It's interesting how different standards for behavior on public transit are over there compared to the US. The €100 fine for playing music out loud introduced by Irish Rail sounds heavenly. Here in Dallas, half the trains I get on have someone openly smoking (cigarettes, weed, meth) on them and the rare transit security officers supposed to be doing something about it are the ones playing loud videos on their phones!
It would be quite distressing because of the accumulation of CO2 in the blood, even with completely adequate oxygenation delivered intrarectally. The slight change in acid-base balance is what makes a person feel the need to breathe, and CO2 is an acidic byproduct of metabolism. This is why people with metabolic acidosis (e.g. in diabetic ketoacidosis or sepsis) have an increased respiratory rate.
Would CO2 still build up if someone isn't breathing at all? I'm guessing so, since you say CO2 is a byproduct of metabolism. Alternatively, could respiration exhaust enough CO2 even in a situation where the lungs are too damaged to take in sufficient oxygen?
All that apart, I'm guessing this would be used in emergency situations, where a patient is likely already unconscious and could be kept under sedation until transferred to ECMO. Is CO2 buildup dangerous on its own? If so, in what kind of time-frame? What's the upper limit on the additional minutes this therapy could buy?
In an acute situation where oxygenation isn't sufficient, the imminent threat of anoxic brain injury and end-organ dysfunction is the concern. Measures would obviously be taken to correct that, up to and including rapidly sedating and paralyzing a patient in order to mechanically ventilate them with an increased fraction of inhaled oxygen and/or additional pressure (PEEP) to increase the surface area in the alveoli available for gas exchange.
Respiratory acidosis (i.e. the accumulation of CO2 and acidification of the blood due to inadequate breathing) is generally not harmful on its own, the concern there is just adequate oxygenation. However there are metabolic causes of acidosis, usually due to lactic acid accumulation, which lead to end-organ dysfunction because lots of enzymatic reactions in the body expect a very narrow pH range to work effectively. This occurs over a period of days, though.
So, it sounds like if this works (big if, of course, at this point), sedation + an enema could be a better "bridge" to mechanical ventilation than CPR. That would be amazing (if it works); science fiction stuff.
I would disagree for a few reasons, at least for its application to cardiac arrest. It might have some niche applications, but that's only speculative.
The main determinant of successful CPR is maintaining coronary perfusion pressure with unrelenting chest compressions so that the heart has a fighting chance at starting to beat normally again. Moving the blood so that it has enough pressure at the aorta where the coronaries branch off of is way way way more important than keeping it oxygenated, which we're already pretty good at. In fact, over-oxygenation in CPR has been shown to be detrimental to outcomes because it causes oxidative stress at the cellular level. Oxygen is nasty, it's amazing that life evolved to harness it.
I do agree that modern medicine (especially emergency medicine) is really cool, that's why I switched careers after working in software engineering. We have lots of tools at our disposal, it's already science fiction. Modern resuscitation involves drugs that manipulate the ion channels of the heart in various ways, we can shift fluids around by changing the osmolarity of IV fluids (and we can pump them into you through your bones after drilling into them if needed...), cardiac monitors and AEDs will time a shock just right depending on the dysrhythmia to increase the odds of success, we can even just repeatedly shock a heart to make it beat in some situations like an AV block. And that's just the stuff that they let paramedics do (i.e. trained monkeys, I am one).
In my thoracic surgery rotations in med school I was taught that the strongest stimulus for increasing the respiratory drive was the acidification of cerebrospinal fluid. Which, of course, correlates with the blood pH. This information comes from some studies in the 60s with goats, and the old guard are happy to hang their hat on it.
There are also chemoreceptors for oxygen concentration in the circulatory system as well.
I think everything you have said is correct, I just wanted to add a few more details for anyone who is interested.
I also built a 3D portfolio website[1] using React and react-three-fiber but I took a different approach design-wise, the HTML content is scrollable like a normal website but the 3D scene subtly matches the perspective of the screen as you scroll.
Btw that site runs horribly in chrome on a pixel 9. The frame rate is low and scrolling has lots of jank. Also the page width is just a little bit wider than my screen width, so there is horizontal scrolling as well.
nice site. one suggestion - it took me too long to realize I needed to scroll down to see your stuff. maybe a little ghost arrow pointing down might help others
For my apartment, I run rtsp-simple-server[1] on my home server and use Raspberry Pis with generic USB webcams running ffmpeg to stream the audio/video to the RTSP server. Then I run camera.ui[2] separately for a nicer interface on top of all the cameras, HomeKit integration, etc.
The only downside hardware-wise is I don't get any indoor IR night vision with these, which some of the nicer "smart home" account-locked ones do.
It's honestly not too bad to set up if you run [1] and [2] in Docker. I've done disaster recovery scenarios of my home infra where I straight up disconnect the modem's uplink and everything works without any issues.
> I've done disaster recovery scenarios of my home infra where I straight up disconnect the modem's uplink and everything works without any issues.
As a Comcast customer in a region with no competing provider, I really respect and appreciate their proactive stance toward ensuring all their customers frequently have the opportunity to reaffirm this level of confidence in our local networking infrastructures.
The fixation on comparing this to a toilet plunger is unnecessary and somewhat off-putting, but yes, this is pretty common nowadays. The LUCAS is a huge help and makes running a cardiac arrest feasible with a crew of 2-3 people, previously it required a larger team and lots of switching out who was doing chest compressions. It also makes it much easier to move a patient while CPR is in progress since you don’t need to pause compressions moving in and out of the back of an ambulance, etc.
They do tend to be… rougher… apparently they do _such good_ CPR that the risk of damaging the great vessels is much higher than with manual CPR, but I think the tradeoff of getting consistent chest compression quality works out in favor of it still.
There’s a saying in EMS: “lift with your firefighter, not with your back!”. My heart goes out to any firefighters named Lucas.
Yep, it has issues so frequently. I wonder how many companies/teams start using AWS and blindly choose us-east-1 without realizing what they're getting into.
<rant>
It's also quite annoying sometimes that some things _need_ to be in us-east-1, and if e.g. you are using Terraform and specify a different default region, AWS will happily let you create useless resources in regions that aren't us-east-1 that then mysteriously break stuff because they aren't in this one blessed region. AWS Certificate Manager (ACM) certificates are like this, I believe.
ACM certificates themselves can be had in any region (and you can use them for stuff like ELBs), but since the Cloudfront control plane is in us-east-1, if you want Cloudfront (and IIRC, also if you want custom domain names for an S3 bucket, but don't quote me on that) you'll have to create an additional certificate in us-east-1.
Your mentioning the pantheon gave me a flashback to how one of my old companies named their non-prod environments. The dev environment services were named after all the Greek gods, and the QA/demo environment services after the Roman gods. It was so horribly confusing…
