Thank you all for the great responses.
@KingOfAll_Tyrants - I had just done a big WC an hour prior, as the tank had been looking 'meh' for a few days. I figured given the volume I administered (back of the napkin estimate was now the DT is a 0.4% vinegar solution), any meaningful rescue would require >50% change. It didn't seem like a small WC would matter, and I didn't have water ready, it was after 10pm, so I told myself 'the tank is already too stressed.' What's the difference between swimming in 0.2% vinegar vs. 0.4% really?!
I'm an inexperienced reefer, but my clinical nursing background tunneled my vision to oxygenation. If you have an ICU patient with a low pH and you can't administer sodium bicarbonate or other tricks to raise it, you hyperventilate the patient to blow off CO2 and administer higher % atmospheric oxygen. All of that, of course, if you can't/don't have time to correct the underlying issue. So I did the exact same thing - turned pumps and powerheads to 100, dropped in airstones, and opened the windows. I'm skimmerless at the moment, would have used that as well.
@jason the filter freak - I am completely convinced that ICU nursing and reefkeeping are the exact same thing, and that reefkeeping has major potential to support training and mental health for clinicians. I worked in a intensive care unit for neonatal/pediatric patients. On a normal shift, I would be assigned one patient who is being kept alive through ECMO (extracorporeal membrane oxygenation), often post-surgical with a window of cellophane-ish stuff covering their still-opened chest, so I could directly observe and monitor the heart. Here are some of the main things I'd be focusing on.
- Pumps drain blood from the body, pass it through several membranes that oxygenate the blood, and pump it back into the body (overflows and returns).
- Once you have a patient on the ECMO 'circuit,' you can perform most lab draws and medication on the 'pump' side of the system (sump system).
- I'd drawn dozens of small blood samples to run an arterial blood gas (ABG - ph, 02, bicarb, c02), and make minute changes in the rate of ventilation, % o2, and others to meet my targets (testing and titrating)
- The goal in ICU is stability, not recovery. My kid's vitals might be crap, but they'll be stable crap. No matter how perfectly you do everything, sometimes everything comes crashing down and makes for a few exciting few hours.
- In such a critical state, kidneys often fail. I'd hook up a dialysis machine to the ECMO circuit, which requires constant titrating of Ca, Mg, K, P, Na and waste export in relation to labs and each others (c'mon, are we not seeing it?!)
This is a pediatric ECMO room (https://www.chop.edu/sites/default/files/ecmo-machine-canonical.jpg). Looks like a cleaner version of my basement. Reefing has been a great outlet for many behaviors/personality quirks that I've locked up since leaving the bedside.
Sorry for the soapbox - but you asked! I am fascinated by the connection here and hope someday to find a way to share reefing with clinicians.