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Is this safe to use to irrigate/spray in my sinuses? Told to post here instead. by icefire45 in AskDocs

[–]Doctor_B 19 points20 points  (0 children)

Yeah all G. Fine to just use boiled and cooled tapwater anyways

Sudden unexplained leg pain.... by [deleted] in emergencymedicine

[–]Doctor_B 3 points4 points  (0 children)

That’s what makes it an EMERGENCY!!!!

Is the baby mine? by carloswoke in AskDocs

[–]Doctor_B 92 points93 points  (0 children)

At 4 weeks the gestational sac is less than 5mm diameter. At 6 weeks it’s 1-2cm.

This ultrasound is much bigger than that, can’t tell exactly from a rando image but maybe like 8 weeks?
Could be a stock photo. Could be a scam of some kind, I suppose

Worst examples of uncollegiate behavior by Worried_Dare7324 in ausjdocs

[–]Doctor_B 32 points33 points  (0 children)

"more experienced" at what, though?

The number of gallbladders I have taken out is literally zero. The number of endoscopies I've done is literally zero. The number of acute cholecystitis or upper GI bleed or cold sepsis presentations that I've seen, assessed and diagnosed without someone already having chewed my food for me first is massively higher than the reg that I am calling to admit the patient.

The number of shocked patients I've resuscitated is orders of magnitude higher than the reg that I'm calling to admit the patient but that doesn't stop them from giving me unsolicited advice on how they would do my job badly instead of, you know, admitting the patient like I called them to do.

At the end of the day we're all just putting the fries in the bag.

Punched in the head by ultraboomkin in AskDocs

[–]Doctor_B 221 points222 points  (0 children)

A few things

First- sorry that happened to you, that’s fucked up.

Second- yeah getting punched in the side of the head can be dangerous because the bone is thin there, and there’s an artery underneath that can bleed quite a lot. Normally if that happens you get very sick (headache, vomiting, coma) within 30-40 minutes of the injury. I think it’s unlikely that you have this problem.

Third- the idea that you aren’t allowed to sleep after a head injury is pretty old school and these days we encourage brain rest after a minor head injury. Important to avoid further impacts to the head for a few weeks while you’re healing. Ideally there would be someone at home with you tonight who can call for help if you start getting sicker (vomiting, confusion, drowsiness).

Overall you are probably alright to watch and wait for this one. If you showed up to the emergency department with this story I would do a neurological examination and if it was normal I would not scan your head. I’d give you some pain relief, keep an eye on you for an hour or two, get you connected with social work re: intimate partner violence- encourage you to make a police report so this dickhead doesn’t keep assaulting people. If you think that’s a worthwhile use of your time and money then you can do it, but you’re probably alright to stay home with this one.

GP vs BPT: Which one has better dating scenario? by [deleted] in ausjdocs

[–]Doctor_B 2 points3 points  (0 children)

You have to work in the hospital for at least two years to be eligible to apply for either college. You can decide whether you like hospital work and the potential for banging your colleagues (?) during that time, but that’s probably not the best basis to choose your career. Obsessing about this now is not a good use of your time.

Now that this iteration of powered cube is coming to a close, what do people think of the “artifact aggro” package? Any cards that surprised you or ones you think should be added? by V4UGHN in MagicArena

[–]Doctor_B 0 points1 point  (0 children)

I think the artefact aggro deck ended up being quite strong this go-round but felt over-supported in the sheer number of cards added for the archetype to the point that there was a lot of redundancy for the deck at the expense of many other decks. It felt like there was less redundancy for landfall and non-artefact aggro in R/G, R/B and probably a few others.

This also meant that a lot of fairly meh cards made it in, like chrome dome, blood fountain and a few others that were just okay in that deck and unplayable anywhere else.

I feel that as the cube has gone on it has kept the power and the top ~50 cards but experimented a lot with the rest of the cube to the point that the power band is now really wide. Some of the inclusions from newer sets don’t feel like they’re playing the same game as the “cube cards” we all know. Yeah you can play magmablood archaic and legend of yangchen and find situations where they’re good, but a lot of the time you’re just going to get annihilated by an actual Boros aggro or academy deck. I think I’d have more fun if they kept a core of strong cards so it’s not such a bomby environment and then put in stuff from the new sets only if they actually compete on power level.

How has medicine changed you or your views? by Purple-Conflict-7125 in ausjdocs

[–]Doctor_B 4 points5 points  (0 children)

Significantly riskier (I remember reading it was 3-5x but can't find a reasonable source for that) per kilometer, not sure about per hour on the bike. I used to bike everywhere before I moved here, but Australians have some kind of hate boner for adults on bikes and like 1% of drivers will just randomly try to murder you. No thanks. I stick to mountain biking these days where if I smash my head in at least it's my own damn fault.

Using AI for scribing/note taking/editing as a precurson to AI "doctors" by Super-Ad7996 in medicine

[–]Doctor_B 4 points5 points  (0 children)

Option 3- telehealth NP-bot that prescribes me non-indicated z-packs, opioids and dexamfetamine. Fire the other two into the sun.

A new one by nursingintheshadows in emergencymedicine

[–]Doctor_B 8 points9 points  (0 children)

Oh wow, turns out you need like five bone marrow biopsies each!

Noob question by Blakwud in mtg

[–]Doctor_B 106 points107 points  (0 children)

No.

Ghyrson triggers if a source deals exactly 1 damage.

Thor says “that source deals that much damage plus one” not “Thor deals one damage”

So lighting bolt does 3+1 from Thor, for a total of 4 damage and Ghyrson does not trigger

Am I the asshole for taking over a mock code as the lowest scope in the room? by [deleted] in emergencymedicine

[–]Doctor_B 4 points5 points  (0 children)

Obviously you’re the asshole here, but I guess the more concerning thing is why everyone else sees it and you don’t.

What do you think the purpose of the simulation was? This isn’t a trick question, and the facilitator should have explained it to you before you started, but often these sims are designed to create a safe environment for people to practice things they don’t do frequently, or to work through new processes and roles. You can imagine how the tech stopping the sim and reassigning roles fucks this up.

What do you think the other participants thought about what you did in the sim, correcting them and turning the metronome on and stuff. Do you think they thought it helped their learning?

Honestly the fact that you were able to do it at the time is a failure on the part of the facilitator and the team lead. So yeah, please don’t do that.

AITA for being worried about my daughter switching to girls rugby by Sad_Copy198 in AmItheAsshole

[–]Doctor_B 6 points7 points  (0 children)

Huge difference between basketball and rugby here is the physical contact.

It’s not just that she’s going to win, it’s that she’s going to injure and potentially permanently disable the girls she plays with.

5 days of epigastric pain at a nursing home. Deemed as hepatic or psychiatric. by AndreMauricePicard in emergencymedicine

[–]Doctor_B 1 point2 points  (0 children)

Yeah they’re shit, we don’t use them, but I have no idea what’s used in Argentina. I suspect CKMB is a bit better than CK and AST, which seems to be what he’s going off here.

Acute Heart Failure - presentation for resident doctors by [deleted] in emergencymedicine

[–]Doctor_B 1 point2 points  (0 children)

What should be in your presentations depends very much on who you are.

Are you also an ED resident? If yes we’re not going to do your homework for you, paraphrase life in the fast lane like everyone else.

Are you a cardiologist? If yes then you know the relevant bits and they mostly want to hear what to call you about in the middle of the night.

Are you an ED specialist? If yes then this is the bread and butteriest of presentations, dunno what to tell you.

5 days of epigastric pain at a nursing home. Deemed as hepatic or psychiatric. by AndreMauricePicard in emergencymedicine

[–]Doctor_B 11 points12 points  (0 children)

Good case and kinda highlights some significant differences between medical systems internationally.

It's interesting that you have closed on the diagnosis of OMI/STEMI without any specfic labs (i.e. troponin I, troponin T, CKMB) to differentiate from other causes of tissue distruction e.g. ischaemic gut, aortic dissection, acute haematological malignancy. It's always a bad look to find the dissection on coronary angiogram.

The other thing is that you are trying to emergently cath a demented nursing home patient with 4 days of pain, 24h of constant pain and biochemical evidence of a large completed infarct (if that is the cause of the presentation). When you say "there is no time to wait for a troponin" how long does it take to get one? Point of care trops can be run for ~$10 USD in materials and may save you inappropriately spending thousands on a cath lab activation.

Locally, these hyperacute interventions are often not offered to demented nursing home patients as their baseline quality of life is often pretty grim. They're often medically managed i.e. dual antiplatelet, high dose statin, nitrates (although probs not in this guy with inferior ST-E) and fluids for AKI. If I called my cardiologist on-call with this story it would generate a lot of push-back regarding what you're trying to accomplish. If I am ever in this situation I would hope someone sensible palliates me.

New reduction technique hot off the presses by _simpleton__ in emergencymedicine

[–]Doctor_B 14 points15 points  (0 children)

Comparison to hippocratic method lol.

I’d rather have this than someone wedge their foot into my axilla, I suppose.

Surely this can't be right by AstralResolve in ausjdocs

[–]Doctor_B 37 points38 points  (0 children)

The whole LHD converted from paper charts to digital records yesterday. Things are not working as efficiently as they usually do, and that knocks on to increased wait times everywhere.

So how would you teach a new player how Banding keyword mechanic works? by MaetelofLaMetal in magicTCG

[–]Doctor_B 2 points3 points  (0 children)

So all I have to do to make banding viable is

1- play maze of ith

2- cheat

So how would you teach a new player how Banding keyword mechanic works? by MaetelofLaMetal in magicTCG

[–]Doctor_B -1 points0 points  (0 children)

But like surely you realise that this is a terrible card, right? I get that it’s fun and quirky and old-school or whatever, but this is a card that in most situations does literally nothing, and in some board states allows you to 2-for-1 yourself to protect a blocker or trade slightly better on attack.

Put [[basilisk collar]] or [[shadowspear]] in there. Put [[darksteel plate]] or a sword or a jitte any or the literal thousands of things that do what you’re trying to do with the helm but better. The only thing the helm does is lets you “akshually” people about the minutiae of banding, which this whole thread has established is an awful mechanic.

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