, big hugs for people with breathing issues that want one. We deserve more love <3

[januaryembrs]

impulsive!hotchner!reader (i’m thinking hotchs sister) x spencer reid

as in reader completely ignores the dangers of the job but somehow it always ends up going how she planned for it to go and then there’s hotch and reid completely pissed at her im talking spencer red faced and spewing facts and statistics on what could’ve gone wrong and hotch just backing him up with a frown and crossed arms

THREE'S A CROWD | Spencer Reid x Hotchner!Reader

description: it's hard enough getting your job done when you work with your boyfriend, even harder when your overbearing boss happens to be your brother.

length: 500wds

warnings: mention of house fire + medical side affects of inhaling smoke

“You’re grounded,” 

You baulked, eyes narrowing at your eldest brother where he’d forced you to sit in the back of the ambulance, the medic draping a shock blanket over your shoulders.

“Grounded? Are you kidding me?” You seethed, and your lips pulled into a snarl when he crossed his arms over his chest, his face tipping on furious, “Aaron, I’m not-”

“Don’t Aaron me, you could have died. Do you not realise how irresponsible you were being?” You huffed, rolling your eyes and sitting back with your own arms lacing over your chest, feeling like a fifteen year old all over again being lectured on why you shouldn’t sneak out to parties or roll weed. 

“Thank you, agent, for saving five citizens from a house fire, that was incredibly brave of you. Oh sure, no problem big brother, anything for the job-” You mimicked childishly, your teeth clenching roughly as you felt their stares burning into the side of your head, pun intended. 

“The biggest killer in fires isn’t the flame itself but the smoke inhalation,” Spencer snapped, his lips pursed together just as annoyed as your brother, and your whirled around to match his glare, “Black smoke not only is the cause of thirty thousand people a year alone, but also supercharges existing health problems and can cause life long-chronic inflammation of the lungs. So yes, you were being irresponsible,” 

You gawped at your boyfriend, the two men staring down at you with irritation, and you had to admit your lungs were feeling a little tender from where you’d ran back in the house to help the father drag his wife and children out of the burning building. But you wouldn’t admit that to them, you couldn’t. Because if they were this worried and vexed at you being asymptomatic, you shuddered to think how overbearing they would be if you so much as coughed. 

“Seriously, Spence, you want in my bad books too?” You snipped, but he doubled down, shaking his head and scoffing in a way you’d never heard from him before. Sometimes you wondered if they took tips from one another on how to be the world’s most affectionate pains in your ass. 

“I am serious, just as serious as heart disease, COPD, cardiovascular issues, emphysema, all of which are common long term side effects of black smoke inhalation-” Spencer continued, and you threw your head back with an eye roll and a groan, feeling your chest aching already with where you struggled to keep your breathing even, already knowing you were going to kick yourself when the two of them hit you with the ‘I told you so’. 

“Man, I would hate to be that girl right about now,” Morgan said to Emily, stuffing his hands in his pockets where he watched you get chewed out by Hotch and Reid. 

“Are you kidding me, being yelled at by those two, I’d take facing a house fire all over again,” She murmured, shaking her head as you shoved past the two of them, the three of you squabbling over the fact they insisted you stayed to be checked over by the EMTs, “Kid’s got balls on her, I’ll give her that,” 

[andhumanslovedstories]

A while ago at work, I had a patient whose condition rapidly deteriorated during my shift, which I believed at the time was due to me not monitoring certain therapies closely enough. Essentially patient had parameters that their oxygen saturations should be between 88-92%. The patient was on supplemental oxygen via a nasal cannula, and was having oxygen saturations of 95% or more. The patient later became lethargic, confused, and hard to rouse. The patient was in hypercapnic respiratory failure, where they essentially were not exhaling enough CO2, the waste product of respirations. Patients who have oxygen parameters of 88-92% tend to be COPD patients, and I'd been taught where giving them too much oxygen can result in CO2 retention.

We ended up having to call a rapid response on that patient who needed to go on the bipap (non-invasive ventilator) to help them breathe effectively, and I went home from that shift feeling certain that I killed this person. That I had triggered a terminal decline that the patient would never recover from.

(Perhaps some context here: my grandfather went into hypercapnic respiratory failure and then died within a few days. Maybe he would have passed either way, I think probably he would have, but the respiratory failure was the moment his decline started accelerating. After he went hypercapnic, he was non-responsive from that point on.)

I called in sick to my next shift because I couldn't face going in. I spent the day thinking about what I'd done, what my moral obligations were, how do you atone for something when you cannot reverse the effects of the original error, and how paralyzed by shame I felt. What did I owe the patient? What did I owe the family? What did I owe myself? How many times had this happened before and I just didn't know because the decline happened after my shift ended?

It was a productive if unpleasant day of trying to sincerely examine myself and the things I'd done wrong without flagellating myself. It'd be almost easily to complete condemn myself and to stop nursing because I'm a Bad Nurse than it would have been to acknowledge the many steps that led to this patient outcome, only some of which I had a hand in. But this was my patient. They were my responsibility. What was the right reaction to have? What should I be feeling? In the course of doing my job, I caused harm to someone I swore to take care of. I still think that I am a thoughtful, hardworking, and compassionate nurse. I don't think the hospital would be better off if I quit. But I hurt someone.

I thought a lot about how this outcome happened, came up with steps to prevent it in the future, and found a new commitment within myself for continued learning. (If you've got a timeline of my particular fixations, this is about when my determination to go to grad school began.) I also thought about how much shame was making me sick. When my patient started declining and I realized the effects of my actions and inactions, one of my first thoughts was genuinely, "Everyone's going to know what I did." It was thought with absolute horror. I'd hurt someone and everyone was going to know it. They were going to know I was bad at my job and bad as a person.

And I was struck by what an unhelpful emotion that was. How much it made me, if only for a moment, tell NO ONE what was going on and what I believed to be the root cause. That it'd be better to let the decline continue rather than intervene because if I intervened that'd be admitting that I'd done something wrong. I didn't listen to that voice that told me to hide what I'd done, but I instantly understood the power of it.

There's this thing called the Compass of Shame which is about the different ways people handle their own feelings of shame--they avoid the shame, they withdraw from themselves and others, they attack others, they attack themselves. I know my own reactions to shame and try therefore not to go with my gut instincts, which are always to say I'm an irredeemably bad person and no one can know about this and if anyone does not about what I've done wrong, I deserve literally whatever punishment they could give me. I've had to learn I can both have failed to complete my responsibilities and still not deserve to lose my job or my flunk this class or give up on college or lose all my friends. But there is something appealing about masochistic shame. Like you can prevent others from judging and punishing you if you sufficiently judge and punish yourself. You'll still be a wretched monster, but no one else needs to know that.

That's actively dangerous for patients, who are the victims of healthcare errors, and it doesn't help prevent future mistakes if we are too ashamed to talk about what happened and why. We'll just keep fucking up in the exact same ways because no one else told us how they'd fucked up that way in the past and here's how we've changed the process because of that. I therefore have an ethical obligation to not internalize shame when I make mistakes at my job. I have tried to remember that while also trying my best to not make the same mistakes twice.

And then a week later, I was sent back to the same floor with the patient who'd declined on my watch. Because I'm a float RN and therefore don't have an assigned unit, I go to different floors every night (occasionally multiple floors on the same night). I see patients for 12 hours and then almost never see them again. Since I was back on the floor, I girded myself and went to go visit the patient, who to my surprise was alert and upright and about the same as I'd seen her at the beginning of my shift before they'd gotten bad. I said hi and asked how the patient was doing, and the answer was that patient was doing about the same as they'd been doing for the last month.

This was not good news for the patient, who was still medically complex, still dealing with an extremely difficult to address condition, but they were also not in the ICU, dying, or dead which is what I'd feared. And with the new knowledge that the patient was, if not okay, than at least stable as ever despite my actions, I could look back on that shift and see it differently, namely that this patient kept continuing to go into hypercapnic respiratory failure with or without oxygen. And then I looked into what I thought I'd been negligent about before and found that the scholarship on it was more complicated and divided than I'd thought. That the mechanism of action that I thought was driving the hypercapnic respiratory failure was in fact waaaaaaaaaaay more complicated than just over oxygenation, particularly in this patient who had a number of muscular abnormalities that made much more of an impact on ventilation than the oxygen would have. And while I still had to improve my practice, upon more reflection I could no longer say there was a direct one to one of my actions and the patient's decline.

I felt simultaneously forgiven, absolved, and humbled. I cannot describe to you the almost sheepish relief that rushed over me. Nothing that bad had happened. What did happen was only ambiguously my fault.

There's a power fantasy to shame sometimes, that you are uniquely bad and that your actions have monumental consequences. My actions on the job can have monumental consequences, but usually they are little things, little cares, little turns, little med doses, little therapies, little steps, little tasks, little jobs, little kindnesses or little cruelties that help a patient move forward or which hold a patient back. I'm there for 12 hours and never again. I can do a lot in that time, but I'm not gonna cure them and I'm probably not going to kill them. It's a relief, and it's a strange disappointment. We want to be important, even in bad ways.

While I can certainly fuck things up for patients, while I can certainly kill patients or traumatize them or withhold care or misuse my position, while I can do all those things, I don't actually have that much power over life and death. Everything that goes wrong isn't my fault. And sometimes something is your fault and nothing really happens except a few people have a bad night and you try not to do it again. I think that last bit is the most important part. I still should have titrated her oxygen down. I'm more careful about that now. I'm trying not to fuck up in the exact same way. I'll find exciting new ways to fuck up, and then I'll learn from those too.

[incognitopolls]

We ask your questions so you don’t have to! Submit your questions to have them posted anonymously as polls.

[scientia-rex]

Wound Care

Ok so, take this with a BIG grain of salt, because I may be a medical doctor BUT you need to know how much wound care training we get in medical school: none. Zip. Zilch. There may be medical schools where you do, but mine wasn't a bozo factory and there was NO wound care training. Everything I know I learned from one of several sources: an intensive 2-day wound care course I did in residency (highly recommend), the local Home Health wound care nurse (highly recommend), a completely batshit insane old white male doctor who started our learning sessions by yelling Vietnam War stories at me (do not recommend), a hospital wound care nurse (highly recommend), and experience (oh god do not recommend).

The first thing you need to know is that wound healing varies dramatically across the course of a lifespan. Kids? Kids will heal. If they don't, get their ass to a pediatrician because there's something genetic going on. Young adults will heal. Middle-aged adults will heal. You know who doesn't heal for shit? The elderly, and people with severe illnesses, and people with uncontrolled type II diabetes.

Your body needs several things in order to heal. It needs macronutrients, so you need to be able to EAT protein, fat, and carbs. If you are on total parenteral nutrition, aka TPN, aka IV nutrition, you are going to be worse at healing. If you are starving yourself, you are going to be worse at healing. If your body is desperately funneling all the calories you take in to surviving your COPD or cancer, you are going to be worse at healing.

It also needs micronutrients. If your diet sucks, you won't heal. Take a multivitamin once in a while.

There are two CRITICAL skin components to healing: collagen and elastin. Guess what we stop making as we age. Promoting collagen isn't just good for "anti-aging," it's good for NOT ripping your skin apart. Taking oral collagen is probably bullshit because your body is going to have to disassemble it to get it across the intestinal membranes to absorb, but it's also harmless, and if your diet REALLY sucks, who knows. Give it a try. Collagen is made of amino acids; think protein.

Another absolutely crucial component is blood flow. As people age, they start to develop cholesterol plaques lining arteries that eventually pick up calcium deposits. This makes blood vessels less elastic, which is a problem, but eventually also blocks them off, which is a much bigger problem. If someone has the major blood flow to their feet decreased by 90% by arterial stenosis, they are not going to heal for shit AND their foot's gonna hurt.

One component of blood flow I hadn't thought about before going into medicine is fluid retention. The way your body works, blood exits the heart at a very high velocity, but slows to a crawl by the time it gets into capillaries, the smallest blood vessels in the body. Water is a very small molecule and can leave the blood vessel, especially if there aren't big, negatively-charged molecules like proteins like albumin in the blood vessels to hold the water there. And we're built for this--some water is supposed to leak out of our blood vessels when it gets to real little vessels. It gets taken back up by the lymphatic system and eventually dumped back into the bloodstream at the inferior vena cava. But if you aren't making albumin--for instance, in liver failure--you may leak a LOT of fluid into the tissue, so much that your legs get swollen, tight, the skin feeling woody and strange. This isn't fixable by drainage because the fluid is everywhere, not in a single pocket we can drain. And because it puts so much pressure on the tissues of the skin, it often results in ulcers. Congestive heart failure, liver failure, kidney failure--these are all common causes of severe edema, aka swelling due to fluid in the tissues. And they're a real bitch when it comes to wound care, because we have such limited resources for getting the fluid back out, which is a necessary first step to healing.

Pressure is another common cause of wounds. Pressure forces blood out of those little capillaries, so you starve the cells normally fed by those capillaries, and they die. It's called pressure necrosis. Very sick people who can't turn themselves over--people in the ICU, people in nursing homes--are especially prone to these wounds, as are people with limited sensation; pressure wounds are common in wheelchair users who have lost some feeling in the parts of their bodies that rub against those surfaces, or diabetics who don't notice a rock in their shoe.

So, if you're trying to treat wounds, the questions to ask are these:

Why did this wound happen?

-Was it pressure? If it's pressure, you have to offload the source of the pressure or else that wound will not heal. End of story. You can put the tears of a unicorn on that thing, if you don't offload the pressure it won't heal.

-Was it fluid? If it's fluid, you have get the fluid out of the issues or else it won't heal. You can sometimes do that with diuretics, medications that cause the body to dump water through the kidneys, but that's always threading a needle because you have to get someone to a state where they still have juuuuust enough fluid inside their blood vessels to keep their organs happy, while maintaining a very slight state of dehydration so the blood vessels suck water back in from the tissues. You can use compression stockings to squeeze fluid back into the vessels, but if they have arterial insufficiency and not just venous insufficiency, you can accidentally then cause pressure injury. The safest option is using gravity: prop the feet up above the level of the heart, wherever the heart is at, at that moment, and gravity will pull fluid back down out of the legs. Super boring though. Patients hate it. Not as much as they hate compression stockings.

-Was it a skin tear because the skin is very fragile? This is extremely common in the elderly, because they're not making collagen and elastin, necessary to repairing skin. If this is the case, make sure they're actually getting enough nutrition--as people get into their 80s and 90s, their appetites often change and diminish, especially if they're struggling with dementia. And think about just wrapping them in bubble wrap. Remove things with sharp edges from their environments. I have seen the WORST skin tears from solid wood or metal furniture with sharp edges. Get rid of throw rugs and other tripping hazards. I had somebody last week who tried to a clear a baby gate and damn near destroyed their artificial hip.

The next critical question: why isn't it healing?

-Are you getting enough nutrients? Both macro and micro?

-Are you elderly?

-Are you ill?

-Do you have a genetic disorder of collagen formation?

Fix why it's not healing and almost anything will heal. If you're diabetic, find a medication regimen that improves your sugars and stick to it. If you're anorexic, get treatment for your eating disorder. If you have congestive heart failure, work with your doctor on your fluid balance. Wear the damn pressure stockings. Prop up your feet.

If, after those two unskippable questions are done, you want to do something to the wound--apply a dressing, do a treatment--that's a whole other kettle of fish. I'll write that later. The dryer just sang me its little song and I need to put away the laundry.