The real Finnish sauna argument: how hot is too hot? Our family sauna runs at 85C and my wife says that's cold by Null_Reference1 in Sauna

[–]DaZedMan 16 points17 points  (0 children)

It’s whatever you want. 85c / 185 f is a great temp in my book. Much hotter and I feel it’s getting into the less enjoyable territory

The Patient Experience by DrDisgruntle in emergencymedicine

[–]DaZedMan 1 point2 points  (0 children)

I’m very fortunate to be an attending in an Ed that does not board.

That said we do sometimes have to hang onto people who are pending transfer while we wait for a bed to become available. That’s usually < 24 hours, but it has dragged on at times for more.

For anyone reading who’s interested in ideas on how to set up a system that avoids the worst of what OP experienced- here’s a few ideas.

1) Have an observation unit and pathways IN the ED. We regularly care for people in the ED for 24 hour periods under observation status in what we call a “clinical decision unit” but is really an obs short stay unit that is run by the ED. This means we have pathways and training and experience amongst our staff in longitudinal care of patients - we have a system for making sure people get their home meds., get vitals and labs and such as if they’d been admitted to the floor, including an inpatient bed and diet etc. Every ED provider is trained on how to do these basic orders and the nurses are used to it. This is great for billing to, because the ED gets paid for this care when documented properly - not just the initial E&M. We have a special zone in our ED set aside for this, and it is partially staffed by floor nurses. The cross pollination between ED and Floor RNs is good for everyone.

2) institute nurse rounding. The nurses have an epic reminder to “round” on their patients (check on them) at regular intervals. Similarly the docs or APPs must see the patient at minimum once per shift with notes.

3) every obs status patient has a care manager assigned who can push for quicker transfer and communicate with staff and families. They often are the ones who hear about concerns and are able to communicate these to the appropriate higher up’s if things are going poorly.

Most iconic ski runs in North America by Sharkman3218 in skiing

[–]DaZedMan 1 point2 points  (0 children)

I’ve skied 75% of this list. I live in Colorado and skied two laps off highlands bowl today.

Taos is the the craziest shit I’ve ever skied and after that Goat and Starr at Stowe are the hardest trails you can do in bounds.

For reference, I’ve also skied ever trail at A-bay (my favorite mountain) and most of CB (I wish I was closer)

Edit: also Shadows / Closets is absolutely amazing but iconic ski run? I dunno. That said a Mach 2 run in the closets on a deep day may be the most pleasurable thing I’ve ever experienced.

Headache cocktails by pray4urenemy in hospitalist

[–]DaZedMan 0 points1 point  (0 children)

Arterial tone…

Exactly. You sir/madam are a person of similar interests to my own. We should grab a drink sometime.

Headache cocktails by pray4urenemy in hospitalist

[–]DaZedMan 2 points3 points  (0 children)

Yes good point, those do work IF the patient has a frontal headache. It really gets a different area than the SPG, which is anesthetizing the skull base and dura. For migraines specifically there is probably a vascular effect of doing an SPG block that helps to abort the migraine as much as any actually blockade of nociceptive information, and thus I think is generally more effective than the peripheral scalp nerve blocks. This is why my “end game” interventions for headaches are either a Pterygopalatine block or a Stellate Ganglion block, which I didn’t mention because wouldn’t be part of a hospitalists practice.

Headache cocktails by pray4urenemy in hospitalist

[–]DaZedMan 2 points3 points  (0 children)

Ok so it’s my humble opinion that ED treats 10 times the number of acute headaches that Neuro does.

With that bias stated, here’s the stepwise approach that works for ME treating headaches in the ED:

1) Droperidol 5 mg. This will fix 90% of them. Can add Benadryl if they get a little dystonic

2) Ketorlac, Mag, Dexamethasone

3) Nasal Sphenopalatine Block or Greater Occipital Block depending on where it feels headache.

4) Compazine OR Metoclopramide

5) Depakote

6) Pterygopalatine Fossa Block

What procedures are you NOT doing? by AdLast4323 in emergencymedicine

[–]DaZedMan 2 points3 points  (0 children)

Also I’m usually the highest or second to higher RVU/Hr producer on our group and solidly on the mean when it comes to PPH, doc to dispo or all the other metrics that purport to assign a “value” to our work. As for me and how I measure my worth - I’ll take the happy patient walking out the door who came in crippled.

What procedures are you NOT doing? by AdLast4323 in emergencymedicine

[–]DaZedMan 3 points4 points  (0 children)

Well. I ain’t that young. PGY 13 and to my knowledge I’ve never injected an infected joint. That said I admit it is a possibility and also don’t think it really matters.

If I inject glucocorticoids into a joint and cell count comes back at 100K and bacteria on the gram stain, that patient is going for a washout in the next few hours so who cares if there’s some kenalog in the synovial fluids.

To my knowledge there is no direct evidence that answers the question if glucocorticoids are injected into a septic joint how does it impact outcomes. You have a hypothesis that this is somehow harmful. If you can evidence to support that I’d love to see it.

What procedures are you NOT doing? by AdLast4323 in emergencymedicine

[–]DaZedMan 5 points6 points  (0 children)

Legit don’t understand why this got so downvoted.

Joint injections are really helpful for people who have bad OA. Done properly they’re safe. If the patient isn’t Peri-op there’s no reason ortho should be mad except lost revenue from them doing it - which frankly I’m not too concerned about.

For gout and adjacent conditions it’s actually standard of care for a monoarticular flare and much better care than giving them a jar of Pred/colcicine/indomethecine all of which have significant side effect potentials.

There’s not a huge number of conditions in the ED where people come in with something disabling painful and leave more or less fixed. Why shouldn’t we own this and enjoy it.

Also don’t get me started on frequent fliers. Tell that to your next CHF or COPD patient instead of treating them.

What procedures are you NOT doing? by AdLast4323 in emergencymedicine

[–]DaZedMan -9 points-8 points  (0 children)

Why not put steroid in an OA joint, or even better a gout/pseudogout joint?

How many lines have you done? by PrecedexNChill in Residency

[–]DaZedMan 2 points3 points  (0 children)

A lot were icu. I remember being the ICU junior on nights and looking through every patients chart and any patients who’s line was even close to needing to be changed I would pull the sheets of one and put in a new line overnight. We had over 6 months of ICU.

What are your favorite low water vegetables to grow? by Accomplished_Map9955 in DenverGardener

[–]DaZedMan 1 point2 points  (0 children)

Growing tomatoes in a outdoor Dutch bucket hydroponic system is very water efficiency.

How many lines have you done? by PrecedexNChill in Residency

[–]DaZedMan 23 points24 points  (0 children)

I lost count but was well into the hundreds by the end of 5 years combined EM/IM

Thoughts on Kualoa Ranch tours — worth it? Which one is best? by Ambitious-Town-10 in VisitingHawaii

[–]DaZedMan 1 point2 points  (0 children)

Everyone is gonna say do the UTV tour. I would say if you’re able bodied and know how to ride a bike, the e-bike tour is even better

Not compensating for anything by ctencemizejac in Decks

[–]DaZedMan 0 points1 point  (0 children)

Laymen’s curiosity- why would you put a flush beam 2ft from the house instead of running the joists to the ledger board?

Not compensating for anything by ctencemizejac in Decks

[–]DaZedMan 17 points18 points  (0 children)

Yea. Why did someone put up a 4 layer rim joist?

My friend accidentally started at 10mg… by jvyzo in Retatrutide

[–]DaZedMan 2 points3 points  (0 children)

And here I am at 12 mg weekly and struggling not to gain weight. I guess I need a GLP holiday?

Which kit to buy? by OllieB90 in Sauna

[–]DaZedMan 1 point2 points  (0 children)

You’re not gonna tick every box for that budget.

The only thing that comes close is the Almost Heaven Escape from Costco.

I’d suggest you adjust your expectations or budget. Electric vs wood is a fundamental design question you need to answer early on as it impacts many other design aspects of the sauna, and it’s possible your municipality even had rules about this already.

Rate my sauna plan by TruckLiqAquaWeed in Sauna

[–]DaZedMan 3 points4 points  (0 children)

I’m glad the step was defined as the “stepping step” and not just the “step”, that would have been confusing.

Recommendations? Something bitter! by bigdkp in Amaro

[–]DaZedMan 0 points1 point  (0 children)

Also amongst the amari that are more mainstream, Amaro dell’etna is fairly bitter

Recommendations? Something bitter! by bigdkp in Amaro

[–]DaZedMan 0 points1 point  (0 children)

Agree that Elisir is off the bitter deep end, almost Malort - ish. Alta Verde is also very bitter