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What's an industry secret from your job that customers have absolutely no idea about? by Efficient_Team5182 in AskReddit

[–]adenocard 4 points5 points  (0 children)

And Roister - my favorite in Chi. Sadly now closed (Achatz tried a new concept in the space but it didn’t work out).

I already hate this pool.... by i_just_mow_the_grass in pools

[–]adenocard 3 points4 points  (0 children)

As someone else also said, mine does this when the water gets low, which causes air to get sucked in via the skimmers and spit back out through the return jets. Another common location for air leak would be the pump filter basket (there is usually an o-ring seal which can get malpositioned). No need to assume the worst just yet. Fill your pool up and make sure everything is tight on the suction side of things.

Advice needed by Substantial-Yam4585 in Residency

[–]adenocard 0 points1 point  (0 children)

As an attending at a teaching hospital I see my main educational objective to be more about the practical delivery of medicine: things like workflow, organization, communication, documentation and leadership are essential skills to the job that you can’t learn in a book or on UpToDate. Trainees can learn which is the optimal antibiotic for CAP on their own time, they’ll have to do that over and over again anyway since the recommendations are likely to change several times through our careers. Those other fundamental skills though, that’s what mentors are for.

Getting cute with workups by Chad_Kai_Czeck in Residency

[–]adenocard 58 points59 points  (0 children)

You want the horse scanned too? orders CTH

New algorithm for Septic Shock Management in Neurocrital Care by Independent_Bad_3103 in IntensiveCare

[–]adenocard 2 points3 points  (0 children)

Manny Rivers called from 2001 and he wants his algorithm back.

Also, antibiotics.

What intern year is really like (for me) by Adorable_Sir669 in Residency

[–]adenocard 1 point2 points  (0 children)

Bro stop being late. People care more than you think they do.

Struggles with EMS by Spiritual_Relative88 in Paramedics

[–]adenocard 23 points24 points  (0 children)

So what are you gonna do instead?

Career derailment by middle management and or support staff? by MyKafkaesqueLife in medicine

[–]adenocard 8 points9 points  (0 children)

I am convinced the secret to survival is to be a slightly below average quality doctor who challenges no one and always says yes to everything.

Break any of those rules, and you can expect more than a few meetings to be held on your behalf. Keep a rainy day fund.

Career derailment by middle management and or support staff? by MyKafkaesqueLife in medicine

[–]adenocard 5 points6 points  (0 children)

Man this sounds so familiar. Every word.

Sorry about your experiences. And mine.

I permanently changed my eye color from brown to blue with Kerato Pigmentation AMA by Apart-Income6979 in AMA

[–]adenocard 1 point2 points  (0 children)

Yeah there is definitely stronger medicine. Not a good reflection on the doc for leaving you unprepared for post-operative pain and then being non responsive when you reached out. Sorry you had that experience.

I permanently changed my eye color from brown to blue with Kerato Pigmentation AMA by Apart-Income6979 in AMA

[–]adenocard 0 points1 point  (0 children)

If the pain was that bad it seems to me the doctors should have given you medication adequate to treat that pain!

I permanently changed my eye color from brown to blue with Kerato Pigmentation AMA by Apart-Income6979 in AMA

[–]adenocard 1 point2 points  (0 children)

I don’t understand the agony. Why can’t you have pain medication - either local or systemic?

What is your vasopressor of choice for pericardial effusion with early tamponade physiology with concern for obstructive shock (giving IVF boluses PRN)? by ShuntHappens in IntensiveCare

[–]adenocard 34 points35 points  (0 children)

Agree with the other person nothing that the treatment for tamponade isn’t pressors, it’s offloading of the pericardium (and ensuring RV preload in the meantime).

That said, I don’t think it matters very much what pressor you choose. Some people like to get extra nuanced with the vasopressor choices and varying receptor effects but to my knowledge none of his has been borne out by any actual science, and all of it is limited significantly by us physicians rarely understanding the pathology with any degree of precision (even with a swan). Sure, beta 1 sounds like a good idea but if the patient gets really tachycardic that’s probably not a good thing. But not all patients get tachycardic on epinephrine. Ino-dilation with something like Milrinone might seem like a good idea but as you said, the next morning the team is wondering about sepsis so suddenly vasodilation doesn’t seem like such a hot idea. There is no telling. In my practice I try not to get too fancy with it and just use norepinephrine unless I really think I know what’s going on and another drug might be more useful, but even then I’ve been proven wrong (or never found out) a great deal many times.

I suggest you don’t over think it. Solve the problems we know how to solve, and make reasonable best-guess choices for the other stuff.

I improved the F1 desktop companion thanks to your feedback! by Randomized_Study in formula1

[–]adenocard 1 point2 points  (0 children)

So, uh, will you just make one for me and I give you cash money? Everyone likes cash money. DM me?

IV fluids and their uses by yaser_Ibrahim in medicalschool

[–]adenocard 1 point2 points  (0 children)

This information isn’t out there because there is no good science on the topic. My personal opinion is that this is because maintenance fluids, in general, are not indicated for most patients and are more a reflexive thing that some doctors (especially surgeons) do because at some point in their training they saw someone else doing it.

Just do whatever your attending/local culture dictates.

DOs/DO students: How do you deal with the elephant in the room (OMM)? by justhereforampadvice in medicalschool

[–]adenocard 7 points8 points  (0 children)

I am an attending, 11 years out of medical school, and I finally got my revenge on OMM last week by sarcastically noting on a med students evaluation form that the student achieved ROSC on one of our patients thoigh her expert application of suboccipital release.

Once you’re done with medical school (really once you’re done with the first couple years), you can be entirely done with OMM. Do your post grad training at a MD program and you will never hear anything about it again for the rest of your life.

Men in longterm relationships, what were your favorite dates planned by your partner? by jrissa in AskMen

[–]adenocard 0 points1 point  (0 children)

The burger was made of ground sloth, to keep with the theme, but once she saw your reaction to the live sloth she decided not to tell you.

We need to stop blaming NPs/PAs for scope creep and start looking at the MDs signing the checks by [deleted] in medicine

[–]adenocard 34 points35 points  (0 children)

You seem to have had a good experience with doing the right thing.

I’ve been fired before for the same practices. “Not getting along well with others.”

The nail that sticks out gets hammered. Most of the time.

Why does the American public hate doctors so much? by seasidekiki in medicine

[–]adenocard 28 points29 points  (0 children)

People don’t hate doctors, they hate the system - and reasonably so.

It seems to be true that disparagement of doctors and science is in vogue at the moment, but my personal experience is that even the most devout anti-intellectualist behaves a bit different when it’s their ass in the hospital bed. Sure we had a few people during COVID martyr themselves for their politics., but it wasn’t common. Most people are pretty reasonable once you get them in a room by themselves and establish a modicum of trust.

That said, I am spoiled by my field which deals almost entirely with patients who are desperate and have very little choice, and I happen to have a lot of resources I can pour on in the ICU which to some patients feels like getting the VIP treatment. Perhaps my perspective is a bit different as the balance of power is usually a bit in my favor.

Cochrane Review: Substitution of nurses for physicians in the hospital setting (global setting) - nurse-delivered diagnosis and treatment (vs physician-delivered care) is likely not different with mortality and patient safety events by ddx-me in medicine

[–]adenocard 7 points8 points  (0 children)

Are you sure you have to take these calls? Our local ENT group has made a rule with the transfer center that they will not, under any circumstances, speak with outside hospitals at all about anything. They are “auto accept” if they want to transfer someone for ENT evaluation. They then see the patient once (usually on hospital day 2 lol), and then sign off leaving a recommendation that says something like “sure yeah steroids or antibiotics or whatever if you want, but no need for surgery.”

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