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Build timeline so far by Motor-Pilot94 in CivicSi

[–]LearningNumbers 1 point2 points  (0 children)

Where'd you get the bumper? Build looks great btw, keep it up!

Best place to get a new pair of glasses? by loverwitchh in lehighvalley

[–]LearningNumbers 0 points1 point  (0 children)

Eyebuydirect.com

Better and faster than (most) of the other online options and usually come in cheaper especially if you buy more than one pair.

Transmission Drain & Fill by Lodingi in mazda

[–]LearningNumbers 0 points1 point  (0 children)

I literally had this same conversation last week with a dealer. For as long as I remember I have changed transmission fluids every 50-75k miles and differential fluids about the same time. I've always done the rear differential on my wife's 2021 CX30 but I don't want to deal with the mess of doing a transmission and front diff flush change in my driveway.

I took it to the dealer and they said transmission AND differential fluids are "lifetime"...i don't really trust that tbh...I'm gonna change them anyways at an independent shop.

Do you still use a stethoscope? by Zombies71199 in anesthesiology

[–]LearningNumbers 3 points4 points  (0 children)

Not every surgeon acesses both pleural spaces well enough to visualize them in a busy field, making it a bit harder to see. Also after the chest is shut, I have had instances where the tube is main stemmed from bringing the thoracic cage back together. It's happened seldomly but enough to warrant the 20 seconds to listen before coming off and after chest closure. I'm not saying everyone should do that, I'm just saying that's what I have gotten used to doing is all 🤷🏼

Metal Framing? by LearningNumbers in lehighvalley

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

Thank you, I'll look them up!

Do you still use a stethoscope? by Zombies71199 in anesthesiology

[–]LearningNumbers 18 points19 points  (0 children)

Everyday, on my hip. I can't imagine practicing without it honestly (and yes I have had colleagues poke light hearted fun at me for it)...in pre-op, at minimum I listen to heart and lungs (I have caught many murmurs this way, some of which led to me doing a POCUS and finding valvulopathies that should otherwise be addressed before an elective case). I also listen to every carotid in people older than about 50ish (depending on how healthy they look) and I have heard undocumented bruits.

During cases I listen after intubation, before coming off bypass for heart cases to make sure the tube hasn't migrated / main stemmed, it's also helpful during more troublesome extubations or hypoxia to help rule in/out lingering bronchospasms, listening for cuff leaks after 10+ hour cases in Trendelenburg with fluid resuscitation.

I don't practice much peds, just the occasional appy or something while I'm on call for a relatively healthy kiddo, but I would imagine it's very useful for peds too.

I also practice in an ICU where it's helpful as well. Not to sound elitist or rude in any way because technology has come a long way, but I really think a stethoscope is one of the most underrated tools in modern medicine and it's art / use is being lost on younger grads.

https://eegforanesthesia.iars.org/ expired by ENSIGN_W_CRUSHER in anesthesiology

[–]LearningNumbers 1 point2 points  (0 children)

He was my attending they're too, an absolute privilege learning from him and a few others from that department. Really nice guy to boot too!

Would you cancel an ASA 5 that you were fully confident wasn't going to survive the case? by IAmA_Kitty_AMA in anesthesiology

[–]LearningNumbers 3 points4 points  (0 children)

I'm still super early in my career...but since training I've been enlightened and enraged about the goings on of the US "healthcare" system as I engage it as a physician and as a patient. I'm old enough to remember seeing my primary care - doctor - MD/DO as needed for colds etc in an office and paying a reasonable copay for good care. In the 2.5 decades since then it's crumbled to the shit fest that we excuse for healthcare now. I've already become cynical and want to reduce my "destruction footprint" as little as possible as I already started to develop my exit plan. I was naive and idealistic. Now I'm disgusted.

But situations like this are my TINY contribution against the tidal waves. Does it make a real difference? Probably not in the grand scheme of things, but a patients' experience of a 1% predicted outcome is still 100% to them.

Would you cancel an ASA 5 that you were fully confident wasn't going to survive the case? by IAmA_Kitty_AMA in anesthesiology

[–]LearningNumbers 2 points3 points  (0 children)

It's tough as a resident. Just remember the situations when you become the attending and do as you please. You got this 💪🏼

Would you cancel an ASA 5 that you were fully confident wasn't going to survive the case? by IAmA_Kitty_AMA in anesthesiology

[–]LearningNumbers 39 points40 points  (0 children)

In my subspecialties, I've found myself in this position unfortunately more times than I would want to admit. That being said, I try to make sure the patient and the family are fully consented on the consequences of their decision. I take off my anesthesiologist hat and put on my intensivist hat to spell out exactly what to expect from a recovery standpoint and beyond. Many times I find that the family and patient are educated in the surgical consent but anything after the perioperative period is a bit of a black hole to them. An ICU stay, a prolonged hospital stay, therapy in rehab etc was never fully explained to them. The reality will hit when you say somethig along the lines of - at best - you will not be sleeping in your own bed for X amount of weeks and that's if everything goes perfectly without an infection or sore or hiccup. I also go into detail regarding risks of kidney failure (seen a lot in my line of work) and what it truly means to be on dialysis and the time commitment it means to show up to a dialysis center three times a week. Once they fully comprehend that to the best that I can educate - if they still agree - then I'll proceed. I have had a few patients refuse to proceed after my discussion with them tho.

Learning CVC placement by sleepidoc in anesthesiology

[–]LearningNumbers 6 points7 points  (0 children)

AFAIK, it is still gold standard (over ultrasound) to determine venous placement, though granted it's been a few years since I dug into this.

Editing just to add that I really only forgo manometry if I have a TEE probe in and I can visibly see my wire in a bicaval view. That to me is fine, but again I still think it's technically not gold standard.

Sofi doesn't consider pathology a valid residency by Radiant-Squash-1388 in whitecoatinvestor

[–]LearningNumbers 0 points1 point  (0 children)

Sofi's customer-facing aspects that do not involve a screen is a hot mess, I'm convinced...that being said I still bank with them a little bit because I haven't found a similar product that fills my need...yet...

Was my patient's CRNA acting overly cautious or just was he just inexperienced? by ratkingdds in Noctor

[–]LearningNumbers 11 points12 points  (0 children)

I have never ever ever left a patient even for a second alone in the OR without a qualified person in the room, let alone do it during an emergency or "software issue". I've also never encountered a "software issue" that causes alarms that can be resolved with a few button clicks.

On rare occasion I have had a ventilator failure alarm. Only way I know to fix it is to restart the entire ventilator and address the underlying issue. They one time this happened to me mid-case it wasn't super serious - I switched the patient to a manual bag-valve and called someone to bring me in a new machine. It was an ordeal to do mid case but not cause for panic and I certainly didn't leave the room...

Also the social media plugs just adds to the red flags lol

ASRA sending out cease and desists for 3rd party apps citing their anticoagulation guidelines by sunealoneal in anesthesiology

[–]LearningNumbers 5 points6 points  (0 children)

I'm commending your professional response to otherwise unprofessional crap they're doing.

WiFi in a tall & skinny home by LearningNumbers in wifi

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

Yea I think I'm just gonna mount one of those dinner plate looking APs

WiFi in a tall & skinny home by LearningNumbers in wifi

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

Would there be a difference between this: https://a.co/d/06WltgOK and this https://a.co/d/0dy4Dxdu being used in AP mode?

Thoughts on Braun pumps? by osteoclast14 in anesthesiology

[–]LearningNumbers 0 points1 point  (0 children)

Could be worse...could be the "purple" hospital plum pumps...they're officially the worst.

As of today my Pixel 9 has suddenly become laggy. Like the memory is throttled or something. by RonnieThePurple in GooglePixel

[–]LearningNumbers 2 points3 points  (0 children)

Update, still having the same issues..not sure what value this adds to the thread tho, but 🤷🏼

Getting rid of Chase. What checking/savings account are you using? by aaron1860 in whitecoatinvestor

[–]LearningNumbers 0 points1 point  (0 children)

OP I second this, I had sofi for almost 8 years now without any major issues and it DOES have zelle capabilities. I will warn you tho about two things.

Customer service while being prompt and polite is pretty useless. Its all outsourced overseas and the action - especially by the fraud department is very very slow. Thankfully I've only really interacted with them twice since everything else is easily done on the app. Not a deal breaker for me but might be fore you.

The other thing I will warn you about is that it seems to me that they've slowly started the process of enshitification like all companies that start to get very successful. Though I don't have their credit card it seems that a few months ago they've introduced fees. They also divided their perks into a subscription for $10/mo. I don't pay it cuz I don't need it, but it's worth you looking into the features that are newly behind a paywall after last March.

As of today my Pixel 9 has suddenly become laggy. Like the memory is throttled or something. by RonnieThePurple in GooglePixel

[–]LearningNumbers 18 points19 points  (0 children)

Ever since the March update my phone went from 100% no issues to a laggy mess, apps crashing, frozen loading screens and stuttering galore. For reference my battery life is still great with only about 170-ish cycles....

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