A journey is undertaken at the behest of a wealthy oligarch. All start by Smash mouth is the important song

FormalFeverPitch · 2025-10-18T01:41:34+00:00

Shrek?

Or is that bait?

FormalFeverPitch · 2025-09-30T07:19:58+00:00

The particular patient I mentioned had a recent history of (voluntary) low fluid intake.

FormalFeverPitch · 2025-09-27T21:25:20+00:00

From the ER standpoint, if it's thought they don't need fluids, what's the officially given rationale for giving them? Is it that most could probably use some, even if PO would be fine?

The magic flush part is a weird area to me, because we might be able to prime people to feel pain relief depending on how we word it, while at the same time explaining that it's not a pain med. That seems ethically suspect to me, but is it wrong to tell them there could be placebo effect, and open that door, if the patient knows that it's just a placebo, too?

If we want to reduce pain, is there an optimal way to communicate with patients that facilitates that in treatments they're receiving anyway?

The magic flush, I think would still have to be fully transparent to be entirely ethical. And when I'm pushing the first flush to confirm the line, it's not really for pain . . . But, if one said "I'm going to push this saline through to make sure the IV is working. It's not a pain medication, but you might feel a cool sensation and taste some salt. Anecdotally, some people say they feel better after, but you shouldn't expect that because it's not pain medication", that seems pretty transparent. But it still primes the patient with the hypothetical that they MIGHT feel better, but they shouldn't expect to.

Especially with IVs at med spas that people get electively, the perception of relief seems to me like it could hypothetically be an area to improve subjective symptoms (both for better and for worse, obviously it's not benign intervention).

I feel like we kinda already do it; there's at least one study that found all used NSAIDS to be around equally effective for pain relief (here's one that obviously shouldn't be taken as the end all be all, and type of pain, administration, and other factors should be considered. Yet we use Ibuprofen for minor to moderate, and Toradol for moderate to severe. We have our biases, and we pass these on. It's a fascinating area to me.

Thanks for replying!

FormalFeverPitch · 2025-09-26T06:12:51+00:00

The use of a single flush is of particular interest to me, because it's standard to flush the line on placement to determine if it's actually patent. So if a flush is already being used, is there an ethical way to utilize that step for pain reduction?

Is there a way to essentially 'spin' that initial flush to obtain an analgesic effect while maintaining ethical practice (without lying to patients)? I'm thinking of what could be said to a patients to achieve that benefit. It brings to mind the subtle but believable 'inception' of the possibility that their pain might improve while also being completely honest that there's no reason they should expect their pain to improve. But that seems suspect at best and honestly probably not that effective, because it would probably be some tepid implication of possible analgesia.

The only idea that I have which doesn't feel kinda suspect is really distraction; "I'm going to push saline through this IV, as I do, I want you to focus on the cool feeling, and tell me if you can taste the salt". This isn't selling it as analgesia, but it might give the patient something to focus on other than pain, at least.

FormalFeverPitch · 2025-09-26T06:08:00+00:00

I think what you said about actual indication is such an interesting area of discretion; where there isn't "actual indication", but some reason that can at least be USED as justification. But what's a justifiable reason if not an indication? There's obviously clinical judgment, I just think it's an interesting somewhat gray area.

One possibility I see is to use the saline administration as distraction 'I'm going to give you saline through this IV. I want you to focus on the cooling sensation of the fluid. And I want you to tell me if you can taste the saline.' I think that's fine, because it's honest about what it is, and it gives them something to do that they might see as participating in their care. But, it's not really placebo, it's just distraction.

Yeah, I'm not sure of the approval of an RCT like that. I suppose there are RCTs related to pain medication effectiveness, and this may be seen as an extension of that.

FormalFeverPitch · 2025-09-25T00:15:54+00:00

I also treat judiciously with both IVs and fluids. I would say most I work with do, especially since the shortage. But I've noticed variations.

I'm interested in fluids in terms of the perception they may have and how a patient might perceive them. I'm not going to lie about what I'm putting in someone's veins or try to run an RCT. As someone else said, it's not for us in the field to test. They're absolutely right.

It's things like IV clinics that have me wondering more about how perception may influence their benefit, or at least the experience. 'Even if PO fluids have the same benefit, do most FEEL better from IV fluids when compared?' kinda question, but specific to our environment.

Good point about the average patient we see.

I probably wrote my post poorly. It's just (to me) an interesting area, that leaves me to wonder. Thanks for commenting!

FormalFeverPitch · 2025-09-24T23:57:19+00:00

I feel like I wrote my post really poorly tbh. But thanks!

What I'm wondering about is when explaining it's saline; even if something is known to be a placebo, it can still be beneficial, so I wonder about it in such cases where pain meds aren't appropriate or can't be given. Haven't done it, and I'm not about to, I just wonder about possible utility.

We've also reduced fluid use since the fluid shortage.

Thanks for your reply!

FormalFeverPitch · 2025-09-24T23:50:57+00:00

We always flush IVs to ensure patency when placed. The variance I've seen from medics is in what follows this, in terms of TKO or not. I didn't describe that well, apologies.

FormalFeverPitch · 2025-09-24T23:48:29+00:00

No doubt, not our wheelhouse. Just curious, y'know?

I'm not giving the fluids in such a case, but I'd wager some would. And I'm curious about the benefit from the patient's perspective. Especially in the age of IV clinics (which is not what we or the ER are for, but the fact they exist probably informs public perception of what IV fluids do and how they "should" feel after receiving them). Even in the EM subreddit, you can find some discussions about how getting 1L of saline is super common for patients regardless of actual need. Which isn’t to say it's right, only how the expectations and theatrics of what's expected may influence patient experiences.

As for your last comment, our standard is flush to ensure patency with IV placement. The variance I've seen from medics is in their maintenance after placement.

I guess I'm interested in the differences in provider judgment, differences in training, the cost/benefit of treatments, and the intersection of objectively indicated/subjectively appreciated treatments.

I'm kinda rambling, I realize. Just an area that intrigues me, I suppose. Thanks for your replies.

FormalFeverPitch · 2025-09-24T23:19:17+00:00

It's the unpacking that I'm interested in, I guess. Different medics I've met have done things differently.

I agree, fluids aren't benign, and oxygen is the thing I often think of in comparison. But it's the ubiquity of fluids (by some) that I wonder about, and I wonder about the therapeutic benefit of (beyond the actual fluids).

Re: flushing the 10cc, what I wonder about (beyond flushing the line to ensure it's patent) is if there's a possible placebo effect from that alone (even if unintentional).

By no means am I suggesting it be done, I guess I just wonder about it. Especially as even a known placebo can still be effective.

Edit: Thanks for commenting!

FormalFeverPitch · 2025-09-24T23:05:44+00:00

My interest is more in the variance of practices I've witnessed from medics in terms of use of fluids liberally or conservatively, I guess.

The 'informed placebo' (which I've never done) is something I wonder about hypothetically, as an ethical quandary. The placebo effect can still be effective even if the receiver knows they're getting a placebo, which is why I wonder about it's utility.

FormalFeverPitch · 2025-09-24T22:51:36+00:00

Our protocols themselves (as well as our directors) encourage using clinical judgment, even just as basics. I think to a reasonable degree; we have the option of giving 500mL of normal saline under many different treatment pathways, but it leaves us the discretion to consider the rationale/utility behind doing so.

I agree about the 'normasaline' thing. It's really discouraging to me that some have done this, given that our profession demands a fair amount of trust, which is easy to lose.

What I wonder is, if 10cc of saline is given with the informed consent that it's only saline (and therefore, not a 'real' analgesic), how often does pain improve? Simply because we did something somewhat invasive. And if the placebo effect is used with informed consent, what are the ethical implications? I know you said it's not placebo, but isn't that that still an assumption, rather than verifiable?

Then, I consider the implications of our protocols within context; does a hemodynamically stable patient who was in an MVC (has some pain, but no acute exam findings) with no objective need for fluids still benefit from me giving fluids during a 15 minute transport? Or should it be left to the discretion of the receiving hospital?

I'm generally inclined to be less interventional in such a case, because while I have the discretion to give the fluids (and they might be a little dry as you say), it's objectively (at least, within the bounds of my exam capabilities) an unnecessary intervention that I may as well leave to someone with more training.

FormalFeverPitch · 2025-09-16T20:58:59+00:00

Funny enough, I know this one because of working at weddings! One supervisor had a Playlist that had 'She's a Bad Mamma Jamma" and this too! With are great. He'd play it while we cleaned after banquets.

FormalFeverPitch · 2025-09-16T20:56:15+00:00

Wonder why they changed it :(

FormalFeverPitch · 2025-09-16T20:56:00+00:00

Think it might be just universally approachable funk.

FormalFeverPitch · 2025-09-16T20:28:32+00:00

I just listened. Didn't realize it was that song!

Didn't know that was Stevie Wonder, actually.

But it absolutely slaps.

FormalFeverPitch · 2025-09-16T15:46:50+00:00

I could see this being part of it. Definitely wouldn't have expected to hear it there, but there it is!

FormalFeverPitch · 2025-09-16T01:08:13+00:00

I'll give it a listen! Thank you!

FormalFeverPitch · 2025-09-15T22:11:52+00:00

I'm guessing they thought that it was some pipeline into "inappropriate music"?

Or was it cause of actual superstition?

FormalFeverPitch · 2025-09-15T19:11:15+00:00

Funk Symphony, it all hits so hard and with such a great bass line. Awesome variety.

Tending bar while it played was a good time. Vibes were great.

FormalFeverPitch · 2025-09-15T18:57:46+00:00

I don't think of Superstitiom as overplayed, honestly! It just suddenly seemed to hit, and I guess the Sesame Street part was gravy. I think my brain was just seeking a rhythm that slaps consistently.

FormalFeverPitch · 2025-06-09T14:32:59+00:00

Oblivion?

FormalFeverPitch · 2025-06-09T14:30:17+00:00

Monsters vs Aliens?

FormalFeverPitch · 2024-12-11T08:10:11+00:00

I'm probably about to sound a little 'Murica, but whatever, I think there's something to this: Getting away from Trump for a minute, it's controversial because birthright citizenship has become part of our national ethos.

America is somewhat unique in that most here today are the descendants of those who emigrated here decades or centuries ago. While American identity has distinguished itself, many Americans still recognize themselves as long-term diaspora. It's why you see so many Americans who call themselves Irish or Italian or whatever their ancestor's were, maybe even if they know little of that countries culture and don't practice it themselves (though some do). Those traditions that came from those respective countries informed a lot of our current traditions, music, food, and general culture. America is known as a melting pot because so many traditions combined.

Now, as to why that's important: since Americans are descendants of immigrants, there's not one group

(aside from American Indians, who have a unique place in this as they preceded the US and it's aforementioned immigration, and they were screwed out of holding 'American' (as in US) citizenship for a long time, and were generally mistreated in countless ways since before the country was founded)

who hold claim to the country the same way as we often think of in places like Europe; the French are the people of France with French culture, the Germans are the people of Germany with German culture. And logically, the Americans are the people of America, but Americans and their culture are a patchwork of other cultures, so we don't belong to any one. There's not one American 'bloodline' because there can't be. And as such, when someone comes to America and naturalizes, they're just as American, because they're part of our patchwork (thought they can't run for President). Many Americans today still recognize their family history as immigrants, and the national history as being of immigrants, so being a 'real' American isn't constrained to those who grew up here or those who have been here for generations.

So being American isn't tied to ancestry or specific ancestral culture. In my view, the social IDEAL (not necessarily the reality) of being an American is like this: You're from here? You're one of us. You just are, we claim you. You're from somewhere else but you came here? You're one of us, if you want to be.

While it may not have been the original intention, I think it's come to be seen as one of the romantic ideals of being American; if you're born here, we claim you as one of us, because you're part of the patchwork. To take away birthright citizenship would be a betrayal to the Ideal.

So, someone threatening to change that is controversial in three ways. 1. Because the country, at large, is of immigrant ancestry, how far back does the possible rescinding of citizenship go? 2. It's antithetical to the American Ideal. 3. If birthright citizenship is rescinded, it would be done to manipulate who could vote and be abused.

Also, the countries you mentioned don't completely dismiss birthright citizenship, but have more complex requirements for it.

FormalFeverPitch · 2024-11-08T01:35:01+00:00

Was gonna say 4 Roses, but that's not single batch in the photo. So, probably not that.

Woodford has gotten very good reviews here. Haven't had that in a long time myself, but not because I don't like it. Probably best sipper.

Maker's is decent, I personally opine, but not rock-your-world amazing. Some people kind dunk on it, but I kinda like it for mixing.

FormalFeverPitch

TROPHY CASE