#respiratory

[leeromeestudies]

respiratory system notes, pediatric version

[r-ene]

08.17.23

>> day 11/100 days of productivity

this day's productivity was more on completing my team's research:

acknowledgements

technical revisions

progress report submitted to the university ethics committee

surprisingly, just these 3 resulted into taking up my whole afternoon 😅 but it was very nice to complete our thesis. we only need to publish it and display it in our faculty and library, haha

also here we have bobby, habitually laying down on the books i read.

[torturing-characters-101]

Hi, i wanted to ask something I had been curious about:

Why is it that in movies, when someone is wearing an oxygen mask, they either don’t speak, are discouraged to do so or have it taken off if they want to say something?

On a tangential note, when it comes to that other kind of masks used in non invasive ventilation, like bipap, can one speak with it on?

You can absolutely speak in an oxygen mask. Unfortunately, even in person people can have a hard time understanding what is being said through an oxygen mask. It's also hard to see the person's lips moving, so I assume it would be difficult to mic/film well.

Without knowing a lot about the sound technology of movie making, I assume this is just a choice so they don't have to dub over what is being said. It can also just add a little flair to the scene- he wants to talk so bad he's giving up his life-saving oxygen!

With CPAP/BiPAP type masks, it's kind of the same. People can definitely talk in them, it's just really hard to understand. This is because the masks are blocking some of the sounds, the machines are designed to force air into the person's lungs (so talking is harder than it would otherwise be) and the machines are noisy.

[postcard-from-the-past]

Respiratory device of a Parisian firefighter

French vintage postcard

[milk-chip]

crippled complaint number 8,793: how fucking dare y'all get covid and not mask and not respect the people who say it could hurt them. I keep being fought on how I want to get out of our place for a bit because our roommate is covid positive and is not masking or being even remotely considerate of me or my immunocompromisation and I just can't even begin to deal with how unreasonable these assholes are!! "oh nobody in our family had a bad covid reaction you'll be fine" I GOT BORDERLINE PNEUMONIA FROM A RESPIRATORY INFECTION! GUESS WHAT COVID FUCKING ATTACKS!!!! ugh my dad literally told me the worst thing for me was going to be my anxiety. like?? really???? worse than my inconsiderate COVID positive roommate?????? I am gonna have a fucking joker arc I can't TAKE it anymore

[roleplay14]

He has a respiratory infection but he looks so fucking pathetic, it's adorable

[igcse-bioworld]

We are all in this together!!

[willowreader]

[blue-genes]

I have covid :(

This is why I don't interact with people.

[respiratorybymatt]

The FDA approved inhaled ensifentrine (Ohtuvayre) as maintenance treatment for chronic obstructive pulmonary disease (COPD) in adults, drugmaker Verona Pharma announced opens in a new tab or windowon Wednesday.

A first-in-class dual phosphodiesterase 3 (PDE3) and phosphodiesterase 4 (PDE4) inhibitor, the nebulized therapy acts as both a bronchodilator and non-steroidal anti-inflammatory, simultaneously relaxing airway muscles and reducing inflammation and mucus production.

[r-ene]

07.14.24

— life lately

let go of my long hair and dyed my hair again bc its high time for a change (kidding) and i have a pictorial for a department event soon, so, yk

my camera roll's filled with ventilators from high flow machines to baby vents to hamiltons bc it became a habit for me not to only write the changes in vent settings anymore but also take a photo of the current settings the time i did rounds (8am rounds, 12nn rounds)

there's so much i've learned these 5 months in my first clinical rotation and i can't wait to share more about it soon 🤗

[malecprscene]

They are members of a popular new band and have many fans, but there are those who don't like their presence. One day, while they were practicing, a man threw a poisonous smoke bomb, causing them to be poisoned, thankfully the manager found out about it and immediately took them to the hospital.

Their condition was quite worrying because they experienced shortness of breath which was severe enough to make them use oxygen masks, except one, because he was in the kitchen getting a drink.

They are: Xion, Zergan, Kio and Bem

[postcard-from-the-past]

Building of the Outdoor School of Suresnes, made for children with respiratory issues

French vintage postcard

[harmoniousworld]

Even though I say I’m having “difficulty breathing”, it doesn’t mean that I’m going to appear the same way as if someone were having a heart attack.

I wanted to make this blog post because there seems to be a lack of awareness on this topic.  The other day, I saw a new doctor on Telehealth. I told her I was having issues breathing and that I preferred to write in the chat log (if there was one).  She said there was no chat log, and I said that I will hang on as long as I can speak.  She did urge me to call 911 if I needed to, but she was pretty hasty, rolling her eyes pretty much the entire time, with an attitude (before I even told her I was having difficulty breathing).   I won’t be seeing her again.  In her notes, she didn’t dismiss that I was ill, but she did write down that I claimed to be having some breathing distress but that I was “talking fine, talking in full sentences / paragraphs, and not in any breathing distress”.  She put something like, “patient claims she’s breathless and can’t talk, yet she continues to talk very fast and is not actually having any issues breathing.” I wanted to put this out here, loud and clear!!  Just because someone is feeling distress upon breathing and while verbally speaking does NOT necessarily mean this person can’t talk “at all”, and it doesn’t mean that this person isn’t suffering to the max when he/she speaks.  There are MULTIPLE manifestations / types of “breathlessness”.  That is an ambiguous word.  That is why I used the phrase “difficulty breathing” earlier on. No matter the semantics you choose to use, the universal message should be clear: that if we tell you we are in distress verbally speaking, WE ARE.   NOT all shortness of breath presents the same.  Of course I was not having a heart attack.  I know what THAT type of “short of breath” is like.  That is a breathing for me that was very fast, with frequent deep gasps, with the worst distress and inability to catch my breath whatsoever.   For my usual daily symptoms, though, my “difficulty breathing” is much different than that!!  I guess even doctors aren’t familiar with “this type” of “difficulty breathing”.  Again, having “difficulty breathing” could mean a variety of things!!   Well, she did technically tell me she was not a doctor but rather a nurse practitioner.  (I even had a NP who didn’t know what dysautonomia was recently, so I can’t hold them too accountable here. But, they should open their minds a little.) Even when I’m not speaking, I have labored breathing.  It’s not the same type as when you have to labor your breathing when you’re in an SVT attack; I get that way too.  That’s much different. When I have labored breathing, I have to manually focus on each breath.  My chest is also VERY tight, and my airways are not that elastic to begin with.  My lungs are always tight and compressed.  I also have apnea both while awake and asleep... and not the obstructive type but the central type where the brain doesn’t even send the message to breathe.  I don’t have apnea all day long.  That part does come in waves.  Some days it’s very severe and breathing isn’t automatic.  At that point I have to focus very hard, and when I speak and my brain is going fast, it becomes almost impossible for me to breathe enough.  I will talk until I get faint and then it jolts me to breath.  But on the moments/days that the apnea is not severe, I still have many other respiratory issues that are exacerbated while speaking verbally. There are moments I can’t speak at all, and there are moments I can speak with just a little distress (which always worsens as I go).  My FEV1 is EXTREMELY low, which is the forced air output. My lungs are also hyperinflated, as seen on chest x-rays. I was also diagnosed with COPD on top of astham and the low FEV1.   When I speak, I am VERY lightheaded / faint.  I get more and more near-syncope as I speak.  My airways get tighter because of their lack of elasticity. I did have nodules on my vocal cords years ago.  I also felt a pop in my airway back in 2010 when this all started with my airways. I did have breathing difficulty since I was a child with exertion.  I see phosphenes (stars) when I speak.  I start to gasp for air.  I take breaks at certain times. I may talk for 4 minutes straight and then suddenly stop talking fully. I may start doing very deep breathing which can sound like I’m sighing... I assure you I never sigh.  It is me deep breathing.  And people don’t even notice the deep breathing.  If you see me in a video, though, you’d see how much distress I’m actually in if I were to highlight the exact moments that I’m holding my chest, breathing oddly, etc.  I start to sum up my answers, EVEN IF I am still talking “a lot”!  This is because I know the convo could go on for a while and I want to answer as much as possible even if I have to sum things up here and there.  For anyone who knows me, they will know I’m an EXTREMELY DESCRIPTIVE person.  That’s just the way I am.  I’m not a person of a few words; I’m a person of many words.  I love to talk.  I was always extremely talkative.   Talking on the phone / video urges me to speak louder, and any time I speak loud, it makes me more breathless.  I also used to be a singer and now I cannot sing much.  That should be full proof right there.  I went from being able to belt out a tune, even though I was always lightheaded to some degree doing so, to being able to hardly finish one stanza while only sitting down.  Now my FEV1 is so low that I can hardly get a few lines of singing out at one time... and I can’t sign with much force for long.  I can maybe sing with significant force for ~2 seconds max. I also can still scream / yell, but only for 2 seconds, and then i’m left suffering greatly afterwards.  After every vocal interaction, I’m suffering SO much.  It actually makes me worse because then I can’t go and exert after speaking.  After talking to someone, it usually takes about 45 min for me to reset and then I can go into a wheelchair or use the bathroom, etc.  People have NO idea how distressing this is.  I would love nothing more than to use sign language or another method, but people do NOT see this as a “real problem” because it’s so rare.  If I were deaf, yeah, sure people will use sign language.  Funny thing is I can hardly hear... I lip read mostly now... and when people turn their backs and I can’t hear them, I have to ask “what” repeatedly.  And it’s not even an issue with volume... I can hear volume fine, so hearing aides won’t help.  It’s a problem hearing clarity, as I have extremely loud tinnitus going on at all times, involving knocking sounds, rumbling, and 8+ pitches of tones, some pulsing.  I also have tensor tempani and tons of ear pressure.  So believe me, I would love to use sign language, but because I’m not “deaf” no one would accommodate that.  And here I will sit, suffering, for the rest of my life!!!!  I also would like to write things down.  Sometimes I do. Some people will not entertain that, because they can see I can still speak. But what they don’t see is how much worse it makes me, how bad I feel during it and after it, and how I can’t do anything for so long after speaking.  It would give me so much freedom to be able to use sign language or write things down.   Just because I can verbally speak does not mean it’s not torturing me.  MY LUNGS FEEL LIKE BRICKS to lift with each breath, and when I speak, I have to lift so much more.  It feels like 100 pounds.  And it exhausts me.  My heart rate goes up.  My heart also becomes inadequate and doesn’t beat right after talking for several minutes or even after exerting at all.  I burn so many calories from just TRYING to speak, due to my heart rate going up.  I get so exhausted just talking a little bit.  I can’t afford to speak but I do it anyway because I’m stuck in a world that only caters to visible disabilities.  If you have an invisible disability, forget it.  You’ll always be seen as meek, weak, and a wuss to outsiders.  I’m so spent and wrung out from all this explaining.  I don’t owe anyone an explanation, but here I am making myself all stressed out because an uninformed, narrow-minded nurse would rather assume than look at my past history or ask me in writing on a message. 

[help-im-a-medstudent]

Today I went in to do a cannula to find a patient only rousable to a VERY firm sternal rub (and immediately drowsy again), doesn't flinch when I take a blood gas, had been fine and eating lunch an hour previously.

No clear sign of why she had low GCS (normal gas, normal blood glucose, no falls etc)

Call consultant who comes and sees her 15 minutes later and she is awake and chatting away quite happily

Me:

[willowreader]

A video explaing how respirators work. The science behind these masks is amazing. They will protect you from COVID and other respiratory diseases.