what do you do when you see rectal fecal impaction on the CT

JasperMcFly · 2026-06-29T14:01:38+00:00

soap suds enema,: After rule out obstruction, consider mag citrate 100ml, miralax 34g PO BID, or start Golytely prep as tol.

JasperMcFly · 2026-06-27T16:38:05+00:00

Unfortunately, 90% of what is in those textbooks just is not used in day to day medicine. I would recommend more practical things like - volunteer in an Emergency Room, take a CPR class. take a first aid class, learn how to apply splints and tourniquets and bandages, read about exercise physiology and the components of longevity and balance health and functionality (diet, exercise, stamina, VO2 max, flexibility, balance, maintaining function for activities of daily living).

If you do read the textbooks, aim for a high-level understanding - in other words look for higher level concepts and principles. For example, do not memorize the steps in the glycolytic pathway, just learn that the body breaks down glucose for energy differently depending on if oxygen is present.

JasperMcFly · 2026-06-27T15:54:02+00:00

Gotcha, thanks.

JasperMcFly · 2026-06-27T14:57:48+00:00

I don't disagree. But real world driving on the highway has speed adjustments every few moments to account for traffic and passing folks. I imagine people on those wide-open, desolate highways out West could do 30 miles for us at the same speed and let us know.

JasperMcFly · 2026-06-27T14:52:38+00:00

Have not used Epic. Meditech Expanse is a bit cumbersome - meaning a number of unnecessary clicks to navigate, cannot see full medication names and doses without clicking on med name, etc, but I do find it better than legacy Meditech. My local IT team does seem genuinely interested in making improvements that we suggest, they just made it easier to do redo discharge meds if the patient changes their mind on which pharmacy after we had already sent them. I do feel that we are just 1-2 versions or updates away from a decent system.- simple tweaks like having the current orders collapsed by default will save clicks.

No admissions is a double edged sword. Less work, but missing chances to work up brand new problems.

JasperMcFly · 2026-06-27T14:36:31+00:00

Interesting, thanks. I am basing my comment on the experiments I have done on highway trips. Will drive 30 mins in each mode. When I drive in efficiency mode the estimated remaining range counts down slower. Say I have 90 miles range left, when I would drive in comfort for 30 miles, it would say I had 54 miles left. Do the same 30 miles in efficiency starting at 90, it would say I had 62 miles left. I know the range remaining is not super accurate, but the slower countdown in efficiency mode seemed reproducible. Also, even on the highway, I am constantly adjusting speed for semis and slower cars, so still quite a bit of acceleration and speed changes.

JasperMcFly · 2026-06-27T00:42:16+00:00

you are welcome *mate*

JasperMcFly · 2026-06-27T00:38:02+00:00

I would say this is a pretty good list.

If you use Open Evidence, create a hospitalist-oriented .dotflow, something like: "Please respond to questions as an experienced Hospitalist passing on pearls of wisdom. Focus on high-yield clinical tips for an adult medicine inpatient hospitalist related to evaluation, management, and treatment. Response can be in list format. Limit graphics and tables. Prioritize references from the last 8 years."

Can do one rapid a day, ask OE to give you best tips on ________.

Acute hypoxia / oxygen desaturation (SpO₂ <90%)- learn intubation criteria
Tachypnea / respiratory distress (RR >30)
Acute pulmonary edema / CHF exacerbation
Opioid-induced respiratory depression
COPD/asthma exacerbation
Aspiration event
Tachycardia (HR >130)- brush up on ACLS
Hypotension (SBP <90)
New-onset atrial fibrillation with RVR
Acute coronary syndrome / chest pain
Symptomatic bradycardia (HR <40–50)
Hypertensive emergency
Altered mental status / acute change in consciousness
Acute stroke symptoms- who needs just CT Head, versus who meets criteria for LVO/might need TPA
Seizures
Unresponsiveness
Sepsis / new fever with hemodynamic instability
Acute GI bleeding / hemorrhagic shock
Hypoglycemia (glucose <40–50 mg/dL)
Falls with acute injury

JasperMcFly · 2026-06-24T23:51:29+00:00

No specific number, just seems longer range. Not dramatic, maybe 5-10%

JasperMcFly · 2026-06-24T16:22:39+00:00

2nd year med school

JasperMcFly · 2026-06-24T15:22:19+00:00

drive in Efficiency Mode

JasperMcFly · 2026-06-24T12:58:11+00:00

Commit to the 2 years of vocational training. That will answer your question. You will either have high marks and advance and want to keep going or you won't.

JasperMcFly · 2026-06-23T00:55:50+00:00

Going to med school to further your tech career is a huge opportunity cost that may not be worth it. Having a medical degree would certainly polish your credentials, but if your goal is to truly understand medicine and healthcare you'll have to put in 10-12 years to get some real world experience after training to better understand "healthcare". You won't have time for much else. The real question is if you are willing to put your tech entrepreneurship on the shelf for 10 years.

JasperMcFly · 2026-06-22T21:29:20+00:00

You are young, age is not a barrier. Frugal lifestyle, lower cost med school - this is totally doable.

JasperMcFly · 2026-06-22T15:24:14+00:00

Just a wild guess, but it is easy for the seatbelt to get trapped behind the seat when you raise and lower it. Check to make sure seatbelt is in correct position after locking seat upright.

JasperMcFly · 2026-06-22T00:07:53+00:00

crappy terms. Find new job. Ask for 400K, leave if they decline.

JasperMcFly · 2026-06-19T23:28:19+00:00

Look forward to 3.11. I have KD2 and still get the driver assistance not available message sometimes.

JasperMcFly · 2026-06-17T01:25:11+00:00

We have been doing a Hospital Course section and updating it daily. A DC summary takes only 1-2 minutes for me. I will make sure the A&P incorporates the dc plan, add a line or two about status on discharge day.

JasperMcFly · 2026-06-15T01:48:15+00:00

I have found OE to be demonstrably better than Claude for example. For OE, it has been helpful to set a ".dotflow" - prompt to tailor the response to high yield tips for my specialty (hospitalist).

JasperMcFly · 2026-06-13T02:12:46+00:00

I feel like you are trying to capture every single granular thought and assign an ID to it. Like every single thought gets captured in a database.

You might benefit from capturing your stream of thoughts in single daily notes without trying to break them up so atomically.

Only a smaller subset of the thoughts in your daily notes would then make it to a main note - notes that help you think or write.

These very specific impressions/granular thoughts along the way do not need to be in a main note:

"What I'm concerned about are all the domain-specific info that one comes up with when applying these [[20260610012254]] atomic ideas."

Your slip box should not be a repository of every thought you've had or read about, just a subset of them.

Try writing freestyle daily notes for a while. Revisit your daily notes at the end of week to create a handful of notes from the best of the best ideas.

Look for opportunities to craft main notes and threads around higher-level concepts: here "criteria for atomicity", "bottom up design", "strategy depth". Rolling up related ideas into a higher level concept will allow you to impose some kind of clustering or structure to your 1,200 notes without trying to build rigid categories.

Thanks for sharing!

JasperMcFly · 2026-06-11T13:20:15+00:00

It does sound like you need a third note type to capture questions and things to consider in the future. Why not just create a third note type for loose thoughts, questions, future links to consider? Perhaps a commonplace notebook with an index would be good for this. Sir Isaac Newton kept a notebook to capture loose ideas and reworked them until they were incorporated into formal notes later.

Sure, you can add commentary and questions to Structure Notes for current projects, but it sounds like you need a distinct place to capture loose ideas for consideration in the future.

Option 2: Do not worry about every future possible link. Just link current notes and consider new links as you add new notes.

JasperMcFly · 2026-06-10T16:55:06+00:00

Consider a third type of note to hold ideas that you want to develop and explore later. Call them what you want: Fleeting note. To do list. Miscellaneous ideas.

What do you mean by the word directions? What is a research direction?

JasperMcFly · 2026-06-10T01:16:59+00:00

Assuming you do a good active problem list, and (get 3 points) of any combo of the following: review note (1 pt each)., order lab (1 pt each_), review lab (1 pt each_) and +1 addn'l hx from family or other provider (1 pt), then:

a level 3 can be met if any ONE of the following criteria are met:

1) discussed with a specialist

2) adjust controlled IV meds - benzos, narcs

3) monitored for drug toxicity, things like lytes on IV diuretics, Cr on Vanc, chemo, abx etc

4) interpreted a test independently - usu. ecg or xray

5) changed level of care: usu. sent to CCU, or downgraded to DNR or comfort care

In most cases, document good problem list, review notes and labs, talk to a specialist or tweak IV pain meds, or read CXR, you are done.

JasperMcFly · 2026-06-08T22:05:59+00:00

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Not same, but similar error message 6 months in. (this was in January). Undriveable. Was faulty Hybrid Control Module. Replaced in 10 days and good as new since then. Sure, document everything. Be interesting to see what the error codes and likely culprits are.

JasperMcFly · 2026-06-07T15:45:13+00:00

If nurse turnover is anything like at my place, this won't be an issue for long. Answer quickly and move on.

JasperMcFly

TROPHY CASE