#amiodarone

[er-cryptid]

Amiodarone

NAMES -- Cordarone -- Pacerone -- Nexterone

CLASS -- antiarrhythmic agents

USE -- treatment of a wide variety of ventricular and atrial arrhythmias

ACTION -- decreases myocardial excitability

#medblr #studyblr #notes #pharm #pharma #pharmacology #amiodarone

[phonemantra-blog]

The Benefits and Risks of Pacerone: A Comprehensive Guide In the world of cardiology and the treatment of heart rhythm disorders, Pacerone, known by its generic name Amiodarone, shines as a vital medication. But what exactly is Pacerone, and how does it impact the cardiovascular health of those who rely on it? In this comprehensive guide, we'll delve into the nuances of Pacerone, exploring its uses, mechanisms, and both the benefits and potential risks associated with its use. [caption id="attachment_60250" align="aligncenter" width="1280"] pacer one[/caption] What is Pacerone? Pacerone, also referred to as Amiodarone is a medication that plays a crucial role in the realm of cardiology. But beyond its name, what is Pacerone? How Does Pacerone Work? The magic of Pacerone lies in its mechanism of action within the human body. Understanding how this medication operates is key to appreciating its significance in managing heart rhythm disturbances. Medical Indications Pacerone is not just another medication; it's a powerful tool in the hands of healthcare providers, primarily used for specific medical conditions and heart rhythm disturbances. Understanding its medical indications is essential: Heart Arrhythmias: Pacerone is often prescribed to individuals with various types of arrhythmias (irregular heart rhythms). These may include atrial fibrillation, ventricular tachycardia, and atrial flutter. By stabilizing heart rhythms, Pacerone helps prevent potentially life-threatening complications. Life-Saving Potential: In some cases, Pacerone can be a life-saving medication, particularly for individuals with ventricular tachycardia or ventricular fibrillation, which can lead to sudden cardiac arrest. It can be administered in emergencies to restore a normal heart rhythm. Dosage and Administration Understanding how to take Pacerone is just as important as knowing why it's prescribed: Oral Medication: Pacerone is typically administered orally in the form of tablets or capsules. The dosage and frequency are determined by the individual's specific condition and response to treatment. With or Without Food: It's important to follow the instructions provided by your healthcare provider or pharmacist regarding whether to take Pacerone with or without food. These guidelines help optimize its absorption and effectiveness. Regular Monitoring: While on Pacerone, regular check-ups and electrocardiograms (ECGs) may be required to monitor the heart's response to the medication. This ensures that the prescribed dosage remains appropriate for the individual's needs. Potential Side Effects Like any medication, Pacerone comes with potential side effects that individuals should be aware of: Common Side Effects: These may include nausea, vomiting, and fatigue. Inform your healthcare provider if these side effects become bothersome. Serious Side Effects: While uncommon, Pacerone can lead to more serious side effects, such as lung problems, liver issues, thyroid dysfunction, and skin reactions. It's crucial to promptly report any unusual symptoms to your healthcare provider. Regular Check-ups: Routine check-ups and blood tests are often recommended while taking Pacerone to monitor potential side effects and adjust treatment as needed. Precautions and Warnings While Pacerone can be highly effective, it's important to approach its use with certain precautions and awareness: Thyroid Function: Pacerone can affect thyroid function, potentially leading to hypo or hyperthyroidism. Regular thyroid function tests and monitoring are crucial while on this medication. Lung Function: In some cases, Pacerone can cause lung problems, including pulmonary fibrosis. If you experience unexplained shortness of breath, cough, or chest discomfort, seek medical attention promptly. Liver Function: Monitoring liver function is essential while taking Pacerone, as it can lead to liver abnormalities. Inform your healthcare provider if you notice symptoms such as abdominal pain, jaundice, or dark urine. Interactions with Other Medications Understanding potential drug interactions is vital when taking Pacerone: Inform Your Healthcare Provider: Always inform your healthcare provider about all medications, supplements, and herbal products you are taking. Some medications can interact with Pacerone, affecting its effectiveness or increasing the risk of side effects. Medication Adjustments: Your healthcare provider may need to adjust the dosages of other medications you are taking to ensure their compatibility with Pacerone. Patient Experiences Real-life experiences can provide valuable insights into the impact of Pacerone: Amanda's Journey: Amanda, a heart arrhythmia patient, shares her journey with Pacerone. She discusses how the medication has helped her regain a sense of normalcy and the importance of close monitoring by her healthcare team. Managing Side Effects: Mark, a Pacerone user, reflects on his experience managing potential side effects. He highlights the significance of communication with his healthcare provider in finding the right balance between benefits and side effects. FAQs About Pacerone Q: What is Pacerone used for? A: Pacerone (Amiodarone) is primarily used to treat irregular heart rhythms, including atrial fibrillation and ventricular tachycardia. Q: How does Pacerone work to control heart rhythms? A: Pacerone works by affecting the electrical signals in the heart, helping to restore and maintain normal heart rhythms. Q: What are the common brand names for Amiodarone? A: Besides Pacerone, Amiodarone is also sold under brand names like Cordarone and Nexterone. Q: Are there any dietary restrictions while taking Pacerone? A: It's important to avoid grapefruit or grapefruit juice while on Pacerone, as it can interact with the medication. Q: Can Pacerone be taken with other medications? A: Pacerone can interact with various medications, so it's essential to inform your healthcare provider about all the medications and supplements you are taking. Q: What are the potential side effects of Pacerone? A: Common side effects include nausea, fatigue, and skin changes. Serious side effects may include lung or liver problems. Q: How long does it take for Pacerone to start working? A: Pacerone's effectiveness can vary from person to person, but it may take several days to weeks to see its full effect. Q: Can Pacerone be used during pregnancy or breastfeeding? A: Pacerone use during pregnancy and breastfeeding should be discussed with a healthcare provider, as it involves complex considerations. Q: Is it safe to drink alcohol while taking Pacerone? A: Alcohol can interact with Pacerone and should be consumed in moderation, if at all. Consult your healthcare provider for specific guidance. Q: What should I do if I miss a dose of Pacerone? A: If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed one and continue with your regular schedule. Conclusion: In the world of cardiac health and the management of heart rhythm disorders, Pacerone, known as Amiodarone in its generic form, stands as a formidable ally. This comprehensive guide has taken you on a journey through the intricate details of this medication, offering insights into its uses, mechanisms, benefits, and potential risks.

#amiodarone #Amiodarone_hydrochloride #Antiarrhythmic_drug #Antiarrhythmic_medication #Cardiac_arrhythmia_medication #Cordarone #Heart_rhythm_control #Heart_rhythm_stabilizer #How_does_Pacerone_work #Nexterone #Pacerone_and_alcohol_consumption #Pacerone_and_grapefruit_interaction #Pacerone_dosage_instructions #Pacerone_uses #Side_effects_of_Amiodarone

[drpedi07]

Amiodarone Drug

Medical information for Amiodarone on Pediatric Oncall including Mechanism, Indication, Contraindications, Dosing, Adverse Effect, Interaction, Hepatic Dose.

#Amiodarone #medication #medications #medicine #drug #drugs #drug information #medical information #drug index #drug center #pediatric dose #Antiarryhthmics #amiodarone mechanism #amiodarone indication #amiodarone contraindications

[mcatmemoranda]

The energy dose depends on whether the defibrillator is biphasic or monophasic. You should know how to operate the equipment used in your facility.

If using a biphasic defibrillator, follow the manufacturer’s recommendations for the initial dose (usually between 120 and 200 J). Subsequent doses should be the same as, or higher than, the initial dose. If the manufacturer’s recommendations for the initial dose are not known, use the highest energy dose available for the first and all subsequent shocks.

If using a monophasic defibrillator, set the energy dose at 360 J. Use this energy dose for each subsequent shock.

If defibrillation is initially successful in terminating the cardiac arrest rhythm but a shockable rhythm resumes, use the energy dose that successfully terminated the rhythm for subsequent shocks.

After 2 shocks have been delivered, epinephrine (1 mg IV/IO every 3 to 5 minutes) may be administered. The vasoconstrictive and positive ionotropic effects of epinephrine help to increase cerebral and coronary perfusion. Evidence suggests that epinephrine is most effective when administered early.

After three shocks have been delivered, consider administering an antiarrhythmic agent (amiodarone or lidocaine). The initial dose of amiodarone is 300 mg administered as an IV/IO bolus. If the arrest rhythm persists, consider giving a second dose of 150 mg as an IV/IO bolus 3 to 5 minutes later. Alternatively, lidocaine may be used if amiodarone is not available. The initial dose is 1 to 1.5 mg/kg IV/IO, followed by 0.5 to 0.75 mg/kg IV/IO every 5 to 10 minutes, up to a maximum dose of 3 mg/kg.

#ACLS #amiodarone

[cmtblogger]

Diagnostic Pathways for Idiopathic Neuropathy

“You have a serious illness of an undisclosed nature” says a doctor to a patient in a cartoon within Dr. Norman Latov, MD, PhD’s recent presentation on idiopathic neuropathy sponsored by the Foundation for Peripheral Neuropathy. There are many cases where people present neuropathic symptoms, but the causes are unclear. The current diagnostic pathways Dr. Latov maps out are familiar and…

View On WordPress

#AIDP #alcohol #Amiodarone #B1 #B12 #B6 #biopsy #Cancer #Celiac #Check POint Inhibitors #chemotherapy #CIDP #diabetes #Electrodiagnostics #GBS #Hepatitis C #HIV #hypothyroidism #Idiopathic Neuropathy #INH #kidney #Lead #Lyme Disease #MAG #mercury #MMN #muscle #nerve #Nerve Conduction Velocity #Norman Latov

[mednotecollection]

🧠 BLUE MAN SYNDROME MedNote Collection --------------------------------- instagram.com/mednotecollection t.me/MedNoteCollection pinterest.com/MedNoteCollection fb.me/MedNoteCollection --------------------------------- #medicine #medical_student #doctor #mednote_collection #MedNoteCollection #usmle #MRCP #pharmacology #amiodarone https://www.instagram.com/p/ConGiGMMKr3/?igshid=NGJjMDIxMWI=

#medicine #medical_student #doctor #mednote_collection #mednotecollection #usmle #mrcp #pharmacology #amiodarone

[bluevelvetea]

Looking at this new illustration from the latest chapter and...

they put his cousin on the marriage candidate wall as well? 😭😭😂 Teruaki my boy you're not beating the allegations

#Kinosaki is not on the wall because the real deal is right there #i love this manga so much #marriage toxin #marriagetoxin #official art #not my art #gero hikaru #kinosaki mei #gero teruaki #that idiot is smiling like he didn't overdose on amiodarone on purpose a few chapters ago

[hopkinrx]

Hyperthyroidism: Its Important Symptoms, Causes, Treatment And Lifestyle

Hyperthyroidism: Symptoms, Causes, Treatment And LifestyleIntroductionFunction Of Thyroid GlandWhat is Hyperthyroidism?Causes of HyperthyroidismSymptoms Of Hyperthyroidism Physical Manifestations Emotional RollercoasterDiagnosis Of HyperthyroidismTreatment Options: Bringing Harmony Back Medications Radioactive Iodine Therapy Surgical InterventionEmbracing a New Rhythm: Living with…

View On WordPress

#amiodarone induced thyrotoxicosis #complications of hyperthyroidism #elevated thyroid levels #factitious hyperthyroidism #goiter hyperthyroidism #graves disease hyperthyroidism #graves disease medication #graves disease tsh levels #high thyroid symptoms #hyper thyroid #hyper thyroid symptoms #hyperthyroidism #hyperthyroidism causes #hyperthyroidism hair loss #hyperthyroidism in men #hyperthyroidism medication #hyperthyroidism signs and symptoms #hyperthyroidism symptoms #hyperthyroidism symptoms in females #hyperthyroidism treatment #hyperthyroidism tsh levels #hyperthyroidism weight loss #hypo and hyperthyroidism #hypothyroidism and hyperthyroidism #i cured my hyperthyroidism #medicine for hyperthyroidism hyperthyroidism symptoms in men #over active thyroid #overactive thyroid gland #overactive thyroid medication #overactive thyroid symptoms

[daicelpharmastandard]

#impurities #Amiodarone EP Impurity F #Medical impurities

[macgyvermedical]

Drug Orders and Doses

@whumpsmith

Cool, so I think the first thing to know is how medication is ordered.

Generally speaking, it will be ordered in 5 parts, known as the "5 Rights" of medication administration:

#1 What patient is getting the medication

#2 What medication is to be given

#3 How much medication is to be given

#4 What time it is to be given (or how often)

#5 What route it is to be given

So an order might be "Give John Smith (5/13/1995) lorazepam 0.5mg IV once prior to MRI"

In this example, John Smith is the patient and 5/13/1995 is his birthday to differentiate him from all the other John Smiths. "Lorazepam" is the drug's generic name, "0.5mg" is the amount of the drug. "IV" is the route, and "once prior to MRI" is the time.

Drugs have generic and brand names. For example, acetaminophen is a generic name. Many companies make acetaminophen, and each has their own brand name for the drug. Probably the most well-known brand name for acetaminophen is Tylenol, but there are others, like Calpol and Panadol. For most people, it doesn't matter which brand of a particular drug is used, just that the active ingredient (the generic name) is the same. For some people it matters because the non-active ingredients may be different between brands, and they may be allergic to a non-active ingredient that is in one brand, but not another.

In a hospital setting, we're going to use the generic name, because the brand of the drug that is cheapest to the hospital pharmacy varies contract to contract, and there are a lot of drug shortages these days. That's why if you're in the hospital you might get an oval green pill one day and a round white one the next day. They're the same drug, just different brands.

The dose is given in milligrams, usually abbreviated "mg". Milligrams are a measure of weight. Cubic centimeter (cc), on the other hand is a measure of volume. At some point we switched from volume based to weight based measures because we had a lot of different concentrations and using volumes for everything made mistakes really common. If you're using weights, it doesn't matter if the concentration you have is 1mg/mL or 10mg/mL for a given drug, you can do the math and come up with a volume that is right instead of just hoping you picked the one the doctor was thinking about when they wrote the order.

There are many routes a drug can take into the body. There is oral (a pill or liquid), IV (injection in a vein), IM (injection in a muscle), SQ (injection into fat), rectal/PR (a suppository, gel, or liquid inserted into the rectum), SL (under the tongue), TD (a paste or patch that sends medication through the skin) and many more.

Times can be once, once every x hours, once every x hours as needed (PRN), once under a particular circumstance, daily, or pretty much any other interval you can think of. "Stat" is a term meaning "right now".

Here's a list of common medications and their dosages:

CODE DRUGS:

Epinephrine 1mg IV for cardiac arrest every 3-5 minutes, 0.3mg for anaphylaxis

Amiodarone 150-300mg IV over 10 minutes for cardiac arrest

Lidocaine 75mg for cardiac arrest initially, if that doesn't work then 37.5 10 mins later

Adenosine 6mg given very quickly for PSVT, if that doesn't work, give 12mg

Atropine 1mg every 3-5 minutes for low heart rate until heart rate is normal

OTHER DRUGS:

Albuterol 2.5mg in nebulizer for brochospasm/asthma attack

Metoprolol 5mg IV every 5 minutes up to 15mg for severe high blood pressure

Furosemide 20-80mg IV for fluid on lungs

D50 25g IV for low blood sugar

Diphenhydramine 12.5-50mg IV for allergic reaction

Morphine 2-10mg IV or IM for pain

Fentanyl 50-200mcg for sedation

Mannitol 20-150g for increased pressure inside the skull

Nitroglycerin 0.3-0.6mg every 5 minutes up to 3 times for chest pain (angina)

Naloxone 8mg nasal spray every 2-3 minutes for opioid overdose

Flumazenil 0.2mg IV for benzodiazepine poisoning, if that doesn't work give 0.3mg, if that doesn't work, give 0.5

Diazepam 15mg rectal gel for seizures that don't stop

Phenobarbital 1-1.5g IV for seizures that don't stop

Etomidate 22mg IV for anesthesia (for things like intubating someone)

Midazolam 5mg IV for sedation prior to surgery

Olanzepine 5-10mg IV for agitation (emergency sedation)

Haloperidol 0.5-10mg oral or IM for agitation (emergency sedation)

#whump reference #writing reference #drugs #whump #medical orders #sedation #anaphylaxis #cardiac arrest #pain

[whumpy-daydreams]

CPR in hospitals

I did a post on doing cpr as a 'civilian' (i.e. in public with no equipment). But most people who follow me are writers! So here's how it goes down in hospital.

It varies on where someone is in hospital having a cardiac arrest, so this is just for if a patient is in a hospital bed with monitoring on.

The first sign is going to the monitor going crazy and the patient unconscious.

Step 1 - pull the emergency button and start chest compressions (they are still the most important thing!)

Step 2 - someone else will give rescue 'breaths' using an oxygen mask and bag (technically called a bag valve mask or BVM). Two breaths after every 30 compressions

Step 3 - someone else is cutting clothes off and putting defibrillator pads on. An anaesthetist may also intubate the patient and put them on a ventilator (this means you can do compressions continuously)

Step 4 - the defibrillator will scan the heart rhythm. If it's shockable (ventricular tachycardia or fibrillation) then everyone steps away while it shocks. As soon as it's safe, CPR continues (most defibrillators determine the rhythm and calculate voltage automatically)

Step 5 - if it's a non-shockable rhythm, give IV adrenaline ASAP

Step 6 - if it's a shockable rhythm, wait 2 minutes after first shock, check and shock again. Repeat a third time.

Step 7 - if the patient is still in cardiac arrest after 3 shocks, give IV adrenaline and amiodarone

Step 8 - continue CPR and give adrenaline every 5 minutes.

The person giving compressions should switch every 60 compressions (two cycles of 30) - the next person is counted in so there's no time without compressions

There are 10 main causes of cardiac arrest - while all of this is happening a team of doctors will be trying to work out the cause so they can treat it. I won't go into the causes because it's boring and technical.

CPR, defibrillation, and drugs will continue until the cardiac arrest stops or the patient is declared deceased.

If someone is in hospital because of hypothermia, remember! They're not dead until they're warm! (there have been cases of hypothermia patients being successfully resuscitated after over 5 hours of CPR!)

#cpr #cardiac arrest #tw medical #writing advice #I got to do this in a simulation with a defib and it was so cool

[halsteadlover]

Eye For An Eye

*Gif not mine credits to the owner*

• Pairing: Jay Halstead x Reader.

• Requested by anon: Hi. I dont know if you have seen Greys Anatomy, but my request is if you could write Jay and the reader in the season 6 finale of Greys. With the reader being in Dereks place(she can be a surgeon) and Jay in Merediths. He doesnt have a gun on him when it happens, so he cant protect them. And instead of Christina, Its Will who does the surgery on Y/N. So I dont know if you have seen it, or if you are completly confused, but if you have, it would mean alot😊

• Warnings: blood, curse words, gunshots

• Word count: 7138.

• A/N: I think this is the longest piece I've ever written and as always it's shitty 💀 I'm sorry for how this turned out but I hope you'll like it. Let me know what do you think, like, comment and reblog if you want 💞 Love you all and thank you for your support.

Each person has a different way of doing, of thinking, of acting. Each situation is different from another and for each one there is a different way of reacting. When you’re happy there are those people who jump of joy, there are those who cry, those who cannot stop laughing or clapping their hands. When you are sad there are people who withdraw into themselves, those who prefer the company of some friends or their partner, those who don’t let themselves be discouraged.

But when you lose a loved one, this is a very broad discourse, difficult to enclose in just few lines, but even in this case each person has their own reaction, their own way of dealing with pain. There are those who cry desperately, those who scream since the pain of the loss is so strong because this is a kind of pain that tears inside you, tears your heart out; there are those who seem impassive, just because they need to metabolize, they don’t cry, they don’t scream, don’t despair, they remain there sitting in a corner to mull over what happened, what was going on.

During your career as a surgeon you had – unfortunately you'd dare to say – the opportunity to witness all kinds of reactions from a family member to the loss of their loved one. You were always understanding, ready to do anything to try and ease the pain those people were feeling even though you knew they hated you at the time since you were the person who gave them the worst news of their life. You thought you had seen everything but, damn it, how wrong you were, how wrong you were in having taken the arrogance of being able to think you knew the human being in its complicated and absurd interest. As already mentioned, every person has his own type of reaction in relation to a certain situation but never in your life, not even for a second, you would’ve thought the death of a patient could also have been the cause of yours.

“Doctor Y/LN, the patient is in atrial fibrillation,” a nurse had warned. You were in the midst of a brain operation on a woman, Ellen Hopkins, a 50-year-old lady who had a meningioma, a benign brain tumor but which, given its location and size, was quite dangerous to remove and carried high risks.

“The patient has her skull open, a wrong movement and I could make her paralyzed for life” you replied, the forceps and the electric scalpel in your hands while you were concentrating on the patient’s brain. “Two milligrams of Amiodarone, fast!”.

“The fibrillation persists,” you commented, lifting your eyes for a moment and placing them on the monitor the patient was connected to. “Damn it!” you exclaimed, putting down the surgical instruments and approaching the patient’s chest “Let’s carry out a cardioversion!”

“Charge at 200!”

Nothing.

“250!”

Still nothing, the fibrillation persisted as the patient’s values plummeted dramatically.

“350! And call cardiology!”

Not being able to use defibrillation again, you continued with the cardiac massage while waiting for a cardiothoracic surgeon to arrive in the operating room.

But Mrs. Ellen died on that operating table before someone even arrived.

“Damn it,” you cursed, taking a deep sigh and looking at the clock “Time of death, 16:33.”

Informing relatives was never an easy thing to do, you never got used to it, and that didn’t change even when you had to inform Mrs. Ellen Hopkins’ husband, Bill. You explained to him how the surgery had gone, you answered his questions, you told him you did everything possible to save his wife but that, unfortunately, she hadn’t made it.

Bill was petrified, speechless. Not a single sound came out of his mouth, not a single word, not a single tear came out of his eyes. He remained impassive, unable to process the information he had just been given. He just looked at you, straight in the eye, for a few moments before turning his gaze and walking away.

You watched him go and it was in vain to try to call his name and speak to him. You sighed deeply, running your hands over your face in frustration, blaming yourself for just ruining that man’s life. You couldn’t even imagine how he must feel at that moment, so you didn’t blame his reaction, as already mentioned, everyone had their own way of reacting to such devastating news.

As you used to do after surgery, you holed up in the doctors’ ward, ignoring everything and everyone and continuing to reflect on that surgery and what you could’ve done differently to save that woman.

And you stayed there all afternoon, until the evening, until your shift was over. They all tried to cheer you up, Connor, Will, April, to tell you it wasn’t your fault but right now you didn’t even want to hear those words, at least not from them. You just wanted Jay and one of his hugs.

Jay had been your boyfriend for almost four and a half years now and given your hectic lifestyles, being you a surgeon and him a cop, it was sometimes difficult for you to even see each other even if you were living together.

That evening it was enough for him to see you come out of the hospital doors to understand there was something wrong with you. He understood it from the way you walked at a slow pace, from the way you had your head down and your eyes on the ground.

“My love,” he began, getting up from his car on which he was leaning and walking towards you. When he finished his shift early, he always used to pick you up at the hospital or wait there until your shift ended too.

A small smile rose on your lips when you saw him, beautiful as the sun. The instant relief you felt when you saw him was something magnificent, it was amazing how even just that was enough to make you feel better.

“Hi baby,” you greeted him, immediately wrapping your arms around his chest and hugging him tightly. His arms encircled your shoulders and he too squeezed you tightly, knowing right away that you needed it right now.

“Baby are you okay? What happened?” he immediately asked in a worried tone as his hand gently stroked your head.

“Can we talk about this later? I just want to go home and forget about this day.”

Jay understood but didn't insist any further, leaving your space and knowing that when you were ready you’d tell him everything.

He slightly broke away from that embrace and with his hands he cupped your face, stroking your cheeks with his thumbs. Without saying anything he kissed you, a chaste, sweet and delicate kiss you didn't even realize you needed until then.

“Has anyone dared to bother my princess? Do I have to beat the shit out of someone?” Jay asked in a menacing tone and expression, in an attempt to cheer you up. He smiled when you giggled, knowing he had succeeded and that, in reality, he was serious about this, as he wouldn’t hesitate even for a second to punch anyone who really dared to hurt you.

“No baby, no one has dares to do this wickedness,” you replied with a joking tone.

“It'll be better for them,” Jay joked, stamping a sweet kiss on your forehead that made your stomach lightly explode like fireworks. God, how much you loved that little gesture. “What do you say to go home and forget about this bad day? We can order something and watch a movie if you like.”

You nodded enthusiastically, looking forward to taking a shower and throwing yourself on the bed.

You and Jay were lying on the sofa, having dinner and watching a movie in the background that neither of you was really following. Your head was resting on his chest, your arm instead encircling his chest as he hugged you tightly, stroking your hair and kissing your forehead from time to time.

“I missed you so much today,” Jay said, making you smile even though he couldn't even see you right now.

“I missed you so much too baby, I really needed this.”

“Do you want to talk about it?” he asked, almost in a whisper. You let out a sigh, almost involuntarily, “You don't have to tough if you don't want to, I don't want to put pressure on you.”

“No sorry it’s just…” you started talking, putting yourself in a sitting position so that you could look at Jay “It's just... Surgery gone wrong, a woman died on the operating table.”

“Oh. I'm so sorry my love,” Jay replied, taking your hand and squeezing it tightly. “You don't think it's your fault, do you?”

“And who else could it be? I was the surgeon,” you blurted out “It was an operation that presented complications but it had 95% of possibilities to be a success, I promised her, her husband...”

“Baby, baby, stop,” Jay stopped you, letting go of your hand and grabbing your face with his hands and making you stop talking. “It’s. Not. Your. Fault. I wasn't there and I don't know how things went but I'm 100% sure you did everything in your power to save her and if there was a chance to do anything to keep her alive you’d do it. Complications happen, they happen, the surgery had a 95% chance of success but unfortunately that 5% is always there, it's hard, but it's always there and it's nobody's fault, much less yours. Don’t blame yourself for this baby, you are one of the most talented surgeons in the entire hospital…”

“Why can't I help but feel like shit then? Maybe I didn't consider some variables, I was too sure and a patient died,” you said, your voice almost broken by trying to hold back the tears. But from the way Jay wiped one, you could tell the attempt was completely in vain.

“Because we are human, it's in our nature to blame ourselves when something doesn’t go as planned and we always need to have an answer to the things that happen but the truth is that not everything has an answer, the universe operates in a mysterious way and I know for sure, I’d bet on it, there was nothing you could’ve done that you haven't already done.”

You sighed, then resting your head on his chest as he hugged you in an attempt to console you.

“I'm here for you baby, cry and let it go as long as you want, I won't let you go,” he continued to whisper, occasionally leaving sweet and delicate kisses on your forehead. He continued to hug you indefinitely, whispering words of comfort to you until you calmed down and stopped crying. You didn't know how to express your gratitude for having such a fantastic man like Jay by your side, you’d never have known how to do it without him. He was your rock, your backbone, what put you back together when your world fell apart.

-

In the next two days nothing special happened, you and Jay went on normally with your jobs, you operated, he arrested criminals.

It was Friday and it was now late morning while you were in the operating room after finishing an operation on a man with spinal problems. As usual, you washed your hands and left the operating room before going to write everything down on the patient's medical record.

Everything seemed to go on normally, lunchtime came quickly and as usual, Jay came to the hospital to pick you up and go eat something together. You were still busy in the last morning visits and Jay took the opportunity to exchange a few words with his brother Will, who was at the reception.

“Look who’s bere, I thought you died,” Will commented, jokingly.

“Yeah, I'm sorry I didn't show up but work has been killing me lately, it's like the criminals have all woken up at the same time,”Jay explained “How is everything going?”.

“It's okay. I’m fine, Maya is back in town tomorrow and I can't wait to see her again, work is going pretty well, in short, I have nothing to complain about and I can finally exchange few words with my little brother.”

Jay chuckled and was about to answer when a man's voice interrupted him.

“Excuse me,” the man said, getting attention “I'm looking for doctor Y/N Y/LN, where can I find her?”.

Jay immediately turned to the man after hearing your name being mentioned and looked him up and down, studying his appearance and making sure he wasn't some ex or, worse, a shady guy. He was a man who couldn’t exceed fifty-five, tall, slender physique, balding. He had his hands tucked into the pocket of his visibly ruined pants and his gaze totally absent.

“She’s finishing her last visits, you can wait in the waiting room and I will call you,” Will replied cordially.

“No, it's pretty urgent. I'm here for my wife and the doctor made an appointment for me today and at this time,” said the man, so calmly, a behavior that was not expected of someone who had a loved one hospitalized.

“I’m sure you can wait here too, the doctor will come down immediately and see you,” Jay continued, but the man insisted that the matter was urgent and he needed to see her right away.

“If the doctor told you that, you can go now,” Will said, going on to explain where to find you.

The man thanked him and started walking towards the elevator. By now he had memorized the way to your ward, which was only on the first floor.

Slowly, the man approached the ward where, however, a nurse stopped him.

“Sir, visiting hours are over, you can't stay here.”

“I'm looking for Doctor Y/LN,” he replied, completely ignoring the nurse's words.

“You can come back here at three in the afternoon, when visiting hours start again.”

Soon the situation plunged completely into the abyss, in a whirlwind of chaos and despair.

The man pulled a gun out of his jacket pocket and without any sign of remorse or hesitation, shot that nurse, making his body fall to the ground, lifeless.

The sound of the shot echoed throughout the entire floor and the terrified screams of doctors, nurses and the patients themselves began to spread. They all started running away at the speed of light fearing for their lives. There were, however, those who couldn’t even get out of bed, asleep patients who were unable to save themselves.

When suddenly Jay saw a wave of people running from the elevator, terrified, he knew immediately that something was wrong. He and Will quickly exchanged a worried look and Jay immediately tried to stop someone to ask for an explanation.

“Hey! Hey! What the hell is going on?!” he exclaimed aloud, but everyone ignored him, continuing to run away. He stopped a man, who in terror stammered a few words.

“A… A man… He has a… He shot… He has a gun.”

Jay’s heart stopped beating for a moment as he heard those words. His mind immediately understood what was happening, who was the aggressor and his first thought was you. That man had targeted you, he wanted you.

A feeling of panic took over him and his brain went completely blackout. His first instinct was to run to the elevator and try to find you before that man found you but Will stopped him.

“Where the hell are you going?!”

“What do you mean where the hell am I going? That man is looking for Y/N I have to find her!”

“Jay you need backup!”

“You get as many people out as possible, I call the rest of the team and look for Y/N,” Jay had replied and before Will could even answer, he run for the elevators. After quickly making the call and making sure the team and SWAT were coming soon, he put his cell phone in his pocket and reached for his gun.

At that precise moment a shiver went through his body as he realized he didn’t have his gun with him and that he had left it in the dashboard of his car.

“Fuck!” he whispered angrily to himself. That didn’t stop Jay, however, determined to find you before the madman did. He began to wander the corridors of that floor, constantly looking around. He felt the sweat tinge his forehead and his heartbeat greatly accelerated, not so much because of the situation but because he knew your life was in danger. He kept praying with every fiber of his being you were okay, that you were able to hide somewhere.

The anxiety and worry he was feeling at that moment were feelings he had felt a few times in his life and knowing that you, the love of his life, were in danger and, above all, he couldn’t do anything to help you, it destroyed him. Deep down he couldn’t even formulate a single coherent and rational thought.

The last thing you expected that day – and to be honest, you didn’t expect at all – was to find yourself face to face with an armed man pointing his gun at you.

“Mr. Hopkins…” you whispered, short of breath and heart pounding. Mrs. Ellen Hopkins’s husband, the lady who had passed away on your operating table a few days earlier, stood in front of you, with an absent look, and with the gun pointing straight at you.

“You killed my wife,” he said, his voice cold, aloof, as if a robot had taken possession of him.

“I… Mr. Hopkins I don’t…” you stammered, having no idea how to get out of that situation.

“You killed my wife!” he screamed at the top of his lungs, showing some emotion for the first time. His sudden change of tone made you jump with fear, and in pure instinct you raised your hands up, visibly trembling.

“Mr. Hopkins, please… Lower that gun, there is no need, I promise you I will answer any of your question.”

“Shut up!” he yelled again “There is no question you can answer! You killed my wife! The love of my life! You took her away from me and today you will die like her!”.

Your eyes filled with tears, but you tried in vain not to cry.

Fuck no, you didn’t want to die, not that day, not like that.

“Mr. Hopkins… I ask you please, let me explain how things went, I’m sure you will want to know why. I know this won’t bring your wife back and I’m terribly sorry about that, I know how much you loved her and how much she loved you, but I can help you find answers if you wants.”

“And what could fix this? She died!” he exclaimed, waving his gun at you and making you jump again.

Oh God please.

“Nothing, I know it won’t bring her back to life, but it might help you find some peace, I’m sure, in fact, I’m 100% sure Ellen would like you to be at peace, she doesn’t want you pining for her death.”

“I don’t want to hear you talk!” Bill continued, now taken by anger and resentment “I hate you! I hate you so much! You were the one who had to heal my wife, make her feel better and not kill her! ”.

Your heart tightened in a vise and you couldn’t not feel guilty. You rationally knew it wasn’t your fault but, subconsciously, you couldn’t help but think so.

“Okay, okay, but please Mr. Hopkins, this thing is just between me and you alright? No one else has to suffer from this tragedy, no family has to mourn their loved one, if you want to blame me that’s fine but leave the other innocent people alone.”

“I don’t care a damn about the others, they were just accidents along the way. I wanted you Dr. Y/LN, you ended my wife’s life and I will end yours.”

Your blood froze in your veins, your brain working hard to try to invent a way to escape from that situation.

At that moment your thought was only one, only Jay, and how much you wished him to appear through that door and take you away from there. You couldn’t stop thinking how that morning could’ve been the last time you saw him, how you wanted nothing more than to take refuge in his arms.

Bill clicked the safety of his gun and a feeling of panic took hold of you completely, fearing that these would be your last moments in life.

“Bill… Please listen to me,” you begged him “I know you aren’t a bad person, I know you are grieving terribly for the loss of your wife and I am so sorry, there has not been a moment when I have not thought of her and I don’t even dare imagine your suffering, damn it, I don’t even know how I would’ve reacted in such a situation. I know it’s just the sadness and anger that are talking now, and you are right to be angry with me, with the world, with whoever is up there who took Ellen away from you and I don’t blame you for that. I know I was the person you trusted most to save her life and I betrayed this trust and I will forever apologize for that, because I wanted Ellen to recover as much as you did. I am not a perfect being, I am human too and as such I can make mistakes but I am ready to pay the consequences,” you spoke, and noticing that he was listening to you you continued “I did my best and believe me when I tell you that if there was a single minimal thing I could’ve done to save her, I would’ve done it but I know you don’t see it that way now. Bill... I… I have a family too, I’m somebody’s daughter, sister, niece, girlfriend and like I said I know you’re not a bad person, I know you never want any family to go through what you are going through right now.”

“You’re wrong Dr. Y/LN,” he replied, suddenly calm, as if all the anger he felt until recently had magically vanished. “I want everyone to feel exactly what I’m feeling.”

The sound of a gunshot boomed throughout your office room as it kept repeating in your mind. Suddenly the whole world around you fell into total silence, there was only a subspecies of hum that you could clearly hear with your ears.

You didn’t realize it right away. It took you a few moments to do it.

You didn’t realize right away he actually shot you. It was only when you looked down and watched the blood splatter spread across your uniform that you really realized he had shot you.

Your body fell into a trance state and you didn’t immediately feel pain, due to the adrenaline flowing through your veins.

You fell to the ground, without strength, the blood expanding rapidly under your body and soiling all your clothes. You had no idea what was going on, you didn’t know if you were dead, if you were still alive, if your attacker was still there, if it was all a terrible nightmare.

Your mouth was completely dry, your jaws so dehydrated as if you had just run a marathon. Your heart was beating madly as your chest rose and fell quickly even though each breath was like receiving a stab, one was more painful than the other.

At that point the pain slowly began to be excruciating, so persistent as to be almost paralyzing. It felt as if millions of needles were penetrating your skin with extreme and devastating agony.

Jay was right there, he had witnessed that frightening and horrible scene from afar, given the open door of your office. He had seen how that man shot you in cold blood and without the slightest doubt or hesitation.

It was Will who literally held him back by force, or he would’ve come to you, or he would’ve tried to save you. He would’ve even taken that bullet for you, he would’ve fought to try to save you, but he couldn’t have done it and now you were probably even dead.

It didn’t do any good to wriggle with all the strength he had in his body, try to escape Will’s grip, yell at him to let him go.

“Fuck Will, let me go!” Jay kept screaming, trying to run away, in despair he had never been in his life. His stomach was in a vise and a lump in his throat had formed.

But when that shot rang out within the walls of that hospital, Jay was completely paralyzed for a few seconds, as if for a moment he had feared he had an auditory hallucination.

He stood still as his mind processed what was really going on.

“No!” he screamed at the top of his lungs, freeing himself from Will and running at lightning speed to your office. He didn't have anything else in mind but you at that moment and he didn't even care that bastard had vanished, he just wanted to see you.

Seeing you poured into a pool of your own blood was an image that would never leave his mind again.

“Baby! Baby! Please wake up, don't leave me!” Jay exclaimed, immediately leaning over your body, not caring in the least he was soiled with blood. He took your face in his hands, breathing a sigh of relief when he noticed you were still alive, trying to mumble something.

“Shhh my love, don't talk, keep your strength okay? I'm here now, I won't let you go, please hold on tight” Jay begged, “Will!” his eyes blurred with tears and only then he realized he was crying “Please don't play tricks on me, you have to stay with your eyes open okay?”.

“J-Jay…” you muttered, struggling to keep your eyes open “It hurts so much...”

Jay cried even more to hear those words, knowing you were in terribly much pain and there was nothing he could do to end that pain. He continued to caress your face, your hair, noticing the paleness of your skin. He knew very well how you felt, he knew how a shot could be terribly painful.

“I'm so sorry I didn't come earlier baby, please don't leave me okay? I love you so much, I can't live without you…” he cried “Try to hold on for me, you'll be fine I promise...”

“I... I want to sleep Jay...”

“No, no, no, no,” he replied, panic in his voice. “Don't fall asleep, okay? You have to keep these beautiful eyes of yours open, can you do this for me my love? I know it's difficult but you are so strong, you are the strongest person I know... Don't do this to me, don't leave me baby…”

But at that moment you weren't strong at all, you weren't a fighter and you didn't have the energy and strength to fight. You just wanted to let yourself go and get some sleep, just for a little while.

The room slowly began to fade as black splotches appeared before your eyes and at that point you could no longer fight to keep your eyes open and found yourself sucked into a whirlwind of darkness.

“Will!” Jay yelled in utter despair again.

Will immediately walked into your office after rushing to get a stretcher and an emergency kit, and seeing the blood and you unconscious in Jay's arms he knew immediately that the situation was dire.

“I’m sorry I was finding these. We need to get her to the OR immediately. Jay help me put her on the stretcher,” Will ordered, trying to stay as cool and lucid as possible even though it was hard for him to see you like that too. You weren't just his brother's girlfriend, you were also his colleague and a very dear friend.

“Take her by the shoulders, I’ll take her by the legs. At three we raise her, okay?”.

Jay nodded, trying to wipe away his tears quickly and did what Will said.

“One. Two. Three.”

They placed you on the stretcher and all three of you immediately left the office, trying to go as quickly as possible to the operating room. It was a race against time, and both Will and Jay knew it, there was no room for mistakes, there was no room for hesitation.

“Will,” Jay called his brother, before seeing him enter the OR.

Will turned and immediately understood the words Jay was about to say.

“I can't be without her, save her please.”

Will's heart squeezed in a vise and never as in that moment he felt a huge weight on his shoulders because he knew if things went wrong he wouldn’t only lose you, a friend, a colleague, an exceptional doctor, but he would also lose his little brother.

He nodded before turning and walking into the operating room.

Jay didn't know what to do with himself. He never felt so helpless and at the same time cutting out from the world.

He didn't know the rest of his team had arrived there in the hospital, that the man was immediately found and arrested after killing that nurse and seriously injuring you and two other people but Jay didn't even care.

He didn't care where he was, he didn't care if he suddenly appeared behind him or even if he went around the hospital. He knew this wasn’t correct, his motto was to protect and serve but he didn’t give a fuck, he wanted nothing more than to know you were alive, safe and sound, that you were okay.

When it came to you, there was no criminal, job or any other matter that had a priority over you, there was nothing he wouldn’t have abandoned just to know that you were happy, that you were well and healthy. You had always been the center of his world since he met you and he didn’t even care how absurd it seemed, but it was the truth, you were his everything, all that was most important to him and knowing he had done nothing to avoid hurting you was killing him, devouring him inside.

The thought there was only a wall to divide you physically but an abyss mentally, was something that Jay just couldn’t understand and in the hours when Will operated on you, he thought he literally died a thousand times.

For the first time in his life he had understood the real meaning of fear and it was a feeling he never wanted to try again. It was horrible, devastating, debilitating, feeling that damned fear, that paralyzing and visceral feeling of anxiety that twisted his stomach in a tight grip. He was afraid of losing you, of never seeing you again.

How could he live without you?

How could he only think of living in a world where you were not there?

He wasn’t ready. He would never be.

This option had never even touched his head since you became a part of his world. He wanted to be with you forever, until his last breath and that was not even enough, because he knew that even in the afterlife your souls would be reunited and you would be together again.

What would he do if he never saw you again? What if he could no longer talk to you, hear you laugh at his sleazy jokes, hear you romp when you were happy, see you smile, hug you when you were sad and wipe your tears when you lost some patient on the operating table? What would he have done without your immense clumsiness, so much that he didn’t even know how you were a surgeon sometimes, without your disastrous cooking, without your hair ties thrown all over the place, without your obsessive way of disinfecting everything? What would he have done without your kisses, your hugs, your way of making him feel so pampered and loved, always, every day and every second?

“Fuck no, no, no, no,” Jay muttered to himself, as if to banish those horrible thoughts from his mind, “God please, please, save her, let her come back to me…”

After about an hour in which you were in the operating room, the rest of the intelligence reached Jay and in vain his friends tried to calm him down.

It was only when he saw Will come out the door of that damned operating room that he came back to breathe a bit and at the same time die of heartbreak and anxiety.

“So? How did it go? Is she fine? Please tell me she’s okay,” Jay spat out, immediately approaching his brother. He studied the expression on his face in the smallest details and a modicum of hope lit up when he didn’t see that typical expression you had when you had to communicate the death of a loved one, he didn’t seem sad, on the contrary.

“The surgery was a succes, I am 99% sure she will recover completely. The bullet had pierced the stomach but fortunately there was no major damage. Now I’m taking her to ICU and we’ll have to wait for her to wake up,” Will explained and couldn’t even explain the transformation Jay underwent. He noticed the precise moment when that veil of anxiety and worry finally disappeared, replaced instead by joy and happiness.

In a rush of happiness Jay hugged his brother, squeezing him like he had never done before. “Thank you Will, thank you so much.”

Will returned that hug, smiling. “You don’t have to thank me, she is very strong.”

“Yeah, she really is,” Jay replied through tears, only then realizing he was crying. “When can I see her?”.

“In a while don’t worry.”

Seeing you lying on that hospital bed was an image Jay would never have thought of seeing in his life, it was literally a blow to his heart. You had oxygen goggles inserted in your nostrils, your face was terribly pale but despite that you were still the most beautiful creature Jay had ever seen.

He stood next to you and he never took his eyes off you for not even for a second. His hand gently stroked your hair, as he used to do when you slept. It had now become a habit, stroking your hair and watching you sleep. Sometimes it happened that you smiled even in your sleep, snuggling closer to him, but this time it didn’t happen.

Your skin was cold under his fingers, as he stroked your cheeks and, God, he would’ve given anything to be in your place, so as not to see you hurt even for a minute.

Jay leaned over and gave a kiss on your forehead, as he kept caressing your face and hair.

“Do you have any idea how much I fucking love you? How do you make me feel? How important you are to me?” Jay began to speak, remembering the words you said to him once and that talking to patients asleep can have a positive effect on their awakening. He left another kiss on your forehead. “Do you have any idea how much you scared me today my baby? God, I've never felt so scared as I did today, not even while I was overseas. Seeing that son of a bitch...” Jay stopped, swallowing the lump that had formed in his throat as he remembered the moment you were shot “I'm so sorry I couldn't stop him, I don't want to imagine how scared you were, I’ll never be able to forgive myself, I was there, a few meters from you, I have always sworn to protect you and keep you safe but I have failed and I am so sorry.”

“Please wake up baby, don't you dare leave me here alone okay? I can't be in this fucking world without you. I swear to you, I'll never leave you alone again, but now you just have to open your beautiful eyes alright? Can you do it for me? Show me those beautiful eyes that made me madly fall in love with you?”.

Jay stood there at your bedside indefinitely, watching you sleep and hoping that sooner or later you would finally open your eyes. Will spent nearly every twenty minutes visiting you and it was in vain for him to try to get Jay to go and rest.

It was when he felt your fingers move slightly, after almost twelve years, that he feared he was truly hallucinating.

“Oh my god, oh my god,” he literally jumped up from his chair, holding your hands as he looked at you “Baby, can you hear me? Please answer me, give me a sign. Please, please, please.”

He felt your fingers move slowly again and at that point he made sure it really happened, it wasn't a joke his mind was playing on him.

It took you some time to understand what was happening, where you were.

Your head was pounding terribly as if you were being hammered, your vision was blurred and you had to blink several times to focus.

The first thing you saw were the artificial lights coming from the ceiling, which at the time were terribly annoying.

“Where am I?” you grumbled with difficulty, feeling weak and completely without strength.

“You're in the hospital, love,” replied a voice you recognized immediately. It was Jay, your Jay. “No, no, stay still, don't get up.”

Your eyes met Jay's and the joy he felt at seeing you awake was something that was minimally comparable.

“You finally woke up,” he said, almost in a whisper, as if he hardly believed it. He stroked your hair, leaving a kiss on your forehead.

Suddenly images of what had happened flooded your mind, the exact scene in which you were shot seemed to repeat itself in a loop in your head.

“Has... Has any other person been hurt?" you asked.

Jay nodded his head, sadly. “But they’re all fine. He was caught soon after, he surrendered without opposition.”

“And you? How are you?”.

He chuckled, taking your hand with his and letting a kiss on it. “You're the one on a hospital bed.”

You let out a faint laugh but it results in a painful twinge. “I guess I deserved it.”

Jay's face immediately turned serious and his heart tightened in his chest as he heard these words. “You can't really believe such thing. You don't deserve to be here baby, it's not your fault what happened, please, get it out of your pretty little head.”

“His wife is dead and I had to save her,” you whispered, your gaze fixed on the ceiling as you tried in vain to hold back the tears.

“His wife died of a complication, every surgery has it, you always tell me, and you did everything possible to save her. You don't have to pay for something you are not to blame for, please stop thinking this okay?”.

You were silent for a moment and you then returned your eyes to Jay.

“Baby... Are you crying?” you asked, alarmed. He shook his head slightly, wiping away his tears quickly and avoiding looking at you.

“No, I'm not,” he muttered but let go when you started stroking his face. He lowered his head and let himself go in a liberating cry, venting the frustration, the anger, the sadness but above all, the relief.

“Oh baby, it's okay, it's okay,” you tried to console him as best you could given your position.

“I was so fucking scared to lose you Y/N…” he whispered.

“I know, love, I know, I'm sorry.”

“You don't have to apologize, on the contrary, I’m sorry, I should be the one to console you,” he said, wiping his tears and then looking at you. Your heart skipped a beat to see his beautiful green eyes shine so bright, still shiny from crying.

“You don't have to apologize Jay, there was nothing you could’ve done to stop it and you don’t have to blame yourself for not being able to stop this from happening,” you spoke up, realizing you were crying too.

“What about we both stop to blame ourselves?”.

“We have a deal,” you faintly smiled “Do you have any idea how much I fucking love you too?”.

Jay let out a laugh, knowing you had actually heard his words as he spoke to you. He stood up again and leaned towards you before grabbing your face and pressing his lips against yours. There were no words to describe what he felt, what that contact caused within him, the relief to know he still had another chance to be with you, he still had he chance to kiss and hug you forever.

“Can you get close to me?” you asked.

“But I don’t want to hurt you.”

“You won’t hurt me, please baby, I need you now.”

“God, how can I say no to this beautiful face?” he said and you giggled, trying to ignore the pain that this entailed. Slowly and carefully, you tried to move in the bed, so you could make room for Jay and not make the stitches fit.

“Be careful baby,” Jay warned, helping you.

Jay positioned himself beside you, trying to be careful not to make any sudden movements, and he put his arm under your head. He printed so many kisses on your face and forehead, still unable to believe the luck of still having you there with him.

“I swear to god I’ll never let you leave the house again, I can’t risk someone taking you away from me.”

You giggled again. “Don’t make me laugh please, it hurts.”

“It’s not my fault you have such a funny boyfriend, it’s something you’ll have to live with.”

You hit him with that bit of strength you had, aching from the wound. “Can you stop it?”.

“Sure my love,” he kissed you on the forehead again. “Now try to rest, okay? You need to regain strength so I’ll get you home as soon as possible. I will always be here beside you, I won’t let you go.”

And with those words of comfort, you slowly slipped into a deep sleep, into the arms of the man you loved and with the hope, sooner or later, everything would be fine, everything would return back to normality.

Tag List: @burgstead, @bebataylor84, @ares-kelani-wayne, @lxna-mikaelsxn, @sande5098, @smoothdogsgirl, @withakindheartx, @jess2013, @maddu-oliveira, @lovemesomepietro, @onechicagodrawings, @jinxfan18, @xeleni-nurse, @ready-hit-it, @rainroo2, @tinfoilhat2719, @hehurst23, @upsteadlovingheart​, @secondaryjob, @nevaehstreater18, @mrspeacem1nusone, @sophiatellerrhodes​, @dedlund82​, @kellykidd​, @rippl3s​, @stephanie708​, @annahargrove​, @smutl0ver​, @kuroe-san, @caroldanverwife, @cbaby, @nosy09, @luvreading67, @danielmarie, @saiyuo12, @alexxavicry, @nachodaze, @waywardhunter95, @fighterkimburgess, @ephemeral3, @mads-weasley, @itskellysev, @lovemedlife, @atarmychick007, @amazedbyitall, @glodessa, @xeleni-dutchnurse, @ossypooh, @itriedtoexplain, @randomwriter1021, @resanoona, @averyhotchner, @ellavanderberg, @mrshalsteadxx, @junevoidzombie, @nocturnalherb16, @croissantthief, @jayhalsteadsbadge, @hereforhalstead, @youngblood199456, @hereforhalstead, @dreamss-wavess

Click here to be added to the tag list ❤️

Masterlist

Buy me a coffee? ☕

#jay halstead #jay halstead x reader #jesse lee soffer #jay halstead x y/n #jay halstead x you #jay halstead imagine #jay halstead one shot #jay halstead fanfiction #jay halstead imagines #jay halstead gif #jay halstead masterlist #jay halstead fic #jay halstead fluff #fanfictions #fanfiction #fanfic #imagines #imagine #oneshot #chicago pd one shot #chicago pd x reader #chicago pd imagine #jay x reader #reader #y/n #jay x y/n #jay x you #you #writing #chicago pd

[clinicalmedicine]

Embark on a journey with Jennifer Carlquist, PA-C, and course director of The Urgent Care EKG Course as she shares 12 essential insights for navigating through EKGs in the urgent care setting. 

1. When a patient has an irregular rhythm, it is important to look closely for P waves. If they are the same shape and distance from the QRS complex, you could be dealing with sinus arrythmia. This is usually caused by breathing.

2. If you have a patient with palpitations, you may find a clue to the cause by asking the patient when the palpitations happen. Often, palpitations only occur when the patient is about to go to sleep which could be caused by anxiety, although this is a diagnosis of exclusion.

3. When you have a patient with tachycardia, make sure you can explain why. Pulmonary embolus can cause tachycardia and will not always be associated with an s1q3t3.

4. If you have a very short PR interval, the first thing you should look for is a delta wave. This is what you will see with Wolff-Parkinson-White syndrome, which can be fixed with an ablation.

5. If a patient has experienced a recent stressful event such as the death of a spouse and has new onset heart failure, consider Takotsubo cardiomyopathy. This can present a myriad of EKG findings, including STEMI.

6. PVCs are not always benign. They can lead to heart failure if there are enough of them. 

7. There is always a reason for sinus tachycardia, while supraventricular tachycardia (SVT) comes on suddenly for no good reason. It’s hard sometimes to tell the difference between the two, but when you start to sort through the history, that’s where it really starts to make sense. Sinus tachycardia will have volume loss, fever, anemia, or anxiety, while SVT patients will usually have none of those. The exception would be if a patient has anxiety after they started feeling the SVT, which is a whole different story.

8. When interviewing a patient about their palpitations, it is always helpful to ask if they have anxiety as well. If they do, ask them which came first: the palpitations or the anxiety. If the anxiety came first, then it is most likely anxiety causing the palpitations, although this would be a diagnosis of exclusion. If the patient feels palpitations and then anxiety comes on, that’s more likely arrhythmia based.

9. It is impossible to diagnose Takotsubo cardiomyopathy from an EKG alone. There are many different presentations of the condition, including STEMI, nonspecific STT-wave changes, T wave, and inversions that are symmetric. If you have a patient with a classic story that involves recent major stress in their life, then absolutely consider this diagnosis. It can be seen during their angiogram, where it will look like apical ballooning, and they will have a reduced ejection fraction.

10. ST-segment elevation can be very minimal and still deadly. It is important when you are screening for ST elevation to look closely at the TP segment. This is the most isoelectric line, and this is where you should draw your line to see if there’s any elevation or depression. As little as 1 mm can be significant for STEMI in the inferior leaves, so it really does matter here. Get serial ECGs.

11. When looking at the intervals at the top of the EKG, one of the most important numbers to look at is the QTC. The QTC should be <460 ms to be normal in women and <450 ms in men. If it is longer than that, consider adjusting the patient’s QT-prolonging medication. We do not usually see Torsades de Pointes until they get >500 ms, but it’s still a good idea to minimize risk by getting the patient off any QT prolongers you can.

12. Torsades de Pointes is lethal and most likely stems from a prolonged QT. Unlike in VT, the treatment is magnesium, but prevention is always the key. Amiodarone can also prolong the QT and can be proarrhythmic, so you may have to choose a different drug in some cases. 

This course is ideal for PAs and NPs practicing in urgent care. Whether you’re new to practice or have many years of experience, you’re sure to learn practical, evidence-based tips you can use on your next shift. You can sharpen your EKG interpretation skills, improve your accuracy, become more proficient, and boost your clinical confidence with The Urgent Care EKG Course.

Visit https://www.ebmedicine.net/ekg to learn more.

Even more content:

Check out one of our latest reels (less than one minute!) by Jennifer Carlquist, the course director.

#doctor #med school #med student #internalmedicine #cardiology

[its-my-whump]

Medwhump May- Day 10

(Hi there, I'm sorry guys, I'm a little behind. Life's just having a blast on my account and additionally my head won't grant me the release through writing, I could really use right now, so duh.)

Emergency surgery

@medwhumpmay

Tw: absolutely no medical accuracy, sorry, cpr, blood, medical whump, surgery

Part 10 (all others here)

"Lets roll!" The doc barked and with a more soothing, but still loud tone, he added. "You're not dying today, hunny!"

xxx

Electricty jumped through the lifeless body and made her jolt on the table. Hands reached up like a ghost was making them, but fell back a brief moment later. Nothing. She was still dead, even though her heart was fibrillating.

"Again!" The doctor yelled. "Clear." Her body flipped again. Still nothing.

"Come on hunny, fight for us!" His jaw was clenched, when he pressed out the words in a tight mubble. "AGAIN!"

Her body jolted, her arms kept laying a bit awkwardly bend, where they fell. Her legs the same, feet fallen to the sides.

"We got a hearbeart!" The grey haired nurse informed the room a moment later.

The little blond came running back, her footsteps getting loud. "OR 3 is ready. Dr. Watson is just scrubbing in." She exhaled out of breath.

The doctor looked from the little blond nurse back at his team, one hand as if steadying his patient on the young woman's shoulder, the other was moving the chest piece of his stethoscope. "Push amiodarone and then get her on the way to OR 3, please." His tone wasn't as loud as before, but still commanding.

xxx

Doc Watson greeted his colluege with a tight nod. "Young female, routine surgery, but she coded on the table. Not sure why till now. Just woke up and we almost lost her again. She's got a pneumothorax left, but decreasing lungfunction on the right side, too. Wouldn't wanna place a chest tube then, but we need to hurry. I suspect a broken rib pierced her left lung due to resus."

"Alrighty. X-ray tech is on her way."

The doctor from the icu left after their short briefing. The young female patient was prepared, preped up under fluorenze lights, equipment attached, being manually ventilated through the et tube down her pipe. O2 stats critically low, but still holding.

In a calm tone the surgeon was instructing his team, what to do and what he needed. An assisting nurse wipped the woman's left side of her ribcage with desinfection. The scalpel was handed over and the man in charge made a vertical cut between 2 lower ribs. Blood welded up and started to flow down her flank. The nurse was back with wipes to garantee a clear view for the surgeon.

The room was calm and professional, when the surgeon pushed his gloved index finger inside the woman's chest through the fresh incision. Her oxygen level dropped and her fast heartbeat sped up more. "You're alright, hunny. We got ya!" The man whispered, pulling his finger out and inserting a flexible tube, one of the assisting nurse had already unpacked from its steril wrapper.

Everything was covered in the woman's blood. The surgeon left fresh red prints on the end of the tube, when he uncapped it.

Blood boobled out instantly. Numbers and monitors were hectically blinking, her heartbeat a fast jumble. An audible hissing tone as air escaped her chest cavity, that had preventing her lungs from expanding.

Tense seconds and her chest literally inflated all by itself. The nurse ventilating her manually exhaled loudly and with every second passing, the patients vitals were climbing again.

They gave her a minute, having a close eyes on her stats. "Looking good." The surgoen annouced.

The x-ray tech was just rolling her cart into the OR. The doctor's suspicion was right. Due to her resuscitation a bunch of ribs were broken or cracked. One had shifted, not traceable when, and pierced her left lobe.

The surgeon called for another assistent and they expanded the already inflicted incision to repair the damage. It was tough and go, her vitals made a ride on a rollercoaster look like a slow walk through the park.

But they got her and made sure, to give her a fighting chance to survive this days, that started out as merely a routine surgery. After another hour, the surgeons had added a new line of black sutures to her belly, closing the entry wound to fixate that rib and seweing the chest tube in place.

->Day 11

My masterlist

#medwhump may #day 10 #emergency surgery #whump #writing #whump writing #medical whump #female whumpee #cpr #resuscitation

[mortemoppetere]

TIMING: current. PARTIES: @rn-zane & @mortemoppetere SUMMARY: zane witnesses emilio 'taking care' of one of his clanmates. they're probably not going to buy friendship bracelets. CONTENT WARNINGS: none.

Rainy nights were always worse, somehow. Emilio wasn’t sure what did it. The smell, maybe, or the extra ache that the heaviness in the air added to his bad knee. His temper was always just a little shorter, his nerves just a little more frayed. Juliana would say it made him sloppy. She’d never shied away from calling him out, even when they’d been in the ‘courtship, looking to impress’ phase of their relationship. But she wasn’t here to call him out now, and the sloppiness remained.

Normally, he would have made sure there was no one else in the alley outside the hospital where he’d chased this particular vampire down to. He’d look around, sweep the perimeter, cover his bases. But the rain and the smell and the ache in his knee all served to distract, and he pounced without thinking first. The vampire turned to dust, and that feeling that made the hair stand up on the back of his neck, the one that told him there was a vampire nearby? 

It stayed. 

Emilio whipped his head around, eyes wild as they landed on a man in scrubs standing a few feet away. If his senses were right — which they always had been — this guy was a vampire, too. In scrubs. Working in a hospital. 

Talk about recipe for disaster.

Turning to face the other fully, Emilio held up his stake in warning. “Tell me who you are,” he said, accent twisting around the words as the adrenaline pounded in his veins, “slowly.”

—

Zane had been running all night. Even though stamina wasn’t really an issue anymore, his brain was completely fried. After almost mixing up adrenaline with amiodarone, he was ushered off to take a breather and come back once he’d composed himself. It wasn’t exactly possible, composing yourself in five minutes in the bathroom with the sound of chaos still seeping in through the door but an attempt was made. A few breaths, not really bringing oxygen but centering him in a way that had always helped when he was still breathing, and a quick check at his phone. “You have time for a quick delivery? Am outside, no rush tho, buddy :D”

He really didn’t have time but this was his job with the community. A job he did well and kept him important and liked. Not that they didn’t like him for him but still. Zane couldn’t take the chance of messing up this soon and losing this precious position no one else in the community could fill. So he made the time, sneaking out of the bathroom and rushing for the emergency blood cooler. The only good thing about this ER chaos - no one questioned a bag or two missing, putting it down to a mistake in charting. Those happened a lot when people were being barreled into the ER with strange bites, weird wounds and high on some drugs no one could classify. Mixed in with the occasional hypertensive elderly woman who forget her meds this morning. 

Two bags of blood in hand, covered by the ratty sweater he always brought with him, Zane traversed the less crowded hallways and down the abandoned stairwells until he reached the rarely used door to the empty alley. It used to be where they kept the organic waste dumpsters but after those kept getting broken into, the dumpsters had since been moved inside under lock and key. And there he was. Until he wasn’t. 

Jack’s red eyes were visible in the dark, not quite hidden by the hulking frame of the stranger whose back was turned to Zane, until they suddenly weren’t glowing anymore. It was like he’d evaporated into thin air, if not for the thin sheen of dust now floating through the air, catching the dim street light. There was no time to think, no time to wonder if this was how he was going to die one day, just evaporating into dust, before he was being addressed. Standing, frozen with the blood still covered by his sweater, Zane’s grip tightened on the door in his hand. The wood creaked slightly in his hand. 

“I work here,” was all he could muster as a response, eyes flicking to the weapon in the broad shouldered man’s hand. Had he killed Jack? Accident? No, not very likely. Was it a vampire thing or just some regular shady ass business? His feet were, on instinct, shuffling very slowly, 1/10th of an inch at a time, back towards the open doorway. “And I should get back inside…”

—

He worked here. Obvious enough, given the outfit. Emilio might not have a ton of familiarity with hospitals or doctors, but he knew enough to know that nobody dressed like that unless they were expecting to end up covered in blood. And despite the fear dancing in the vampire’s eyes, he didn’t seem outright surprised to have seen someone turn to dust in the alley outside. That probably meant he knew there was a reason for it, right? Was he in on it? Paranoia clawed at Emilio’s chest, desperate and uncertain. 

“More than that, I think,” he said lowly, taking a step towards the man. “Stop moving.” He didn’t want to kill the vampire without reason — Emilio’s code of ethics made little sense to anyone outside of Emilio himself, but it did exist — but he’d do it if the only other choice was to let an unfamiliar vampire flee into a hospital full of vulnerable people. Too much damage could be done otherwise, and he could justify that risk.

Taking another step forward, Emilio wagged the stake in front of him in warning. He did his best to hide his limp as he walked, sacrificing comfort for intimidation. “You know him? This asesino I just took care of? He was a friend of yours?”

—

Zane froze in place, the low grumble of the man’s voice settling in his spine with an uneasy feeling of genuine fear. The stranger was getting closer, menacingly waving the weapon - a stake? - in his hand. Was he going to get impaled?

Despite being told to stop moving, Zane dropped the sweater covered bags to the ground and raised his hands slowly. The rules of vampire versus stake were probably different than being held at gunpoint but Zane’s brain was short circuiting and he really didn’t want to die tonight. ‘This asesino I just took care of.’ It took a second to register the Spanish thrown in there and then a few more to properly swallow its meaning, not to mention the casually macabre way this man spoke about the loss of life (or unlife) that had just taken place. 

“He isn’t - or wasn’t, a murderer. Or not that I… You’re the one that just impaled him and are threatening me, I haven’t hurt anyone. Ever. I wouldn’t. Not just because of the healthcare code and all that, just in general.” He was rambling, wondering what, if anything, could get this man to simply disappear. Maybe nothing would work, Zane had seen his face and the characteristic nose and beard would be burned into his retinas forever. Not to mention the icy glare in those eyes, covered by what seemed like years of stress and not too much smiling, maybe. Would Zane get killed to protect this man’s identity?

“And I won’t tell anyone. That I saw you, I mean. Or Jack. I can keep a secret, they’ll just think he ran off or got into some trouble and you won’t need to be connected to this. I just want to get back to work.” 

—

The vampire dropped what he was holding, and Emilio’s eyes flickered down briefly to the ground. The sweater, which had been covering the real prize gathered in the man’s arms, shifted as it was dropped, revealing the plastic underneath. It looked like… a bag of blood? Someone more familiar with hospitals would have likely known what it was for, but to a man who’d grown up among people who’d much rather die with glory than visit any kind of real medical professional, it seemed foreign. He had no way of knowing where the blood had come from; given the way he was raised to feel about vampires, he could only assume something sinister. 

“Where did you get that?” He gestured to the blood bags on the ground, suspicion clear in his expression. “You drain someone for it? Have your fill and decide to save more for later?” Was that what he was doing in the hospital? Using it as a way to troll for his next victim? It was a scary thought, the idea that a vampire was smart enough to extract blood from someone and put it into a bag to make use of later.

His eyes darted briefly to what remained of the dust on the concrete, a sharp laugh cutting through the air. “If you think that, maybe you didn’t know him.” There was every possibility that this man had just gotten wrapped up in something too big for him to understand. If that were the case, Emilio almost felt sorry for him. Almost. The blood bags on the ground were still suspicious enough to arouse Emilio’s paranoia to the extent that it was difficult to feel real empathy for the vampire. 

“Tell anyone? Who would you tell?” Not his coworkers in the hospital, surely; none of them would see any sanity in the claim that he’d seen someone turn someone else to dust outside their place of employment. Other vampires, maybe? If he knew one, did he know more? Paranoia crawled in again.

—

Zane followed the stranger’s gaze to the rumbled sweater, the corner of a bag peaking out, and it took everything he had not to start cursing out loud. Stupid, impulsive brain, making him throw his literal loot to the ground for everyone to take a peek at. How nice it would be, to have a functioning head that gave a split second ‘maybe you should think about this’ before his body just did whatever the heck it wanted to. In the same vein, lying didn’t exactly come naturally to him under the most relaxed of circumstances, which this certainly wasn’t. So a truth bomb it was. 

“Drain someone, what…” Eyebrows furrowed and he was almost tempted to ask a follow up question to what kind of operation this man thought the hospital was running but thankfully, the very serious air of the question stopped Zane from insulting this man and most likely getting stabbed. “No, that’s just… I stole it. Not from a person, just from the… fridge. It’s from a blood donation but just… not being donated to someone in the ER like normally.” Did that make sense? Maybe, it was hard to tell when his attention kept passing from the stake to the speckles of dust that used to be his Netflix binge watching buddy and back to watch every twitch in the man’s muscles for a glimpse of an upcoming attack. 

There was no real answer to how well Zane had known the vampire-turned-dust, however. He’d known his name, how long he’d been with Alma and that he liked suspenseful shows. It had more so been the fact that there was no way he’d been living with a group of murderers, or even a single murderer, for this many months without realizing it. The whole reason for providing the blood bags was so that no one would have to get hurt and no one would have to starve… right?

Obviously, displaying the looted bags of blood hadn’t been Zane’s only slip up, evident when the interrogation about who he would tell started. “No one,” he blurted out, seeing something rise behind the other man’s eyes that made Zane’s skin crawl. “Really,” he added for pointless emphasis, wondering if he’d have time to grab the bags of blood before slamming the door shut. It locked from the inside and would at least give him a moment to think about his next steps. Maybe not, but it was worth a try. 

One foot sweeped at the sweater covered bags, swooping them most of the way back into the hallway before the sweater got stuck on a stray nail. He was already trying to hurriedly close the door so when it slammed on the bags, leaving a good few inches of open door between him and the armed stranger, all he could hope was that this guy wasn’t a fast runner.  

—

If it was a lie, it was a bad one. He stole the bags from a fridge? Whose fridge? Another vampire? Emilio’s head spun with the possibilities, eyes darting from the bags of blood on the concrete to the man who’d dropped them with no small amount of suspicion. What was he supposed to do here, exactly? He knew the vampire he’d killed had deserved it, but he couldn’t say the same for this one. On the surface, he seemed like a scared hospital employee who’d just witnessed something unexpected. If not for the bags of blood he was trying to make off with, Emilio might have wondered if his senses were lying to him with their claim that the man was undead. But the blood was a dead giveaway. 

And so was the fact that his next statement was a much more obvious lie. Maybe that was a good thing, considering; Emilio had a baseline now, a known lie to play off of. If that was how he sounded when he was bullshitting, it seemed much more possible that he’d been telling the truth about where he’d gotten the bags. The immediate defensiveness in response to the question was enough to lead Emilio to believe there were, in fact, more vampires in this guy’s inner circle. That probably meant the blood bags weren’t just for him, then, which also made sense. It’d be a lot of blood for one man alone. 

“You can be honest with me,” he said, still brandishing that stake, “or we can have a problem. And I don’t think you want to have a problem.” Threats, with vampires, tended to be the kind of thing that could go either way. Back in Mexico, when his family name had always allowed his reputation to precede him, they’d been effective more often than not. But now? Emilio hadn’t used his surname in years for fear of what it might bring to his doorstep. The only thing he had to back up his threats was him. Luckily, in this case, that seemed like it might be enough. The vampire had just seen him stake one of his buddies, after all. And he looked pretty uneasy about the whole thing. Good. 

But… sometimes even the most well-believed threats didn’t have the effect you were hoping for. Emilio had wanted to scare the guy into talking. Instead, he ran. And that was… less than ideal. There was a time when Emilio had been far faster, able to keep up with anyone and everyone, but that time had ended in Mexico, when everything else ended with it. His bad knee screamed at the mere concept of making a break for it, but he ran anyway. 

If not for the jacket catching in the door, that would have been the end of it. Emilio wasn’t fast enough to keep up and, if that door had closed, there was no way he’d have been able to get into that hospital undetected. But the door remained open just enough for him to slide his fingers through and yank it the rest of the way, sliding inside and taking off after the vampire.

—

Fuck, fuck, fuck. Zane could hear footsteps thudding down the halls after him and something told him this guy wouldn’t have any qualms about being spotted sprinting down hospital halls, seeing that he’d just casually murdered someone. A vampire, but someone nonetheless. Not that the odds of running into someone down here were very high - these halls only had traffic around shift changes and that was hours from now. Zane was well and truly alone down here. Pens and bottle caps jangled in his pockets as he ran, a few even slipping from their safety and tumbling to the ground. Escape routes, escape routes…

The sound of running still closing in behind him, Zane sped up and turned the corner, just barely avoiding the abandoned stretcher that someone had been planning to fix for months now, with a dexterity that only came about from avoiding patients on the move every day in the ER. Slippers hanging on by pure will, he tried to regain speed from the turn which was hard enough without the slippery hospital floors and ill fitting slippers. Fuck, he was going to catch up to him, he was going to drive that scary looking stake right through his heart and no one would ever know where Zane disappeared to and no one would probably even care enough to notice much anyway-

Clang.

Zane’s head whipped back around which really made it hard to run fast but it was instinct - you hear a noise, you look towards it. The stranger was clutching his knee, the stretcher now askew and clearly, not everyone was as good as dodging stretchers. Even static ones. For a second, Zane slowed and stared, the instinct to treat the wounded taking over before his brain rebooted back to the situation at hand. Imminent death. Right. Slowly but surely backing up towards the nearest access restricted door, Zane fumbled for his keycard and swiped at the reader behind his back. As it beeped, the words slipped out before he could really stop them. “Sorry.”

The door shut behind him and he sprinted until he reached the entrance to the ER, feeling like he definitely should have been panting by now. Head reeling, the first thought on his mind, and the dumbest, was that he’d just lost his favorite sweater.

—

The hall was empty. It was definitely a relief, both because Emilio wasn’t looking to explain to any concerned doctors or nurses why he was chasing one of their coworkers through the hallway and because it meant there was no one for the vampire to grab and use as leverage. Hostage situations got sticky fast, and Emilio had never been particularly good at navigating them. 

Of course, even with not curious bystanders, this situation wasn’t ideal. He was at the disadvantage here and he knew it. Not only did his old injury slow him down, but the vampire also had the advantage of knowing these halls. Whatever else he’d lied about, the claim that he worked in this hospital seemed to be a true one. He navigated the twisting halls with relative ease, leaving Emilio to follow and do his best to keep up.

It was a losing battle. He knew that. He knew there was no world where he caught up, knew that it was a matter of time before this vampire found someone or something to use against him. He didn’t expect that to come in the form of a haphazardly placed gurney in the middle of the hall. So focused on following the vampire, Emilio didn’t register the obstacle until he’d barrelled straight into it. He couldn’t keep himself from toppling to the ground, bad luck ensuring that his bad knee took the brunt of it. The hunter couldn’t bite back a string of curses as he fell, clutching his knee and gritting his teeth against the pain.

Ahead of him, the vampire stopped. Emilio tensed as he turned, scrambling for his stake only to find that it had landed out of reach. And, Christ, this was it, wasn’t it? He’d taken off after a vampire through the empty halls of a hospital, and now he was going to die here, alone and forgotten. Estúpido. 

Except… the vampire didn’t make a move towards him. Instead, puzzlingly, he apologized. He said sorry, and he looked like he meant it. Before Emilio could unpack that, the vampire was gone, disappearing behind a locked door with a definitive beep and leaving the slayer on the floor in an empty hallway, feeling more lost than he had in a while now. 

Wicked’s Rest. Weird place.

#rn zane #zane: when it rains #wickedswriting #s1 writing #season 1

[heardatmedschool]

“Why is it that, when there’s an adverse effect, it can always be caused by those two?”

About amitriptiline and amiodarone.

#medicine #med school #medblr #pharmaceutics #pharmacokinetics #adverse reactions #side effects #yes this was low key quoting mcgonagall