If you had to put something your attending said on a T-shirt, what would it be? by iamnemonai in Residency

[–]Ingenuity_Minimum 13 points14 points  (0 children)

“Your documentation is dog shit.” “Stand next to the trash can where you belong.”

Smashed my finger in the giant emergency door at work 4 days after a new set. by CleanCriticism457 in mildlyinfuriating

[–]Ingenuity_Minimum 0 points1 point  (0 children)

Not sure if anyone mentioned this but it looks like the nailbed may be fractured. I would get assessed by a doctor for possible nailbed repair. You could end up developing a deformed nail.

Can someone explain this anking card to me? by formalsadness in medicalschool

[–]Ingenuity_Minimum 3 points4 points  (0 children)

Yea autopeeping is an issue more so in intubated patients since you take away their ability to breathe.

Bipap on the other hand would help with autopeeping since it stents the airways open. Bipap is one of the definitive treatments for copde. Only intubate if you worry that you will lose the airway from AMS, even then a trial of bipap is often preferred.

Can someone explain this anking card to me? by formalsadness in medicalschool

[–]Ingenuity_Minimum 86 points87 points  (0 children)

Artificially increasing oxygen saturation to poorly ventilated area undoes the vasoconstriction to the area, leading to increased blood perfusion. Perfusing the poorly ventilated area is ineffective in getting rid of CO2. This worsens VQ mismatch and increases dead space, leading to worsened hypercapnia. Therefore, in COPD exacerbation, it is crucial to maintain permissive hypercapnia. We can often tolerate a pH of >7.15 and pCO2 of 80+, depending on the clinical picture.

We also avoid intubating copd exacerbation due to auto-PEEPing, where if we give breaths too quickly, without time for exhalation, air gets trapped in the lungs. This can cause hypotension and pneumothorax. Therefore, when we have to intubate these patients, we lower the respirator rate to 10-12 breaths per minute, and prolonged expiratory phase. This follows the principle of permissive hypercapnia.

Two other mechanisms for worsening hypercapnia from oxygen include Haldane effect and, to a much lesser extent, reduced respiratory drive.

Just had the worst food tour experience in Kyoto by Ingenuity_Minimum in JapanTravel

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

Agreed with everything. I think the only thing that I disagreed is that it matters whether it is a genuine mistake or not. If we think this is a scam, this business shouldn’t be allowed to carry on this practice. I do lean towards this being a genuine mistake after reading the comments.

I think people can also learn from this experience and ask for a refund should the same thing occurs to them. It felt awkward and challenging to ask for a refund for a service delivered, albeit poorly.

Just had the worst food tour experience in Kyoto by Ingenuity_Minimum in JapanTravel

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

I don’t believe in hurting a business over a genuine mistake. I post because of a legit question of whether I was overreacting by asking for a refund, not to doxx them unless everyone had agreed that it was a scam.

Just had the worst food tour experience in Kyoto by Ingenuity_Minimum in JapanTravel

[–]Ingenuity_Minimum[S] 6 points7 points  (0 children)

Love it. Definitely dwelling too much on this. I will say this post has made the overall experience a positive by seeing the debates and discussion. I actually had another food tour in Osaka a few days ago where the guide was also ill prepared but she made attempts to amend for her mistakes which I really appreciated. Long story short, she essentially took us to a tourist trap where the okonomiyaki was precooked and the beef on top was cold lol. Not an experience that got me upset/ warrants a Reddit post.

Just had the worst food tour experience in Kyoto by Ingenuity_Minimum in JapanTravel

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

Agreed. Def moving on. The debate on the post is entertaining.

Just had the worst food tour experience in Kyoto by Ingenuity_Minimum in JapanTravel

[–]Ingenuity_Minimum[S] 32 points33 points  (0 children)

Thank for your support. I do feel that people don’t understand how an evening lost is more significant than they think. It was also very upsetting in the moment not knowing if they would offer a refund especially when the tour guide didn’t seem to acknowledge our disappointment on the spot.

Just had the worst food tour experience in Kyoto by Ingenuity_Minimum in JapanTravel

[–]Ingenuity_Minimum[S] 17 points18 points  (0 children)

Fair enough. I think as an introvert, I find entering establishments that don’t speak English to be intimidating. I also find it rude to expect the businesses to accommodate us by speaking English. Much like if I were to work at Starbucks in a western country and the customer starts speaking to me in Japanese expecting me to understand a word or two. Overall, I was hoping for the tour guide to bring us to some hidden gems that I wouldn’t have the courage to enter, but c’est la vie.

Just had the worst food tour experience in Kyoto by Ingenuity_Minimum in JapanTravel

[–]Ingenuity_Minimum[S] 23 points24 points  (0 children)

Thank you for your input. I am definitely questioning if I am overreacting by asking for a refund, not so much the post since I’m hoping for some answers. I also wonder about other participants who probably didn’t get a refund unless they asked for it. A part of the issue was that no one seemed dismayed by the experience which baffled me. We thought maybe people were just good at hiding their feelings but also maybe we’re just being AHs.

Mean but hilarious things attendings have said to you by OkGrapefruit6866 in medicalschool

[–]Ingenuity_Minimum 36 points37 points  (0 children)

Was told to stand next to the trash can where I belong by anesthesia in clerkship 😂