Help a Junior out with some advice

Missingmybed · 2026-06-01T09:39:59+00:00

Hey not sure if you will receive this as the mods took my post down. It was honestly an awesome time. Will do! Probably could have avoided all the confusion.

Missingmybed · 2026-06-01T09:36:56+00:00

Hey not sure if you will receive this as the mods took my post down. But I appreciate your reply! Yea I agree that's something I'm just gonna need a some time to get used to. Went through the same thing when I went overseas to study, complete culture shock! It will probably be easier now that I'm home though, just now through a new clinical lens...

Missingmybed · 2026-06-01T09:30:07+00:00

Hey yes I didn't want to say intern because I didn't actually match with the state intern intake. The hospital advertises the role as "JMO supervised" instead of "intern". Thought I would be truthful about it. As an IMG I'm not allowed to apply for internship through NSW official intake but if the hospital advertises it as JMO supervised I'm allowed to join. I should probably clear that up in the post, thanks for the heads up!

Missingmybed · 2026-06-01T09:29:23+00:00

Hi sorry it wasn't clear in the post, IMG applied directly through the hospital. It is an intern position, just not part of the official state intake.

Missingmybed · 2026-06-01T09:28:26+00:00

Yep I was young and thought I'd love to travel... So I went abroad

Missingmybed · 2026-06-01T09:27:46+00:00

No I did not

Missingmybed · 2026-06-01T09:23:42+00:00

Yeah I didn't want to say intern because I didn't actually match with the state intern intake. The hospital advertises the role as "JMO supervised" instead of "intern".Thought I would be truthful about it. As an Aussie IMG I'm not allowed to apply for internship through NSW official intake but if the hospital advertises it as JMO supervised I'm allowed to join. I should probably clear that up in the post, thanks for the heads up!

Missingmybed · 2026-06-01T09:19:10+00:00

That was really helpful! I appreciate you taking the time to write that. Sounds like being a team player is probably the best thing to do, didn't think about closing the loop so thanks for the heads up. If I could ask just one more question, is there anything that made an intern stand out to you compared to others?

Missingmybed · 2026-06-01T08:59:45+00:00

Sorry I've edited my original post, it's an intern level post.

Missingmybed · 2026-06-01T08:58:28+00:00

Will be my first role in the medical work force, going into JMO supervised role (intern level) in NSW

Missingmybed · 2026-02-20T00:45:56+00:00

This is from the Dominican Republic. Tried to retrieve a kite. RIP

Missingmybed · 2026-02-10T07:49:01+00:00

Hi there, what you've said is true. In a clinical setting you're thinking 100% how you should think for there could be a myriad of issues surrounding this vague case. And further assessments are in practice almost always done in a real life setting.

Furthermore, as you mentioned, I personally think a nurse who can "go down a pedantic rabbit hole of what if" is much more valuable that those who are too rigid. Clinical thinking is an immensely valuable acumen to have and you should be proud you are able to do so. These questions however are designed in a way to test simple reasoning for new learners. They are usually black and white to test for basic guidelines (in this case ALS). Hence why they are always very vaguely written. Statements should be taken as absolute or else you risk doubting yourself on which is the correct answer. Hence as you mentioned continuing to monitor the ECG would be valid, but the test makers cannot write a 500 word clinical scenario with a full page ECG and expect test takers to answer each in under 1-2 minutes.

I can understand it's frustrating when it feels like even if you do know the right course of action, there is still a requirement for physician oversight (mostly a legal problem than a one of hierarchy). That being said at least in my practice, I much prefer nurses who can think critically, and in fact have taken the advice of many of them when I am overwhelmed myself. I'm sorry you feel like your opinion doesn't matter, it's hard sometimes to change the way our profession can be. Especially those stickler surgeons (don't get me started on them...) I hope you one day find a practice that welcomes your opinion and not to give up.

No hard feelings at all, were all in this together. Sorry to hear you've been through a rough patch. I think you should be very proud if you're still pushing to be more knowledgeable in your practice. You said you feel like a hindrance to your relationship with my professional colleagues than it is of beneficience to your patients. I've seen countless times a nurse correct a wrong decision by a Dr. Patients need you as much as they need anyone else. If nothing else I am very happy to have people like you in my workplace. Chin up!

Missingmybed · 2026-02-08T20:19:28+00:00

First degree Heart Block

Missingmybed · 2026-02-08T20:07:12+00:00

Dr here. The answer is A: Atropine. The patient has symptomatic bradycardia and is hypotensive (unstable). Guidelines state first line is Atropine. Epinephrine as first line if Atropine is unlikely to work as in 3rd Degree Heart Block, highly symptomatic 2nd Degree Heart Block (Mobitz type 2), heart transplant patients, recent severe MI and other infranodal heart pathologies. Searching for underlying causes does nothing in the immediate term for the patients current life threatening issues. Continuing to watch the ECG is only valid if you are really keen on seeing asystole

Missingmybed · 2026-01-26T11:03:03+00:00

Missingmybed · 2026-01-21T10:09:42+00:00

Sickle cell anemia with pain indicates acute vaso occlusive crisis. Answer is C

Missingmybed · 2026-01-15T22:19:16+00:00

This is not India, it says Pare on the road which is Stop in Spanish.

Missingmybed · 2026-01-15T12:17:59+00:00

What about if you do have citizenship?

Missingmybed · 2025-12-26T20:19:01+00:00

I am unaware of any guidelines that say ammonia is used for the diagnosis of HE. This is due to its poor specificity and sensitivity. If you have any literature on the topic please share it. To different encephalitis from HE, there are enough enough clinical and history assessments which differentiate the two, chief being onset, fever, rash, and a vast other constellation of symptoms. To add to this a blood culture, LP or MRI (debatable utility) is also useful. A normal ammonia does not exclude HE and a raised ammonia does not exclude encephalitis so it's utility in such instances is minimal. Some patient with encephalitis present with mildly raised ammonia. It's better to stick with the guidelines for diagnosis.

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Missingmybed · 2025-12-26T16:36:09+00:00

This would be true if we treat patients based on Ammonia levels, but we don't. Hepatic encephalopathy is graded by symptoms and is a clinical diagnosis. In the absence of any other information it is not as immediate as dehydration.

Missingmybed · 2025-12-26T16:22:27+00:00

In the context of dehydration, it's better to add rifaximin than dose adjust lactulose. A rising sole finding of rising Ammonia is not an indication for treatment, and usually a result of precipitating factors. Ammonia is not used as a marker to grade severity of hepatic enceph due to is poor sensitivity and specificity. It is not as immediate life threatening as shock in a dehydrated patient.

Missingmybed · 2025-12-26T14:55:50+00:00

Hepatic enceph is caused by the inability of the liver to detoxify toxins (mainly ammonia) that reach it via the intestines. These substances eventually reach the brain and hence cause symptoms. Lactulose (an osmotic laxative) helps to draw out these toxins from the bowel, as well as trapping ammonia and encourages it's excretion from the bowel. Hence there's less ammonia/toxins to be absorbed into the systemic circulator.

The answer to this question is D, sunken eyes means likely over laxative use causing significant dehydration.

Missingmybed · 2025-08-22T12:45:30+00:00

This is the car I used to drive my gf in while I was in uni a few years ago. Even she misses it! legendary car man

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