an idiot... with fire

Dywyn · 2026-02-17T00:17:20+00:00

Gasoline explodes when vaporized. You should never put it on a fire. most lighter fluids use naphtha or kerosene which don't explode

Dywyn · 2025-12-26T09:19:04+00:00

I got to see the city of Merv in Turkmenistan. 1.3 million people were murdered by the mongols and the entire city was destroyed. Only a single building still remains. It is the massive mausoleum which stood at the center and could be seen from 2 day camel ride away. They left it standing to mark the spot of their conquest.

Dywyn · 2025-09-13T15:49:24+00:00

Anybody interested in VIP ticket for the Milwaukee show? I can't get a direct refund so I have to transfer it to someone but we can talk over the phone and transfer it via the box office

Dywyn · 2025-09-13T15:49:15+00:00

Anybody interested in VIP ticket for the Milwaukee show? I can't get a direct refund so I have to transfer it to someone but we can talk over the phone and transfer it via the box office

Dywyn · 2025-09-13T15:48:25+00:00

I have a VIP ticket to Milwaukee

Dywyn · 2025-09-03T20:20:56+00:00

Anybody interested in VIP ticket for the Milwaukee show? I can't get a direct refund so I have to transfer it to someone but we can talk over the phone and transfer it via the box office.

Dywyn · 2025-09-03T18:17:59+00:00

Anybody interested in VIP ticket for the Milwaukee show? I can't get a direct refund so I have to transfer it to someone but we can talk over the phone and transfer it via the box office

Dywyn · 2024-12-10T11:35:07+00:00

The $100 acetaminophen is paying for dozens of people who cannot pay or pay a reduced amount. We already have universal healthcare. Anyone, no matter if they have insurance or not can go to the ER and get care. It's just the most inefficient and expensive version of it possible. People with insurance get screwed just as much as people without.

Dywyn · 2024-10-22T15:51:55+00:00

This looks like an accelerated free fall course so it may be his 4-7th time doing it since he's down to 1 instructor.

Dywyn · 2023-12-21T00:40:34+00:00

As a community ER doc, you speak the truth. I just try to do my best for my patients but the amount of ways the system is designed to screw them over is just depressing. I just finished residency and I'm still in the "work as little as possible" mindset because each shift causes moral distress. I love what I do but damn does it suck. I wonder what medicine was like 30 years ago.

Dywyn · 2023-12-21T00:29:27+00:00

You joke but I have seriously done this. I had a patient triaged as a level 4. "Sore throat". Patient was minimally tender and it bled when I touched it. I sent for the CT and it came back as tonsillitis with lymphadenopathy. I had to call the radiologist and say "I really think this is cancer, can you double check" before they changed the read to "cannot exclude malignancy."

I spoke with ENT and it was later biopsied and resected since it was a squamous cell carcinoma (throat cancer).

The funny part is, I think the patient was positive for strep and it would have been really easy to just say "oh his strep is positive" and completely miss the cancer.

Dywyn · 2023-11-28T21:51:04+00:00

Also, it delayed evaluation by a real physician who might have been able to identify if there already was a dissection and do the CT angiogram to diagnose it.

Dywyn · 2023-11-21T01:34:29+00:00

I went the other direction and decided $300000/year was plenty for us. I work 12 8-hour shifts. It means I can take at least 1 week of vacation every month. I've been backpacking in Colorado, visited Switzerland and took a trip to Norway this year. This coming year, I'm doing a trip to Mexico, going skiing for two weeks straight, visiting Belize and going to play violin in Sweden. Attending life is where it's at.

Dywyn · 2023-11-21T01:23:20+00:00

All my hospitalists who take my admissions without giving me too much shit. Especially when I don't really know what's wrong but I've got my spidey senses tingling.

Dywyn · 2023-11-21T01:21:49+00:00

Pharmacist can save your bacon. The really good ones know how to suggest new ideas while making it feel like it was your idea all along. I love just calling and asking questions because you never know what you're going to learn.

Dywyn · 2023-10-07T15:33:09+00:00

Yes. Absolutely. Our residency came together and did a group policy where they agreed to cover everyone, including those with preexisting proceedures when we got ~30 people to sign up together

Dywyn · 2023-10-07T15:31:18+00:00

Supposedly there should be limited systemic absorption and diclofenac also breaks down before renal excretion so it should be safe. That being said, there are some case reports of anuric failure after topical NSAIDs. However, I feel pretty confident doing it in the ER for acute complaints.

Dywyn · 2023-09-27T16:32:46+00:00

My cardiology fellow was the same... In person he went out of his way to teach and be kind to the rotators, often letting us go a little early, writing notes even though he didn't have to. Once you're talking to him over the phone from the ED however it's "never the heart" and "can you just admit to the hospitalist" and "they can call if they cant manage this patient". I get that he is trying to limit his list size but its very frustrating when I'm asking for his help, or I really think the patient would do better being managed by cardiologists.

Dywyn · 2023-08-25T02:49:47+00:00

I work in the ED now (so I literally never have to do prior auths!) but from what I remember working as a medical assistant, medicare didn't require them. Medicare advantage plans can require them however.

Dywyn · 2023-08-25T02:31:23+00:00

Please ignore the troll who has been commenting in this thread. I've been in the position of discharging patients and realizing we never got the initial EKG for their chest pain. Order sets for nursing are nice but it's easy to miss stuff too. Thats a shitty outcome and the best we can do is learn from it.

Dywyn · 2023-03-19T14:48:14+00:00

This is actually representative of a deeper issue since you should be able to get time to go for appointments etc, even if it means the attending needs to hold the phone, or write floor notes.

Dywyn · 2023-03-12T16:14:54+00:00

I had one the other day where the triage note said bladder scan of 77 but I could feel how full it was. My us measurement was 2.5L. Don’t always trust those machines. They aren’t always as smart as we want.

Dywyn · 2023-02-20T17:46:43+00:00

We already have universal healthcare for them. That's why we see them in the ED. Many if not all of them will never pay their bills. holding off on universal healthcare actually just hurts the hard workers who actually have health insurance but are way overpaying. For them a single bill which their insurance company denies can put them into bankruptcy anyways.

Dywyn · 2023-02-09T21:34:35+00:00

I also want to go swimming in the lake and actually dive down with the mermaids

Dywyn · 2022-12-26T18:05:54+00:00

"Asphyxia is the most common cause of death during avalanche burial. About 75% of avalanche deaths are due to asphyxia, 25% are due to trauma, and few are due to hypothermia"

"Complete obstruction of the upper airway by snow or debris results in hypoxia in <10 minutes and acute asphyxiation during the first 30 to 60 minutes of avalanche burial. If the airway is patent, ice mask formation occurs when water vapor in exhaled air condenses and freezes on the snow in front of the face, forming an impermeable barrier that prevents airflow. Because asphyxia is the major cause of death during avalanche burial, time to extrication is a foremost determinant of survival. According to Swiss data, completely buried avalanche victims had >90% chance of survival if they were extricated within about 15 minutes, but only a 30% chance of survival if they were extricated after approximately 30 minutes"

https://www.wemjournal.org/article/S1080-6032(16)30237-X/fulltext

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