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ð ð REALISTIC ARTIFICIAL WREATHâ¨ The needles of this Christmas wreath are made of premium environment-friendly PVC, look ultra-realistic and lifelike, helps to add a touch of color and the feel of nature to your home.
ð ð BEAUTIFUL CHRISTMAS DECORATIONSâ¨ This artificial wreath is an attractive addition for indoor and outdoor decoration, especial for Christmas. Using it can get more festive atmosphere and express your love for life. It will look great in any decor, use this wonderful winter or fall front door wreath for festive fall, winter, and Christmas decorations in your home or covered outdoor locations.
ð ð REALISTIC CHRISTMAS ELEMENTSâ¨ The Christmas ornament wreath is decorated with red berries clusters , linen decor,imination pine leaf and pine cones .Perfectly matched with Christmas that can create a festive atmosphere to your home.
ð ð WIDELY USED IN VARIOUS OCCASIONSâ¨ The small Christmas wreaths can be used on the front door, living room, wall, fireplace, porch, door, window, store, hotel, Christmas party, Christmas tree, and anywhere indoors or outdoors you can hanging.
ð ð MODERATE SIZE DURABLEâ¨ diameter of the wreath is 12 inches, fit door and wall decoration. Made of durable plastic, you can put the wreath away for next Christmas, and leave on the happiness.
Descrition: Designed specifically for Christmas: Our unlit Christmas door wreaths are 100% handmade, with a unique bow, and are specially designed to celebrate the holidays. Classic Christmas elements: The Christmas decoration wreath is decorated with 3 bows, and the green base is decorated with red fruits and pine cones, adding a happy atmosphere. Widely Used in Various Occasions: The small Christmas wreaths can be used on the front door, living room, wall, fireplace, porch, door, window, store, hotel, Christmas party, Christmas tree, and anywhere indoors or outdoors you can hanging. Common Size and Reusable: 12 inches artificial Christmas wreath is hand-made with high-quality materials, and comes in sturdy packaging. After Christmas, you can put the wreath into storage and used again for next yearâs holiday decor. Applications scene: Perfect floral decor for office,leisure,bedroom,living room,coffee table,windowsill,balcony and soon. Feature: 100% brand new and high quality . Quantity: 1pcs Materials: Polyester Light color: As shown Product size:30Ã30Ã7cm/11.81Ã11.81Ã2.76Inch Packing size: 30x30x8cm /11.81x11.81x3.15in Net weight:150g/0.33lb Gross weight: 300g/0.66lb inner diameter: 4.72 inch outer ring diameter: 13 inch Package Content: 1PC Christmas Wreath
“There are some things you learn best in calm, and some in storm.”
– Willa Cather
Over the past several years, I’ve thought a lot about what to say during the immediate moments after a failed cardiac arrest or traumatic resuscitation. When the rush of adrenaline comes to a screeching halt and all that is left is a deafening silence, Read More
A strategy of high-sensitivity cardiac troponins over short time intervals for the diagnosis of acute myocardial infarction has been recommended in European cardiology guidelines. Hyland Motion Sickness
Acid-Base Workshop: At the beginning of the conference year, multiple faculty members ran a workshop on acid-base abnormalities where we worked on identifying acid-base disturbances, determining primary respiratory or metabolic abnormalities, causes of such disturbances, and if compensation was appropriate. Perhaps one of the most challenging types of patients we encounter with an acid-base disturbance is an acidemic patient who we believe requires intubation. Below you will find a variety of resources on acid-base disturbances and more specifically, intubation and ventilation in this patient population. Read the case, consider reviewing the resources below, and think how you would approach this tenuous patient.
A 23 yo F with a PMH of poorly controlled T1DM presents to your ED complaining of nausea, vomiting, and abdominal pain. She ran out of her insulin 3 days ago and didn’t have the funds to refill it. Her FS is 415 on POC testing.
Vitals: 123/80, HR 120s, O2 98%, RR 32, Temp 98.2
General: sleepy but arousable to voice
HEENT: dry mucous membranes
Chest: CTAB, kussmaul breathing
Cardiac: regular rhythm, tachycardic
Abdomen: soft, NTND
VBG: 7.03/14/65, Calculated Bicarb 5
You hang fluids and start an insulin drip, but the patient becomes progressively lethargic and has vomited twice despite anti-emetics. You decide you need to intubate. What next?
What are the risks of intubating this patient?
What would be your intubation strategy? Method, intubation medications, and things to pay attention to?
Would you consider giving any additional medications (apart from paralytics or sedation medications) prior to intubating? If so, why, and what would be the dosing?