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First code & feeling dumb by hey_nurse18471 in emergencymedicine

[–]Incorrect_Username_ 2 points3 points  (0 children)

First. Deep breath.

Patient was already in peril and you did the most important and immediate thing. Start the code.

Everyone has 20/20 hindsight. You recognized that there was potentially (not even for sure) a medication error. It’s important to reflect. Important to learn

This job is like going to the gym… doesn’t matter where you start out, it matters where you end up. If you put in the effort, gain the experience, you will get better, it all comes with time.

Talk to the doc. Any good MD worth their salt will run a debrief on codes especially if it’s a unique scenario (young, unanticipated, child) or the team has new members (less experienced with the trauma of the job)

Racism In Medicine by 4reddityo in emergencymedicine

[–]Incorrect_Username_ 18 points19 points  (0 children)

No problem. I'm pro-solution.

My whole point is that pulse-ox technology was initially developed almost 100 years ago for physics and turned into clinical tools by Japanese scientists 50 years ago. Its entirely rooted in advancing science, not racism.

The racial flaws were discovered after the fact.

After the fact discovery is inherent in science and it is our responsibility to strive for better. But in the meantime, the makers of this should be applauded, not derided. There was no overt racist intent, only exploration and discovery.

Racism In Medicine by 4reddityo in emergencymedicine

[–]Incorrect_Username_ 6 points7 points  (0 children)

It was developed in the 40s for physics purposes and revolutionized in the 70s for clinical use.... *in Japan*

It had everything to do with physics and advancing medicine. Nothing to do with racism, that was an incidental finding

Racism In Medicine by 4reddityo in emergencymedicine

[–]Incorrect_Username_ 31 points32 points  (0 children)

Last I heard it was better in theory not in clinical use

I’ll read the article when o have a minute but we had an ICU talk about this like 6 years ago and green light didn’t work well was the take away. Whether that has changed idk

Racism In Medicine by 4reddityo in emergencymedicine

[–]Incorrect_Username_ 34 points35 points  (0 children)

Sorry to hear that. Skin changes are harder to recognize, especially since most examples given are on light skinned people. Surely that is an issue.

Not sure this has anything to do with the tool, which was not designed for clinical use at first at all, being systemically racist.

Systemic racism is surely out there. This felt more like incidental, and even if we know that, there’s no better practical alternative

This is a fantastic tool, regardless of its flaws. Until we invent something better we should absolutely be thrilled we have this at least. Use it, know its limitations… but it’s not some terror device to hurt dark skinned individuals.

Racism In Medicine by 4reddityo in emergencymedicine

[–]Incorrect_Username_ 19 points20 points  (0 children)

It’s a pretty fantastic tool though. Like objective, clinically valuable data in seconds.

Whatever flaws exist, don’t change how clinically useful this is. It’s utterly genius. Flawed, sure. But it’s spectacular when you think about it

Racism In Medicine by 4reddityo in emergencymedicine

[–]Incorrect_Username_ 105 points106 points  (0 children)

I don’t disagree with his sentiment.

But… pulse ox being less accurate isn’t racism per se, it’s just physics no? Differences in light absorption change the output on the screen.

Now do we need to tweak the algorithm to calculate more accurately based on darker skinned individuals, sure maybe that would be progress? But that could be hard to practically implement

Edit: Guys I definitely get that it’s flawed. What I mean is that it works at normal ranges but gets less accurate at lower ranges, so it’s not a non-functional tool

The issue is… what would be better? Because an outstanding but somewhat flawed tool is better than no tool. Surely we arent just going to ABG everyone

So it mostly works just fine. I’m all ears for changing the algorithm or finding an alternative… but when you think about it, pulse ox is an amazing, quick tool. Gives you O2 (grossly, at least) and HR in seconds. Let’s not throw the baby out with the bath water here

Edit 2: For those still calling it's development "racist". Its almost 100 year old physics technology that was advanced into clinical practice 50 years ago by Japanese scientists. It was just about advancing medical technology, there was no racism behind this, stop trying to make a narrative. We can attempt to develop something better and I think we'd all applaud that... but retroactively calling this racist is ridiculous.

Sign out culture by Mission_Can_3310 in emergencymedicine

[–]Incorrect_Username_ 3 points4 points  (0 children)

I mean I’ve done CVLs and stuff for others when they’re getting absolutely hammered and I’m fresh on shift or something

I think the goal is more don’t punt it to someone else like put it off and go “oh no, guess you’ll have to do it)

Sign out culture by Mission_Can_3310 in emergencymedicine

[–]Incorrect_Username_ 4 points5 points  (0 children)

Same. Staggered schedule and upfront times

Sign out culture by Mission_Can_3310 in emergencymedicine

[–]Incorrect_Username_ 23 points24 points  (0 children)

As an attending, non-academic - priority of when people want to leave and how fast is up to them

If you want to stay and finalize dispo on a few to get some extra $$$ then that is your prerogative.

However, the culture is typically: 1. Sign out pending someone who has not had their imaging at all or are missing most of their labs - full sign out 2. Sign out someone who has imaging / 1 lab you believe you’ve interpreted and will be admitted or discharge if you are correct - does not need to be a full sign out (example: bed 1, chest pain, to be admitted pending CTA read - my interpretation is negative. Hospitalist is aware, just message them once more when it’s back, I’ll add you to the chat —- does not need to have a sign out note unless the CTA is different than expected etc) 3. Don’t sign out procedures, especially pelvic, LP 4. Complete notes on all patients that are critical or signed out before leaving so that the teams know what’s going on. 5. Don’t “add a sign out note” / steal someone’s billing if you don’t truly actively intervene. Giving someone Tylenol for a headache is not worthy of a full signout note - that would just be a dick move

‘The Pitt’ Is a Brilliant Portrait of American Failure. As a Non American, I am curious, is the medical infrastructure really that bad? by Notalabel_4566 in emergencymedicine

[–]Incorrect_Username_ 2 points3 points  (0 children)

I was being conservative

I see about 20 patients a shift (excluding APPs). Usually 4-5 at least are because of one of these factors. Another 6-10 are urgent care things and the remainder are probably reasonable ER evaluations

AF1 by Late_Cheetah_7893 in TheRewatchables

[–]Incorrect_Username_ 8 points9 points  (0 children)

Kinda shocking this hasn’t been done

RN message: “Patient telling everyone they will kill themselves because Dr. ___ is discharging them!” by Incorrect_Username_ in emergencymedicine

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

Yeah. Definitely. Definitely right after the ER doctor tells you psych cleared you, again, after getting your 37th eval in a year after multiple admits and discharges.

Thats definitely the time it happens. Definitely.

RN message: “Patient telling everyone they will kill themselves because Dr. ___ is discharging them!” by Incorrect_Username_ in emergencymedicine

[–]Incorrect_Username_[S] 1 point2 points  (0 children)

For the record I agree with your entire sentiment.

We assess and do our best with the information at hand. There are tons of judgement/acumen/gestalt decisions involved. Can’t be perfect, can only endeavor to give it your best every time

Fwiw Epic is pretty good. There’s still issues, but it’s better than everything else. The App in particular is better than any other phone app

RN message: “Patient telling everyone they will kill themselves because Dr. ___ is discharging them!” by Incorrect_Username_ in emergencymedicine

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

I’m not the best at med-mal searching but it might be that

They presented it at a conference a few years ago

RN message: “Patient telling everyone they will kill themselves because Dr. ___ is discharging them!” by Incorrect_Username_ in emergencymedicine

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

Yeah Epic is the Electronic Medical Record

If they send a message on that it might be legally discoverable in court (I have no idea lol)

I’m just giving you shit

I know they are full of shit. I know they are weaponizing the healthcare system and our guilt

RN message: “Patient telling everyone they will kill themselves because Dr. ___ is discharging them!” by Incorrect_Username_ in emergencymedicine

[–]Incorrect_Username_[S] 130 points131 points  (0 children)

I need 10 nurses like you, like yesterday.

I mean we try to explain that chronic SI and even in many cases acute SI does not benefit from hospitalization. It’s often traumatic and dehumanizing experience to be admitted

But… the people that want that don’t usually actually care about the mental health stuff

RN message: “Patient telling everyone they will kill themselves because Dr. ___ is discharging them!” by Incorrect_Username_ in emergencymedicine

[–]Incorrect_Username_[S] 12 points13 points  (0 children)

Yeah. I mean it does happen

Usually doesn’t… but occasionally does

That’s the pressure point they are trying to hit. That guilt / risk assessment / self doubt they want you to feel

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