Blissful Life

When you apply skepticism and care in equal amounts, you get bliss.

Month: October 2019

  • Permanent Record (Book Review)

    You could call it an autobiography of Edward Snowden or you could call it a manifesto for democratic citizenship. You would be right either way. This book is a how-to guide for becoming a hacker (in the realest sense of the word), a good parent, and a good lover.
     
    A fair bit of caution advised though. The book will leave you paranoid. Once you realize the perverse amount of surveillance that you are subjected to without your knowledge, it becomes surveillance with your knowledge, and I don’t know which is better.
    I had once written a blog post titled “When Doing Good is Bad For You” from my own experience. In that I talk about how social revolutionists will perpetually face the dilemma of not doing anything versus fighting the system and putting themselves at risk in the hope of being able to improve the system. I have seen many others face the same dilemma. Edward Snowden also faces the same dilemma and we know what path he chose.
     
    But till I read this book, I could not make that connection. That Ed Snowden is a human just like you and me. That he went through situations just like you and me. That the choices he had to make are the choices that confront us all similarly. That we are all perfectly capable human beings who can do great things.
    It also gave me another realization. That the democracies we live in are very far away from ideal democracies. And that forgetting this can have real life consequences. And that despite all that it is necessary to continue the fight.

  • Understanding Adrenaline Dosage

    Have you ever administered adrenaline for anaphylactic shock? I’ve never had the unfortunate need to. I’m sure anyone who ever does will forever remember the correct dosage. But for me, it is always a confusion. Every time I vaccinate someone at my clinic, I look up the dose of adrenaline just to be sure.

    The first problem is the dilutions. Dosages of adrenaline are (or were) mentioned in dilution. 1:1000 & 1:10000. There begins the confusion.

    Firstly, let us understand where the 1000 comes from in 1:1000. Have you seen a small vial of adrenaline? That is 1mL. It has effectively 1mg of epinephrine/adrenaline. But why is it called 1:1000? Because 1mL of water = 1g of water = 1000mg. So, the 1:1000 actually refers to 1mg of adrenaline : 1000 mg of water. Unnecessarily complex!

    All you had to say was 1mg in 1mL. And that is why this labeling is now being followed in some countries.

    So, there you have a small vial – a 1mL vial – with 1mg of adrenaline in it.

    Now, let us look at the other form epinephrine comes in. Epinephrine also comes in a big syringe of 10mL. But even this 10mL contains only 1 mg of adrenaline. The total amount of adrenaline in this 10mL form is the same as a small vial.

    What is different then? Well, when the volume increases without increase in amount, the concentration drops. The 10mL form is more dilute than the small vial. Can you guess the dilution? It is 1:10000 or more easily expressed as 1mg in 10mL.

    So, the first thing to internalize is that the small 1mL vial we see has 1mg of adrenaline (it may say 1.8mg of an adrenaline salt, but the effective amount of adrenaline is 1mg). And this is a concentrated form of adrenaline.

    What that also means is that the 1mg/1mL adrenaline is never used directly IV! The reason is that this can cause an arrhythmia or other damages to the heart muscles.

    If you’re bored reading text, watch this youtube video telling these same things.

    Now, the dilute form and the concentrated form are for slightly different uses. The concentrated form is given IM in anaphylactic shock. The dilute form is given IV in cardiac arrest.

    When giving IM adrenaline for anaphylactic shock, the dosage in adults is almost always 0.5mg (0.5mL of the concentrated vial). If you can remember this fact it is easy to calculate the pediatric dose as well. The adult dose can be thought of as if it applies to a 50kg person. So 0.5mg for 50kg = 0.01mg/kg and that is the pediatric dose. (This 50kg adult approximation applies for many other drugs in calculation of pediatric dose. Let me know in comments below about other drugs that can be calculated this way).

    When giving in cardiac arrest, in which case the dilute form (1mg in 10mL) is used, the adult dose is the entire 1mg (or 10mL) given intravenous and repeated based on the protocol you follow.

    That is all there is to know. Just a 0.5mg and a 1mg.