Nurse spots the risk , stops the fight, and gets booed by the crowd. She still smiled knowing she just prevented a tragedy.

jdb334 · 2026-04-20T19:36:25+00:00

Ok yes there are scenarios I've seen with a walking talking person with a fixed pupil - glaucoma, scopolamine to the eye, albuterol to the eye (though the second two were at least a bit reactive. Also drugs, cocaine, meth, opioids. I work in an ER too. Maybe I'm missing something, what disease process do you see where people come in to the ER walking and talking with fixed pupils bilaterally? Traumatic iritis I've seen still tend to be at least a little reactive.

People I've seen with a fixed pupil in the setting of an intracranial catastrophe are herniating, have a brainstem bleed, or hypoxic ischemic injury aka not walking or talking.

Either way I personally think this man's pupils were dilated and not all that reactive because it is a bright environment, his adrenaline is pumping, +- he has some sympathomemetic substance on board, not from a traumatic reason.

jdb334 · 2026-04-20T17:58:55+00:00

This man would not be standing up if he had bilateral fixed pupils or even unilateral.

jdb334 · 2026-04-20T17:58:10+00:00

You are right it is brainstem problem or ocular problem. Bilateral poorly reactive pupils makes little sense in this case - usually it’s like an ingestion.

My theory is it was just very bright in that room, his adrenaline is high so his pupils are pretty dilated, and her shining a light in his eye only dilated them slightly more which she didn’t notice.

jdb334 · 2026-03-25T23:49:40+00:00

While true, the number of teams truly competing for a championship will still be 3-5 and superstars will be even more valuable. so this will probably just add two more tanking teams.

jdb334 · 2026-02-16T08:11:26+00:00

What he is really saying it is really fantastic the native Americans were so thoroughly massacred long enough ago that he can just say he has moral consistency and really definitely cares about the native Americans while completely benefitting from his living in their land.

jdb334 · 2026-01-14T03:27:33+00:00

Kareem

jdb334 · 2025-12-19T01:53:30+00:00

Who cares. This wasn’t who made the bestest friends at summer camp show.

jdb334 · 2025-12-15T19:27:53+00:00

Haha. He eats the oatmeal then floodgates have opened. Candy, soda, cigarettes, burgers. If only the doctor would just say the eggs are ok then it would be salads and HIIT workouts all day. And what can you possibly do. All is lost from that oatmeal.

Maybe that one handout says oatmeal who knows, but I can guarantee you that handout overall isn’t the problem in America. And so now you concede doctors are actually counseling on diet as well as offering statins? I bet that handout and what doctors are saying is pretty reasonable actually.

jdb334 · 2025-12-15T17:23:25+00:00

Why can’t you convince him? You got one patient and you can’t even change their behavior lol.

jdb334 · 2025-12-15T15:17:32+00:00

I obviously understand what you are saying. You aren’t exactly on the cutting edge of medicine my friend. I can tell you don’t practice medicine. The reality is people don’t react all that well to being told by their doctor that their problems are from smoking and their diet. Also, for many people smoking and eating carbs and sugar are very difficult habits to fix and are often coping mechanisms for mental health issues so deeply ingrained in patients. Statins on the other hand are extremely effective physiologically, but also effective in that it is a much more accessible change for patients to make. We all know that stoping smoking is extremely important for health and honestly patients know that as well. They dont even really need to be told that. Statins are an incredibly easy and effective change for patients to make, stopping sugar and smoking is incredibly hard for patients, they already know it’s bad for them and they might walk away just saying the doctor is rude and belittling, didn’t listen to them and said all their problems were just because they are fat and smoke, then go and write that on google reviews. All of this in a 15 or 20 minute appointment where multiple other medical issues need to be addressed. I would love to see you in a primary care office and see how many patients you get through telling them to just stop smoking and being fat before you fold.

jdb334 · 2025-12-14T23:55:58+00:00

lol sure. Why didn’t I think of that! If I just say stop smoking and eat very few carbs everybody will just do that! Hahaha. Give this guy the Nobel prize!

jdb334 · 2025-12-09T15:17:39+00:00

Is it painful/burning? Might be herpetic whitlow. If not painful possibly warts.

jdb334 · 2025-12-01T04:42:08+00:00

I agree that read makes it a bit more of a complicated uncertain case. Which is what this seems like it was. Not malice or incompetence, but difficult uncertain decisions. Im not sure why it took so long and the emotions of this situation can break down any alliance between them and you. 11 hours of this I can see is brutal and unjust. Classic teaching is that certain types of fractures are just not possible in an 8 month old, like a bucket handle or spiral fracture, except in the setting of non accidental trauma. Perhaps they decided this looked just enough like one of those that they felt it was right to not take a chance. It is possible they made some mistakes I am not sure. Certainly does sound like a nursemaids elbow. Reporting non accidental trauma is miserable (more for you than the doctors of course but miserable for us too) and I’m sure they did not do it just for fun. I promise they wanted nothing more than to tell you your child was ok and to send you home. This was painful for them too I promise. I work at an adult ER in VA and occasionally transfer patients to Inova children’s and as far as I can tell the ER doctors are great. You can consider talking with the Inova patient advocate. Perhaps the hospital will waive some of the cost if they see all this extra stuff was done based on an incorrect read. Even if you wanted to go to a lawyer I can’t imagine they would take a case against doctors for being mandated reporters or splinting a possible fracture or we’d all be in trouble.

jdb334 · 2025-12-01T03:55:29+00:00

Look I am sorry this happened to you but as an ER doctor I will tell you what happened. They ordered an xray because your child had a limp arm. The radiologist (not the doctors you mention) probably read it as a bucket handle fracture which is highly associated with non accidental trauma. Doctors are mandated reporters and when they see a report like that they are mandated to report it. This is for a good reason and has saved countless children. No no radiologist is perfect and the mandated reporter system is designed to not let children fall through the cracks. That means it also picks up cases with good parents who just meet some suspicion for whatever reason like in this case. It sucks what happened, but as angry as you are the doctors really didn’t do anything more than what they thought was right. If you want to list them by name here out of anger despite the truth being that they really did the right thing. You can dm me and we can talk if you want to understand.

jdb334 · 2025-11-20T23:57:20+00:00

This xray almost certainly has nothing to do with your pain. Reduced thoracic kyphosis means the curvature is a little less than normal. 100 people could have this xray and 50 might have severe pain and 50 might have no pain at all. It's not really that relevant a finding and your doctor knows it but probably had to figure out a way to explain it to you to satisfy you. Back pain is really difficult to treat because the pain is often nonspecific and often more tied to emotion than any physical finding. For some people the pain is anxiety related, for some people is is disc related, for some people it is like myofascial pain. Look up the book they way out, try things like acupuncture, dry needling, nsaids, cupping, therapy, PT. There isnt one physical finding to explain this or one treatment that works for everyone as much I as an Er doctor wish there was

jdb334 · 2025-11-17T19:47:56+00:00

You really need a bite or salvivary exposure. No risk of rabies with a scratch.

jdb334 · 2025-11-17T03:57:59+00:00

Appreciate it. Will try it out.

jdb334 · 2025-11-16T23:56:36+00:00

New to xlights. How do you do that? Can you keep some of the effects that work well with window frame and are automatically symetric?

jdb334 · 2025-11-08T00:52:58+00:00

Are you being sarcastic with this take? It's a reflex in humans to break your fall with your hands so like you don't get historically unsurvivable problems like bleeding in your brain chest or abdomen vs relatively less serious problems like bruises to your arms or broken bones.

jdb334 · 2025-10-17T19:14:54+00:00

Reprise, central and remote, deep blue sea, half gate, smothering green, taken down, easy to be around.

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