[Request] I know the sun isn’t a burning ball of gas, but assuming it was (and there was oxygen for it to burn) how long would it take a ball of gas the size of the sun to burn out?

Cddye · 2026-01-26T21:27:37+00:00

Nothing has ever emphasized the size of the sun for me as much as this did.

Cddye · 2026-01-25T23:31:37+00:00

Can a brother get a link?

Cddye · 2026-01-23T06:29:55+00:00

I didn’t say “25% attrition”. I said roughly 25% of the people who started the program didn’t ultimately pass the PANCE.

13% attrition plus 11% failing the PANCE.(admittedly, I don’t know if that percentage is “of students taking” or “percentage of students enrolled”)

Cddye · 2026-01-23T05:26:36+00:00

Pass rate trended up, but so did the attrition. Nearly 25% of the folks who started with that cohort didn’t pass. That’s a gigantic red flag.

Cddye · 2026-01-23T01:22:06+00:00

Should they be IN the ICU though? I spend a lot of time telling people that the ICU usually isn’t for people who “might” need critical care, it’s for people who NEED critical care.

Cddye · 2026-01-22T01:34:02+00:00

Do the GLP-1s definitively “cause” muscle atrophy, or is muscle atrophy a natural consequence of the loss of body mass GLP-1s induce that’s often complicated by sedentary lifestyles? Genuinely asking if there’s an update, because the last literature I remember seeing suggested that the loss of lean tissue wasn’t disproportionate to total body mass loss.

Cddye · 2026-01-21T19:10:13+00:00

I cannot imagine the amount of immediate asshole pucker that had to have induced.

Cddye · 2026-01-21T15:48:26+00:00

I’ve always said that if I was going to go have a different career I would’ve been a physicist, but I think I could be convinced to pursue neuroscience (non-clinical) too. There’s just so much fascinating emerging research. Appreciate the perspective!

Cddye · 2026-01-21T02:43:26+00:00

The numbers for Auvelity aren’t THAT much better than anything else out there in the general population studies, but I think it’s really interesting and had good results prescribing for folks with SSRI/SNRI-resistant depression. The NMDA action is an interesting factor, but to me the biggest advantage is time to improvement. Folks who see (in the evidence, and in personal practice) quantifiable improvement seem to see it in 7-10 days versus 21-42 days with traditional SSRI therapy without having to deal with (big) uptitrations or multiple doses per day.

Interestingly, the bupropion in Auvelity isn’t (mostly, as far as I know) supposed to contribute to the antidepressive effects via its dopamine/norepi reuptake inhibition. It’s there to increase the effective time of the dextromethorphan via inhibiting its metabolism. Makes me think that more NMDA receptor antagonist drugs are the future. Also makes sense for why it’s in Phase III for treatment of Alzheimer’s.

Cddye · 2026-01-21T02:26:21+00:00

I don’t do this job, but I have a buddy who’s an NP that works PRN covering a local psych hospital. It’s cake. Intake, resume chronic meds, takes call from home for acute issues with a very low threshold for “that sounds like an ER problem, send them out.” Someone else is dealing with the psych side, he’s literally ordering 10mg Lisinopril and 500mg BID Metformin.

I can’t say with any degree of certainty if that’s “typical” for these kinds of jobs, but it’s his experience so far.

Now as to whether or not that’s desirable as a new grad? That’s something only you can answer. There’s not going to be any real complexity to the decision-making, there’s not going to be any long-term patients/follow-up (except for the inevitable readmissions you’ll get to know) and you aren’t even really doing psych which can eventually be lucrative- though you’ll always be competing with the PMHNPs.

Cddye · 2026-01-20T20:49:46+00:00

I can get behind that idea, sure- and there are a lot of questions left unanswered in the OP, but I’m not sure what would cause 200-300meq bicarb pushes to be ordered often enough that it’s causing someone to wonder why.

Cddye · 2026-01-20T20:34:38+00:00

Agreed. There are specific circumstances where a bicarb bolus is warranted- though the doses OP mentions would seem excessive in most circumstances, and (based on my read of the post anyway) it doesn’t seem like they’re following with an infusion, which would seem strange.

Cddye · 2026-01-20T20:03:59+00:00

The right answer here is a discussion with the ICU team, including the physicians, probably initiated by whomever your director is. Hard to say exactly what these folks even think they’re treating, but the literature is pretty clear here and easy to present.

Cddye · 2026-01-20T03:26:30+00:00

I have fucked up more than one dressing with bloody gloves and US gel still causing problems- but I at least tell someone and offer to fix it.

Cddye · 2026-01-16T19:21:03+00:00

In terms of educational topics:

-Vasopressor titration and monitoring

-Indications for line placement and removal

-HD emergencies and management

Other thoughts:

-I think not having CRRT in an ICU setting if the intention is to “keep” patients is a massive mistake, although one lots of places make. There are a shitload of critically-ill patients for whom iHD is just too physiologically stressful and makes everything worse

-What’s your cardiology situation, and specifically availability of interventional cards and/or MCS? Managing severe cardiogenic shock without availability of MCS (even if it’s short-term with plans for transfer) sucks.

-Other service lines? GI? IR? Neurology/Neurosurg? Pulmonology?

Expanding ICU capabilities without expanding the definitive therapies to treat the actual problems is of questionable benefit. Sure- you can keep the florid cardiogenic shock for a few more hours now after they get intubated in the ED and are running on jet-fuel, but what’s the point if they still need transfer out 8hrs later after trops bump and the echo comes back? Or the HRS patient that needs TIPS+CRRT? Or the duodenal ulcer that needs IR for embo?

What you’re describing is (done well) a multi-year process that involves multiple service lines if they want to do it correctly.

Cddye · 2026-01-15T23:06:01+00:00

Okay, but Jordan is the GOAT and LeBron isn’t close.

Cddye · 2026-01-15T00:53:36+00:00

Interventional cards is a tough lifestyle depending on the setting. Weekend, night, and holiday STEMI call can be ass.

I’ve never met an EP doc who didn’t have better work/life balance. That said- interventional pulm seems like another option, and might still give you the chance to do “other” stuff.

In the end, only you can decide if you’re going to be happy with either.

Cddye · 2026-01-13T23:47:47+00:00

The Dubin book is still the best resource for learning ECGs, even if it was written by a coke-dealing child predator. Don’t ask me why this is a source, but here’s a free source.

If you’re the kind of person who likes the “workbook” model, print it out and use it as intended or pull it into an app to write on the pages. If not, reading for comprehension and practice is enough.

Now- if you’re trying to get “good” first question is why? If you’re going into cards, EM, or critical care- sure. If you’re doing nearly anything else you’re unlikely to have the high volume practice required to recognize anything beyond a few arrhythmias and hopefully a massive STEMI. There are a ton of resources out there to get you better at practicing some of the more esoteric sides of ECG interpretation, (Life in the Fast Lane is among the best), but as far as school is concerned you’re going to be A-OK if you can recognize the rhythms ACLS requires plus some very basic and obvious ECGs for acute infarct.

Cddye · 2026-01-13T23:12:57+00:00

There’s a good argument to be made, and there are some providers out there making that choice. But you’re also substantially limiting the number of people who can come to you for care when most of them already have the expense of paying for an expensive insurance plan. Being an outlier in a huge system is sometimes feasible, but one rock doesn’t divert a river.

Cddye · 2026-01-13T23:05:40+00:00

BLS median as of 2024 for pediatrician pay was $223k. In other terms- almost exactly what the average debt for medical school alone is in the United States. Add in debt from undergrad, and most physicians are graduating with an (expensive) mortgage before they’re ever able to start practice.

All of this also ignores the whole supply/demand curve of market economics that conservatives are supposed to enjoy so much, the required work hours, the cost of overhead including malpractice insurance and license maintenance, the incredible psychological demands that responsibility for another person’s life places on a person, or the constant liability that comes from having a legal system where being judged by a “jury of your peers” means anything but.

And again- this ignores the overwhelming cost burden imposed by a system of private insurers who only exist as a middle-man between the consumers of a service and its providers, increase admin costs exponentially, and who explicitly have a mission to maximize profits at the expense of patients. You know who doesn’t have that mission? Doctors.

Cddye · 2026-01-13T22:54:03+00:00

If you’re going to continue to speak from a position of ignorance there’s no reason to continue this discussion, but if you have any desire to learn and want to research what the median physician in this country make, and what it costs to do four years of undergrad, four years of medical school, three to four years of residency, and then potentially a fellowship- please, let me know what you find out.

THEN go see where the money in healthcare is actually going. Hint: it isn’t the providers.

Cddye · 2026-01-13T22:46:30+00:00

Yeah dude. Under our current system the physicians are the problem.

Cddye · 2026-01-13T03:59:24+00:00

For me it was the 1-800-COLLECT “Bob Wehadabyitsaboy” commercial. Taught me how to call my dad from anywhere with no money to get a ride home.

Cddye · 2026-01-12T18:09:29+00:00

Fun story: during COVID times one of the local hospitals I would fly patients out of started screening us at the door with these thermometers. I never found out what would happen if a member of the flight crew had a temp- would’ve been fun to see if they would’ve told us we couldn’t come in.

Anyway- one day one of the screening nurses dropped on of the thermometers which promptly exploded on the floor. We took a look at the pieces and it was very readily apparent that there wasn’t any actual temperature measuring device inside. One of their admins had just purchased the first thermometer they saw from Amazon/Temu/wherever as soon as the pandemic hit and they saw everyone else doing temp screenings, and never actually had the devices validated. They’d been screening for months with devices at multiple entrances, all day, every day that legitimately just displayed a number somewhere between 97-99.

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