37 Burst results for "Emergency Room"
Fresh update on "emergency room" discussed on WBZ Afternoon News
"Get more people have actually it for free. Create more places for them to get vaccinated. Mobilized more medical teams to get shots and people's arms. Increased supply and get it out the door as soon as possible. City, one of the most challenging operational efforts ever undertaken by our country. But you have my word. We will manage the hell out of this operation. Mr Biden in his speech, also warning things will get worse before they improve when it comes to the virus. He also defended his nearly $2 trillion covert relief package, saying it is time to go big as millions of Americans are struggling. 601 Nobel for a Boston attorney, arraigned today in court on several charges, including rape. Gary's A Rolla was arrested just before one o'clock this afternoon in the city. Police have been looking for him for several days, even putting out an alert earlier this week asking the public for help. NASA Rolla has charges or husband charged rather with rape and sexual assault in years past. Now he's being held pending a dangerousness hearing next Thursday. Also today, Governor Baker assigned a new bill into law, making it easier for those who need emergency care at the hospital. It was four years ago when Laurel leaves showed up at Somerville Hospital, suffering from an asthma attack. Unable to find the emergency room entrance in her state of distress, she collapsed and died just steps away from the acute care she desperately needed. Today. Governor Charlie Baker signed Laura's law. It requires hospitals to improve lighting and signage and provide monitoring to ensure that all patients in crisis are able to access emergency rooms without unnecessary challenges. Waris husband, Peter DeMarco led the campaign to win passage of the lawn named for his wife. Today, he voiced with gratitude for the unanimous support accorded Laura's law. He says he hopes that helped save the lives of others who, like Laura, arrive in an emergency room, desperately needing care at the Statehouse. Mike Macklin WBZ Boston's news radio. It's 602. Maybe your by your computer right now. If you open up Google in your Web browser, you'll notice a very cute doodle of students out there playing basketball in a room. That Doodle. It's a special tribute to Dr James Naysmith, and in that name sounds somewhat familiar. That's because he's the inventor of basketball, which happened over at the Y M. C. A international training school in Springfield. You can actually in the doodle, See Naysmith in the corner, watching students throw the ball and make the shot every time into that basket now Mass live reporting today. Back in 18 92. Naysmith laid out the brand new game and the original rules in a newspaper over at Springfield College. Flags vandalized on the cape of those flags honoring first responders. Details on the case coming up in about two minutes..
Texas Health Plano Sets Up Emergency Tents For Non-COVID-19 Patients, Dallas Area
"Health Presbyterian Hospital in Plano has set up tents in the lobby to treat non covert patients in response to overcrowding in the emergency rooms due to the pandemic. Texas health plan. Oh, President Joshua Florence says Given increased demand, they wanted to be able to expand capacity so those patients can be seen and treated quickly to many of the patients. They're very, very grateful and appreciative that we've given them another opportunity to move to the system or quickly and be seen and certainly that we have them separated. He says. The lobby space is easily accessible, intense offer privacy for the patients.
Fresh update on "emergency room" discussed on WBZ Afternoon News
"Access emergency rooms without unnecessary challenges. Flores husband, Peter DeMarco led the campaign to win passage of the lawn name for his wife. Today, he voiced with gratitude for the unanimous support accorded Laura's law. He says he hopes that helped save the lives of others who, like Laura, arrive in an emergency room, desperately needing care at the Statehouse. Mike Macklin, WBZ Austin's NewsRadio following last week's violent attacks in the U. S. Capitol left at least five people dead federal prosecutors who saying that the mob that seized the capital did so with the intention of capturing and assassinating government officials were on that from correspondent Mike Bauer, the filing asking a judge to detain Jacob Chancellor. The Arizona man who's Horned outfit led him to be dubbed the Q and on shaman. Prosecutors wrote. Strong evidence, including Chancellor's own words and actions of the capital supports that the intent of the capital rioters was to capture and his Assassinate elected officials in the United States government, the lawyers pointed to a note The chancellor left on Mike Pence's death warning the vice president, it's only a matter of time justice is coming. Meanwhile, Chancellor's lawyer is asking President Trump for a pardon, claiming Trump invited Chance Lian I'm like power. Later today, President elect Joe Biden will unveil his covert vaccination plan. The president elect has an aggressive covert 19 relief package he's hoping will help Millions of Americans struggling during the pandemic still needs to get through Congress, though, and likely would need support from at least a few Republicans is calling for $400 billion to deal with covert 19, including more money for testing, assisting schools and vaccinations. Vaccine roll out in the United States has been a dismal failure thus far. The plan earmarks $160 billion for a national vaccination program. The president elect is promising to deliver 100 million shots in his 1st 100 days in office. Deborah Alfa Rhone CBS NEWS Washington 302 Police in Westminster had their hands full today responded to a barricaded suspect that the roadway.
Kevin Bacon Gives Kyra Sedgwick Agonizing Bikini Wax
"Kyra sedgwick says that she finally found something that her husband kevin. Bacon is not good at it. and it's giving her mckinney wax. Watch this okay. I'm not saying it was a disaster but the fact that we did not have to go to the emergency room was an absolute miracle movements. Like i thought you knew how to do this. This user that you do the filter my god. That was from kimmel last night. Would you ever let you ran wax you. I mean. I feel like we're like in a new york. We're in a new phase even with him having to just i'm like is it still the same size like things still look normal down there because i haven't seen it in eight weeks like all i keep trying to bend over. It's not it's not saying. Hey so i thought that was the line. I could never imagine being like. Here's the wand. Here's the strip. Have a good. Like i trust my lay lake. The blade wouldn't lady parts. Thank you with him and wax. I just is there. No other way by the way i i don't know maybe this is discriminatory. Maybe i'm making myself a target for some backlash. But if i go to my waxing lady and it's a man. I asked for a woman so i just do myself. I'm a man. I don't trust myself down there. Furthermore there are a few things. I like to keep private in my relationship that my man will never see one of those amazon rain. Jungle down there. And i also would would always want a woman as well. I don't know. I just feel like she knows better what i want. No no
Vaccine Hesitancy is Solvable
"Dr montgomery rice so happy to be able to talk to you about this today. You know. I think a lot of us have been watching a catastrophe within the catastrophe or one of them which is that covid. Nineteen has disproportionately in acted people of color. And i think even more disproportionately killed people of color. You know one would hope in that situation. That african americans would be at the front of the line to get their vaccines and i wonder if you can talk a minute about where we are. And why african americans are in some cases more reluctant than others to get the vaccine. We know that this virus has disproportionate impact of people of color. Not just african americans but latte necks and questions were raised early on with their something unique about race or ethnicity that put people at greater risk what we really recognize when you look at the science that this virus did not discriminate that if you were in proximity with someone who was infected you had a higher chance of being infected nat next and african american word the people who were the essential workers because they are the people who check people into emergency room. They are the orderly. they're the ones in food service. The other ones in transport driving your buses. Who were picking up your trach. Who will work in restaurants etc. So you know that they were at increased risk of being infected so with not that this virus was discriminatory per se against people because of their race. Ethnicity is the social determinants. They have led to this now. Having said all of that we know that we see a disproportionate number of health disparities because of the social constructs that are not allowed for greater access to care and then access to the greatest level of quality of care. And so we have made a alan effort in the scientist community to make sure that black scientists have been at the table of the backseat discovery and development the valuation of the data in the clinical trials and then the decisions at the fda cdc of the allocation and and of course people saw you getting your first dose of the vaccine on on cnn and one of the other. I recipients of the pfizer vaccine was an african american nurse in long island So they're clearly been efforts. Would you've been in. The center of to have prominent trusted african american voices publicly getting vaccinated if someone sees you getting vaccinated on cnn. Sure that builds trust the institution you represent all the things you're talking about but at the same time what my friends are saying or what my neighbors are saying or what i feel like the people i know are going to do is going to have such a big impact. How do you create influence at that level around accedes. So you know i take a lot of phone calls a lot of emails and I tell people the truth always so when we didn't know stuff early on jacob. I told them we didn't know yet. We needed to give time for the studies to be completed with vaccine trials and then as we started to know more we then shared more. And so what. I've tried to do is to be transparent about what we don't know and open even more open about what we do know and at no point have i ask people to deviate from those healthcare practices. Oh of the three ws washing your hands wearing your masks in watching your distance and recently i added a p on that so as three ws. Nlp now being patient for wind is your turn to receive a vaccine. And so i think is really really critical that we as healthcare providers as scientists. Let people know that. This is evolving. That's what i've tried to do with my peers. Is to make sure that they understand that. We don't know everything but what we do know. Be confident in that.
California issuing waivers to bypass strict nurse-to-patient ratio rules amid COVID surge
"Largest upsurges in covert 19 cases in the country. California's issuing waivers permitting, some hospitals temporarily bypassed the nation's only strict nurse to patient ratios. Over, nurses say forcing them to take on more patients is pushing them to the brink of burnout and affecting patient care. At least 150. The state's 400 hospitals have been granted 60 Day waivers. Which will now ICU nurses to care for three instead of two people and emergency room nurses. Overseas minis half a dozen patients.
COVID-19 hospitalizations skyrocketing in the US
"Matters are unfolding in emergency rooms this hour. More people are hospitalized with covert nineteen than any other time since the pandemic began especially in los angeles county the epicenter of the outbreak in the us add to that the threat of more contagious variants. That have emerged in the uk in south africa.
New variant of the coronavirus spreads in California
"Of days. Another crush of coronavirus cases in here in L, A and statewide are expected to potentially overwhelm emergency rooms. When will the enormous number of Corona virus infected patients begin to level off? One epidemiologist is telling Can ex It's probably not any time soon, and in fact likely to get worse this month, we'll put hospitals already in crisis into further severe crisis to deliver care to sick people. You see allies, Dr Lauren Miller, speaking with KNX with the Lundquist Institute. The vaccine will make a different right now It's really only been rolled out to one or 2% of the American population, and the difference will be really at this point small, He says. This new Corona virus strain that S'more infectious. It's not detected at least yet in Los Angeles, but there has been a case in big bear it, he says. Given the fact people travel, it is likely here already just undetected. Craig
Every 15 minutes someone in Los Angeles County dies from the coronavirus
"In Los Angeles County. Now someone dies of covert 19 every 15 minutes. Here's NPR's Leila Fadel. It took this county 9.5 months to reach 400,000 cases of covert 19. But in the last month that number has doubled to over 840,000 cases. L, A county supervisor Hilda so lease That is a human disaster and one that was avoidable. But I need to underscore that it could be worse. The situation is already beyond our imagination, but it could become beyond comprehension. If the health restrictions in place are not fully obeyed. That number will likely go up after a weekend of New Year celebrations. Despite lockdown rules again, so lease hospitals are declaring internal disasters. And having to open church gyms to serve as hospital units are health care workers are physically and mentally exhausted and sick. Dr. Ornish Mahajan heads Harbor U. C L, a medical center. Were overrun and our emergency room. We're taking care of patients literally in the hallways sometimes because there is just no beds available. We have equipment. That's You know, almost running out, and so it is a really unbelievable situation here. They only have a few ventilators left only a handful of high flow oxygen, a setup that pushes high pressures of oxygen through the nose. You're ordering more, and we will borrow if we need to from our sister hospitals, But every hospital is struggling with this. The ICU is at 150% capacity and the staff is getting exposed not at work, but because there's so much community transmission. Meanwhile, so many hospitals, ers and ICUs are so full. It's prompted new directives from the Los Angeles County Emergency Medical Services Agency. If in a M T can't get a pulse from a person who's had a cardiac arrest after 20 minutes of trying to resuscitate them. The ambulance shouldn't bring them into the hospital because there's basically no chance of survival and that ambulance in bed are needed for someone else.
Doses Of Antibody Drugs Remain Unused As They Present Various Challenges
"The federal government says it has delivered more than 300,000 doses of monoclonal antibody drugs to help facilities nationwide. They're designed to treat patients with mild to moderate covert 19. The ideas keep those patients out of the hospital, but Many of those doses are sitting unused, due in no small part to the challenge of administering those drugs. NPR's science correspondent Richard Harris looks at to healthcare systems that have overcome those hurdles and are seeing hopeful results. Monoclonal antibodies present all sorts of challenges. They're given to people who have active infections, but who aren't hospitalized, so it's important to treat them without exposing other patients to risk. The drugs by Regeneron and Eli Lilly are also given by infusion, and that process takes a couple of hours. So when you add all this up, you know it's really a logistical challenge to deliver this therapy to a lot of people. But Dr Howard Long at Houston Methodist Hospital, says they figured out how to do that. They've opened clinics around Houston and doctors affiliated with the hospital are referring eligible patients. That is people who are over 65 or who have health conditions that put them at high risk. So at this point we're doing about 50 to 70 infusions a day, and patients are usually scheduled within a Relatively short period of time. So from the time they call into being infused, it's usually less than two days. The timing is important because these drugs appear to beam or effective early in the course of the disease. Mostly help people who aren't mounting their own strong immune reactions and, well medication sits unused in many locations around the country. That is not the case at his hospital, Hong says. Right now we're constrained more by the drug supply. They use it as fast as they get it. Any doctors nationwide aren't so enthusiastic about these drugs, though treatment guidelines issued by the National Institutes of Health say there's actually not good evidence to know whether they work. That's because the Food and Drug Administration relied on studies of just a few 100 patients to grant these drugs, emergency authorization. So these are very small numbers that under normal conditions nobody would never publish in the journal like New England Journal of Medicine. Yet this is, you know, kind of headline news. Welcome Toko bit time right. But doctors are gaining experience. Houston Methodist is now treated more than 1100 patients, Hong says. We're seeing results that are comparable to what was reported in the clinical trials by Eli Lilly and Regeneron about six or 7% of patients who are treated end up in the hospital or emergency room. He figures that without treatment about 15% of the most high risk patients could end up in the hospital or ER. Doctors affiliated with the Mayo Clinic or also encouraged by their experience. They've dust more than 2000 patients in Minnesota, Wisconsin, Arizona and Florida. Dr. Raymond reasonably has done a preliminary analysis of the 1st 1000 or so patients and finds low hospitalization rates. More importantly, there is some signal that is also reducing death. But again this our preliminary analysis we have to kind of make sure that this are all vetted by pure review. But this is what we're seeing. That's why we're happy. Unlike a clinical trial, this real world experience doesn't have a careful comparison group so doctors can't say for sure that these patients are faring better. Even so, these encouraging findings may be swaying doctors who weren't sure they wanted to refer their patients for treatment. There's nobody says patients are also becoming less skeptical. Initially, there were more declines than accept. But no, we're actually seeing more except than declines, and even though it takes a lot of person power to provide this treatment reasonably and Hong believe they're actually reducing the overall workload. Keeping patients out of the hospital. Richard Harris NPR
EMTs Enduring Long Wait Times With Patients Outside Hospitals During Pandemic, Los Angeles
"Of how dire the medical crisis has become in L, a county. Paramedics are being advised to reduce their use of oxygen and to refrain from transporting patients who have virtually no chance of survival. The measures are being implemented to allow medical workers to focus on patients with a better chance of being saved. KCRW's Darryl sentiment has the details. This new directive from L. A county's Emergency Medical services agency says that paramedic should not transfer patients who have experienced cardiac arrest. Unless they can be revived at the scene. In normal times, ambulance crews would take those people to the hospital in the slim hope that they could be resuscitated. In another memo, the agency said that ambulance crew should only administer bottled oxygen to patients whose oxygen saturation levels fall below 90%. That reflects both the regional oxygen shortage and equipment problems that have limited oxygen delivery. It's some hospitals. The Army Corps of Engineers has sent crews to address those issues at several older hospitals in L. A county. Meanwhile, officials have devised a plan to shorten hours long wait times for ambulance crews who arrived with patients at hospitals that are filled up there, setting up new tent like receiving spaces outside of emergency rooms to accept patients. Freeing up paramedics to respond. Other calls for
ER staffer dies amid virus outbreak possibly linked to costume
"Meanwhile, in ER staffer is dead after a covert outbreak in a California hospital following a Christmas celebration. An emergency room employee has died after a coronavirus outbreak led to dozens of staff members in the department testing positive for the coronavirus. The outbreak at the Kaiser Permanente San Jose Emergency Department has infected at least 43 staff members over the past week. Investigators are trying to determine if the sudden spread was caused by an employee who warned inflatable Christmas costume of the First the department on Christmas. The hospital says the outbreak began soon after the holiday
An inflatable Christmas costume may have spread coronavirus particles at a California hospital, potentially infecting 44 employees
"In some states are experiencing hospital outbreaks in records for new cases and deaths are being reported in North Carolina, Arizona and here in California, where AH holiday event may have sparked a terrible outbreak among health care workers 43 emergency room staffers at Kaiser Hospital in San Jose have tested positive after an employee show. Would up on Christmas day wearing an air powered costume investigators say it's possible the fan inside that costume may have spread infected air droplets all over the hospital. Another hospital outbreak to tell you about in Washington State 30 patients at the Peace Health Medical Center in Vancouver got the virus after they were admitted for other health issues here in Los Angeles. Doctors and nurses are overwhelmed. Some hospitals are turning into morgues and a number of funeral homes say they are being so inundated with bodies there. Having to turn family's away. It's Claudia Cowan with Fox News, According to Johns Hopkins University, the U. S has had more than 20 million cases of Corona virus so far. All right. Ah, ah, they're
Coronavirus surge hits Los Angeles
"Number of coronavirus cases continues to surge across the country and California is especially hard hit infections in Los Angeles have doubled in the past month, surpassing 800,000 this weekend. Remember station kpcc Jessica Ogilvy has more This is the fastest acceleration of the pandemic so far, marking a doubling of cases in L. A county since the end of November, Health officials say they are desperate as L A hospitals are at capacity. Ambulances are being forced to wait as many as eight hours treating those patients in the vehicle when no emergency room beds are open. Some funeral homes are also overbooked and turning family's away. Authorities are worried the worst is not over yet with another post New year search possible
Kaiser Emergency Room in San Jose Center of COVID-19 Outbreak After 43 Staff Members Test Positive
"43 emergency staff members at Kaiser Permanente and San Jose of tested positive for covert 19 over the past week, and a statement sent to KCBS Kaiser officials say the infected staff members tested positive between December 27th of January 1st. Kaiser says it's investigating how the outbreak occurred. But officials tell the San Francisco Chronicle that a staff member did appear briefly in the ER on Christmas. Wearing an air powered costume, saying that if any exposure stemmed from that it would have been quote in assent and quite accidental. As the person wearing the costume had no coded symptoms and showed up toe lift the spirits of people
Aggressive squirrel attacks reported by residents in Queens, New York
"And it's only fitting that 2020 come to a strange end. New Yorkers are on the lookout for some aggressive squirrels. They've attacked at least five people in Queens since November, 1 woman was attacked and ended up in the emergency room with an injury to her hand after being bitten last week. Some experts say the squirrels, maybe on the attack because people in the neighborhood I've been
Los Angeles County Hospitals Divert Emergency Patients As COVID Cases Surge
"Crisis in the U. S. On average. One resident is dying from the virus every 10 minutes as the spread shows no signs of letting up something. County Supervisor Hilda So lease regrets. I'm quite quite frankly, not proud. That L. A county has the largest number of Kobe cases right now. Most L A county hospitals are now diverting emergency room patients elsewhere because of overflow conditions caused by the ongoing case Surge overcrowding caused 96% of L. A county hospitals to divert ambulances at some point During this past weekend, an average of 33% of hospitals were diverting patients before the current case surge started in November. On Sunday, at least five L. A hospitals declared and internal disaster. Vice President elect Kamila Harris is set to
Los Angeles Sees Staggering Increase In Covid-19 Deaths
"Of people dying from Corona virus in L. A county is truly staggering. Dr. Barbara for rare, is the county's public health director. Last week we lost someone to call the 19. On average, every 10 to 15 minutes. Between November 8th and December 19. Our average daily deaths increased by a staggering 600%. From tell 12 average deaths per day to 84 average deaths per day. The county is reporting more than 70 new coronavirus deaths today and estimate that about 430 more people have died over the past three days. Those numbers still are going to be confirmed that would bring the county's death told to just under 10,000. Another 13,600 people have tested positive. The daily number of new coronavirus cases has risen by nearly 1000%. Since the beginning of November, and the county safer at home order has been extended indefinitely. Many L A County hospitals have reached a crisis point as the wave of covert 19 patients continues to grow. Situation is truly dire. Doctor Casino Galley, the county's health services director, says about half of all staff beds and more than two thirds of staff to ICU beds are filled with covert patients. Nearly all hospitals are diverting some ambulances. But soon there won't be any place for these ambulances to go. And if I as I said before, if The hospital is on diversion that no hospital is on diversion. Galli says ambulances waiting hours to offload patients are becoming defacto emergency room treatment areas. Some hospitals are having a hard time providing badly needed oxygen to covert patients. Some hospitals have had challenging challenges with securing oxygen delivery through often aging, half hospital infrastructure. This alone caused at least five hospitals in the county to go on internal disaster yesterday, a designation Which the hospital closes to all incoming AMs. Traffic is that as the situation is now, Galli says, it's probably going to get worse. The county's still reporting huge numbers of new cases well over 14,000 Day on average, total confirmed cases are approaching 735,000 and with a large backlog of deaths being reported, total fatalities are approaching the 10,000 mark. Club, you pesky
Los Angeles Hospitals are pushed to limits, death count hits new record
"Across Los Angeles County or being pushed to their limits carrying for new coronavirus patients. More than 6700 residents are hospitalized with the virus with more than 1300 in intensive care. Some ambulance crews have been waiting for hours outside emergency rooms to offload patients due to lack of space. The county also reported single day records of covert 19 deaths on Wednesday and again on Thursday, with no update provided on Christmas Day to an outage experienced by Spectrum service in the Los Angeles area. Updated numbers are expected later today that will cover the past 48 hours.
Dr Fata: Seeing Yellow | 4
"Patty hester was helping a patient at work in the emergency room on the morning of august. Sixth two thousand thirteen. It was busy morning. Her colleague came in the room with a patient and tapped patty on the shoulder. Come here right now come here. I'm rock with her towards break room i to have time what she said. Patti catch your doctor. Patty walked into the break room and stared at the tv quote. We are michigan. Hematology oncology here in rochester hills. Were fbi agents are executing our search warrant. My sources are also telling me that a doctor has been arrested on charges related to healthcare fraud s fbi helicopters. They swarmed in on this morning. And i'm looking at this news. It has named goes across then. Then i have my cell phone in my pocket. and it's like this. you can feel it vibrating. All my dad from that point on her cell phone wouldn't stop buzzing all day. One call was from the fbi. You'll be getting your chart than the news. Said we'd like to interview you. Patty went home. Her husband was in front of the tv. Federal agents say in court records that doctor for allegedly kept patients on chemotherapy. Longer than necessary to cash in on the billings agents allege for da also directed that patients be diagnosed with cancer in their medical charts. Even when they did not have the disease patty wondered. Was she one of them. She didn't have to wait long to find out the next day a dark. Suv with tinted windows. Pulled into the driveway. An agent stepped out of the car and patty opened the door. Her whole family behind her. He said i'm very sorry and handed me my chart in the disk. I just sir cry. My family sobbing sobbing. It was horrific. She put the disk into her computer and began to scroll through. It was just lie after lie after lie. The also gave her a list of oncologist that she could see to get a second opinion. Ten days later patty saw a new doctor for the first time she brought with her. The disc at the fbi had given her. After the dr ransome tests she came into patties exam room hugging. And i am so sorry and saw sorry. You don't have it you don't have a patty began to cry. Her doctor said that she wasn't yet sure what had made her sick in the first place but she was sure that patti didn't have cancer. You need to live your life. You need to live your life. You not gonna die. I said if you do anything for me could you just please write it down town. She's forty where you want me to write it. And so she whipped out a prescription pad. And that's when she wrote a tricia has has no evidence and diaz in the weeks that followed other fatah patients or their loved ones sought their medical records. Saint joseph mercy. Oakland hospital filled these requests free of charge but crittenden had a different policy in some cases. The hospital asked for more than a thousand dollars to fill. The requests fought. Victims protested outside the hospital eventually crittenden relented and waive the fees but the victims and their families still needed someone who knew the technical lingo to look over the records. That's what i did for my fun. Time in the evenings nurse angeles won tek. I would go through the patient's medical records in a way. I feel like for me anytime. Somebody reached out to me. I said yes i didn't. I felt that that was something that i could do. And maybe you know. Help with the guilt of i should have done more. I wish i could have done more. One of those requests came from michelle mannarino. Her mother joan had died in two thousand ten six months. After angela's visit fatah had treated joan for breast cancer but when they met at a hotel in a banquet room angela had some news from michelle. And i remember looking at her records and the chemotherapy and i remember one thing that struck me was one of chemotherapy. Drugs that she was given is typically given for colon cancer. And i thought with this is odd like why would you give this for a breast cancer diagnosis.
"emergency room" Discussed on Important, Not Important
"Outdoor park inch in Scottsdale and there was a all these booths setup and you know some boots you know you go to get a little Indian sack they would have Hannah painting or whatever. So anyway, I had my booth there for my Gresham campaign just to talk to people in the community and hear about the issues that matter to their families and so I was kind of walking around strolling around just you know doing the. meet. Greek. Thing and this was obviously before Cova and and as I start coming back around this ripple back to my booth. There's a little girl who standing at the side of it little Indian girl. She was about nine years old and see her standing there, and then as I'm walking towards her she captures my eye and she runs to me runs to me just you know with just this like her eyes light up and she comes to me and she gives me a big hug just rats arms around me tightly and she's just like Dr Harold Hero and I you know her at she was just the sweet girl who was hugging me and then she's like she takes my hand. She goes I wanNA take you to see my parents I wanna take you see my parents and so there's this couple that standing on the other side of the booth that was talking to some of my staff. So she drags me over to them at she liked presents me to her parents and she says to her mom. And I'll never this she talks presents your mom. Mom I could be this. I could be Dr All. Get better than that and. I you know I mean tears came to my eyes her mom gave me a big. Hug. The Dad gave me a big hug and she just kept show this little girl just jumping up and down like I could be a doctor I could run for Congress I could be a leader and it's it was it was exactly that what you've said is C-. You can't be which can't see. Right And for this little girl. She was just marveling at the fact that there was a brown woman that was a physician that was hoping to to be a voice in Congress, and it made all difference for her. And that is critical for every kit out there every young person should be able to look at that composite of our leadership in our most, you know stately halls whether it's at our state capitals, town city halls, or in DC, and be able to find people in that composite picture that look like them to tell them. You too can be here you. You should be hear your voice is important here. I love that we have. It must have been a nice moment. It was amazing. It's amazing. There's a lot of tears. Her just a, it was just a big crew group bear hug. We're we're remember hugs. All Free Covet. Hero. I want to ask you about your your history, a bit Quinn and I are are very big supporters of of cancer research and treatment efforts. and. Cancer seems to have been a major part of your life. Can You? Can you talk to us a bit about what cancer has taken from you and and where it has taken.
"emergency room" Discussed on Important, Not Important
"If they couldn't afford I, mean. And this is in the middle of a pandemic mid. It's unconscionable. It's almost. Like imagine, any human being would ever push for this Sir and I believe we've got an I imagine because of the number of people who are the demographics of the people who've been affected especially people who? Really suffered and further faced A. Higher Mortality Averages but. I think there's what do we have? What is today? The October sixth were at like seven and a half million. Diagnoses for for covid food seven and a half million pre existing conditions. Seven and a half million probably not seven million new Americans with pre existing conditions. But for a lot of them later to injure a number of them, it's it's maybe their first one and. Guess what you know. There's a lot more coming at. If you strike down the ACA I it's it's going to be. It's I. IT feels incredible. Feels like so many people have forgotten what it was like until that day in whatever was two, thousand ten when when you when preexisting conditions are covered right well and realize that we still didn't like it to the finish line right we still have millions of air against like just prior to this pandemic we still had millions of Americans. families all across this nation that still either were under uninsured right and but we've seen the benefit of the. We've seen the benefit not just to you know outcomes and people being able to stay healthier and seek primary care and and focus on preventative care and things like that. But we've also seen the economic benefit. So it's really important that we realize there's a human toll there's an economic toll and the sooner we you know. Imprint Bat inextricably link in our minds and understand that. This I mean this pandemic, for example, right? It is laid bare all the fragility of our healthcare and economic systems and it's shown how one is directly connected to the other I mean as soon as a pandemic kit. Molly when people got sick and they lost their jobs because they could go to work or because they. Were in the hospital or they just were too ill to to work but all the people that lost their jobs because businesses closed down at production of things stopped and so forth. Of those folks we have seen how the healthcare and the economic systems are so tightly linked and we don't take some decisive action to strengthen our healthcare system and address these economic inequities we are. We're not gonNA, find our way out of this even once the viruses eradicated, we're we're going to be back to square one so we can't go back. We have to learn from this and do so much better. And I think it's important to know and thank you for for the context I. It's it's so true I mean. Again you go to make America great again thing it's like no, it was fundamentally broken before moving showed up and exposed everything. But I wanNA talk a little bit about because we've tried to look we are to middle middle-class straight white guys there couldn't be more privilege on planet earth. And so we tried to recognize that but also have have folks on like yourself who who, who, look and have different experiences than than. We do certainly I mean besides the fact that you've like thirty years of medical training besides those details I'm close I'm getting close adequate experience. Brian it's not just conversation. Okay But one of the things we we we've. Always tried to point out and certainly over the past year, tried to do much better job of his to to to to helping people understand into sale that you know the the inequities in. Billy any of America's systems they are not broken. They were they were designed this way the they're designed in very racist unequal way and I want to talk about how with you a little bit about how that leads to the healthcare system. That is also not necessarily broken. It is designed to be reactive and procedure and profit base. So like you said, obamacare's this huge step forward, but it you know and it was imperfect from the start of reasons. But was far better than the previous situation. Now you know trump has spent four years trying to destroy it and might that might happen in a couple of weeks, right But but at the same time. There's still millions of people with no healthcare or that they don't know what's included in in Medicaid or they're just lied to, and so they don't go to annual checkups. They have tons of underlying conditions because of all the toxic air they're exposed to. So adults get chest pains or they're a young, you know Latino Kit or black you'd with asthma, and so they go to the emergency room right now you don't have a cardiopulmonary person that they see frequently to check on their asthma. Or they don't like you said the young woman with cancer. They don't go those first few times because they fear those bills where they blow it off like people do, and then they go to the emergency room and is wonderful. As Emergency Room doctors and nurses and staff are a massive expense, not only on the system obviously but the person, and so I wonder if you can talk about. How we translate an pivot from this from from this reactive procedure profit based system to something that is like you said, solution based that is preventative. And we are treating. We're we are supporting health instead of constantly treating disease something that has value driven. Yeah. Well, that's a great question and you know we talk about this a lot in in medical circles about moving away from procedure and the number of interventions that tend to drive revenue, and that's considered somehow the the value of our or the significance right of any medical institution, and that's why a lot of hospitals have struggled financially during the this pandemic is. Because there are a lot of elective procedures surgeries that were put off right or canceled or delayed. That was their major revenue stream and all sudden. We're realizing how important it is to go back to that value based you know template of of medicine and so I I love the fact that you mentioned preventative care right when because look we we have to we spend..
"emergency room" Discussed on Real Wealth Real Health
"Conversation. I've really enjoyed I'm sure that the listeners will choose so many nuggets around, you know, being a doctor and Entrepreneurship and a businessman and never stop learning and, you know being grateful and present and giving birth. So, thank you so much for joining us today. Well, I'm on Earth. Thank you guys for having me. I sincerely appreciate if you guys need anything. Just holler. I'm on social media just linked in Facebook all that stuff. Just holler to anybody needs anything. Just holler at me when we really appreciate it and will include everything in this shown owns the link to your book and any, you know, your business sites, and so that people can connect you directly. So once again, thanks guys. Thanks for tuning into real wealth real Health. We hope that you've enjoyed today's episode and found it both informative and insightful. We welcome all your questions and thoughts or feedback about today's episode. And especially we welcome your questions about specific topics that you would like us to cover. So she doesn't email at podcast alpha.com. And if you have a moment, we really appreciate ratings and reviews as it helps us grow our online community and our interactions with you and we'll also be linking to a number of articles on topics that we might have touched on during our conversations. Some of them are brought some of them are technical but we're always meaning to provide information that helps you better understand the mechanics of building this healthy Financial Foundation, especially if you're looking to do this with real estate, Bye..
"emergency room" Discussed on Real Wealth Real Health
"I called all the book companies and said hey if I find mistakes in your book, can I get the book for free and they said sure and so every time I would find them I send them a copy I would tell what log. And and then it got really fun at the time. I'm going to really take myself there was a thing called Palm pilots and I was like, hey, we need us converted least booked since his digital cuz the future medicines going to be very digital and we gotta get away from textbooks and we got to put it on digital and so they listen to me and I was part of its think tank with all the different book companies and tell them how to make the next book editions in version. So it's kind of fun cuz looking back there's a lot of books in med school with my name in it for helping them. And that's just all that drive from that having that made me get there. So it also speaks very much to the necessity of invention of getting what you want. But also creating a win-win like you said that a few times like it was win-win for everyone and you offering something in exchange for or something else. We're so often. I don't know there's a lot of entitlement in the world, you know, everybody feels entitled. I know do a lot of times too for things and but yet this approach to Sing Wong Know what I need and what want what can I offer in exchange for what I want and you were doing it a really Progressive Way like you were seeing some Trends evolving and you you were sort of like an early age content curator with Harvey's Corner as well, which I love thank you. And I think it's you know, I don't feel bad that I grew up the way I did if anything. I'm happy thousand. I called about successfully invention. I feel like life is about Reinventing yourself and it's always evolving and it never stops and I like sharing this story about my son loves her short. We were in my emergency room. I said, hey, you know in the background he was doing a Tik Tok and this was about a year twice a year and half ago and I said, hey just post something online. It helps your dad with the company a little free advertising. He never did it. But then for some reason that video went viral he had about four million hits and I said and you should have, you know, tagged us or something and and but my story is this song I said some looked at your dad know some people in the media let them meet with you and just kind of teach you and techniques and and all the stuff to increase your your ads in the future. If you want to start doing this for a business, he looked and he said Dad don't you see I have four million people already with this one video and I'm have all these people I can teach them that I don't need anyone to teach me. I said Son the way you think you are the best that's the minute. I know you're on your way down and you need to like stop and be humble and keep Reinventing yourself. And so I truly believe for those and I know it's hard as a doctor. I know I've worked hard and I'm here but if I'm not continuously learning really humbling myself. I'm trying to always improve. I'm going to start going down as a doctor. Yeah this amazing story. Thank God for that. It's really good advice to to remember all the time. It's that Zen mind beginner's mind of always being always being humble and always being in in that beginners line. So it's really good dog. Yeah, it's a really good anecdote. So I should wanted to ask you a little bit more to get into the emergency centers because you have about 20 of them. We have some emergency rooms were about to have number eight but you're right as far as twenty between all the different companies that have is about 20. Okay? Okay. So what what prompted you as you were, you know doing like being a doctor to to start either buying or building your own emergency centers talk to us a little bit about you know, the development. Let's just kind of a fun story. So my heart it has always been patient care and I know that sounds cliche. It's like every doctor wants the best for their patients, but for me, I just felt like man I want to do whatever I can for my patients and I started working at a hospital and the hospital administrator. Basically if I like was in the principal's office call me and say hey you're ordering too many tests. You're spending too much time with patients and I would look at him and show my daytime like I'm silly. I'm seeing just as much as everybody else. It's like yeah, but you tend to order more and I'm like but I'm still as productive as a buddy else that like, well, you know, it's going to affect our profit margins and if you get your family, if you can let the family practice doctor ordered those tests, more power to them in this way. We can save some money and I said well as a doctor, I feel like I'm not helping my patients the way they need to be helped and I disagree and at the time I was one of the last owners of this big gap company in Dallas and I remember going to the our company saying if the if this is morals and this is what you want me to do then literally here you go. I'm getting back to my sister's you can buy me out. I'm out and remember to tell me do you realize how much money you're giving up by doing this and I said, it's okay. I totally want to leave. I'm okay with saying here you go. I don't want ownership if this is how you guys are making money. And so I left and my way out. I remember telling one of who's not my business partner. Tell my the nurse I said, you know one day we needed just start off. We are when they really just need to buy one and create a company that has a values that you have and I have and literally fast forward from that conversation to the day. We first open our own brand it was probably like fifteen years later. We opened our first emergency room with our name on it with our own brand and ever since everything about our policies are poor teachers. So we take care of patients just the way I think it's supposed to be done. And so I feel blessed being a position that I can drive Healthcare certain way Drive patient experience a certain way. This is the culture of company. This is what we do and I feel really blessed to be in a place in medicine that I can do that that I don't have to listen to the hospital system. Tell me this is how we want you to practice I say no, this is how I want to practice and I can do the opposite with my boss just to say I want you to do whatever think is best for our patients and don't worry about money. Don't about insurance status or if they can then pay for the bill just take care of the patients and I can do that and feel good about it. You know, it's always great to hear these stories each month. So many option for mirrors and they all have different thoughts about.
"emergency room" Discussed on Heather Dubrow's World
"That heather dubrow world. But know I do save. I've had jackets in my wardrobe for twenty five years. and. You're interested in vintage box so I know you told me about it, but so is it only like designer stop? Only designers. It's designer stuff, and it's dresses that were made for me by this designer in Amsterdam named Edgar. Voss, who's not alive anymore passed away like? I don't fit ten years ago and he don't I feel like I've told you about him, but he so. My parents lived in Amsterdam for fourteen years. My Dad worked for a company that was based right outside of Angstrom, so we used to go a lot, and it's such a gorgeous city, and they lived on this canal, and the people are so lovely. It's just an amazing place. Pot was always legal. There was going to find. And this designer that was a friend of my mom's Edgar. It was like a throwback I remember. Going to at around the same time, maybe maybe a couple years before this going to Giorgio in Beverly Hills. And Giorgio. Was this the store that you'd go into? And it was like a major throwback. They had a bar that you could sit at for coffee or champagne, and they would bring you out the clothes and they would fit them to you. They would make you custom things it was at. It was just phenomenal, so edgar was the same thing. Was this big beautiful showroom? You could go in and pick things off the rack if you will, but he also did all these incredible custom things, and he would make the shoes and color them to match them and jewelry and everything, so it was like a one stop shop. You'd walk in and. Just head to tell it was a bit. You know unconscious chewing if you will, it was like little over the top, and like what I loved about bat was that it was amazing for stage and you know my mom's cost. You Me Anyways, so she always loved that kind of thing. and. I think I posted pictures of my mom at my wedding before like he made her dress for that, he made my grandmother's dress he he was at our wedding. I mean he was. He's just so talented and amazing. So besides the designer things in the box I have a bunch of the Agra vase dresses in their. Super. Cool And I think I have maybe a dresser to if I haven't gotten rid of them, the Guy Address or two from pageant days. Yeah, that's cool. And how big is the box? Is that like the suitcase? It's like one of those larger size tupperware's. That's like a a smaller trunk on it. Very clear tupperware yet. It's like I really need to go through the and so I told you that I had Amanda. My organizer come yes. So we did the whole house. I'm redoing my pantry. and. You know what when I did it for years almost four years ago. You don't think about stuff like I didn't think about something because i. have all these cool canisters. They etched the side of them like sandblasted them, so it's like sandblasted on clear you really, it's hard to read it. and. And then I got these silver canisters with flip tops for like nothing. But you can't see in them. So they either have to be labeled properly, or if you want to change, it was like I, Dunno, it just needed like an upgrade. Pulled out everything in the kitchen got rid of anything extra realized what was chipped in cracked and needed like like. You're saying you so stupid which I have not replaced in so long the potholders. Where you know their ages, they're so all. Thorough mountain start crash. They were so old they had like holes in them and I'm going. What am I doing? It's potholder because you know what they weren't good enough. You don't need to replace every day. I was doing the same thing you did with the beach thing. The Catarina was doing something in jeter fingers in there. There was a whole on one side. I go okay buying new potholders there. We go so handled that big just. But they think the best thing, and they're not done because they had to order certain containers, and whatever I kinda shifted things around. So we right off of our garage was kind of like the mud room and I had these lockers for the kids to put their backpacks and their things after school. They never used them ever. Because it didn't make sense. Why would they leave them there when they need? Their stuff for school and whatnot so I think when I was building it. Maybe they were younger and I was thinking. You know you pull at your lunch. Dump your stuff in there. You come upstairs I. Didn't really think that, so they largely gone unused, so decided to do is use them as a runoff pantry for like paper goods and like little coke bottles that go on our coke machine, an extra popcorn. Stuff like that backup pantry. Like a backup Patrick, then here's the other thing I was holding one thing that I didn't realize. So. When I buy something. Let's say buy a pair of shoes right. And I. Don't really do this with, but I'm just using this as example, I keep the. Box. So if I bought like a pair of earrings or purse, you know it comes in like a purse bag, and then it comes in a box and the whole thing. I keep them because every time we moving, you know historically, we have all the time. I take all my costume jewelry I pack them all back. into those boxes to move. So a man does here and she's like okay seriously. You have boxes of every size everywhere. Like in the garage it takes up to closets in the luggage room. It takes up a whole shelf and even in my closet closet like this area behind the mirror doors on one side that her my hampers, and all my little things for traveling and everything you know what the tissue paper and Whatnot Am. I shoo bags and everything and I had like. Dozens and dozens I mean there's GonNa. Be Thousands of them around the house. and. You always kept them to do what would that? Well. Sometimes they use them to pack. Because sometimes I'll put my you know my costume jewelry like earrings or something a put them in jewelry pouches, and then take all the pouches and put them in a box..
"emergency room" Discussed on Get Deeper with The Dolan Twins
"I don't know man I don't know about that. Would like did kites rare nowadays are super. I saw kite today. Flying people are so fucking bored nowadays but like was he clo- did you have clothes on. Yeah see and then even if he was naked. There's no pasta action call you. I just thought of that. I feel like that could've could've happened. It just made me laugh yet done. It's done until tomorrow afternoon when I can take my kite out. You just you just get that. Get that up going for it. I wanted to I WANNA do some. It's never been done. I would say that it's never been done nine till tomorrow. Done that or cool achievements. There's a lot out there and what this this whole thing is. There's so much that actually probably hasn't been new physically work for but then there's some shit that you could do you guess. World Records are really specific and people are older so through to specific. You're thinking about something that's never been done. It has to be specific. Yeah that'd be get borderline to specific when we get good ones. We get ones that are actually. Everything's been fucking done. That was a good round. I feel like that was a I think even get away. I think I'm going to got a win there and you could have been three sweep right. There was it was close. All right One do some shoutouts. Ethan. I really do. I know you I heard you saying it. You hear me saying that all week. Yeah you into the microphone but we muted it. When you said it's been. He's been nonstop saying show. I said the the whole entire episode rewind. You'll hear it. Enya at punds for Dolan's what's up any grading spell that and y yet. He's getting good. Her name is an annual Tanya. It's for sure on yeah well. How do you pronounce? She's such a fucking asshole. He's all gray. How do you think you spell? That sang it completely wrong. No Birlik there's like. There's no way tonight. We'll have no way on you. How do you pronounce A. N. W. A. R? There's two ways. Pronuncia does probably to is pronounced and known saying no I would say Kanye but I'm just different. I'm not like most boys. You get next one. See if you can say this one correctly might be a tough one for you to read Julia. Back at dawn. Dolan's Julia shoutout to you. Hey love you Just GonNA underneath the rest of the the the two more. I'm going to both of them. 'cause no you don't get. I do know. Let's do a guessing game. I WANNA play guessing game all right. Zoey shutout out. The Zoe Appear Bailey. It's my middle name. Shut up name. Don't look I l. e. why are you sure? Yes okay. Oh that's scared the heck out of me what is that cap. Okay even touching someone with his foot and I didn't know what the sound was. Coming from all right Ari airy it even is infrared literally put how to pronounce it so great and what mess it up and he still off very now. Spn Dolan shut out. It's so much more of an L. This love you if someone take one after. You roasted someone for doing that. You do that all the time. Ed Guys if you want to be shared out in next week's podcast tweet linked to this podcast so that we know why you wanna be shattered out and read it five stars and we will show yeah shake devoted to to have your tweet be found easier. It helps us out when we're looking for shouts but with that being said there's more to be said next week so how nice that was great. Yeah Well Hey. I can't wait to start podcast video. I know Joyce says every week but it's fun like this but I think it's GonNa make it more fun. You know what I mean. Yeah I'm just for this podcast to evolve yeah League for ever meet. You know what I mean guys. All right guys we're going. We're going GONNA to sleep from the beach. I'm praying for Grayson because he has to enter that room tonight but it doesn't smell bad. I just I'm excited to give it a whiff so excited. I only excited the word. Maybe Nervous Ryan will at one hundred ten being the worst smell ten being the best male. Xp Washington the next week. Our guys come next Tuesday. Come back from I really see you next. I really hope it gets good reason. Not a good thing to say yeah. That's a good dude. Like my mom was really mad at this one woman. One time and she's She's such a see you next Tuesday. I was like what does that mean. That's what I say. Youtube videos on youtube videos every podcast every week and then she's like thinking about the Akron. Oh you mean it with love your all right Cenex..
"emergency room" Discussed on Get Deeper with The Dolan Twins
"So I went all out on the gift reason because he does deserve it. And guess what I go all out for you guys how much it is know. Or it's however much it's over to the title of the last video but We should get into later on. I think that is it. The most money we've ever spent a day get into now their conversation leader. And because I'M GONNA I'm GonNa Forget this even before said I'm going he had. He had a twin telepathy feeling that that I put in him was weird twin celebrity. You're putting shit breath no in your head. I had the weirdest twin telepathy feeling today in a such a great way. While I was long boarding I went down to the beach to longboard. You told me this text me and and I fucking like. I felt weird. I wasn't with Ethan. And he he stayed home and I felt weird like I fell. He needed me or like Ethan was going through something physically painful and I was going on and literally get on my phone after. I walk up the hill and Joe. He called me and he's a Yo don't freak out but I just kind of stabbed myself. I was making avocado toast and I had to go get stitches right now and I swear I sensed it and until you got home from the hospital like your all straight. What your stitches. I felt weird and I wasn't even really my only I was in the ocean. You'll yo I'm you your phone don't you don't you don't have to check on me and I still did 'cause I'm a good brother but until you got home and I didn't even know when you got home. I like the feeling went away. And then you're like. Oh my God actually felt like I was feeling your pain today. That ever happened before I physically feel like. Oh my finger hurts. I felt emotionally. It was emotional discomfort and yeah. That's the first time that's happened really no. I think it's happened before but it never thing though. I think I've heard that before twins. Ken They if something's wrong I can send them. Something's wrong that's that was. I mean you fucked up so we got a new knife at our new house and I didn't expect the knives as is my first time user next that we actually got it yesterday. and I've been making avocado toast pretty much every morning that we've been here. I've been using the old knives from the Old House. And they're all dull so we got a new knife set. It's very pretty matches. The house great aesthetic And they're nice knives. The sharp lives are supposed to be and I guess because I've been cutting avocado toast of cod does with butter knives. I didn't realize that Knives could be this sharp so I went to. I sliced the Avocado Pretty Nice. I actually got like a full like Nice right around. The circumference of the buildup is a little Little lengthy so I'm trying to make a good. I'm trying to make epic because it was really fucking prophetic. Okay okay. I opened avocado perfect slice. I hit the pit like you're supposed to do it. Horizontally with a knife and then turn an pull it out and it didn't WanNa hit it. It just like bitch out and like the knife came right out because it was so sharply. The pit like success came to the night succumbed. I don't know what the fuck that anyway and then I had a poke the pit like stab the knife. You know what I mean. How quickly we'll do because it wasn't coming the other way so I stabbed it and the fucking night went right through the heart shit you with through the hardest pit through the back of the Avocado. This is how it happened but any stab at that hard. It was just really sharp. He's in literally. Even Dolan is a smart guy. He's a sharp guy you know he. He's like always on his toes prepared for life prepared for anything. I have full confidence. That Ethan can conquer anything. He says his mind to in toll he steps in the fucking kitchen dude. His commonsense goes out the fucking window when he's in the kitchen. I literally don't understand it like he play your microwave. It's peaking now until I if I tell you to pull your mic. Wait screaming Mike Mike Right now. Continue Okay my my. My wife almost called it my wife. I really know it only but whatever its own engine closed not yelling. Don't suck that Mike Breath so when he's in the kitchen guys he can't tell fucking salt from a fucking Dan Watermelon. I'm not even kidding. Like that's the weirdest out. A crazy analogy no literally need salt in fucking be a watermelon. I Wanna I needed salt on like it's just gone. He stands in front of the garbage cans. And what? I'm trying to throw it out. I can't pull it out because it's pull out your and always hits his ass every time you fucking God a he. A heat one in the kitchen with people event session right now. Broker you back to my story. All right guys know commonsense in the kitchen so isolated habit so I stabbed myself with a knife in my finger. It went through the avocado through the pit through the back of the avocado out of the avocado through my skin to my fucking bone. And that's when I was and okay another fucking. Lapd here with their helicopter cool. We're trying to record a podcast. My living room sounds like he's about to land on the house. Yeah all right thanks. Alcazar ruined my storage. I grazing did just all right. So then yeah I I was okay. It's probably not gonNA be that bad. You know what I mean like. I poked Istat slice. It did feel a little uncomfortable but happened so fast that it was just more startled than in pain or anything like that so I looked at it and it like wasn't bleeding yet. Sorry if you guys are afraid of blood But lucky for you. If you're afraid of blood it wasn't bleeding it So I was like okay. It's probably not that bad. It's not even bleeding and then I Took one step and gets my heart race. Went up a little bit like one little pitter-patter and I just started gushing blood all over the sink it was a squirting out of serious it was like sorry guys is really disgusting and that. I just had a I was you know I was kind of in the house. Dolo because Grayson was fucking surfing all day and so I rolled up the paper towels and they just grabbed it because they couldn't wrap around my finger I haven't seen the be hanging on by threaten. I don't WanNa pull it off so I looked at my finger is okay. I probably don't need stitches. And then I looked a little bit closer and there was a guts coming out of my finger so it was okay. Need stitches because if I don't then I have white bedsheets. I'm going to go to sleep tonight and I'm GonNa wake up and my bedsheets are going to be read all over because it's it just wasn't stop bleeding and I'm gonNA touch my guts and then my guts are going to start bleeding. You told us at breakfast time I did. I thought it was actually lunch. Time had avocado toast for launch. Okay would change the I probably should have stuck to the fucking routine stick to the fucking system trust. The system should have had it for breakfast. It'd probably be sharper. You know what I mean no pun intended but housing are. I don't want to go to hospital so I went to the hospital because there was nothing else to do and I had to go alone because Grayson was with me and I don't even think you're allowed to go with anyone else now because of corona so I went in with my mask on and I I was like dude was like no one in there at all. It was just me in the emergency room alone and they called me right in and they got right in the nurse. Dude comes in and he's really like not leaving like talking to me and stuff all right like Right whatever and then he walks out and he's like in the doctor walks in he goes will happen on my cut. My finger making avocado tick finger making avocados okay And then he looks at my finger and then he walked out and no one said anything yet and then. The nurse walks back in and he yells to. The doctor was in the hallway. Now he's like. Do you want me to clean this thing or what. And he's like. Yeah could you and I was like what the fun? It's not something you want to hear. No like they were like bowling. Didn't WanNa do it and I was like okay I was thinking that he was probably going to be slobby and Chin. That's not good. Because he had a suture me and so the do starts squeezing the liquid on my cut and it hurt and then he was. What are you do? And I'm like I do suffer entertainment. And obviously we're in La so a lot of people say that and he was So pre or or post career. Basically saying I haven't heard of you before. Entertainment Selah Gear. Nobody and who the fuck are you? Like the heck. There's so many people here chasing their dreams that if they heard that really like upset you know what I mean like I had to deal with Shit so much in high school and there's so whacked the fucking say that and then I was like okay. I'm I'm youtuber. And he's like Oh really. What's your channel do? What kind of content do you do? And I with my twin brother Dolan Twain. All these random fucks now using the word content. I know I know it's so weird. The word content the word content became silly mainstream. Like it used to be like your written a medium so let's figure what content Which which I don't even really like the word content. Sometimes I just accidentally say because it's so common now you're content. You just say what kind of videos exactly. So what the fuck? That's a big peppy. So's a comedy. And then he's like funny. Which three do stand up. What do you say when you that's what I'm saying? Whatever when anyone asses the like what do you doing your comedy based mcvitie's my brother and I guess we try to be funny and the are you funny. Yeah what am I going what do you? What do you want me to say right now? Who who what asshole is going to go. Yeah fucking funny like Dude. I don't even know if I'm funny though. That's that's the serious answer. I don't know yeah I just say I hope I mean yes it's true. I still think it's an asshole thing to do. Don't send someone up to like say somewhere but are you pre or post career cringed rate. Just because it's like. Oh you're you're listen anyway so I told him I'm youtube. And for some reason he was stoked to hear that and then he started calling me boss man and shit like because he left and then he came back and started calling me boss man and went on the channel or whatever but I don't like that he didn't like say I was. I GONNA spiring actor. He treated me like. Shit like fuck that and like you said that if you're a new actor in La and you're in the hospital and you're kinda getting roasted by your doctor or nurse..
"emergency room" Discussed on Get Deeper with The Dolan Twins
"It was it was honestly. I understand the numbers this because this leads me into what I WANNA talk about right now. I hate keeping secrets for me. I just had to do that for good reason. And I hated it. This is set up. What that was a set-up there was a setup I'll tell you being a stinky little sneaky little stinker no I Yeah he keeping secrets from for me thin even though it was a nice thing that I just did recently that I had to keep. We'll is yesterday's video right today yesterday in the video but I think it was yesterday. Yeah so if you haven't seen yesterday's video I got Ethan a housewarming gift. To his surprise he didn't know I was getting it for him. And we actually like full-on will not we. I actually surprised Ethan. I it because I because fast I did it. Normally things go. That's moved what I'm making you videos but it did and I was like wow God is really on my side right now. Defied distance equals time with the housewarming gifts. What do you mean like? Because of the basis. We'll go. This series of events happened that day to for me to literally be talking about the gift and then you going behind my back and getting a gift. That's impossible to get in that short amount of time. You getting that gift and then surprising me with it today that I talked about it like I almost feel you put the thought of the thing in my brain and I don't know I walked out of my room and Ethan was in the kitchen already which is already weird. He's never like up before me but I walked out of my room and Ethan was at the kitchen counter eating breakfast and he had a picture of the gift that I got him pulled on the computer and he was like freaking out over it. It's fucking weird. I took a shower. Texted the guy who's going. Give me the gift. He got me the gift I went and picked it up and I. I brought it eastern later that day. So these this gift that Grayson got me. This thing that I was looking at the don't want to spoil it. Most of you guys probably know what we're talking about if you've seen the video it's what we're talking about but this gift takes at least a fuck like five six months normally get your hands on so It just didn't make sense automate. It was the only one in the entire West Western side of America. Pretty much there's eight. There's eight boutiques in America or twelve. The person that I talked to as connections a four and it was the only one within those four and those are all on the west coast. That's how rare this thing was and I got it for even an hours. It was crazy awesome. That's that's a do. I had nothing else to say. Besides God on my side. He just made it happen. Doodo I while I was what made me pull up the picture of it that morning but it had to be some twin telepathy weird shit dude. I had like the weirdest feeling in my stomach about it. That was a damn. I fucking need this thing you spend. I'm not in any position right now. Just get it. I can't commit right now. I can't pull the trigger because I don't feel like you know I haven't earned it yet and I one thousand percent thing that you earned it. Thanks Bro is that the most surprised you've been all out for from. Gif like probably in like the past was surprised. I can't think of anything at least video close to Huby. No I freak the fuck out dude. I shed a tear. I don't do that either. Surprise you on your birthday with the with the board with the longboard. Oh yeah that was. That was. That was because you know that. Did that started like they got us back in the long boarding again when we were in Australia. Grayson surprised me with like my old like dream longboard from USA longboard when we were like literally thirteen years old and we were always the board so fucking cool but it was like four hundred bucks or whatever and okay well. Obviously I'm not going to get that just just like I'm not gonNA spend my money on that because I was thirteen years old and made eighty dollars off a brand deal and that was all I did that. You're That was the next year because maybe fourteen but eighty dollars off of a brand deal and bought a long one hundred twenty bucks back then and I got the smaller version of it. That didn't fit me because it was cheaper and I only made eighty bucks off the. I'm not complaining but I just think it's fucking hilarious. How a brand? Play me like that. I was fourteen but it's also cuche it is it's adorable but anyway this one was out of my price range back then and the fact that great got it for me like what like six years later it just like it was simple and it was really really thoughtful because he brought me back to those days and then it started the got back the long boarding and now we do it all the time and it's fun as fuck it has. I thought it was too old to keep doing it. But Dude I'm literally GonNa do it until my fifty toll intellect can't anymore like I feel it's the best like it's the feeling that I get when I'm like bombing a hill and then like it's basically my control whether or not I fuck up and get seriously injured. It's an adrenaline rush. But like you you have to be in control to slide and stop yourself and do everything like that. And like once you execute the slide perfectly and use sloat in you slow yourself and you get control your board again. Yeah you're like I did that. And then it's also the only thing you think about while you're doing you're going GonNa Fuck Shit. Yes you can't have anything else on your mind. You have to be it forces you to be in the moment and that's why I love low morning so much if there's somebody hobby that requires your full undivided attention for one reason or another. I suggest that you pick it up. It's so good to just like do something that you literally cannot be thinking about anything else while doing. There's nothing like that. I think it's like it has to be a pretty extreme hobby or something may even knitting fucking thinking about something else. There's GonNa fuck the whole quilt up. Yeah even you know anything like that But yeah you were saying about. You want to be doing it to your fifty. I thought it was too old to be doing that. You'd fuck thinking that you're too old for things you know what I mean on Ryan. I remember we were having a conversation in like you're talking about your birthday. Come up and everything I do. I don't give a fuck how old I am like Ryan. Looks like he's like sixteen somehow. Still my dad like he looks like he's fifteen is like in the seventies. Now it's crazy it's crazy but did you send me a picture. Dale's mad young but it was really cool. 'cause you were you were telling me that. I give a shit dude like it's the same thing like twenty seven. Dad Picks. I was sending some dad. I didn't get any whatever that's I guess. We'll talk about leader But yeah it's so true man because I we really were tool to longboard or whatever the fuck dude who gives I feel? I feel better than I ever have. Now that the extreme hobby and I also feel different about age I you sleep on my birthday and I don't really like getting old. I don't understand like one celebrating getting older like. That's that's something shitty that no one wants to do is get older but do i. I can't wait until old fucking raisin like. I will be so I will know so much I will have experienced much and I am I. If you guys know me in Grayson by now you know that we try to do everything. We can in our power to pay ourselves in memories. We we talk about it a lot. Dude I will have paid myself so many memories. By the time I'm older you know being older just means you have more memories and you have more nostalgia. You've more all the things that make you feel good. You know what I mean and that's something that That money can't buy but money can buy you something in in this case is what I bought. Ethan Something that sparks a memory or sparks a significant landmark in your life. And I I bought Ethan. This housewarming gift not only just a housewarming gift. But because I was so proud of him for accomplishing his dream of getting home in moving to La when we were fourteen We looked each other in the is go. We'RE GONNA GET LA. We don't know how yet but we're gonNA fucking do it. We don't have. We don't have the resources we don't have the money yet. But we're GONNA fucking do it and we did it and before we were out of our teen years we were able to purchase a home in in the hills here in California in Los Angeles and I it's still surreal man. Yeah it's real and I I'm proud of Ethan and I'm extremely thankful for him in this drive in me. That debt has kept me to keep going and stay motivated over these years because we've gone through some crazy ups and downs. But he's really kept me on track in kept my head straight and allowed me to to keep pushing forward and now man here in this that you got me do I will. I'll be able to look back on it when I'm an old raisin. I'll have it until then and it will always remind me of this moment and that nostalgia that I'll get when I'm enjoying. This gift will be like fucking no other. You know when you listen to the song from six and you're like Holy Shit I feel tinguely. You know what I mean Dude. I listen to fireflies owl city yesterday and it threw me back to fifth grade and I was like this song. Sounded like fucking knows weird unsettling God speaking to me. When I was in fifth grade I was so. How do I feel like this? This song makes me feel crazy when I was little I was. I love this song. Did something it did something to me physically. I'm not even kidding. I literally felt like a fifth grader when I was listening to it yesterday and I felt that feeling. You know what's funny? A you said firefly's remembered the song in my head kind of and then dude. I remember singing that song with a friend. The Pera to that song to in the hallway fifth grade. I could literally smell the halls. That's how much brings me back and it just and that's why we created a fragrance brand to because then it's Daljit Stella is it plays the biggest role out of pretty much anything in my life every like I have a fragrance right now my bathroom that when I spray it immediately brings me back. It's it's it's my fragrance. Actually I mean I don't mean to plug but it's like grace notes. Samba or yeah. It's my signature signature. Said that we made with our company wake heart and when. I spray it. I literally feel like it puts me right back in Australia and I feel all the vibes. Happiness and shit that it brings me and that's that's why I'm so fascinated with fragrances. We're we're going in every direction right. That's all I mean. We just talked about music fragrance gifts. Anything can do it to you but like if it's going to be an fucking nostalgia slap in the face in the future do it for yourself now and yes. Thank you for giving me this gift. It is timeless and that was ironic. If you've seen the video.
"emergency room" Discussed on The Indicator from Planet Money
"This Week Cove. Nineteen has continued its relentless spread across the US the US now has the most confirmed cases of any country in the world and as much as corona virus is a health story it is also a story of scarcity. Not Enough not enough tests. Not enough masks not enough. Ventilator is not enough doctors not enough hospital beds. Economics is the study of how to best allocate limited resources and that is exactly what emergency rooms across the city and across the country are doing right now. Trying to figure out how to Best Allocate Limited Resources Jessica Vaughan Vorhees is an emergency room doctor at New York Presbyterian Methodist Hospital in Brooklyn. She's been an er doctor for thirteen years. She actually lives just a few blocks down the street from me. We even apparently go to the same coffee shop. At least we used to but spoke to Jessica by phone both because of social distancing requirements. And because she has been working almost nonstop for weeks she was just on a very rare break and she talked to me about how she makes these decisions and how these decisions get made in hospitals today on the show scarcity.
"emergency room" Discussed on Reset with Jenn White
"Hi I'm Jen. White and this is reset as record this on Tuesday afternoon. The number of confirmed Kobe. Nineteen cases in Illinois is over five thousand and more than seventy people have died in the state as those numbers grow. Healthcare workers on the frontlines will face mounting challenges. Here to give us a sense of what's happening in area. Hospitals is Dr Ernie Wong. He's chief of emergency medicine at North Shore University health system. Dr Wong Welcome Theresa. Thank you for having me Gin so first of all I just want to check in with you. How are you doing? I'm doing really well. Thank you for asking It's been a lot of Prep and a lot of hours but I'm actually quite energized. And engaged in the whole process described. It's like being an er doctor during this health crisis. What are you seeing in the emergency room at the hospital? We're at a point. I think in the pandemic were we can learn from the lessons. That other cities have already told us right so I watch the news. You see what's happening in Italy in Spain Washington New York and we are just basically take a look at that and say this is what's coming and how are we going to prepare for it and in no point in history have. We had this kind of luxury to do this so my prep for my Physicians and staff really send around three things. One is Protect your people protect the patients and then protect everybody else and in that the preparedness You have to make sure that your staff are both physically and mentally ready to handle the influx of patients. We have to make sure that they have the right p. That they have the right protocols in place that we've done simulation so that they're ready. When the patients coming in a moment's notice this week we've started to see in our hospital. The inflection point rise in terms of the number of cases t severity of cases. Our patients were putting in the intensive care. Units and the number of patients were putting on ventilators. And so this. We're just starting to see the beginning of the wave. I believe even as you're able to look to other states and other countries and learn from what they're doing what are some of the biggest unknowns at this point. Well we don't know where our curve will flatten and I I have hope because of our shelter in place order that was placed on the twentieth by Governor at that time we had five hundred eighty five cases in the state of Illinois whereas in New York at that same moment in time there are thousands of cases so they were already accelerating their curve. So I really do hope that this will work and you know the time line stuck out. She said No. The virus determines the timeline. So that's one unknown number two. Is You know our our healthcare workers can be okay and my sense is yes. They're they're going to be okay. We're going to Brazilian Some we'll get infected and some have some might get quite ill but has this. Virus has shown the majority of people do recover and these Individuals will recover and come back into the workforce and we will be stronger for it. He thin a doctor for more than twenty years. What are some of the biggest challenges that your doctors and other healthcare workers are facing right? Now you know I think the humanity of cases we're seeing you know it was theoretical Up until probably few weeks ago when we had the first cases start to come in to our our system. And you see the you see the virus when you look into. The patient's is you see the apprehension being Zaidi sometimes fear you see their breathing and that face of the virus I think Really brings it home to each and every one of us. I've been very very profoundly affected by talking to these patients and In the past you know could provide guidelines or about what to expect you know with the course of their disease because we knew a lot about the disease. Well this is brand new and so these conversations have been Much more nuanced and I think more emotionally impactful is part of the challenge. Also from what? We're hearing the fact that patients have to be isolated from some of the people they love who ordinarily provide that emotional support right now absolutely. We have patients going upstairs By themselves the visitor policies that most institutions have been changed. So that you really can't have a visitor in your room The patients are isolated from the staff In order to go in you have to gown up and put on your p. e. before you go in and it's very isolating it is. I think difficult to watch What's going on in Europe and you know people are dying alone. It is it is very sad to see And that is something that is very unique to this We really have to kind of re refocus how we think about this. I think as we've been covering covert nineteen. We've been hearing about shortages of medical supply and testing equipment across the state in the Nation House North Shore. Fearing right. Now how well prepared do you feel? I feel very well prepared. Gin and I will give So many Kudos to our administration. are People behind the scenes. What I've learned is that this is a team sport and everybody is essential from the person who does supply chain procurement to it to the environmental services people because if they clean the rooms right That PUTS PEOPLE AT RISK. And if they do their job well it protects our staff and IT PROTECTS. The patients are administration has been truly truly Helpful in helping US strategize and redesigned spaces within our hospital to be able to handle an influx of a large surgery patients safely and giving us the resources to do The patient care and the p. p. e. that we need so. I feel very good about well. North Yours one of more than a dozen. Illinois hospital labs at have onsite testing. What does testing look like at North Shore? Yeah we were very fortunate Kudos to our lab to be able to develop our in house testing capability early And so what's that allowed us to do is be able to make decisions Much more accurately in real time and anticipate and so a good example of this when we started testing Back on March tenth. We had one case positive. The next day we had one case positive and then the next day we had seven and at that point I call been -mergency media Emergency Meeting of all of our Physicians in Nursing Leadership to talk about strategy and how we're going to deal with an influx of respiratory patients and then we acted on it and we developed our strategy so having the data is very powerful and every day. I come in to the office and that look at those curves and I see where we're going and Right now it's still going up But that's that's that's been very important part of our our strategic Plan the other important thing is that you have to have coordination from the top so our chief transformation officer who is our our chief pandemic officer. I'm GONNA call her because she really has taken this and made everybody organized. We are on the same page. We have daily Communication calls and readiness calls so the doctor. Lakshmi House deserves a tremendous amount of credit. And then we have our inpatient unit that we have to work very closely with on the hospital side and on the critical care site. Make sure that all our protocols match so that we're all saying the same things. We're all acting on the same Parameters to make sure we provide the appropriate care for the patients that are coming in. We're talking to Dr Ernie Wong Chief of Emergency Medicine at North Shore University health system. We're talking about the challenges. Er doctors and healthcare workers are facing on the frontline the covert nineteen pandemic coming up in about ten minutes. We'll take your calls about Kobe. Nineteen with two infectious disease. Experts on the line. Stay with us for that a doctor. We know you're working be especially stressful during this. Time is something you alluded to earlier. In conversation the National Center for Post Traumatic Stress Disorder published guidelines on. How healthcare workers can manage their stress associated with this outbreak. What kind of impact is this? Pandemic having the mental and emotional wellbeing of healthcare workers at every level of the health system and their families. Yes the impact is great and the impact is Due to their the realities of the potential dangerous of contracting the virus at work and it's also the anxiety of the unknown and I am so proud of my nursing colleagues. Who Am I tex? And their registration staff or advanced practice providers who come in every day they put on there and they just walk into the rooms knowing what is potentially behind the door and they do their jobs with professionalism and courage so we do a lot of walking around just checking people's morale temperature making sure people are supported We have at our system Services to provide support and counseling if needed there have been Psychologist who have volunteered hotlines to our staff and made themselves available. I mean what a wonderful thing and so I think It it it. It community spirit that we've we've kind of banded together and we support each other number one and number two is having just the ability to kind of talk about this and and. Kinda highlight all the great work that emergency healthcare workers do on a day-to-day basis. That's been really really great. And people are sending food and there's a lot of food That is being sent to our emergency departments by really really generous shops and restaurants and Just the general public doing. It's it's really been amazing. And what about for the families of of your staff at the hospital? Are there additional support for them? We talk a lot about you know what we do when we go home you know. How do we take off our clothes? How do we show her? How do we keep our families safe? there are many people who have decided they're going to move their family await and self isolate themselves when they work others take a more moderate approach. I don't think there's one right way By really we we look to each other and I think our our main goal is to share our ideas on what we're doing and and I don't know there's one right way for two to support our families. Remind us how the general public can best help and support healthcare workers right now the the simple hallmarks. Are you know stay home? The it's very difficult I understand that it's it's very Economically impactful for people's livelihoods is very difficult to be away from your family and friends and your co workers. But really the only way to flatten. This curve is to distance yourself and so that you don't spread it person to person that's the number one thing Washing your hands meticulously also very important. I would say porting. Don't hord masks give them to the healthcare workers the they need it co three to five times more likely to get infected by this if they don't had the proper PPE. And then you know the other vulnerable groups of people that really need the EMS.
"emergency room" Discussed on America Dissected with Abdul El-Sayed
"I see family. Businesses handing out inventories that have pink slips and that too gives me gives me hope and fuels my optimism You know so so. I'm hopeful but I should be clear that you know I share those examples not to Not to absolve our leaders The proverbial calvary that you just referred to not to absolve our leaders of their responsibilities to us but demand that they prove themselves worthy of of the sacrifice. That my colleagues in my community is are making you know. I want our leaders understand that the fact that our cleaning staff is here day in and day out does not mean that they do not need paid sick leave and a livable wage. Much the opposite they need and deserve it and they need deserve it now You know I want our leaders to understand that the fact that our neighbors are checking in and caring for one another does not mean that they do not need a well funded public health system capable of rapidly and reliably testing in much the opposite they need and deserve it and they need and deserve it now so You know I think you're right that I am An optimistic someone who's hopeful by nature and I continue to be but I'd be lying if I said there wasn't work to do and I realized that you were someone who who knows that As as much as anyone and I know that the weight the moral weight of the work that you do day in and day out has to weigh heavy on you. What do you do in your off time? Not that you have that much. But what do you do in your off? Time to try and Lift off or to get your mind. Somewhere else Well I I think it's what I do during other times as well which is a laugh at the the many ways in which I I ended up Falling falling short in between shifts. I think you'll you'll get a kick out of this but you know so working in the emergency room. I recognize that I I'm at high risk of of Catching the infection into I do. My best to to change and Wash up and all that good stuff before I come home and I remember when all of this started Early on I say you know what I I I I WANNA make sure that I I sort of to the best of my ability. Quarantine myself from My wife and so instead of I'm going into the bedroom after coming home from a shift. I Went to the living room. rolled out the Yoga Mat through blanket down in a pillow and slept there. And then I woke up a couple of hours later Clean IT ALL UP. Put It away and And went off to work. My wife was Was Still Sleeping And that went on a couple of days in a row until I finally had a day off and My wife and I had just finished watching a movie and I said you know when I'm I'm exhausted it's It's time for me to make my bed and I grabbed the Yoga Mat and I- unfurl it And I just hear her exclaim. Wait you've been sleeping on the Yoga Mat and I go. Yeah and I go. Why and she she goes. I've been using the Yoga Mat every single day. And so what have been happening in our house. Despite my Best and well-intentioned efforts to quarantine was every single day. I'd come home from the emergency room. She'd be asleep. I'd unfurled a Yoga Mat. Sleep for a couple of hours. Roll it back up and leave for the emergency room again only to have her wake up an hour later unfurl it and do yoga. So you know we're we're taking the quarantine and social distancing seriously but But I'd be lying if I said there weren't times when we fell short and And I'm laughing about it. So so that's That's what I'm doing when I'm not there. Well Dr Akasha. Were really grateful for you for all your colleagues on the front lines who are out there. Every day Serving your neighbors and your loved ones in your friends and your colleagues We're pulling for you. We hope that you stay healthy. And Safe and We'll keep pushing to make sure that you all have the resources that you need to do. The critical work that you're doing right now if you have one message for listeners out there what is it shoe I would. I would entail folks to stay hopeful. You know I I think that This is something that we can get through But we're going to need everyone to to not only do their part but to push our leaders to make sure that the system falls into place you know I I often have patients who will say something to the effect of. You Know Doc the stars finally aligned for me and you know. It's one of those things that I hear and and I often sympathize and empathize and feel the same way but I I also realized that no one should have to wait for the stars. To align and quite candidly. No one has to if the systems already do so I would encourage folks and not just stay hopeful not just chip in and do their part but then push our leaders to make sure that the system's align in a way that that leaves no one having to wait for the stars to do so. We deeply appreciate you your optimism. Your hard work and Thanks for taking time out of what I know is a really really busy schedule To Join US today. Thank you again thank you. I'm doing all you're doing this front before we go. I want to tell you what I'm watching right now. I knew tests are coming online. But how are they going to be used? One of the main challenges right now is that we're not doing community testing particularly well so we have a pretty skewed picture of. Who's getting sick? Can these new tests facilitate a better view on the pandemic clusters? We're seeing the hardest images of pain and suffering. This country has seen in a long time communities that have not yet been hit. His heart are preparing. Can they prevent the kinds of outbreaks we've seen in the hardest hit communities and as we do? Americans are coming together to support each other through this mutual aid societies and notes of love and solidarity. Remind us of who we are at our best. Can we stay together as this continues to unfold? That's all for today. But if you'd like to support organizations leading the fight to support our most vulnerable during this pandemic donate crooked. Media's Corona Virus Relief Fund at crooked dot com slash corona virus. America is a product of crooked media. Our producer is Austin Fisher. Steven Hoffman is our senior producer. Charlotte Landis Mixes and Masters The show production support from territory and Sydney wrap. The theme song is by Takayasu Izawa. Alex Aguirre our executive producer is Sarah and I'm your host Dr Abdul El-Sayed. Thanks for listening..
"emergency room" Discussed on Today, Explained
"<Music> are not <Music> at <Music> all <Music> <Music> <Music> <Music> <Music> <Music> <Speech_Music_Male> Jim. <Speech_Music_Male> <Advertisement> Hamlin is a staff <Speech_Music_Male> <Advertisement> writer at the Atlantic <Speech_Music_Male> <Advertisement> he also <Speech_Music_Male> <Advertisement> hosts a brand new <Speech_Music_Male> <Advertisement> podcast called social <Speech_Music_Male> <Advertisement> distance. <Speech_Music_Male> <Advertisement> It's all about <Speech_Music_Male> <Advertisement> living through this pandemic. <Speech_Music_Male> <Advertisement> You can find it <Speech_Music_Male> <Advertisement> and subscribe <Speech_Music_Male> <Advertisement> wherever you're listening <Speech_Music_Male> <Advertisement> to this right now. Just <Speech_Music_Male> <Advertisement> search for social <Speech_Music_Male> <Advertisement> distance <Speech_Music_Male> <Advertisement> <Speech_Music_Male> <Advertisement> during his daily <Speech_Music_Male> <Advertisement> press conference earlier <Speech_Male> <Advertisement> today. New York <Speech_Male> <Advertisement> Governor Andrew. <Speech_Music_Male> <Advertisement> Cuomo was asked <Speech_Music_Male> <Advertisement> about the <Speech_Music_Male> <Advertisement> personal protective <Speech_Music_Male> equipment <SpeakerChange> shortage <Speech_Music_Male> <Speech_Music_Male> equipment <Speech_Music_Male> and <Speech_Music_Male> P P <Speech_Music_Male> <Advertisement> is <Speech_Male> <Advertisement> an ongoing issue <Speech_Male> <Advertisement> right now. We <Speech_Music_Male> <Advertisement> do have p. <Speech_Music_Male> <Advertisement> p. e. <SpeakerChange> for <Speech_Music_Male> <Advertisement> the immediate future <Speech_Male> <Advertisement> now. <Speech_Male> <Advertisement> That was very confusing <Speech_Music_Male> <Advertisement> to us. Considering what <Speech_Music_Male> <Advertisement> Dr Calvin Son <Speech_Male> <Advertisement> and other <Speech_Male> New York City healthcare <Speech_Male> workers had told <Speech_Male> us so we <Speech_Male> reached out to Governor. Cuomo's <Speech_Male> <Advertisement> Office for comment <Speech_Male> <Advertisement> and the New York <Speech_Music_Male> State Department <Speech_Male> of Health responded. <Speech_Music_Male> We remain <Speech_Music_Male> confident that <Speech_Music_Male> we have enough. P. <Speech_Music_Male> <Advertisement> P. E. in stock <Speech_Music_Male> <Advertisement> for the immediate <Speech_Music_Male> <Advertisement> need <Speech_Music_Male> <Advertisement> but for long <Speech_Music_Male> <Advertisement> term requirements <Speech_Music_Male> <Advertisement> we continue <Speech_Music_Male> <Advertisement> working with manufacturers <Speech_Music_Male> <Advertisement> <Speech_Music_Male> <Advertisement> and distributors <Speech_Music_Male> <Advertisement> to maintain <Speech_Music_Male> <Advertisement> and increase <Speech_Music_Male> <Advertisement> our supply. <Speech_Music_Male> <Advertisement> They did not <Speech_Music_Male> <Advertisement> respond <Speech_Music_Male> to questions about <Speech_Music_Male> whether there was enough <Speech_Music_Male> <Advertisement> p. p. <Speech_Music_Male> <Advertisement> to change masks <Speech_Music_Male> <Advertisement> every day <Speech_Music_Male> <Advertisement> or between <Speech_Male> <Advertisement> each patient <Speech_Male> or <Speech_Male> whether there was enough. Pp <Speech_Music_Male> At all <Speech_Music_Male> New York City hospitals <Speech_Music_Male> <Speech_Music_Male> we reached out to <Speech_Music_Male> Dr Sun <Speech_Male> and he replied. <Speech_Music_Male> I hope that's not <Speech_Music_Male> <Advertisement> a joke. I <Speech_Music_Male> <Advertisement> haven't seen anything <Speech_Music_Male> <Advertisement> yet. <Speech_Music_Male> <Advertisement> <SpeakerChange> It's
"emergency room" Discussed on Today, Explained
"Listen you're about to hear a ton about five jeep or priority. Have you'll hear about how fast it is? And how it's poised to revolutionize the way we communicate but the thing you really need to know T. mobile's five G. Network covers more Americans in more cities than anyone else see. Mobile's invested billions of dollars in new towers and cell sites with range. That can't be beat because T. Mobile understands that owning the latest tech and means nothing. If your network doesn't have you covered soap while other signals are getting blocked by windows and walls. T. Mobile's nationwide five G. Network is reaching more Americans wherever they are because they want people to experience it. T. Mobile is five G. TRAILBLAZER. You can be to find out. More about T. mobile's first best nationwide five Gene Network T. DASH MOBILE DOT com. That's T- dash mobile dot com capable device required coverage not available in some areas. Downlink only some uses may require certain plan or feature. Cat Dash Dot com today. Explained is brought to you with support from the Economist. Checks and balances podcast. It's a new podcast from the economist. It covers the two thousand twenty elections and the road to power in America. It's a podcast that takes a view but doesn't take aside each week. The economists team of experts will take you through the events and ideas that are shaping the political landscape in an exceptional election-year exceptional is such a nice way to put it. The economists checks and Balance. Podcasts goes beyond the headlines and the Horse races to dive deep into what's happening and why it matters kind of like our show so if you like our show maybe you'll like this show topics include. How important is money in American politics very or whether or not Donald Trump is delivered on all those campaign promises. Some or just. What kind of country will be living after the twenty twenty elections? Damn I'M GONNA listen to this show for a global view on democracy in America subscribe to the Economist checks and balances podcast. Now that's checks and balances for the global view on democracy in America in an extraordinary election. Year check out an apple podcasts. A CAST YOU PODCAST APP wherever Dr Jim. Hamlin doesn't practice medicine anymore but he writes about it for the Atlantic and way back in January. He published an article bluntly titled. We don't have enough masks. The level of pandemic has been modeled and warned about as a very real possibility and yet our country did not invest in the preparation that would be required for it. And why? Don't we have enough. These masks to begin with. Don't we have a stockpile or a reserve or something? We're bad at preparation have a tough time allocating funds to potential problems except for the military to pay huge military but the stockpile was started. As a way of saying you know if there's a biological warfare attack on the country and we run out of masks or antibiotics or ventilators anything we could need. In that scenario. We should have those kind of hidden away around the country and then h one n one hit which was not an attack but it was just an outbreak and we went through a vast majority of our masks. At that time there was some restocking but the warning sign. That should have been there that said. Hey we almost use this all up. What if something much worse hit us? That didn't make it home. And and why? These end ninety five mask. These alike surgical masks plus carpenters. Use Them I use them. I'm cleaning my house. Like what is it about them? That's so essential to healthcare workers. These are the kind of masks that allow you to get right up. In someone's face. While they're coughing and put a tube down their throat to ventilate them and keep them alive which is obviously a super high risk scenario. You don't mean we're being told. Stand six feet away from somebody. Who's not even coughing and you're asking a doctor a nurse to get their face right up near someone. Who's definitely sick? They need to be changed regularly. And ideally disposed of right after you use. I mean that's the standard protocol without it. They're almost certainly contracting the virus and even if they don't personally get very sick they would be spreading it to other people they see to the rest of the staff and if the doctor decides to take a risk they might have to go into isolation quarantine later or get sick or be totally out of the workforce so the whole healthcare system breaks down. If we don't have this p. p. e. during a pandemic we just heard from Dr who says that he's been using the same mask over and over for days and is putting in his oven when he gets home at night. To disinfect it. It's shocking probably. Ill advised a lot of people have been calling on president trump to use this defense production act to ramp up production of masks. Wh what is that. Act Exactly for people who are unfamiliar. This is the Korean War. Era thing that is not used. Except in the most extreme circumstances. But it's sort of March and writes for the government to go and say to a private company. Hey we need you to do something right. Now you'RE GONNA turn auto factory into making ventilators and it actually works out. Kinda well because that auto factory probably wasn't going to sell a lot of cars right now anyway and if they could stay in business by making ventilators kind of win win and the president can order places to stop making for example. Close and figure out how to make these masks. We'll be invoking the defense production act just in case. We needed another words. I think you'll know what it is and it can do a lot of good things if we need it. It sounds like he doesn't know what it is. It's hard to believe anything that he says because he's lied consistently and he's indicated that hasn't been invoked then sort of said that it doesn't need to be because places are doing this already voluntarily using it's actually a big deal. I mean when this was announced it said Trimmers through our business community through our country. Because basically what are you doing? You're talking about you're going to nationalize an industry or you're going to nationals. You take away companies. You're going to tell companies what to do. The truth is most people nobody would know where to but then the FEMA director said otherwise on Tuesday indicated that it was being invoked so just a little while ago. My team came in. And we're actually GONNA use the for the first time today. There's some tests kiss. We need to get our hands on and the second thing we're going to do is go to insert some language into these Mass contract we have for the five hundred million mass Dp will be in that today. So we'RE GONNA WE'RE GONNA WE'RE GONNA use it when we need it and we're gonNA use it today. What should be happening is that it should be invoked to its fullest potential to get these masks to people because without them. There is no healthcare system. We can have all the ventilators we want. We could have all the doctors but if you can't protect them it's a plate out analogy but you're using soldiers to war without guns and of course once we get the masks if we do there is the issue you just referenced of ventilators and also just space. How is this situation looking? Not Just New York but across the country right now with with ventilators and hospital beds not good so new. York is adapting for field hospitals right now. They're called field hospitals but they're kind of just modified public spaces like Javed's convention center where you could go. And ideally received some care in their calling into service asking for volunteers from doctors retired. Nyu Just said that. Medical students could graduate early and be recruited into the cause while. Yeah 'cause we're also running out of doctors and nurses that certainly exists and it's hand in hand with the masks situation right. Yeah and that supply chain of the number of providers. You have can quickly break down as soon as people are. Don't feel safe coming to work or have family members at home have kids. They have to take care of all these different reasons that they can't do their job as they normally would. And as we heard from Dr Sun when we don't have masks we lose doctors nurses when we lose doctors and nurses. We have to start making some difficult decisions right. Yeah and we're already starting to make those decisions in New Yorker being urged not to seek care unless you are very sick and doctors are being told not to test except among people you know if they would require hospitalization if they if they got a positive test so we're already rationing. Who's getting tested? Who can come to the ER who can wait it out at home and so those rationing decisions that haven't posed extreme ethical challenges but you could very quickly get into a situation and we certainly will in places around the country. We'll get into decisions about who gets the ICU BEDS. And who doesn't who gets to come into the hospital. Who doesn't even when you're in a situation where yeah under ideal circumstances I would give you a hospital bed but but you need to go over to the Convention Center and be treated by glorified medical student and that's GonNa make some people very uncomfortable. I mean are we going to get to the point where we have to let people die? I don't WanNA forecast here. But that's something we need to absolutely treat is a very real possibility. There are always decisions about you. Know How care should be pursued when there's a ninety nine year old person with advanced dementia and metastatic cancer. Who DEVELOPS PNEUMONIA? It's not the correct course of action to take them to the ICU. It is the correct course of action to help them be comfortable. Those are discussions that we don't like to talk about but will have to be made factoring and other concerns right now. Like could that bed be he no used by a thirty year? Old Schoolteacher versus that ninety nine year old person and the doctor has the two of them sitting in front of them. The decision has to be made in some way. So I think that's the level should be thinking of right now. Yeah just hearing you present that scenario. It just feels like so foreign to our culture. This is America. Yeah we tend to ration care based on who has jobs and money and so it makes people very uncomfortable and think about rationing care even if you are able to pay and even if you have insurance there's no hospital bed for you to purchase the scary thing for Americans as being a normal working employed person who's always been able to see. A doctor always been able to get into the hospital if they really needed to. Who will have to go to a convention center a gym or hotel or or be asked to stay at home and that uncertainty? Yeah it can be terrifying to people you know Jim as someone who thinks about health care all the time when everyone else is. Is You know quibbling about politics and.
"emergency room" Discussed on Today, Explained
"That it's over to President Trump's desk for sharpie time unemployment numbers came in from the Labor Department today and they were staggering in history-making kind of way three point three million. Americans filed for unemployment benefits last week for context in well over a half century of collecting unemployment data. The highest number of claims ever recorded with something like seven hundred thousand in October of nineteen eighty two from grim too grim. More than one thousand people have now died as a result of Kobe. Nineteen in the United States. New York is now reporting. Close to forty thousand confirmed cases but keep in mind. The true number of cases is expected to be much much higher. Louisiana has far fewer cases confirmed at the moment. Something like two thousand. But the governor there says his State is experiencing the fastest growth of new cases in the world right now potentially due to Mardi gras festivities from a few weeks ago. Meanwhile the President Continues his campaign to get the country back to business as usual. He tweeted on Wednesday. The lame stream media is the dominant force trying to get me to keep our country closed as long as possible in the hope that it will be detrimental to my election. Success solely get in touch with today. Explained called 202. Six eight eight five. Nine four four with any questions about the corona buyers or email today explained box dot com also. We are on twitter at today. Underscore explained I am Ash. Romney's firm nationwide five. G. is here. Thanks TO T MOBILE. They just built the first largest and only nationwide five gene network in America. Nobody else comes close. T. Mobile's invested billions of dollars. That's billions with a B in New Five G. Towers and cell sites across the country making their signal more reliable both indoors and out find out more about T. mobile's nationwide five G. Network at T DASH MOBILE DOT com. That's T- dash mobile dot com capable device required coverage not available in some areas. Downlink only some uses may require certain or features. Ct DASH MOBILE DOT COM. New York. City has become the center of the corona virus crisis in the United States and the hospitals. There are nearing capacity. One General Medicine residents at Elmhurst Medical Center in Queens told The New York Times. The situation there was apocalyptic the work of healthcare professionals. These hospitals has never been more important so it's crucial that they stay safe at work and once their shifts end. Go home with all my clothes in the laundry. Run them right now. And you know shower. Dr Calvin Son is an ER doctor in New York City. Who's been picking up shifts in emergency rooms across the city. Kind of like a freelancer for matters of life or death. I asked him what life's been like during this crisis usually come in in their structures lining down the block by ems or work through the waiting room and it's jam packed. Probably all with presumed cove in nineteen positive patients all spreading it to each other one another not really social distancing when it entered the emergency room already have an emergency room filled with stretchers in the hallways outside the rooms. Most of the emergency rooms in New York City don't even have like dedicated rooms with doors. Essentially one giant room with cartons in patients only separated by curtains emergency medicine physicians and nurses and staff and pe- as mid level providers advanced care practitioners the nurses all in the center and we're all crammed together in a small space and we try to see as many patients as possible and doing our best to get people who don't need to be there out of the hospital as soon as possible so they don't infect themselves right the longer you're exposed to cove in nineteen the more likely you're GonNa get it so it's essentially think of a burning building and we're trying to get as many people out of his burning building before it collapses cove in nineteen can be airborne it's air syllable you sneeze you call or you intubate somebody. It then goes into air and it can survive in the air for three hours. We are breathing in this air especially under the context of not being provided protective personal equipment Like ninety five masks to able to prevent ourselves from getting sick. Let's talk more about protective personal equipment. Or P P like those and ninety five masks. You said you don't have enough of because there's been a lot of talk about shortages right and these aren't fancy masks. I bought a bunch at home depot last year. Do you have enough supposed to be switching out in ninety five Max per patient however there are so few n ninety five masks or just masks in general that we have to use one single mask over the course of many days over many days many days yes. I've warned the same and ninety five mask for about five days before I was able to get a donation from my friends just recently. I was wearing my personal protective goggles that I had to steal from a bundle kit from another Er that worked in that was supposed to be of disposable goggles. I've kept that one for eight to nine days until my brother gave me his goggles yesterday. And a face shield. Those meant to be disposed with his plastic flimsy. Pay Facial that I got a week and a half ago I still have the paints wearing off on the way. You're taking your and ninety five mask home with you like the mask that you use to protect yourself from all these patients who might have cove nineteen. Yeah I'm my stuff is right. Now is an oven because today somebody said well if you don't have a UV light which is one. Theory to disinfect old. Ninety five masks try putting in a hot environment. That's over seventy degrees Celsius or one hundred and twenty degrees Fahrenheit. Wow I'm guessing. The conventional practice today was finally a fresh batch. Still reusing stuff. Because I never know when it's going to run out again. Is this just you problem because you kind of like a an Er freelancer or are like the full timers who work at these hospitals? You go to every day going through this to know emergency room. No of New York City has enough personal protective equipment for their entire staff on unlimited police adequate amount for this pandemic. This sounds Bush league. I mean are you telling me that you you wear the same mask. Saint goggles same plastic face shield all day in these hospitals dealing with Kobe. Nineteen patients and then take it home and go back to work and put that same stuff on again the next day. Yes for the last two weeks I went in was able to get a mask on the early stages of endemic but seeing the writing on the wall I decided to play it safe and then keep that mask after my shift instead of throwing it out and rinse and repeat for the FE. Shield and the goggles. Anything I got was worth its weight in gold and I kept it until just yesterday. I got a huge batch of personal donations from friends and family who came back to my apartment. They literally handed to me and ran away given the one I'm exposed to now I have a bachelor I can give it to my staff members who've who've been starting to survive on the same ask in my situation but only after I went on my social media for two weeks calling for help. It took two weeks what could have happened. Those two weeks I could have been exposed. Other people exposed. Thank God they came up together but it shouldn't be coming from them and the the doctors and nurses you're working with re using masks to. I mean I used to bring donuts and coffee and pizza for my residents in. Pa's and nurses and nurse practitioners. Now I bring in masks today. This morning brought him in my donations from my friends and all my God people were just taking two or three at a time putting their pockets. Yeah it's like a lottery that we don't WanNa play for were forced to play. How long can you and your fellow doctors in New York? Keep this up. Having of things. Don't change I think in about one or two weeks in May collapse collapse. How we don't have enough beds. We don't have enough ventilators. We don't have any room. Patients will have to go outside and and then and then you're gonNA have to enact New York state's ventilator guidelines that they published on their website in November two thousand fifteen health. Ny Dot Gov. I think has his public on the ethical decision making that goes into deciding who gets to get a ventilator or breathing machine to live in who get palliative compassionate care without a ventilator. Do you know it works. Who gets to live and who who dies. It is impossible to expect every single clinician to unilaterally decide who gets to live and who gets to die. That's unfair because not all of us have that experience or training in rationing care. It goes to a committee in a committee of ethicists administrators and doctors takes in the clinical assessment that is provided by the people on the ground and then decide whether to get a ventilator enough. We haven't crossed that bridge there. I think it is hostile dependent. And once we get to that point out get a better idea of what the parameters are. The governor of your state seems to be taking this pretty seriously. He's been asking for military intervention and more help from the federal government for a while now but the president seems to be you know urging the country to words moving past this to having everyone in the clear by Easter. I mean if you could talk to the president today. What would you say to him? I would say this is not your lane. You don't know what's like to be in the trenches taking care of these patients who are young and healthy who may die from this who have spread to other people. You don't know what it's like to come into the emergency room and know that automatically you're exposed to this virus that you can bring home to your family members so this is not something that he should comment on. What are you most need right now? We need the military. We need federal support FEMA. We need disaster infrastructure to be put in place and build a new hospital from scratch with cove in nineteen only patients with negative pressure rooms. You activate the millions and millions and millions of dollars that you get when you declare national emergency and you put those millions and millions of dollars into building a hospital basically anyone with Coburn nineteen gets the best care the best clinicians all bound up in Hazmat Topic. Bunny suits head to toe. So we're all protected taking care of these patients that the best our ability get enough ventilators to take care of the patients that need them and make sure nobody dies. Then we develop a vaccine by then and then everyone becomes immune once we maxine. Everyone like we did with Jake Smallpox we have the money for it. We have the resources for it. But does someone want to pull the trigger and activate all those things? I sent a lot of reluctance because we have developed a habit of trying to find a way to cut corners. And that's how we got into the problem. The First Place Hari Calvin well I really hope you get it. I really hope you all get what you need to stay safe. And keep other people healthy as well too because we don't in one or two weeks the system will collapse. I WanNa say that is that we will get sick right a couple of my colleagues on life.
"emergency room" Discussed on Mayo Clinic Talks
"Than about six five milligram tablets of oxycodone a day. You should consider this as a reversal. Medication and Patients who have a psychiatric illness as a complicating factor in their care especially including those with clinical depression. So they should have that available as well as these are high risk medications if taken in overdose. I'm fascinated by naloxone because they don't understand it hardly at all but you just said a reversal. Kind of I've thought. Is it like an eraser like just like it's a do over or is it a a life jacket you know that you can keep the patient alive until you and let the effects of the opioid filter away as time goes on? What exactly does Milan do? I like? The idea of thinking of it as an opioid eraser over it really does especially given an adequate doses reverse opioid medications profoundly it immediately puts patients into a withdrawal state which you have to be prepared for because they can have a vomiting diarrhea and certainly psycho motor agitation even violence and this takes effect after an injection within several seconds or minutes and so. I like the idea of thinking of it as an eraser. There's some important caveats to that though because a dose of Naloxone will last about an hour and a lot of the medications that were reversing are longer acting than than the lock zone will be and so patients who have to take that lacks who by standards who administer. Naloxone should alert emergency services and that patients should be monitored and evaluated for a longer period of time to make sure that the duration of the medications doesn't exceed the reversal agent and then they go back into overdose state. Well that's why I think about it as a life preserver. Because you're still out in the ocean. The boat dissolve. But you can you know the life preserver. Gets you to the emergency room or wherever just long enough? That's that helps me understand now. What is drug diversion? It's very frequent. Actually that will have patients come into the doctor's office or to the Emergency Department and say you know I've had this pain and it didn't go away with some very strong pain. Medication that my spouse or my grandmother had on hand that we took a dose of while that sounds very innocent upfront. It's actually not a very long jump from that situation too. There was thirty pills leftover and so I gave it to a family member and I'm not sure exactly what they did with it but maybe they sold it to somebody. Where maybe they took that medication. Or maybe they're keeping it on hand for a party so drug diversion is the diverting or taking a medication that's prescribed legally for one patient for an indication that's necessary and using it or diverting at taking it to another person for whom it's not prescribed and who doesn't necessarily meet those indications for the prescribing. What don't patients understand about this? Because when I hear this advice or when I hear this here's how it should be. I think patients are thinking. Oh you're just being the law and I think I can take care of this medication work for me. I think my husband could take it or my sister. Take it but is there. Is there other things going on? That patients don't understand. Yeah and I think that we have some history with this which we can rely on as well because this has been a problem for some time and we know that the highest risk for diversion or misuse of opioid medications really comes with the amount of medication that's prescribed number of tablets higher dose for example. And so if we're giving a lot of an amount of medication to people It really puts patients and the community at risk for these things. I know that we always feel that. We can manage these medications but it is very common that medications go missing and it's very common. That people even believe they're managing them correctly. May Not end up doing that in the long run. Well I've got my L. advil or my profound and everybody in my family shares that or if somebody says oh my I have a headache I give them an Ibuprofen so I understand why people think I've these opioids I got for my wisdom teeth and there's two left. I'll just keep them in case. I have a headache. I mean I can see why patients do that. But it's not the same because the medication is different and there is still a need for expertise. In our country we have we have a the popularization the popularization of a lot of self management things. And I think that that's a really good trend for a lot of things but there are some things that still require physicians nurses and pharmacists who have expertise in managing these things to help keep individual patients and our population's safe all right speaking of physicians. How do you know then that a patient isn't doctor shopping? So they're not getting an opioid from their sister in law but maybe they're going to different physicians and getting multiple prescriptions. Yeah and we'd spoken a little bit. Before about the prescription data monitoring programs that are in place in most states in the nation and are required by at least twenty seven different states in Guam to be accessed prior to writing. Some prescriptions for opioid order controlled substance medications. I think that that's a helpful resource and we need to make sure that we're doing that. More reliably I also think that there's other efforts within regions which have been very helpful at quelling this problem including sharing of electronic medical records between different institutions so that we really have access to. Who's getting what from where and from whom and finally let's talk about The dispensing of the opioids in the emergency department At one o'clock in the morning to go back to our previous example when opioids are determined to be Needed for some acute pain. What is the best method for administering them? That's a good question now. There are certainly patients. They can't take anything by mouth or who have severe pain that needs to be acted on. Within seconds to minutes and those patients may require intravenous or intramuscular administration of opiates however for patients with chronic pain in the absence of cancer. It's really not a good idea to be using intravenous or intramuscular what we call. Parental administrations have opioids for chronic pain. Beyond just that administration method in general chronic pain patients who have long term opioid use should be getting those prescriptions from a single provider with whom they maintain an OPIOID therapy agreement. We shouldn't be allowing doctor shopping or treatment in the now. That's easier.
"emergency room" Discussed on Mayo Clinic Talks
"I hello and welcome to Mayo. Clinic talks the OPIOID edition. I'm Tracy mccray and with me today as detrick. Ac clements and emergency physician practice leader. Who works in the OPIOID stewardship program at Mayo Clinic in Rochester? Today we're going to take a look into the OPIOID crisis from the emergency department. Prospective Nice to meet you Dr Clements. It's supposed to meet you. Thank you for having me because of the urgent nature of the Emergency Department. That's what you're there for. I would think that emergency physicians might have a different perspective on prescription. Painkillers treating patients than a primary care. Physician might has the OPIOID epidemic changed how physicians evaluate and treat patients in the ED. Well all physicians. I think actually want to help alleviate pain and suffering. It's one of the reasons that we go into medicine. And it's like part of the hippocratic oath and so I think that the difference that the emergency department has is that a ton of patients that we see actually have acute pain that requires treatment however we also have patients who are addicted to medications and maybe acutely intoxicated or withdrawal states and we have patients who may be seeking prescriptions for recreational use or even diversion purposes. And what I think is different about the emergency department than perhaps primary care other settings is is. We will see all three of those situations in a single day and so it makes it very difficult to Really assess for who needs prescription medications and who to trust and who to make sure that you're treating their pain adequately I wouldn't have even thought of that. The only category of I've ever been in is I am in such bad pain. I agreed to come to the emergency room or I had to come to the emergency room to the people who are trying to find a prescription because of an addiction. Are they acting or do? They pretend that they're in pain. Or How do they present? So that's a really difficult question to answer. I actually I tend to trust people and so when I say. Are they acting or are they lying? I don't think so. I think that they are feeling pain. It's just that that pain may not be in the same category as an acute pain from an injury. For example it may be more along the lines of their feeling the physical effects of withdrawal were desire of those medications. And that's an entirely different kind of suffering here. Yeah what expectations are placed on physicians or the Prescriber in this case as it relates to pain control and to opioids specifically. This is a great question as well. I really think that we have both societal and personal expectations that we said both on ourselves and our patients set on us really play into the OPIOID crisis. First of all like I had said prescribers really wanted to alleviate suffering. And we WANNA do that as thoroughly and completely as possible as well patients who come in. They want the strongest and most effective medications. And if you don't believe that tried to find Acetaminophen there's not extra strength because everything has to be the biggest strongest and most effective and if there's something stronger we want it because we want that pain to be gone or to be alleviated to the highest degree. Why are you taking? And if it's not going to get rid of it exactly but I think that that expectation from a societal and patient perspective may actually not be reasonable. I think that we need to understand the indications and the reason that we're treating pain is to improve functional status and to make it tolerable. It's not to make it go away and I think that's a completely different mindset than a lot of people have but in general. We don't have any magic bullet. Apart from sort of numbing medications like lie to Kane. That's going to make pain go away. It's going to numb it or it's going to dull. It are there. Specific situations or health conditions when a patient should not be prescribed an opioid. There's certainly the textbook answer that patients who are abusing illicit substances or have abused and opioids should not be prescribed for their opioid medication. And that's really an absolute contra indication but there's other relative contraindications as well if someone is taking other medications that have drug drug interactions with opioids. They should be avoided and that includes Sedating medications like Benzodiazepines. The World Health Organization has a strong recommendation that this be avoided due to a significantly increased risk of accidental overdose and death of both of those types of medications are taken together and there's other drug drug interactions with specific opioid medications that come into play so for example trauma doll which is usually thought to be a lower potency. Opioid can have interactions with psychiatric medications and cause significant in dangerous conditions and so those are also relative contraindications in addition to that there are medical diagnoses which probably are not treated with opioid medications based on the expected duration of the pain. Severity of the pain or the mechanism. By which that pain happens so traditionally we may have given migraine headaches. Opioid medications in general. That's not indicated because it's not mediated through the Mu Receptor pathway that opioids act on additionally lots of chronic pain syndromes as fibromyalgia or chronic idiopathic. Abdominal pain shouldn't generally be treated with opioids because the neurotransmitters that are involved in that pain are also not likely well treated by that opioid pathway and opiates in that case. As they've been taken maybe even longer term can be taken for the four into effect more than any pain control effect. I would think that if you're going to see your physician and you've got an office. Visit scheduled. Time is not as much of the essence as it is in the E. D. So if you have the patient's record then you then you know the different all the different drugs that you just mentioned but if someone shows up in the emergency room at one o'clock in the morning your Reli- if you don't have their records you're relying on them to tell you what medications they are taking and they might not be the best reporter of that information based on their in a lot of pain or it's one o'clock in the morning I can't remember anything right now because I'm sitting in an emergency room. I mean how do you how do you address that? Yeah so I think that. There is some ancillary data which is important to take into account as we're discussing Reliable sources of information. Certainly we can cut reach out to in contact other healthcare organizations that may have cared for the patient or pharmacies where they've had their medications filled nearly every state has instituted a prescription drug monitoring program. Which is a program where when patients fill controlled substances in pharmacies those prescriptions and the details related to them are entered into a database that can then be accessed by downstream providers who are caring for the patient in. May need to know that important information by the time. I'm done recording. All of these different podcasts with the U. fantastic physicians. I'm going to be able to say this but I'm not quite sure at this. Point is so opioid. Opiates and narcotic they are not the same thing or are they. They're not the same thing and I think that it's important that we do understand the differences in those definitions that being said full disclosure on a day to day basis. We all slip into kind of using them interchangeably. So first of all. An opiate are generally naturally occurring alkaloid substances that come from an opium. Poppy the three main ones being morphine codeine empathy bang now narcotic really used to be kind of synonymous with. Opiates when they only had those medications available it comes from the Greek word. That means mind numbing but it has taken on a legal definition as well. It really now is any substance which can be used illegally realistically and is listed on a national level so it doesn't just include opiate or opioid medications but things like cocaine and methamphetamine now legally fall under a definition of narcotic okay now opioid medications is really a more encompassing term for the kind of medicines that we're talking about today that encompasses not only the naturally occurring substances from the opium poppy but it also is partially synthetic medicines like heidrick. Oh Dome Oxycodone hydromorphone as well as fully synthetic compounds like Fenton Hill which are structurally not similar to. Opiates but still act at the same receptor and through the same mechanisms. So by using the the word opioid. We're really talking about apples and apples. As opposed to just the naturally occurring. It sounds sort of like a semantic discussion but I think it's important. So with so many opioids available to you. You just said there's a natural occuring lund's synthetic ones how in the world does a prescriber pick one. I mean where do you start? Are there important differences other than just the potency? Or where do you begin? I think that's a great question you know. We're really aiming for the analgesic effect. Which is the ability to help pain? And with different potencies we do have systems and conversions that can Talk about equal analgesic dosing. So that's how potent is a medication that the dose for dose will give the same amount of pain control effect and so we try to write prescriptions so that their standardized to equal analgesic dosing on a standard scale of what we'd call. Milligram. Morphine equivalents. Now this is relatively new does not per is not purveyed by any means medical care and everyone doesn't do this but I think that it's really important because we don't always appreciate the potency of some of these medications so oxycodones for example is more potent than morphine and when we are writing those prescriptions. We WanNa make sure that we're giving the correct dose for the correct duration and so if we convert them to milligram morphine equivalence. It helps us be on the same playing ground. That being said is there are some differences that go beyond just the pain control effective these medications. There's evidence that medication such as hydromorphone have significantly higher euphoria Interfax exceed just the ability to control pain and so a lot of people are going back to the old standard of morphine because feel the pain. But you don't care about it actually. I've said that exact sentence and so I think that's a really good description. And there are a lot of places including institutions which have gone to policy of Prescribing Morphine. And not partially synthetic things like oxycodone hydromorphone based on the perception that they actually have a higher euphoriant effect than the old standby of things like morphine as the lay person. And you know you sit around cocktail parties or whatever and talk about. I A lot of people I know I have had this happened to. Where if you're in the emergency room or if you are given some sort of opioid that makes you sick either immediately or in the long you know next. Ten to twelve hours is there. Do you figure that in like this is a medication that makes people sick sometimes. So we don't WanNA use that one or do you just say this works will deal with the sickness later. Good follow up question because there are medications that certainly have a different side effect profiles go through things and people also experience those medications differently so while some patients may say that trauma. Doll doesn't cause a euphoria type effect. Other people will say it's more you for into than some other medications and so there's a there's a personal experience of that as well but there are some side effects to these medications which are common including nausea. Some people get itching related to them. That doesn't necessarily mean that it is an allergic reaction These medications and especially the old standbys like morphine can cause direct release of Histamine which caused a lot of those symptoms. What point do you consider prescribing naloxone? So Malak Zone is an antidote to opioid medications and it works very quickly and very potent to immediately reverse the effects of opiates. So essentially what you're doing. Is You administer or you prescribe lock zone as you're asking them to Have a rescue medication. In case they accidentally or intentionally have an overdose are thinking on. This has come a long way as this used to be really a hospital based medication but it saves lives in the community when people have naloxone available in case of those accidental or intentional. Overdoses there are some patients that would certainly benefit from having the Laksono available in those are folks that would be at the highest risk for having an accidental or intentional overdose including folks who have higher doses of opioids prescribed to them or who have a high abuse or addiction potential. So really if you have a history of an opioid overdose in the past. I think it's really important that prescribers consider letting their patients have access to the lock zone and many pharmacies in states across the nation. Actually have this available without a prescription and so Prescribers and patients alike should look into their regional Regulation of this medication to see where and how to get it if you have opioid doses which exceed fifty milligram of morphine equivalents per day Which means if you're taking more.
"emergency room" Discussed on Dumb People Town
"You get great extra content and all that great stuff inching our way towards five hundred. I think we need to make a big leap here. You guys we can do that. And we we appreciate the sport. Like, you don't even understand. One last story. I've sent him by Casey coup. Stick. Stories more Casey K underscore comedy. Thanks, casey. A new strip club on the on the San Antonio's northeast side is not even open for business, but is already causing controversy there. Opening new strip clubs doesn't it seem like there? We've already had them like McDonald's and Starbucks. There's always. There's another nice mom pop strip club right over there. And these guys counts. It's awesome pains for WalMart came in and put in all those strip club local work. I took it away. It's still local work. Could be agreed or at WalMart and then turn around and be agreed or at the strip club. Why Why not? not differences atop code? Same same thing. But different top hat. I love this. This is what a business would be called in dumb people. Some people fear that the emergency room. Gentleman's lound could be mistaken as an actual emergency room. -mergency rooms gentle ones. People are in their drinking out run in with a knife in their arm. Because that's dumb people. I got a bone that needs to be taken care of you've come to the right place. We'll take care. That right. Husband could tell their wives. That's why didn't come straight home. We I saw receipt on your AmEx Bill from the emergency room. That they were serving champagne. Helps make you feel better..