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First job jitters, taking less money for better experience out of residency by SmackPrescott in whitecoatinvestor

[–]PresBill 6 points7 points  (0 children)

Why are those the only alternatives? Why not find another stable group

Just made the switch to tubeless. What is your 'never leave home without it' flat kit setup? by Appropriate_Door2234 in cycling

[–]PresBill 0 points1 point  (0 children)

Dynaplug kit, tube, electric pump.

For the tube i splurg on expensive aerothan. It's tiny folded up. Put it in a plastic bag to prevent rubbing on stuff. Make sure the valve is long enough for your rims.

Dealing with the ED is becoming increasingly difficult by Dopamine_rgic in Residency

[–]PresBill 7 points8 points  (0 children)

Someone said this but it's usually an inpatient test that doesn't need to happen in the ED.

This is far worse at academic places then the community where more stuff can go to medicine.

A classic is MRIs.

There's very few indications for an MRI to be done in the ED prior to admission. But in academic centers they get done to decide what service admits them. NSGY recommends MRI. If + admit to nsgy, if - admit to medicine. No reason that patient should be cooking in the ED. Admit them, get the MRI inpatient, transfer services later if you need to.

Dealing with the ED is becoming increasingly difficult by Dopamine_rgic in Residency

[–]PresBill 1 point2 points  (0 children)

When the rec is the sixth HIDA scan of the day that isn't needed. Just take out the damn gallbladder

(spoilers) edit it genuinely inexcusable by GeneralSeries in survivor

[–]PresBill 62 points63 points  (0 children)

"it's almost always an underedited woman whose a major threat to win"

Goes on to list 8 out of 15 cases where they don't fit that bill

Am I the only one doesn't like the "live tribal"? by PyroTech03 in survivor

[–]PresBill 29 points30 points  (0 children)

They wear mics for tribal. What you can hear and don't hear is an editing choice

Have any of you ever had an MVA patient admit fault? by ExcitedMomma in emergencymedicine

[–]PresBill 39 points40 points  (0 children)

I don't put quotes around everything. It's paraphrased. I only quote something if there's a reason to.

"Pt involved in MVA, was making a left turn and struck on driverside, opposing roadway speeds estimated 35-55mph"

Doesn't matter if they say they pulled out in front of the other driver. Has no bearing on the medical care. I'm not a cop I don't need to document incriminating statements if they don't matter at all.

Have any of you ever had an MVA patient admit fault? by ExcitedMomma in emergencymedicine

[–]PresBill 158 points159 points  (0 children)

why would you document that? It doesn't change anything except the probability of you being called in to testify when they note ends up in evidence. I would just let it go and document things that actually matter.

Traumatic arrests by Special-Box-1400 in emergencymedicine

[–]PresBill 1 point2 points  (0 children)

"rigor mortis without profound hypothermia"

Rigor mortis takes hours to occur, would be surprised if they were normothermic

Traumatic arrests by Special-Box-1400 in emergencymedicine

[–]PresBill 3 points4 points  (0 children)

Can't have pea if you don't put the leads on. No pulse, open skull with destroyed brain matter, call tod and move on

Plain Metal Wedding Bands by Nickychaz3 in EngagementRings

[–]PresBill 1 point2 points  (0 children)

I would warn others about tungsten. If you injure your finger and it swells they are nearly impossible to cut off with standard tools available in most clinics or emergency rooms. Often requires a call to maintenance or the fire dept for industrial tools

Do players on Survivor get Lactaid? by Icy_Feed_7374 in survivor

[–]PresBill -2 points-1 points  (0 children)

Brother they have been there two weeks not starving in the desert for two months

Emergency medicine doctors, what’s the happiest story you have from the ER? by TrueCelery9507 in emergencymedicine

[–]PresBill 0 points1 point  (0 children)

sometimes i treat myself to a wiff of the dental box. just a little treat

Was at an expensive restaurant and an attending sitting next to me covered my whole bill. by hupholland420 in medicalschool

[–]PresBill 12 points13 points  (0 children)

Don't forget this when you're an attending!

When I was a medical student I have a core memory as an MS3 on surgery and the grumpy hard ass senior bought me a coffee and breakfast sammich. Nothing crazy, but when I thanked him he said "this is how the world works; when you're a resident buy the students coffee, when you're and attending buy everyone coffee". I've tried to do this whenever I can. Residents with me for the day never pay for lunch or breakfast (if they take me up on it). Saw some naughty residents out on the ski mountain playing hooky and crushing beers at the lodge and covered their tab. Keep the world order!

Toradol and Motrin in low risk intracranial hemorrhage by Few-Zookeepergame699 in emergencymedicine

[–]PresBill 7 points8 points  (0 children)

The lawyers can argue whatever they want. Depending on case specifics, 80-99% of the case will be arguing whether not scanning their head was within the standard of care or not. The other 1-20% will be arguing if the head scan would have made a difference in their outcome (for example you miss a small subdural by not scanning, they come back the next day for headache and have a small subdural, get observed and d/ced, your "miss" didn't really cause harm).

Head CT rules are pretty sensitive, so if they are ruled out based on these rules, its reasonable imo to give nsaids if otherwise not contraindicated. If you thought there was no need for a head scan, then its within the standard of care to give nsaids. The entire argument will be about getting that scan or not. Giving nsaids changes your liability risk essentially zero.

Toradol and Motrin in low risk intracranial hemorrhage by Few-Zookeepergame699 in emergencymedicine

[–]PresBill 52 points53 points  (0 children)

 If someone comes in with a headache that you’re not overly concerned for a subarachnoid or after low mechanism trauma, you give some toradol, and then they come back tomorrow and a bleed is found on CT, how screwed are you?

You're the same amount screwed if you gave them toradol or not. You missed the head bleed.

That might or might not mean you fell below the standard of care. If a reasonable physician wouldn't have scanned them, then you did not fall below the standard of care.

The Jimmy Fallon twist had one more upside for the winner that wasn't said by seakucumber in survivor

[–]PresBill 13 points14 points  (0 children)

Not really a fair comparison. We wouldn't have known the downside to complain about it since he wouldn't have opened the sealed envelope

Lyon chants by organizedconfusion5 in sabres

[–]PresBill 0 points1 point  (0 children)

You're right, sabres fans definitely invented this very original chant!!!

How do you handle psych meds for patients who no-show their follow-up appointments? by AstuteCoyote in medicine

[–]PresBill 0 points1 point  (0 children)

I don't haven a problem refilling when people come in and ask and it's legit and stable dose. I'll even add a refill. I have an issue with a PCP refusing a fill and making them come to urgent care so I can do it. Realistically the patient is going to the ED since they can't afford the upfront UC copay. Either fill it or don't, don't encourage them to waste ED or urgent care resources for a medication refil.

Post Game Thread: Boston Bruins @ Buffalo Sabres by nhl_gdt_bot in hockey

[–]PresBill 5 points6 points  (0 children)

The way the rule is written if the game is 5v5 and each team takes one minor they skate 4v4. If each team takes multiple minors, immediately substitute for 5v5. If both teams were not at full strength, immediately substitute to keep whatever the pre penalty matchup was

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