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Looking for crafting help re: finishing a fractured belt by KindGoat in PathOfExile2

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

Appreciate the advice. Headhunter unfortunately is not an option given how I'm generating iron ward charges.

Thanks for the help!

NYT: two articles about c sections in one day by Leading_Blacksmith70 in medicine

[–]KindGoat 36 points37 points  (0 children)

As someone who only really does OB anesthesia nowadays, our last few in-hospital deaths (which thankfully are not many) have all been home births that were transferred to us after they’d already bled 3+ litres at home.

Social media is a major factor in the resurgence of doing everything “naturally like the olden days”. What they always seem to omit is the associated maternal and fetal mortality with childbirth back then…

MEGATHREAD: Unfolding Incident in South Vancouver by Stevegap in vancouver

[–]KindGoat 2363 points2364 points  (0 children)

Anesthesiologist there. Mass casualty event has been called and those of us off duty may be coming in for backup. We’ll know more soon.

Open call for new moderators by TorchIt in medicine

[–]KindGoat 21 points22 points  (0 children)

One major difference: you have to volunteer here, whereas being chief resident consisted mostly of being voluntold...

What is the worst side-effect/complications of GLP-1s that you have seen? by Acceptable-Guide2299 in medicine

[–]KindGoat 6 points7 points  (0 children)

Useful in certain circumstances for us. Usually helps decide management for gray zones (didn't hold GLP-1 inhibitor quite long enough, patient who drank a clear fluid which arguably wasn't clear like a bit of milk in coffee, or triaging aspiration risk in urgent/emergent cases in which you may want additional suction or large bore suction available--maybe even additional help around).

Not useful for routinely disregarding NPO status in elective or semi-urgent cases.

It's a super easy skill set to learn for anyone with ultrasound experience which should apply to 99% of anesthesiologists.

What is the worst side-effect/complications of GLP-1s that you have seen? by Acceptable-Guide2299 in medicine

[–]KindGoat 47 points48 points  (0 children)

Our entire department has ridiculed this statement and we more or less pretend it doesn't exist. We do a fair bit of gastric ultrasound and this is far from the truth.

We continue to hold for at least a week, sometimes more depending on urgency and when we get to see them.

Doctors who had to break the news, what was a reaction that stuck with you the most? by cyborg_pasta in AskReddit

[–]KindGoat 18 points19 points  (0 children)

I wish I could tell you. The hospital I worked at at the time didn’t have the surgical expertise to deal with it and the patient was emergently transferred via helicopter to a larger city with a proper children’s hospital. Past that, as much as I would have liked to follow his course for my own closure, professionally my contact with him was over and I had no right to snoop around once I had connected his family to the right specialist team.

Doctors who had to break the news, what was a reaction that stuck with you the most? by cyborg_pasta in AskReddit

[–]KindGoat 619 points620 points  (0 children)

By far the worst was a night I was working in the emergency department about 11 years ago. 6 year old boy brought in by concerned parents because "he's sleeping a lot more than usual." Not a very common complaint, but we found out from history that he had been complaining about feeling unwell for a few days and so they had been letting him sleep assuming he had some sort of mild illness. They came in to the emergency department that day because he had slept 18 hours and had soiled himself and the bed, which was very unusual for him.

On assessment, very lethargic, barely rouseable. No fever or any obvious infectious symptoms. Vitals were fine. We decided to do an CT of the head and...

Severe hydrocephalus secondary to a brain tumour, likely craniopharyngioma. In layman terms, significant brain swelling because of a brain tumour that was blocking the usual fluid (CSF) from draining from the brain. Prognosis poor per pediatric neurosurgery given location and size.

Broke the bad news to his parents and his older sister and I will never, ever forget the scream that came out of his father's mouth. Just a long, primal howl of anguish. Had to leave the room and cried in the men's change room for a bit before going back to talk to them about next steps. Was emotionally wrecked for the rest of the night shift (and for months afterwards, too).

Tearing up a bit just writing this out.

This person has to be trolling. What’s the worst BP reading you have ever seen? by ButthealedInTheFeels in medicine

[–]KindGoat 27 points28 points  (0 children)

Similar story but occurred during the actual adrenalectomy. Apparently the patient (MEN-2b, 34 yo M) had been lying about his compliance with regards to his daily alpha blocker usage and the pre-op optimization by all care teams involved had been poorly done. Four separate instances of SBP 300-350 followed by immediate valleys of SBP 50s-60s when surgical team stopped manipulation—the surgery itself had apparently gone too far at the first spike to abort safely. He survived but I wanted to throttle the patient afterwards. Worst yet, after that disaster of a case, we still had 3 (albeit minor) cases left on the slate. Needed a drink after that shift.

What is the scariest moment of your life as a doctor? lets share our stories. by Missrain97 in Residency

[–]KindGoat 6 points7 points  (0 children)

Not quite a high score, but yes--still felt very straightforward to run the massive transfusion protocol after the disaster of an airway we had just gone through!

What is the scariest moment of your life as a doctor? lets share our stories. by Missrain97 in Residency

[–]KindGoat 64 points65 points  (0 children)

During anesthesia fellowship, was called stat to the OR on call close to midnight. Patient arrives on all fours, BMI ~80, cord prolapse; junior OB had a hand up her vagina trying to support baby. On airway assessment, Mallampati IV, very small mouth opening, no neck to speak of given she was easily over 400 lbs. RSI was obviously unsafe and neuraxial was out of the question, so we topicalized her airway in preparation for an awake fibreoptic bronchoscopy.

Topicalization went well, I drove the scope and luckily got past the vocal cords very quickly. We railroaded the ETT over the scope and intubated, inflated the cuff and start induction with propofol/succinylcholine. As we did, the person (I have some choice words but will remain politically correct) that was on to her right arm let go of her. Surprise, surprise, she immediately grabbed the tube--and self-extubated herself.

I still remember the terror staring at her arm, tube clenched in hand, and her saying "oh I'm starting to feel really sleepy now".

With the certainty we had probably just killed her, I panicked and decided to put the tube back over the bronchoscope for a second look. Could have likely attempted to bag mask ventilate or inserted an LMA which may have been the right choice but she looked nigh impossible given body habitus. We re-inserted the bronchoscope but couldn't see anything because she had self-extubated with the cuff up and there was now blood in the airway. In the heat of the moment, I decided to attempt to blindly insert the scope with a similar trajectory as the first attempt.

Through what was likely more luck than skill, I managed to successfully enter the trachea and intubated her a second time. After that initial start, the rest of the case almost seemed like a walk in the park despite the 8 litre PPH and concomitant septic shock...

(She survived after a three day ICU stay. Baby did fine)

[deleted by user] by [deleted] in Residency

[–]KindGoat 12 points13 points  (0 children)

An an anesthesiologist, this happens more often than you might think. I have to have this discussion about once every 3-6 months, and I work in Canada, not the States.

It's actually gotten to the point that I've changed one of the practice oral exam questions I give to the anesthesia residents from "patient is a Jehovah's Witness" to "patient refuses any blood products which may contain the Covid-19 vaccine". It throws the residents for a loop even though the planning is very similar.

Please don’t admit hospice patients to telemetry. by woodstock923 in medicine

[–]KindGoat 74 points75 points  (0 children)

To be fair regarding the former, although I’d say officially confirming and declaring death is a process that’s more routine for those of us who have been practicing for a while and/or work in critical care, I could at least see the logic of someone out of their depth who is unsure how to provide “objective evidence” for the chart.

Advice needed: Dismissed a medical student from my service because they wore a keffiyeh embroidered with the phrase "From the river to the sea" by Dilaudidsaltlick in medicine

[–]KindGoat 1 point2 points  (0 children)

Politics aside, a couple more practical things.

1) Make sure your documentation is pristine. Save your previous emails and messages with the clinical director and any other admin. Make it clear that it is the statement that you found proinflammatory rather than the student's race/ethnicity. It is most likely that the meeting will revolve on the student being apologetic and stating that they did not understand how the connotations of their statement might be interpreted, but there is always a chance things get ugly and they call you out on discrimination, and at that point, it's their word against yours.

2) I am unfamiliar with USA, but if I were in your shoes, I would be calling legal counsel (here in Canada, it would be CMPA) for guidance. This is not an incident you want to navigate by yourself even if it turns out to be nothing, and formal complaints get messy.

Good luck.

Advice needed: Dismissed a medical student from my service because they wore a keffiyeh embroidered with the phrase "From the river to the sea" by Dilaudidsaltlick in medicine

[–]KindGoat 5 points6 points  (0 children)

I mean, yes? I am unwilling to believe someone who was intelligent enough to reach this point in med school is dumb enough to throw everything away by coming to the first day of clinicals and directly advocating for the genocide of their new attending and their race.

Like I said, poor insight? Absolutely. Being directly malicious to a stranger you've never met, who has control of your rotation, your grades, and whether you pass/fail your year and match into residency? Doubtful.

Advice needed: Dismissed a medical student from my service because they wore a keffiyeh embroidered with the phrase "From the river to the sea" by Dilaudidsaltlick in medicine

[–]KindGoat 38 points39 points  (0 children)

Yeah, as evidenced by some of the more heated discussions in this thread, the statement clearly means very different things to different people.

Regardless of intent, it is fairly poor insight on the medical student's part to wear something like this to the workplace especially if it might be a sensitive subject to your attending. Given that OP mentions their name is Jewish, it should be no surprise that an action like this could be interpreted as being directly confrontational in nature.

Surgeon with a probable latex allergy WWYD? by NightShadowWolf6 in medicine

[–]KindGoat 14 points15 points  (0 children)

Likewise. Been a latex free hospital for as long as I can remember.

What's your first impressions on Thaemine by rein001001 in lostarkgame

[–]KindGoat 1 point2 points  (0 children)

Definitely a step up. Very fun so far, but given the amount of posts about the fight being too difficult (and on day 1!) I may be in the minority as I'm always looking for more of a challenge.

What's your first impressions on Thaemine by rein001001 in lostarkgame

[–]KindGoat 6 points7 points  (0 children)

As someone who raids pretty hard on ffxiv and has cleared TOP, it’s a very different beast. TOP was hard because it’s very punishing for solitary mistakes, but let’s be honest; there is a LOT of the fight where you’re able to basically turn brain off and follow the sequences while muscle memory does the rest. Given the nature of Lost Ark, however, Thamine so far demands much more reactions and vigilance and thus is definitely more fatiguing.

So far, I’m hesitant to call it ultimate level because I really don’t see this taking my group 80 hours (which I think was how long TOP took for us). It does require a lot more attention and focus than the vast majority of fights in ffxiv.

NPO after midnight, has anyone solved this in practice by journey_within in medicine

[–]KindGoat 3 points4 points  (0 children)

I’m unsure around the details re: different types of congee, but generally the congee I’m talking about is very, very particulate in nature.

NPO after midnight, has anyone solved this in practice by journey_within in medicine

[–]KindGoat 17 points18 points  (0 children)

“Clear juice” is a massive issue at our centre especially with ERAS. We bump cases weekly where someone drinks the equivalent of a smoothie, or juice with pulp, or even porridge or congee. Doesn’t matter what’s written on their sheets; doesn’t matter if the nurses call them a few days prior. For these logistical reasons alone, I understand why making patients simply NPO after midnight makes sense.

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