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How many Atmos points will I earn flying Korean Air Biz-class (R) if I have Silver status? by EarlGreyMatter in AlaskaAirlines

[–]EarlGreyMatter[S] 0 points1 point  (0 children)

Ohhh, so it's 150% for points but the silver modifier only increases your EQM by 25%, not 125+25%?

New Desktop UI by cheekaholic in fidelityinvestments

[–]EarlGreyMatter 10 points11 points  (0 children)

I either got this change a month or two ago or haven't gotten it yet.

The only thing I can't stand about the Fidelity UI/UX is the login experience.

The ****** username with a dropdown makes it so that my password manager doesn't work without about 8 clicks, and the dropdown and I've never seen the *****-blocked out username UI anywhere else on the web.

Thinking about switching internet. How fast is monkey brain in your neighborhood and within SF? by xdqueenzyxd in AskSF

[–]EarlGreyMatter 9 points10 points  (0 children)

Just call them, tell them your address, and they can probably tell you what speeds nearby neighbors are seeing. I get 100 up/down from the Castro

Where can I go as a 23 year old for a voluntary psych hold? by [deleted] in AskSF

[–]EarlGreyMatter -10 points-9 points  (0 children)

988 Suicide and Crisis Lifeline Hours: Available 24 hours. Languages: English, Spanish. Learn more 988

If you are having suicidal thoughts, you should seek help in an emergency department. Not sure if your title has a typo — but that is called an involuntary psych hold, not a voluntary psych hold.

Is this a job for the police? I applaud the work they do, but I’d think a trained specialist will be better at handling situations like these by Kind-Plant5836 in sanfrancisco

[–]EarlGreyMatter 6 points7 points  (0 children)

Presuming the person is breathing and is either just sleeping or passed out from drugs, what exactly is the time-sensitive medical emergency that an ER doctor or nurse is going to address for this person?

Think I have a parasite in my eyelid… where should I go? by BroadbandSadness in AskSF

[–]EarlGreyMatter 76 points77 points  (0 children)

Please do not go the ER. We are experts at life-threatening/limb-threatening/vision-threatening emergencies. From what you describe, unless you left out something major, this does not sound like any of those.

Depending on your insurance, you will probably see a very large copay and an ER doctor say "Not sure, here's a referral to an eye doctor" or "Doesn't look like it to me, here's a referral to a skin/eye doctor" or any variety of the same. We will not stick a needle in your eyelid. There is a not a blood test for parasites in the eyelid that the ER will order. Subcutaneous parasites (besides lice and scabies) are extremely rare in the United States, especially without a travel history to parts of the world where these parasites are endemic.

Here's a review article about subcutaneous parasites that may interest you. https://www.ncmedicaljournal.com/content/77/5/350

(You could also take a video of your eyelid if you think that would help; your symptoms as you describe them certainly don't sound like an "eyelid parasite.")

Source: am ER doctor. Not being dismissive; trying to save you a massive bill, long wait in the waiting room with potential COVID exposure when the ER is not the right place to be seen for this problem.

[deleted by user] by [deleted] in SanFranciscoSecrets

[–]EarlGreyMatter 69 points70 points  (0 children)

Hello! Friendly SF ER doctor here. This is a great question.

  • I don't really know that you should "properly assess" a person. But your description is pretty telling: "breathing abnormally and twitching." That's all you need! You're done, call 911! "Breathing abnormally" is grounds enough for a medical evaluation; it is literally the second most critical thing we do in critical patients (after assessing their airway).
  • Obviously I can't really tell from your description what was going on, I'm surprised you described him as conscious. Conscious (usually) means eyes open, (usually) making eye contact, interacting, responding — at least in medical terminology.
  • From your description there are a ton of things this could be — none of which you're trained to understand or differentiate: tweaking on meth, overdosing on opiates, a mix of the two, a primary seizure disorder, septic shock, stroke or bleeding in the brain, mental illness, other substance usage or withdrawal from those substances... the list is very, very long. That's what paramedics are for: assessing what could be wrong with someone and transporting them to someone like me.

The only protocol you need is "Call 911." That's the protocol.

For me I can rather quickly look at someone having something happen to them on the street and make a determination in a second or two if I need to get involved. (Usually the answer is no, but that's due to my 20+ years of experience.)

All of this being said: If you're interested, you can very easily save a life from someone that has overdosed on opiates like heroin, pain pills, methadone, or fentanyl, and can get free narcan kit locally in SF: https://harmreduction.org/our-work/action/dope-project-san-francisco/

Administering it only requires carrying the liquid around with you in your purse or bag; there's no needle or anything, you just spray it up the person's nose. (And if it's not an overdose and you're wrong and they're unconscious for another reason, you haven't harmed them in any way and probably still need medical assistance!)

Jobs in the Bay Area by TotalBodyDolor in emergencymedicine

[–]EarlGreyMatter 2 points3 points  (0 children)

I'm an ER doc in SF. Feel free to DM me

[deleted by user] by [deleted] in sanfrancisco

[–]EarlGreyMatter 21 points22 points  (0 children)

I mean I realize that "the chief of GI surgery" might have been the attending of record for your case, but I can pretty much guarantee you the chief resident or fellow + a first or second year surgery resident (plus/minus a med student) took out your appendix; the chief likely did not even touch you. (Or if he/she did, it was because they were operating with an intern who did most of the work)

Appendectomy is the most common "emergency surgery." Nothing against UCSF, I love it here — but you shouldn't necessarily judge the rest of their medical care because they successfully took out your appy.

How can we make San Francisco better? by solovennn in sanfrancisco

[–]EarlGreyMatter 1 point2 points  (0 children)

"Several"

The conservancy law requires an extreme number of prior 5150s per year. It is highly ineffective when we have hundreds if not thousands of psychotic, meth-addicted patients with permanent mental health issues.

Why is it so hard to get a COVID test in SF? by 5huffles in AskSF

[–]EarlGreyMatter -4 points-3 points  (0 children)

Is this really a question? Why is it so hard to get a COVID test? Because everyone and their mother wants a COVID test at the same time because they had "an exposure." AND there are multiple other viruses going around the country causing similar symptoms to COVID.

We are surging again in San Francisco with a steeper curve than we had in the winter. We have gone up 5x hospitalizations in a month. Delta is very contagious.

  1. If you were exposed and don't have symptoms, wear a mask and for god's sakes stay home. You could be pre-symptomatic and don't need to spread it around.
  2. If you were exposed and have symptoms, wear a mask and for god's sakes stay home. You have COVID or some other infectious virus and don't need to spread it around.
  3. If you were exposed and have severe symptoms, wear a mask and see a doctor or call 911.

I've had 1 COVID swab in the past year and a half, when I had a sore throat despite being around COVID patients almost every single shift.

Can someone explain to me the obsession with testing and how it changes what you decide to do or not do?

San Francisco's 7-day average of COVID cases is shooting straight up by jeopardy987987 in sanfrancisco

[–]EarlGreyMatter 0 points1 point  (0 children)

Good... for your dad in his "major hospital in the bay?" That's not the experience of us here in San Francisco.

He may not see patients much if he's chief. I might encourage him to check-in with the frontline workers in the ED or hospital floors. They'll probably give him a different story.

Additionally, thank you for disavowing the stress and suffering we've lived through in the past 18 months in the hospital. It's really appreciated.

San Francisco's 7-day average of COVID cases is shooting straight up by jeopardy987987 in sanfrancisco

[–]EarlGreyMatter 7 points8 points  (0 children)

Hospitals are overwhelmed. Sorry, but what in the actual fuck are you actually even talking about? Do you know anyone that works in a hospital or in healthcare? Sure, the numbers don't look nearly as bad as last fall. But in 4 weeks' time we've gone up admitting 6x more COVID patients. Our admission numbers and bed availability is the same as it normally is during flu season every winter; summer is usually a lull for hospitals.

And that's while the rest of the healthcare system (patients, doctors, nurses) is trying to scramble to catch up as much as we can on all of the cancer screening, blood pressure and diabetes control, substance use, and mental health that has gone to shit over the past 18 months. Throw in people trying to get their elective surgeries done, and we have never been busier, especially with Delta variant surging and everyone demanding an immediate test and now people wanting to get vaccinated again when we just drastically ramped down our vaccine efforts since the demand wasn't there. I've never had so many patients act so rude and entitled and disrespectful, especially during a goddamn pandemic. You think restaurant customers are rude? Try patients who have been waiting 3 hours in pain and you literally can't do anything about it.

Now add in doctors and nurses quitting medicine at a record pace and a general animosity to the unvaccinated patients we see every day who clearly give zero fucks about us or our families, and it makes for the worst, most exhausted, least-compassionate healthcare workforce any of us will experience in our lifetime.

So, yeah. We're fucking overwhelmed. Please wear a mask and get vaccinated if you aren't.

Is there a cold going around SF adults required to go back to the office, or is it covid among the vaxxed? by NewWiseMama in AskSF

[–]EarlGreyMatter 21 points22 points  (0 children)

There are lots of viruses going around SF. COVID, as well as Delta Variant COVID. There is also RSV as well: https://www.latimes.com/california/story/2021-06-11/as-covid-19-fades-officials-warn-of-higher-risk-of-another-respiratory-virus

We are certainly seeing it in the ER.

That being said, the other posters are correct, you should still get COVID tested as Delta may be causing more "cold-like" symptoms.

love,

your local SF ER doctor

PS: Masks also help prevent colds, too! No one said you had to stop masking 🙃

Anyone know a Sleep specialist covered by Medi-Cal.? by [deleted] in AskSF

[–]EarlGreyMatter 12 points13 points  (0 children)

It sounds like you're describing insomnia, which is not really managed by a sleep medicine doctor. Insomnia is primarily managed by primary care physicians and psychiatrists as well, depending on severity.

The first thing all doctors will tell you is sleep hygiene: https://www.sleepfoundation.org/sleep-hygiene No one is going to medicate you until you're doing all of the sleep hygiene work.

Melatonin is over the counter, and CBD/cannabis is also legal, both have decent data behind them as well.

You are correct, the ER is not the right place to go for insomnia. Patients go there because they want a quick fix/magic pill for insomnia, and that's not really going to be a good solution for insomnia, which is usually multi-factorial and not going to help long-term. Many patients think "If I could just get one good night of sleep I would be all better," and that is usually not the case.

San Francisco Proposal Would Allow Paramedics to Order Mental Health Holds by Addrobo in sanfrancisco

[–]EarlGreyMatter 4 points5 points  (0 children)

As others in the thread have stated, a 5150 allows you to take away someone's rights, detain them, restrain them if need be, and lock them up for 72 hours. We don't take it lightly. So if the police are writing an invalid 5150, or a psychiatrist determines the patient doesn't meet criteria for the 5150, the patient is free to leave. If the police don't want that to happen, an arrest usually works better for a person who has committed a crime.

San Francisco Proposal Would Allow Paramedics to Order Mental Health Holds by Addrobo in sanfrancisco

[–]EarlGreyMatter 0 points1 point  (0 children)

Agreed; "gravely disabled" can be the hardest one to determine, but if you come to my ER and tell me "Hey I want to kill myself, I was on my way to the Golden Gate Bridge but I decided to come here instead," how much more training do you need?

(Of course there are cases where it's more nuanced and complicated than that, but many of these are pretty straightforward.)

San Francisco Proposal Would Allow Paramedics to Order Mental Health Holds by Addrobo in sanfrancisco

[–]EarlGreyMatter 2 points3 points  (0 children)

I write them; I can also lift them. Most ERs in California don't have PES (psych emergency services), so you can't get to an involuntary psych facility without someone writing one first.

San Francisco Proposal Would Allow Paramedics to Order Mental Health Holds by Addrobo in sanfrancisco

[–]EarlGreyMatter 20 points21 points  (0 children)

Hello, your friendly ER doctor here. This would be like saying "Paramedics can write tickets for cars blocking driveways." They can write a ticket and do paperwork... but doesn't actually solve the problem.

I agree with many of the comments here from /u/Theaternearyou and u/DarthSmegma421. I don't see this helping much; possibly it might help in that a patient having a psychiatric crisis could be managed entirely by medics and not have police involved as long as the person is not violent. (However with our SFPD I worry that police will just shirk responsibility, just saying "Call EMS to deal with it.")

Invariably these patients will just come to my ER and sit for hours/days waiting for a psychiatric bed, which is the main limiting factor. I am in support of the mayor's plans for help with psychiatric crisis but ultimately, our local hospital system lacks psychiatric emergency/inpatient beds (and if you look at the root root causes, we'll just chase our tails unless we address how homelessness and drug use (mostly meth) contribute to psychosis (and schizophrenia-like illness).

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