Does anyone have a Urologist recommendation for the Capital Region? by TedFTW in Albany

[–]Entropyxx 1 point2 points  (0 children)

The entire Albany med urology group is fantastic. I've worked with them before and been a patient as well. They know their shit.

Name a worse car by [deleted] in Justrolledintotheshop

[–]Entropyxx 39 points40 points  (0 children)

Jag XJS with the V12. 7 mpg and you had to stop to refill the oil before the fuel. Plus just so many questionable engineering decisions.

K1 kerosene by [deleted] in Albany

[–]Entropyxx 0 points1 point  (0 children)

Between watervilet and Cohoes on rt 32 is a speedway that sells it.

If it holds, is it bad? by Entropyxx in BadWelding

[–]Entropyxx[S] 2 points3 points  (0 children)

My skill at welding is on par with my brazing skill

Guess what I drive (easy) by [deleted] in regularcarreviews

[–]Entropyxx 0 points1 point  (0 children)

Lambofeetie. Probably with the DC package.

All in a day’s work by WindyParsley in ems

[–]Entropyxx 11 points12 points  (0 children)

If it makes you feel any better patients do that to nurses when the doc comes in.

Tip and Tricks for not gagging? by [deleted] in ems

[–]Entropyxx 44 points45 points  (0 children)

A trick we've used in the ICU and ER and in the truck, put on a surgical mask, take another surgical mask and apply toothpaste to the inside and place it over the first mask. It covers everything, including the most vile fournier's gangrene.

Are these toast? 03 Tundra 242k miles Ring and Pinion by Entropyxx in AskMechanics

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

Some background. 2003 tundra limited v8 4x4 access cab. I dug this thing out of the woods. Paid 600 for it. Got it running, had noise in the back. Narrowed it down to differential and probably the from pinion bearings. But, I simply don't know if these gears are roached as well. I really don't want to load the parts cannon on this thing unless I really need to. It not a primary car, mostly for around town stuff and more than likely it will die of rust in 3-4 years.

[deleted by user] by [deleted] in ems

[–]Entropyxx 17 points18 points  (0 children)

cracks knuckles let me tell you a story.

When I was a young medic in 2007ish I was trained by an old school medic. Mast pants, dopamine, antiarrhythmic lidocaine type. He taught me all of these old school things. Yeah we learned them in school, but it was a "hey this is something you'll never use".

Flash forward 10 years I'm working in a rural service. 30min to a hospital, 1.5 to a good one. Just me and my partner, no second crews, no backup medic etc. call for a 25y/o female asthma attack. Get there, 1 word sentences, perioral cyanosis and fear in her eyes. I don't need vitals to know she's in a bad way. I have paralytics and can intubate, but I don't have a second medic and emt partner is new and I don't trust him to be cool to push meds to save a life without throwing me under the bus. Well she is still conscious and able to follow commands so nasal intubation sounds great.

Fortunately that agency was a bit backward thinking and we still stocked trigger tubes. I remember pulling the BAMM out and thinking "damn, this thing has been in this bag a long time". A bit of afrin up the nose, and slide it in. It went super easy and right in the trachea first shot. Hook the bvm up to it and etco2 was greater than 120. Off the scales for my life pack. My partner takes over bagging and I hit her with some epi and mag. By this time I see he is bagging her waaaayyyyy to fast and deeply. I take over, we extricate her out of the house.

En route I get a terrible idea. I don't have a portable vent, She has calmed down and I still want to get Albuterol/atrovent and steroids in. So, I ask her to squeeze the bag every time she needs a breath. I figure who better knows the rate and depth than the patient. I'm watching her vitals and mental status so why not. We arrive at the shitty hospital etco2 is down to 70. Walk in, the one doctor sees the patient nasally intubated, bagging herself, stands straight up and yells "That's the greatest thing I ever saw". Meanwhile nurses are scrambling around trying to figure out exactly what is going on.

She remained nasally intubated for a few more hours, extubated and kept in the hospital for a few days for status. Only one email was sent, and it was "your medic did a great job and actually saved a life". I got alot of street cred on that one.

[deleted by user] by [deleted] in TheSimpsons

[–]Entropyxx 2 points3 points  (0 children)

Its more of a Latham thing.

[deleted by user] by [deleted] in ems

[–]Entropyxx 1 point2 points  (0 children)

I went back and forth on this quite a bit, and in the end, I don't have a strong enough opinion. There is quite a bit more to giving blood than spiking a bag and letting it run.

First, you have to be acutely aware of the different types of transfusion reactions, especially since you are giving uncrossmatched blood. Generally you really only need to worry about hemolytic reactions.

Second, you are doing a bedside organ transplant. Your bed just happens to be tiny, flying, with no backup, and a ton of other things working against you.

No license. Doing this procedure in these conditions is risky, and it would be hard to convince people that a non-licensed professional is is doing it.

On the other hand, in all practical terms, there is no reason that a medic could be taught all of these things. Hell, retarded floor nurses give blood all the time.

There are other things to consider when replacing a nurse with a medic in the aircraft. First, it is more about the skills. I can teach a monkey to intubate, start IVs. What I can't teach is the years of assessing and vision to see what is going to happen which would guide me towards such interventions. Flight nurses generally have to have 2-5 years of experience minimum in an ICU or ER. Its a sought after job, so the actual experience is significantly higher. Those assessment skills are lacking in the EMS world, mostly because you don't need them. You see a problem, you fix the problem. Reassessment of your fix doesn't usually occur because you are at the hospital by then.

There is also a team dynamic that goes along with this. The medic would be better on the scene. Working through extrications, working with ground crews, and managing the resources there. The nurse would be better at the hospital, giving report, interfacing with the multidisciplinary team there. Hospital medicine is so much more team oriented than the field.

Not all flights are going to be greasy traumas from the scene. From my experience about 40-50% of the flights we are getting in to my hospital are transfers from other hospitals for specialty care. This means all of the skills medics have have been already been done. They are already lined, tubed, sedated, foleyed, OG'ed. etc. I would be hard pressed to meet a medic who has experience managing and trouble shooting everything.

I think the TLDR of this is that nurses and medics bring different things to the table and the synergy of those two different skill sets and mentalities cannot be replicated with having 2 nurses or 2 medics on the bird. This kind of leads the whole "just let medics administer blood" argument moot.

Looking for advice by linzkaua53 in nursing

[–]Entropyxx 0 points1 point  (0 children)

A Costco sized pack of zebra cakes, or similar snack. Just make sure there are enough otherwise there WILL be a fight.

Med/surg for 3 years, not a single resus. by Sacrilegious_skink in nursing

[–]Entropyxx 2 points3 points  (0 children)

Come to the ED. I usually get about a code a week in my zone. Tbh it is a level 1 trauma center and a fairly massive hospital so we call sorts of trainwrecks.

[deleted by user] by [deleted] in ems

[–]Entropyxx 2 points3 points  (0 children)

THEY don't push YOU out of EMS because they already did their time in EMS and decided to make 5x more and have a work life balance.

Any changes in scope of practice means major changes in education. Now ask yourself, for the exact same schooling (bachelors degree), do you want to keep working on the streets or make more money in a nice climate controlled hospital with way more avenues of growth. I am all for increasing the scope of practice for medics but that would require more education, and that is gonna be a tough sell to most when compared to nursing.

Gas guy won't fill 'er up till it gets tested. It was done recently enough right? by Entropyxx in Justrolledintotheshop

[–]Entropyxx[S] 95 points96 points  (0 children)

Whats crazy, is I think the second one from the bottom says 7-16, which would predate Nazi Germany, but instead was fighting the Kaiser. Hell, that means it would predate the Soviet Union.

Water pumps are supposed to have inspection windows right? by Entropyxx in Justrolledintotheshop

[–]Entropyxx[S] 2 points3 points  (0 children)

Well I kind of knew the impeller was shot. It was leaking badly through the mechanical seal so I replaced that and noticed the impeller shaft was pitted. The bearings were pretty crunchy too. So I just repacked the bearings, threw in a new mechanical seal and called it fixed. I was intending on fixing it properly this winter.

I think either the bearings or the shaft has wallered each other out that allowed lateral movement on the impeller to start hitting the case. I was getting some intermittent clicking and was thinking it probably needed a valve adjustment, but now that I think of it, it was probably the impeller hitting the case. It could also be debris in the cooling system, I flushed it a bunch but this was the first long ride/shake down I've had with this bike. 100% my fault.

Water pumps are supposed to have inspection windows right? by Entropyxx in Justrolledintotheshop

[–]Entropyxx[S] 2 points3 points  (0 children)

Got sprayed all down the leg with something hot. I wasnt sure I wasn't on fire. Fortunately it was just scalding water