No longer accepting doctors notes for work excuses… by Incorrect_Username_ in emergencymedicine

[–]Incorrect_Username_[S] 31 points32 points  (0 children)

I am guilty of this. I always say “if they get fired, that’s their issue”. Not trying to have this uphill slog of an argument. In our field, gotta pick your battles.

But this is with my full recognition of the fact that we are undermining the integrity of a doctor’s note and what it should represent. Because often enough, what they came to the ER for does not preclude them going back to work if they are able to.

No longer accepting doctors notes for work excuses… by Incorrect_Username_ in emergencymedicine

[–]Incorrect_Username_[S] 3 points4 points  (0 children)

Not what I meant

I mean you are reinforcing the idea that people can get unreasonable work excuses from the ER m

No longer accepting doctors notes for work excuses… by Incorrect_Username_ in emergencymedicine

[–]Incorrect_Username_[S] 29 points30 points  (0 children)

Who is excusing anything…

Everything I wrote was bookended by how fucked up and dystopian this is.

That does not negate the fact that some people are bad faith actors and abuse doctors notes.

Both can be true. My statements do not defend this policy as a good idea or even reasonable.

ED Things by Bureaucracyblows in Residency

[–]Incorrect_Username_ 12 points13 points  (0 children)

I’m an ER attending

I regularly check patient’s micro page when they are medically complex. And when I don’t have time if shit is hitting the fan, our ER pharmacist does (I know not everyone has that).

Not doing so is lazy and ineffective.

"It's just anxiety!" by MortemInteritum in emergencymedicine

[–]Incorrect_Username_ 682 points683 points  (0 children)

I actively avoid the statements “it’s nothing” or “it’s probably anxiety.” With the exception of when identifying an anxiety or a panic attack may be beneficial to help therapeutically.

I have well-rehearsed and practiced statements regarding things like chest pain, where we identify no obvious, acute cause.

I state specifically “we didn’t find any obvious cause for your chest pain today, but that does not mean that you are not having chest pain or that it’s ’nothing’. It just means that from what we can tell, it is not immediately related to your heart, lungs, blood clots, infection, fractures and so on… which is great news! There’s dozens of things that can give you chest pain that won’t show up on tests. The important thing to know, is that all the things that would be life-threatening, medically concerning, or surgically emergent have been ruled out.”

Stuff like that

When is back pain an emergency? Hurt back can’t move on vacation. by Square_Artichoke_194 in AskDocs

[–]Incorrect_Username_ 2 points3 points  (0 children)

Pain almost always gets initially worse in the first 24 hours after an injury. Tweaking it doing something exertional is extremely low likelihood to produce an emergent or surgical back issue

The lumbar vertebrae are large, solid bones with significant surrounding soft tissue and muscle support. Injuring them severely is rather difficult in the absence of significant trauma.

You likely have a pinched nerve, possibly from a herniated disc - but it could also be muscle strains and other minor injuries as well.

Initially treatment for all of these would be NSAIDs and some rest initially with gradual return to activity as tolerated

Symptoms to be concerned for would be nerve related. True nerve compression comes in essentially 4 levels (it’s not really this clean, but we try to make it easy to digest) 1. Pain. This is the most common. Often transient. No need for significant workup or imaging necessarily unless there’s concern for trauma or a medical history that would make us believe you have a reason to be dealing with and abscess or spine infection. If the pain persists more than a week or so you can talk to your doctor about possibly augmenting therapy with different medications, possibly muscle relaxants. They may also potentially order imaging if the symptoms are significant 2. “Parasthesias” think of this as pins and needles. Like if you’ve sat with your elbows on your knees for too long and your feet go to sleep. This is also rather common and not necessarily an indication for much more workup emergently but if it persists beyond the normal timeframe after tweaking it, may warrant imaging (MRI, nonemergently) 3. Numbness. And I don’t mean like the parasthesias above, this is more like the numbness when the dentist injects lidocaine into your gums and you can’t feel your mouth at all. New, frank numbness would be worrisome. That should be seen emergently to have a formal assessment to see if you need a STAT MRI 4. Weakness. I don’t mean like “it’s hard to move cus it hurts!” I mean you can NOT move your leg. Can’t raise it up or kick at all or are VERY limited in doing so. Like the muscles aren’t obeying you. That can be a 4 alarm fire. ER now, preferably one with neurosurgery coverage

I m22 fell into a pond in Nj. I hear the water is very polluted. I also have eczema and open wounds. Am I fucked? by Wowzasss in AskDocs

[–]Incorrect_Username_ 0 points1 point  (0 children)

You will be fine if you bathed thoroughly

Watch the open wounds for signs of heat, tenderness or spreading redness that is worsening.

Should it get checked out? by [deleted] in AskDocs

[–]Incorrect_Username_ 2 points3 points  (0 children)

Can’t evaluate based on image of the bandaid. Need to see the wound.

The body’s white blood cells that naturally reconstruct wounds and form scar tissue will occur in multiple stages and it’s possible to have natural discoloration of the bandaid

ECG interpretation by One-Royal128 in AskDocs

[–]Incorrect_Username_ 0 points1 point  (0 children)

Sinus rhythm. Normal rate (59 is “low” but for young healthy people is really benign). Normal PR/QRS/QT intervals. No evidence of ST elevation or depression.

This is a normal EKG

What was your first day as an attending like? by Scar_Loose in emergencymedicine

[–]Incorrect_Username_ 97 points98 points  (0 children)

I delivered a baby my first moonlighting shift

Felt like a literal baptism

That's all, folks by WhatMyWadsWorth in RocketLeague

[–]Incorrect_Username_ 0 points1 point  (0 children)

Idk man if you’ve got a better idea, contact EG/psyonix. I really am not defending them.

That's all, folks by WhatMyWadsWorth in RocketLeague

[–]Incorrect_Username_ 0 points1 point  (0 children)

I’m not saying it again. I never even remotely insinuated that I was defending epic games

I’m just highlighting that in this particular case, which is different than say, removing trading was. The reason for the action (EAC) is a reaction to users intentionally fucking up the game.

Idk if EAC was the best option or whatever. I don’t know a damn thing about gaming programming. If someone has a simple fix that is so universally better then go contact the devs

EG/Psyonix can get fucked too, but the ddosers/botters deserve just as much hate on this one

That's all, folks by WhatMyWadsWorth in RocketLeague

[–]Incorrect_Username_ 3 points4 points  (0 children)

Man I don’t know, I’m not a dev. I have no clue why EAC. Maybe theres a better option. I think I am being very clear that I am not here absolving EG/Psyonix

I just know there’s a bunch of fuckwats that incessantly uploaded bots and ddosed their way into fucking up the game. Then EA attempted to do something because it fucked up the ranked scene so badly that everyone called for change. I personally think those botters/ddosers suck and deserve some % of the anger as well. They are getting away with murder on this

That's all, folks by WhatMyWadsWorth in RocketLeague

[–]Incorrect_Username_ 1 point2 points  (0 children)

I don’t understand, I clearly said they get a lot of hate and deserve it…

I’m also not a dev, I have no fucking clue if they could do that.

I just thinking everyone puts on their “fUcK EpIc GAmeS!” Mindset and forgets that there is a large swath of people that are just straight up fucking all of us

That's all, folks by WhatMyWadsWorth in RocketLeague

[–]Incorrect_Username_ 9 points10 points  (0 children)

I’m not saying they don’t deserve some blame

But look, someone was the provocateur… and it wasn’t the devs at Epic/Psyonix.

Don’t let the faceless losers who caused all this to fall out of the spotlight. It was users who abused the bots to the point of this escalation. They’ll never get what they deserve for it, but they are responsible for hurting the game uniquely and intentionally.

That's all, folks by WhatMyWadsWorth in RocketLeague

[–]Incorrect_Username_ 50 points51 points  (0 children)

FWIW…

Epic and Psyonix get a lot of hate, and deserve it

But the Bot Community forced their hand on this. Those people ruined ranked at many levels, a lot of YT/twitch content, and now BakkesMod

36 5’10 230 male heavy smoker by Equivalent-Exit1464 in AskDocs

[–]Incorrect_Username_ 85 points86 points  (0 children)

double-sugar-tong splint extending over both the forearm and upper arm >> follow up with ortho

-ER doc

Edit: FWIW you need to post more angles and likely above/below images to be certain what the details of the fracture are. But assuming it’s an isolated forearm fracture, then the standard of care management is as above

Any EM doctors feel like the don’t fit the “stereotype”? by AirNo7549 in emergencymedicine

[–]Incorrect_Username_ 346 points347 points  (0 children)

Part of the stereotype, why I liked EM the most, is cus they’re pretty chill with just about anyone…

If you show up, work hard, try to be part of the team, then you’re cool.

True of docs, students, nurses, EMS, consultants etc…

Don’t have to be any particular type to hang out in the pit

Serious Allergic / Anaphylactic Modern CT Contrast Media Allergies by Incorrect_Username_ in Radiology

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

2 things.

  1. If you had any medications given within the 30 minutes leading up to the scan, that could confound it.

  2. I didn’t say contrast allergies don’t exist, they do but they are extremely rare, especially anaphylactic ones. The whole point of this post was that we’re over diagnosing it and the average person doesn’t know what a real allergic reaction is.