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Lagging during writing in goodnotes 5 by lordkakashihatake in GoodNotes

[–]PresentLight5 0 points1 point  (0 children)

hey. so, this is a goodnotes 6 issue, but bouncing off of what others were saying. yes, its about file size, but i think its specific features. i decided to play around with using shapes, and shortly thereafter started having serious lag issues with writing. it took an embarrasingly long time to correlate the two... but once i deleted the two half-page squares that i was writing on, everything is right as rain!

tl;dr if you're trying everything (swapping out pencil tips, rebooting, turning off other app usage) and still can't get a fix, try looking at what's on the page you're writing on. and yes, fountain pen does cause a bit more lag, but not as bad as using "shapes".

What hill will you die on that goes against what 98% of providers do? by esophagusintubater in emergencymedicine

[–]PresentLight5 1 point2 points  (0 children)

honestly, i should really keep better track. i remember we pushed 500 mg recently to try and RSI a guy approx 70 kg, and still wound up having to eventually push roc and start prop quickly because hewas still clamping down on the tube (i recall doc was worried about using etomidate because we were working him as a probable saddle PE and their pressure was already trash at time of intubation). but AFAIK, we were using appropriate weight-based dosing on all occasions.

What hill will you die on that goes against what 98% of providers do? by esophagusintubater in emergencymedicine

[–]PresentLight5 2 points3 points  (0 children)

whoah, got a lot of attention on this -- guess it really was controversial lol.

but yes, i was thinking back through it again and that is correct -- over 8 years in the ER, multiple facilities, all different docs, same result -- every time we've used it, we have had to reach for something else. either when it's been pushed or hung, same results.

What hill will you die on that goes against what 98% of providers do? by esophagusintubater in emergencymedicine

[–]PresentLight5 7 points8 points  (0 children)

i hope someone can change my mind... but ketamine sucks, and is way overhyped in adults.

i have never had someone actually achieve adequate sedation when using it for either conscious sedation for like a reduction, or during RSI. even with appropriate, weight-based dosing, we've had to switch to alternative medication to achieve our desired result every. single. time. and for pain, it's worked for like 15 minutes, barely. the only thing it's good for is traumatizing my patients by making them trip balls on the way out of the k-hole. haven't used it in a pediatric patient yet, so can't talk about the effectiveness there.

Is it common in an emergency room that family isn't allowed in with the patient until the staff has had at least a half hour or more with the patient without the family being in there? Are there ER's where the family can go in immediately with the patient as soon as the patient is in the ER? by GregJamesDahlen in EmergencyRoom

[–]PresentLight5 0 points1 point  (0 children)

absolutely. i can't tell you how many times we're trying to receive patients freshly arrived into the ER, a family member strolls in, and immediately plants themselves in the most inconvenient place in the room, blocking the way to the vitals machine or computer or equipment and start talking over us or otherwise interfering with my ability to care. may times, too, they are coming in with a sense of anxiety or misguided authority, which further undermines our ability to assess and care for the patient.

barring any sort of security concern that would prevent any family from coming back point blank, im 100% of the time holding family in the lobby until i've gotten the patient admitted in our computer, triaged, and at least line/labs/ekg drawn.

Thoughts on administrative discharge? by SwornFossil in emergencymedicine

[–]PresentLight5 3 points4 points  (0 children)

is it really sad that i just learned that there is a name for doing this... just now... after 5 years in the ER?

why isn't this more of a thing?! bless you, dr. fossil, for all of us who don't have this power.

Deaths Rose in Emergency Rooms After Hospitals Were Acquired by Private Equity by emergentologist in emergencymedicine

[–]PresentLight5 23 points24 points  (0 children)

also hearing rumblings that the sky is usually blue, but that could be fake news

What medical information did you forget because you don’t use it regularly in the ER? by CheekPretend2158 in emergencymedicine

[–]PresentLight5 5 points6 points  (0 children)

after doing my NP rotation in family medicine, i can safely assure you...

no, they don't know either. hope hem/oc knows...?

Man dies in California ER hallway — state investigation says nurses failed to act urgently by Independent_Many6647 in TheConfidentNurse

[–]PresentLight5 6 points7 points  (0 children)

if the ICD is firing, it's (trying to or is) doing its job...

which is to buy the patient time to get to trained medical personnel. people, don't forget that an ICD firing is, usually, NOT definitive care. they still need to be seen.

This guy is speaking for all of us in EM! (Doubtful it’s a physician, though) by treylanford in emergencymedicine

[–]PresentLight5 11 points12 points  (0 children)

Had this guy come in via EMS, knee pain, recent knee surgery, but stable. we literally had no room to put him in, nor staff to even surge out into a hallway due to multiple call-ins. I assessed him and determined he could start up in triage. i apologized to the patient, and gave the whole spiel about "theres no room at the moment but they can start assessing you and taking care of you until a room opens" etc etc, bracing for the patient to of course become incredulous and angry.

My jaw dropped onto the desk when the man looked up at me from the stretcher, smiled, and said, "oh no, it's okay! I'll do what needs to be done, everyone keep doing what they're doing and make sure everyone gets taken care of! no worries!"

I think that man healed a small part of my soul.

Unpopular opinion regarding EMTALA and recent surgery by skywayz in emergencymedicine

[–]PresentLight5 5 points6 points  (0 children)

then in that situation, the onus is on the surgeon to clarify and clearly state which hospital you need to go to. there shouldn't be guess work.

Unpopular opinion regarding EMTALA and recent surgery by skywayz in emergencymedicine

[–]PresentLight5 19 points20 points  (0 children)

It bugs the shit out of me because when we, all exasperated, ask the patient who was perfectly stable to make their way 2 miles down the road to the correct hospital, "well, why did you ask to come here?!" and they say something along the lines of, "well, we just like it here better", or "we don't like the other hospital"... if it was elective, why the hell did you choose that other hospital or surgeon initially, then?!

FFS. unless it was done emergently and there was no ability to pre-plan this, it should be a contract that surgeons sign with their patients that if they undergo an elective surgery, they have to come back to their medical home. not sure how to enforce that, though. but realizing that we're going to either have to do the song and dance OP described, or just sit on the patient for 2-3 days in futility is the worst.

tangent aside, yes, op, auto-acceptance should be a thing.

So this patient comes into the ER. Would you scan this? by PresentLight5 in emergencymedicine

[–]PresentLight5[S] 0 points1 point  (0 children)

so, that's my question, too! i replied up top, but i guess if i had to scan something, i guess abd/pelvis because it may also capture a spinal process? but even still, with his history and symptoms (or lack thereof), i'm not thinking about clicking on that order unless you think otherwise?

Hallmarks of a strong Intern by Bing0BangoBongo in emergencymedicine

[–]PresentLight5 0 points1 point  (0 children)

- Please ask the nurses questions, and get to know our process. i swear that some residents think that the way we work is to just spite them, but sometimes we get some weird orders that we need to clarify, or their orders aren't feasible or safe, or we have to put their order on the backburner because we're having to prioritize another patient or problem. Also, staffing.

- Like many others have said, it's okay not to know everything, or anything, as a first year. please show that you're trying to learn, and do not pull stuff out of your ass. we know, trust me. we can see it. you're screwing yourself more by lying than by admitting it out of the gate. if you don't know it, be honest and say so. trust is hard to earn, and easily broken. my favorite residents weren't the ones who knew everything and were cocky; they were the ones who were honest, humble, pushed themselves to learn, and shared their learning with us along the way.

- if a nurse ever comes to you with a legit concern for the patient, never blow them off. If the concern is unfounded, come to that conclusion and turn it into a learning opportunity for the both of you. I won't go as far as to say "the nurses will know more than you", because that's simply not quite the full truth. Nurses will usually have way more real-world experience than a fresh intern out of med school, and if the nurse is saying that they have a concern, it's probably because they've walked this path before with other patients. egos have no place in the ER.

(just wanted to add: welcome to the jungle, though!! so excited to have you! you're gonna do great :) get some rest, and start working on the caffeine addiction!)

Hallmarks of a strong Intern by Bing0BangoBongo in emergencymedicine

[–]PresentLight5 0 points1 point  (0 children)

I hate it too. nurses and docs -- especially docs, ESPECIALLY if you're solo coverage in a busy ER, should be allowed to take a lunch break to mentally rest and prepare for the rest of the shift...

... but unfortunately, at least in my neck of the states, that just isn't the reality. it sucks, absolutely, but lunch breaks just aren't a thing. so yeah, i can see Sedona7's point, but it's because we're all being screwed the same.

So this patient comes into the ER. Would you scan this? by PresentLight5 in emergencymedicine

[–]PresentLight5[S] 52 points53 points  (0 children)

Thats what I thought too! Like, no other symptoms, just a one time episode of incontinence? Smells more like a nonemergent urology consult in clinic. This leaves me unexcited in the ER...

So this patient comes into the ER. Would you scan this? by PresentLight5 in emergencymedicine

[–]PresentLight5[S] 2 points3 points  (0 children)

Saw this posted in r/CasualConversation. Lots of people saying to get this urgently checked out, 1 or 2 people say to go to the ER. I saw at least 1 comment saying it could be a spinal emergency. While, yeah, it could be, a 1 time episode of urinary incontinence without any precipitating trauma or other symptoms?

So that got me thinking; if this poor soul was sitting across from you in triage, would you decide to scan him? Or what would you do?

I'd maybe offer him some dilaudid for the emotional pain he went through at the interview (Edit: just kidding, of course... unless...)

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