For the Kids

 

Daily Mass Reading and Reflection September 5th 2025

Daily Mass Reading and Reflection:

First Reading (Colossians 1:15-2)

A reading from the Letter of Saint Paul to the Colossians

Christ Jesus is the image of the invisible God, the firstborn of all creation. For in him all things were created, in heaven and on earth, visible and invisible, whether thrones or dominions or principalities or authorities. All things were created through him and for him. He is before all things, and in him all things hold together. He is the head of the body, the church. He is the beginning, the firstborn from the dead, that in everything he might be preeminent. For in him all the fullness of God was pleased to dwell, and through him to reconcile to himself all things, whether on earth or in heaven, making peace by the blood of his cross.

Responsorial Psalm (From Psalm 100)

Indeed, how good is the Lord,
Eternal his merciful love.
He is faithful from age to age.
Response: Come before the Lord, singing for joy.

Gospel Acclamation:

(John 8:12) Alleluia, alleluia.
I am the way, the truth, and the life, says the Lord; no one comes to the Father except through me.
Alleluia.

Gospel: (Luke 5:33-39)
A reading from the holy Gospel according to Luke

The scribes and Pharisees said to Jesus, “The disciples of John the Baptist fast often and offer prayers, and so do the disciples of the Pharisees, but yours eat and drink.” Jesus answered them, “Can you make wedding guests fast while the bridegroom is with them? The days will come when the bridegroom is taken away from them, and then they will fast in those days.” He also told them a parable: “No one tears a piece from a new garment and puts it on an old garment. If he does, he will tear the new, and the piece from the new will not match the old. And no one puts new wine into old wineskins; if he does, the new wine will burst the skins, and it will be spilled, and the skins will be destroyed. But new wine must be put into fresh wineskins. And no one after drinking old wine desires new, for he says, ‘The old is good.’”

Reflection:

Dear friends, Saint Paul reminds us today that Jesus is the image of the invisible God. An image is a representation, whether a drawing, painting, or sculpture. God the Father is unseen and invisible, but in Jesus, the unseen God is revealed. As Jesus himself said: “Whoever has seen me has seen the Father” (John 14:9).

Jesus is the image of the Father because he is one with the Father, consubstantial, eternal, uncreated. He shows us love and mercy, for God is love, and in Jesus we see that love lived out. He is before all things, with the fullness of God dwelling in him, the source and sustainer of creation.

But friends, we too are made in the image of God. Created male and female in his likeness, our very bodies are temples of the Holy Spirit. God lives in us, so when people encounter us, they should encounter him.

This is a profound responsibility. To say we are images of God means our lives must reflect his holiness, truth, and love. If we hate, lie, steal, quarrel, or seek revenge, we give a false image of God. But if we love, forgive, and act with mercy, then we reflect God’s true image.

As the psalmist reminds us, God crowned us with dignity and entrusted us with dominion over creation. He has given us the gift of his likeness.

So let us ask ourselves today: When people see me, do they see God? Do I give a true or false image of the One in whose likeness I was made?

Lord, hear our prayer.

May God bless you and have a wonderful weekend.

Pal Ronnie 

Vasopressors Emergency Medicine

What Are Vasopressors?

• Potent medications that constrict blood vessels → increase blood pressure.

• Goal: restore tissue perfusion in very hypotensive patients.

• Can also affect heart contractility and heart rate (inotropy).

• Commonly called “pressors.”

• Main inotrope used: Dobutamine (covered at end).

Receptor Sites

• Alpha receptors – vascular walls → vasoconstriction → ↑ BP.

• Beta-1 receptors – heart → ↑ contractility + ↑ heart rate.

• Beta-2 receptors – lungs → bronchodilation, vasodilation.

• V1 receptors – vascular walls → vasoconstriction → ↑ BP.

Key Vasopressors

1. Norepinephrine (Levofed)

• First-line agent: septic shock, neurogenic shock, cardiogenic shock, obstructive shock.

• Not for hypovolemic shock unless adequately volume resuscitated.

• Potent alpha activity, slight beta-1.

• Mixing: 4 mg in 250 mL NS (also 8 mg/250 or 16 mg/250).

• Onset: 1–2 min.

• Dose: 2–40 mcg/min (sometimes higher, e.g. up to 200). Start ~2 mcg/min.

• Titration: usually ↑ by 2 mcg every 3–5 min (per facility).

2. Vasopressin

• Pure V1 agonist.

• Never first-line, but added to norepinephrine in septic shock.

• Works well in acidotic environments.

• Onset: up to 15 min.

• Dose: 0.03 units/min (not titrated).

• Mixing: 20 units in 100 mL NS.

• Uses: septic shock add-on, diabetes insipidus, alternative to epinephrine in code situations.

3. Epinephrine

• Affects alpha, beta-1, beta-2.

• ↑ BP, ↑ HR, ↑ contractility, bronchodilation.

• Uses:

  • First-line in cardiac arrest.

  • Anaphylaxis and refractory shock.

  • Preferred when shock + low HR (no compensatory tachycardia).

• Onset: ~1 min.

• Concentration: 1 mg/250 mL or 4 mg/250 mL.

• Dose range: 0.5–2 mcg/kg/min (start ~0.1 mcg/kg/min).

• Complication: can ↑ lactate (important for lab interpretation).

4. Phenylephrine (Neo-Synephrine)

• Pure alpha agonist → ↑ SVR, ↑ BP.

• Add-on agent (after norepi, vasopressin, epi).

• Onset: 1 min.

• Concentration: 50 mg/250 mL NS.

• Dose range: 10–200 mcg/min (start ~100 mcg/min).

• Titration: 25 mcg every 3–5 min.

• Side effect: reflex bradycardia.

5. Dopamine

• Affects beta-1, alpha, dopamine receptors.

• Unpredictable effects → not commonly used in ER.

• Onset: 5 min.

• Concentration: 450 mg/250 mL NS.

• Dose: 2–20 mcg/kg/min.

  • <10 mcg/kg/min → beta-1 + renal perfusion.

  • 10 mcg/kg/min → alpha → vasoconstriction.

• Downsides: arrhythmias, less reliable vs norepi/epi.

6. Dobutamine

• Main inotrope (↑ contractility).

• Primarily beta-1 (contractility) + some beta-2 and alpha (vasodilation).

• May drop BP due to vasodilation.

• Uses: cardiogenic shock, heart failure (though controversial—“don’t whip a tired heart”). Sometimes add-on in septic shock.

• Onset: 10 min.

• Concentration: 500 mg/250 mL NS.

• Dose range: 2–20 mcg/kg/min (start at 2, titrate by 2 every 15 min).

Special Preparations

Dirty Epinephrine Drip

• 1 mg epi in 1 L NS.

• Run wide open → ~20–30 mcg/min.

• Use: critical, crashing patients (e.g., anaphylaxis, near-arrest).

• Buys time for pump infusion setup.

Norepinephrine Drip (self-mix in emergencies)

• 4 mg norepi in 250 mL NS.

• Label, shake, start infusion quickly.

Push-Dose Pressors

Phenylephrine Push-Dose

• Used for hypotension during RSI or sedation.

• Prep: 10 mg phenylephrine (1 mL) into 100 mL NS → 100 mcg/mL.

• Dose: 50–200 mcg (0.5–2 mL).

• Caution: do not use in bradycardic patients (can worsen).

Epinephrine Push-Dose

• Used in crashing/pre-arrest patients.

• Prep: Take flush (10 mL NS), remove 1 mL → 9 mL left. Add 1 mL from epi amp (1 mg/10 mL) → 100 mcg total = 10 mcg/mL.

• Dose: 10–20 mcg per push.

Complications of Vasopressors

• Extravasation → tissue necrosis.

• Arrhythmias.

• Ischemia to organs (heart, periphery, gut).

• Reflex bradycardia (phenylephrine).

• ↑ Lactate (epinephrine).

Clinicians Must-Knows

• Okay to start pressors peripherally in crashing patients (esp. norepi). Central line needed ASAP.

• Pressors are compatible with each other (verify per facility).

• Always have the next bag ready, never run dry.

• Know how to mix norepi, epi, and vasopressin yourself (don’t wait for pharmacy).

• Vasopressin: do not titrate, just start/stop.

• Label all lines (at pump + near patient).

• Do not bolus pressors → risk of acute hypertension, ischemia, arrhythmias.

• Allow time for onset before titrating further.

• Follow facility protocols + preceptor guidance.

• If starting a second pressor, advocate for arterial line placement.

Peter would be Fisher of Men

Reading 1 – Colossians 1:9-14

St. Paul wrote, “He delivered us from the power of darkness and transferred us to the Kingdom of his beloved Son, in whom we have redemption, the forgiveness of sins.”

Responsorial Psalm – Psalm 98
R. (2) The Lord has made known his salvation.

Alleluia – Matthew 4:19
Come after me, says the Lord, and I will make you fishers of men.

Gospel – Luke 5:1-11
And Jesus said, “Do not be afraid; from now on you will be catching men. When they brought their boats to the shore, they left everything and followed him.”

Reflection

My dear friends, today’s Gospel reading is one of my all-time favorites. Peter had reached the point of exhaustion while at the sea fishing with no success. He had fished all night long, casting and recasting, yet found nothing. He was ready to give up, he had already begun washing his nets, preparing to walk away in defeat.

But then Jesus appeared. He told Peter to cast his net once more, and not only that, but He showed him where. This simple act of obedience brought about an overwhelming catch, more than Peter could have imagined.

How many times in our own lives are we tempted to give up? On ourselves, on our family members, on our friends, on situations that seem hopeless? We often end up with giving up as the only solution atbour disposal. And yet the Gospel reminds us that it is often at the very moment of surrender that the Lord steps in with grace, direction, and abundance.

Today, let us pray for the wisdom and perseverance to never give up. When life feels empty and our efforts seem wasted, may we remember that Jesus may be asking us to cast the net one more time. His timing, His guidance, and His presence can turn emptiness into overflowing blessing.

Lord, grant us the strength to trust in You, and the courage to never give up. Amen 🙏 

-Pal Ronnie-

A Relationship Story: North America et Indian Subcontinent

On a spring morning in Jersey City 2025, I met a young woman in the kitchen we shared. She was pleasant and well-spoken, and introduced herself as Jessica. I returned the gesture, and from there we began what turned out to be a wonderful conversation. I soon learned she was a medical student finishing her specialty in plastic surgery.

Over the next few weeks, we shared more conversations and meals. She was very warm and friendly and eventually Jessica introduced me and another suit mate to fine Indian cuisine, and my palate quickly adapted to the new flavors. 

However, my contract in that city eventually came to an end, and I left, but we stayed in touch.

Today, after some five months, I heard from her again. She is back home in India, and it was genuinely heartwarming to reconnect.

Interestingly, just yesterday, I also met a wise man with Ivorian, Ghanaian heritage, easily my father’s age. He told me in our conversation that in this life, the only thing that truly matter and can bring meaning, and can endures, is relationship. Our relationships with others are the one thing we can always count on, at least the good ones. He was right. 

So I remind myself, and I remind you: stay human, form good relationships, and cherish them.

-Pal Ronnie-

Hello Planet 👋

 

The Power of a Military Government

 

Burkina Faso is the northern neighbor of Ghana. That country is quickly becoming the strongest and most respected nation in the Sub-Saharan region. With a military government, they always get things done, no pretense and no appeasement of any interest groups. You can tell I enjoyed my government classes in both high school and college. War is war; no sentimentality. A tribute to Animal Farm.

Stay awake and stay human 

Pal Ronnie 

What the Eyes Saw: The Awesomeness of God’s Beauty

 

Daily Mass Reading and Reflection: Feast of St. Gregory the Great

Today, the universal Church celebrates the memorial of St. Gregory the Great, a pope of profound humility, wisdom, and pastoral care. As we begin, we acknowledge our sins and God’s boundless mercy.

• Lord, have mercy.

• Christ, have mercy.

• Lord, have mercy.

First Reading – 2 Corinthians 4:1-7

Paul reminds us that the treasure of the Gospel is carried in “earthenware jars”, fragile humanity, so that it may be clear that all power comes from God, not from us.

Responsorial Psalm – Psalm 96
Response: Proclaim his marvelous deeds to all the nations.

• Sing to the Lord a new song; sing to the Lord all the earth.

• Tell among the nations his glory, his wonders among all peoples.

• Proclaim to the nations: God is king; he will judge the peoples with fairness.

Gospel – Luke 22:24-30

A dispute arose among the apostles about greatness. Jesus reminded them that true greatness is not found in lording power over others but in serving. “I am among you as one who serves.” He promises that those who remain faithful will share in His kingdom.

Gospel Acclamation:
Alleluia, alleluia. I call you my friends, says the Lord, for I have made known to you all that the Father has told me. Alleluia.

Reflection

St. Gregory the Great lived this Gospel truth. Though elected pope reluctantly, he embraced the role as Servus servorum Dei, “Servant of the Servants of God.” In him, leadership was expressed through humility, wisdom, and service.

Paul’s reminder that we are fragile vessels yet filled with God’s treasure speaks directly to Gregory’s papacy. He reformed the liturgy, strengthened missionary outreach, and guided the Church through times of turmoil, not by worldly greatness but by faithful service.

The message for us: greatness in God’s kingdom lies in service, humility, and fidelity. Like Gregory, we are called not to seek titles or honors but to embody Christ’s love in action.

Prayer of the Faithful

• For the Church, that her leaders may imitate the humility and wisdom of St. Gregory.

• For those in authority, that they govern with justice and compassion.

• For the poor, the sick, and the forgotten, that they may experience God’s mercy.

• For our community, that we may live as servants of one another in Christ.

God bless you and have a wonderful day.

Pal Ronnie 

Dusk at the Park with the Moonlight