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Many people have the compassionate wish to benefit others, but few understand how to accomplish this successfully in daily life. Bodhisattvas are friends of the world who have such strong compassion that they are able to transform all their daily activities into ways of benefiting others. The path of the Bodhisattva was exquisitely explained in the universally loved poem by the 8th century master Shantideva. With this commentary, the full effectiveness and profundity of this wonderful poem are revealed in full and made applicable for our time. This practical handbook is essential for those wishing to follow a way of life characterised by greater empathy and compassion for others.

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Mechanisms of Pneumothorax in the Critically Ill

Air can accumulate in the pleural space in three ways:

Diagnosis of Pneumothorax in the ICU

Pneumothorax can be difficult to recognize in a critically ill patient. Physical exam and clinical signs and symptoms are unreliable and nonspecific, but may raise clinical suspicion for pneumothorax:

Because clinical signs are unreliable, radiography is required to diagnose pneumothorax.

Chest Ultrasound to Diagnose Pneumothorax

Mounting evidence suggests that thoracic ultrasonography by an experienced operator can be as accurate as chest X-ray at diagnosing pneumothorax. However, a brief training period is required.

Mounting evidence

The "lung point" (absence of sliding lung next to sliding lung) has a 100% specificity for pneumothorax, but its sensitivity is lower. The lung point sign is dependent on at least part of the lung contacting the chest wall -- therefore, it's better to diagnose small pneumothoraces and becomes less sensitive as a pneumothorax increases in size.

The presence of B-lines along with sliding lung has a 100% negative predictive value for pneumothorax at the point examined -- multiple areas must be examined to rule out pneumothorax with confidence.

Video tutorial on the bedside ultrasound for pneumothorax (thanks to the Vince Woman Suede Platform Sneakers Black Size 365 Vince Hbs4t

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Chest CT and Chest X-ray to Diagnose Pneumothorax

Chest CT is the gold standard for diagnosing pneumothorax, as well as determining size. Size is of less importance than clinical severity (hypoxia, distress, pain, hemodynamics) and pneumothorax size should not dictate management on its own.

Authors argue that chest X-rays have become effectively obsolete and should not be relied upon to diagnose pneumothorax in the critically ill patient. Pitfalls include potential loculated pneumothoraces occurring in heterogeneous ARDS or patients with pleural adhesions, as well as difficulties interpreting supine films. Although they essentially argue ultrasound should replace chest-X-rays, it's clear that most intensivists do not have this expertise.

FOOD+WINE: Wine Pairing and Tour
Saturday, September 2, 2017 - 2:00pm to 3:30pm
Jowler Creek Vineyard Winery

Tantalize your taste buds and give your palate a workout at this fun and interactive wine tasting experience. During this event, learn and laugh while tasting Jowler Creek Vineyard Winery's lineup of eight award-winning wines. See how Jowler Creek turns sustainably grown grapes into wine. Treat yourself to a small plate of delicious bites or delectable foods chosen to pair perfectly with wines and take your wine glass with you at the end of the event.

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Saturday, September 2, 2017 - 6:00pm to 9:00pm
Jowler Creek Vineyard Winery

Watch the sunset from Jowler Creek Vineyard Winery's wine garden and enjoy live rock 'n' roll music performed by Red Velvet Crush. If it's rainy, the band will perform inside the barrel room. Wine and beer, by the glass and bottle, and cigars locally made by Weston Tobacco will be available for purchase. Jowler Creek Vineyard Winery will also sell picnic pails pre-packed with food to enjoy alongside your favorite wine. There is no cost to attend. No reservations are required to join in the fun. No outside food or beverages (alcoholic or non-alcoholic) allowed.

Saturday, September 2, 2017 - 7:00pm to 9:30pm
Tipple Hill Winery Vineyard

Enjoy live music by Halle Kearns at Tipple Hill Winery Vineyard on September 2, 2017.

Labor Day: Live Music and Libations
Monday, September 4, 2017 - 11:00am to 5:00pm
Jowler Creek Vineyard Winery

Jowler Creek Vineyard Winery is open on Labor Day! Pack a picnic basket, sip on some red and white libations and relax in Jowler Creek's wine garden or 67-degree air-conditioned barrel room while listening to live music from The Good Sams Band. Enjoy a variety of fun and relaxing yard games including giant Jenga, Yard Yahtzee, Angry Birds, washers and redneck golf. Free event. No reservations are required to join in the fun. No outside beverages allowed.

Tipple Hill Winery Vineyard -
Thursday, September 7, 2017 - 6:00pm to 8:00pm
Tipple Hill Winery Vineyard

Create a porch sign during Tippling Thursdays Creations on September 9, 2017. The instructor will provide you with step-by-step instructions. Must prepay and register for this class online. Nonrefundable.

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