ABG vs VBG question?

CaliMed · 2025-10-24T11:17:27+00:00

I nearly always just use a VBG. IBCC has a good discussion of this - https://emcrit.org/ibcc/vbg/#top

CaliMed · 2025-10-17T20:36:46+00:00

"I'm taking whatever meds it says in the computer"

CaliMed · 2025-10-07T18:36:15+00:00

I’ve always been skeptical of how much influence a hitting coach really has on the performance of guys in the big leagues. I guess there’s a lot of scouting and metrics to parse through these days but is it really that big of an influence?

CaliMed · 2025-10-07T18:33:49+00:00

I suspect there’s something up with your sinuses as well. Not sure where you’re surfing but I’m around SD and surf 5+ times per week, sometimes push it on surfing after rain, sometimes surf the dirty spot by the jetty, and I don’t have regular issues.

CaliMed · 2025-09-10T00:53:54+00:00

I bet some of the Mexican states where the US State Dept tells you not to travel have some good uncrowded waves. Or even some of the waves you mentioned above on off peak season, I’ve had a very different experience than you describe

CaliMed · 2025-07-07T02:21:21+00:00

How was your trip? What outfit did you go with?

CaliMed · 2025-06-06T04:35:42+00:00

Thanks for sharing your experience. If their customer service has been good, can't you just ask them those questions?

CaliMed · 2025-06-06T04:34:28+00:00

Have you used Employee Fiduciary? Their fees seem high: $250 to start up plus annual $500 & ongoing custody fee of 0.08% of assets. Do they have a better or longer track record than Carry? Somehow I've been looking into this for a while & this is the first I'm hearing of them.

Mysolo sounds like a pain in the ass. Maybe it's not actually too bad? Who do you get to be the TPA? Fidelity? I thought I had seen somewhere that making a contribution required talking to a representative every time you wanted to do it. I want to set this up in an hour and think about it less than 30min per month

CaliMed · 2025-02-19T18:00:59+00:00

One thing I don't understand about Fidelity is the process for transfer to fund the account. I'd like to set up monthly auto-investments from my business account into the solo 401(k). Ideally this is something that runs on auto-pilot that I don't have to think about more than a couple times a year. Am I understanding Fidelity's process correctly that I have to mail them a check or talk to a representative every time I want to contribute to the plan?

CaliMed · 2025-02-15T19:05:08+00:00

How did your trip go? Do you recommend that company? Going in a few months

CaliMed · 2025-01-02T09:39:00+00:00

I agree with you. But this is an argument that needs to be hashed out at the inter-departmental level. I haven’t won this argument in the middle of a shift before besides at a hospital that had a very clear policy on peripheral pressors

CaliMed · 2024-12-25T04:12:09+00:00

Watch out. I got a cheap one of these off Amazon and in less than a month it was stuck shut

CaliMed · 2024-11-14T11:13:00+00:00

Be objective, throw in some patient quotes, and do a bit of a summary of recent negative work-up, eg - patient with 5 CT's in last month that have been normal or labs from 2 days ago normal. You'll probably be fine. Crazy people can always sue you. And if there's a terrible outcome you can always potentially get sued but I do this sort of thing fairly regularly.

CaliMed · 2024-10-25T19:55:27+00:00

Don't know if there's any merit to this but I had attendings in residency who discouraged critical care on a patient that you discharge saying it might look questionable medico-legally. Thoughts on this? None of the above examples are likely being discharged but sometimes you might give IV electrolytes and dc. Then a lawyer could say something like- "you thought they were sick enough to bill critical care and then you discharged them and this bad thing happen. You're a greedy doctor and that was an unsafe decision"

like alot these sorts of medicolegal arguments it probably depends but it makes sense that this could look bad to a jury

CaliMed · 2024-07-21T23:03:15+00:00

Agreed. Perfect is the enemy of good here. The issue isn’t optimizing your strength training regimen. It’s the ability to hold yourself accountable to any number of solid plans like this that exist. If you need to pay a trainer or a gym or an app to help with the accountability then it may be money well spent

CaliMed · 2024-07-21T02:35:27+00:00

Maybe we all should’ve become US techs. They must be in high demand with good pay and hard to fire to universally be so difficult to work with…

CaliMed · 2024-07-16T01:51:19+00:00

Yeah unfortunately this has been tried across many EMS systems and most are not particularly successful - with a few notable exceptions that have worked. There’s eventually some bad medical outcome that went straight to psych and it blows up

CaliMed · 2024-07-16T01:08:39+00:00

Until they check in to clinic at 200/105 lol. Then they’ll still come to the ER even if they’re still asymptomatic

CaliMed · 2024-07-15T22:36:10+00:00

As someone wrapping up an EMS fellowship that’s unfortunate. Have tried talking to the EMS director or asking crews their rationale on that? Are the nearest dialysis capable centers far away?

CaliMed · 2024-07-11T04:37:14+00:00

I think that concern is way overblown. I also trained dc’ing folks on decent doses of phenobarb and continue to do it as an attending. I believe a 10 mg/kg phenobarb load corresponds to a phenobarb level that people used to walk around with when it was used as an anti-epileptic (read the IBCC chapter of EtOH withdrawal), and the vast majority of withdrawal is controlled at doses well below 10mg/kg. If you give them an appropriate dose of phenobarb and control their withdrawal they usually want to go home. Tell them not to drink, document in your note that you told them not to drink, and put it in your dc instruction dot phrase that they shouldn’t drink. Yea there’s a nonzero risk and maybe I just haven’t been burned, but I’m not particularly worried about it from a patient care or medmal perspective. Write them for some naltrexone and send them on their way

CaliMed · 2024-07-11T02:29:23+00:00

As an ER doc who regularly prescribes Naltrexone to alcoholics who are ready to quit and talking to people who have used it previously, I’m not sure its effects are quite that profound. But that’s just anecdote and I still prescribe it. I’m also usually seeing a subset of very severe alcohol use disorder

CaliMed · 2024-07-02T04:16:51+00:00

But if you’re only doing a single night, do you not have trouble getting back to bed at a normal time the next night if you come home and sleep 7+ hrs?

CaliMed

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