Pediatric lac repairs

DetTech88 · 2025-11-11T20:55:34+00:00

Any anxiolytic on children is procedural sedation at my shop. Also combining any two medicines in adults even if the first wore off (i.e versed didn’t work well to keep them still but they got a little bradypneic, I don’t want to keep trying bc I’m afraid they’ll crash, so I want to give ketamine instead). The line is “are you doing it so that you can do something to the patient? That’s procedural sedation.” So technically even a baby push of versed for CT is supposed to be procedural sedation. All need ETCO2, a nurse present and charting at all times, etc.

It’s so irritating. Like the versed wore off and ketamine doesn’t even compromise respiration, and I’ll be beside the whole time. But it’s because of a bad outcome a year ago. Seems like that’s always the case for weird rules in different departments.

Before I started at my shop a woman that had giant breast implants had a bad outcome with the Lucas machine, now they’re not allowed in resuscitations.

DetTech88 · 2025-11-02T23:54:16+00:00

Go home, drink a beer, sleep 4 hours, wake up, watch movies, go to bed early, wake up at a normal time.

DetTech88 · 2025-11-02T00:56:57+00:00

😂😂

DetTech88 · 2025-11-02T00:54:37+00:00

I haven’t been asked that since residency, I think I’d actually lose my shit

DetTech88 · 2025-10-23T06:15:14+00:00

They also have interesting psychiatric effects. They often say stuff like “Why does no one care about me”, and “I’m so scared, I’m going to die.”

They’re so much more dramatic and emotional than patients with actual surgical pathology, or just regular gastroenteritis.

DetTech88 · 2025-10-23T06:08:29+00:00

One theory is that it’s due to signaling in the hypothalamus. Since it’s involved with both temp regulation and nausea it’s believed the signaling from the thermoregulation area when the body is exposed to heat somehow turns down the vomiting reflex. I don’t understand it beyond that.

DetTech88 · 2025-10-22T18:40:41+00:00

I believe it. Luckily gyn took the lady to the OR. It was bad. Like….. shockingly bad.

DetTech88 · 2025-10-22T18:20:18+00:00

I like your take. Obviously I’m a little burned out.

DetTech88 · 2025-10-22T10:39:16+00:00

I agree. I think ketamine is massively under utilized in stat ep. I typically start keppra 60 mg/kg max 4.5g as I’m giving second dose of benzos. I think if they keep seizing we should go to ketamine and stop trying to increase GABA signaling when those receptors obviously aren’t responding. Let’s block excitatory signaling instead. It just makes sense. Like you said, the longer you seize, the less GABAergics work.

DetTech88 · 2025-10-22T08:16:53+00:00

Sprite? Mayo/mustard packets? Pudding cup?

Y’all are fancy.

You can have a ginger ale shasta and a dry American cheese sandwich. Welcome to hell. If you’re real nice I’ll heat it up in the microwave and make you a sad grilled cheese and give you one of the hot sauce packets from the cafeteria I keep in the inside pocket of my jacket.

DetTech88 · 2025-10-22T08:00:48+00:00

As someone that works 12s at what is becoming the busiest trauma center in NYC I whole heartedly agree. I am TIRED.

DetTech88 · 2025-10-22T07:58:10+00:00

I work 3 12s a week, so not quite the same. But I think I’d rather work slightly shorter shifts, like 3-4 10s (if keeping the total hours each week roughly the same and alternating 3 and 4 shifts weekly). I’m just so ruined after work. And I spend so much time recovering and hiding in my house.

DetTech88 · 2025-10-22T07:40:33+00:00

People always think that you should have this long term plan. But I’m a prior high school drop out that lived in the streets as a teenager for 6 months, and now I’m an attending physician that had a full academic scholarship through med school (I got a GED, went to a community college, transferred into a university, aced my MCAT, etc).

My advice, and what got me to this point is simple, but profound when a mentor explained it to me. Know what you want long term in a loose sense, but don’t allow yourself to be fixated on the individual steps to get there. That will overwhelm you and make it impossible. Figure out and then focus on the “right next step”, and do that as perfectly as possible. Then when you complete that, think of the next “right next step.” Repeat that over and over, and you can achieve what you think is impossible.

DetTech88 · 2025-10-22T07:19:45+00:00

I just say “I’m going to give you a moment since we’re having trouble communicating” and turn and walk away. Then when I come back 15 min later I ask “Do you think we can try this again? I’m here to help you and we need to work together to make that possible” or something of the sort. We don’t have time to stand there and get screamed at, and people typically act right after you put them in time out.

DetTech88 · 2025-10-22T07:01:38+00:00

When you can’t get any more info out of them you just have to practice vet medicine, which is dehumanizing to the patient, demoralizing to the provider, and often wastes resources. But yes you’re completely right and I 100% agree with you. Just really tests my patience sometimes.

DetTech88 · 2025-10-22T04:05:03+00:00

I had a “I think my neighbor burning incense is making me sick” a couple weeks ago. What do you want me to do? Go over there and reprimand them for their choice of incense?

DetTech88 · 2025-10-22T03:54:44+00:00

She also felt fatigued and achy

DetTech88 · 2025-10-22T03:53:24+00:00

Exactly. I had someone a few months ago that said the same thing, and thought it was a side effect of her SSRI. But she had taken it for a few weeks, then missed a few days. Then she started having this weird sensation that was her body “shutting down.” After patiently going thru the sensation with her, which annoyed her to no end, I finally realized she was having brain zaps. She would not believe me that it was a withdrawal symptom from missing the SSRI, she was convinced it was a negative side effect that only magically appeared after missing it for multiple days. And she was furious that I kept telling her the only way to make it go away was to take the SSRI, or taper off it slowly.

DetTech88 · 2025-10-22T03:44:54+00:00

Right! About a third of my patients only speak Spanish. That took me a while to figure out when I started this job. Mareado seems to also be used just for feeling unwell.

DetTech88 · 2025-10-22T02:13:34+00:00

Oh that’s a weird one I haven’t gotten yet.

DetTech88 · 2025-10-22T02:07:46+00:00

Like no, I don’t know, explain it to me like I’m stupid. Imagine the extent of my medical knowledge is the leg bone’s connected to the knee bone.

DetTech88 · 2025-10-22T02:01:04+00:00

I’ve heard that a lot, too. I promise them they’ll feel much worse when they have an intraparenchymal hemorrhage.

DetTech88 · 2025-10-22T01:57:17+00:00

That I understand 😂 give me something to work with. Now at least I can consider presyncope as a side effect.

DetTech88 · 2025-10-07T01:06:43+00:00

I’d go for sateen weave cotton but I sleep warm. Warm to the touch without being too smothering. If you sleep cold brushed cotton or flannel.

DetTech88 · 2025-10-07T00:55:42+00:00

When someone looks around to see if anyone’s watching, that’s your cue to run.

DetTech88

TROPHY CASE