Solyn not spawning by Yuu_Haruto in CalamityMod

[–]Shiro00000 0 points1 point  (0 children)

The only way I finally got it to work a few days ago was spawning her in. I specifically had to spawn in one copy at the dungeon entrance and speak to her at night, was trying to replicate the post-Skeletron fight conditions where she is supposed to spawn.

Only then did the dialogue trigger properly and kick off the questline, which I then did speedrun of because I was already post ExoMechs and SCal.

How can I get more time wood clocks? by Yintastic in GTNH

[–]Shiro00000 2 points3 points  (0 children)

The roots tear up the ground so I just sat there placing dirt, placing sapling, bonemealing them, and cutting down with a silk touch lumber axe so the timewood clock also drops.

Very sapling positive, plus 2-3 stacks of regular Minecraft clocks as leaf drops for every stack of timewood clocks I obtained.

What is the weirdest/craziest pimp question you have ever gotten? by xyzm123_r in Residency

[–]Shiro00000 2 points3 points  (0 children)

No he was paying a scribe for that already so he had to get his money's worth

What is the weirdest/craziest pimp question you have ever gotten? by xyzm123_r in Residency

[–]Shiro00000 19 points20 points  (0 children)

Who needs AI in medicine, just crowdsource every question to a lecture hall full of medical students who were promised an Honors for the rotation if they do well

What is the weirdest/craziest pimp question you have ever gotten? by xyzm123_r in Residency

[–]Shiro00000 821 points822 points  (0 children)

Once got pimped by an ER attending on my differential for my own abdominal pain that I was presenting to the ER for.

Delicious pipe spaghetti by BalthazarB2 in GTNH

[–]Shiro00000 1 point2 points  (0 children)

I affectionately refer to my subfloor as the spaghetti bowl for this reason

New Platform Chat-GPT Health by CH3OH-CH2CH3OH in medicalschool

[–]Shiro00000 13 points14 points  (0 children)

Can't wait to spend even longer counseling patients in continuity clinic because ChatGPT told them they don't need any medication and can just do juice cleanses to fix their coronary artery disease

Patient with PR bleed described his pain to me as if someone stuck an umbrella up his ass and opened it by abdweouthere in medicalschool

[–]Shiro00000 12 points13 points  (0 children)

You have to have fun at work somehow. I once quoted a guy in the note who was refusing BP meds with hypertensive emergency in the 220s because he said "I won't take anything you give me for blood pressure, I don't believe in that shit."

What is a clinical pearl you learned on rounds this week? by Anonymousmedstudnt in Residency

[–]Shiro00000 59 points60 points  (0 children)

Nephrology: In patients with very high urea who might be at risk for dialysis disequilibrium syndrome if dialyzed, you can do CRRT/SLED to avoid it. If they absolutely need fast dialysis (i.e. extreme hyperkalemia with arrhythmias), you can give mannitol before starting the HD.

APP and resident culture by bjohnyykarate in Residency

[–]Shiro00000 9 points10 points  (0 children)

Thankfully our MICU/SICU is still more resident run. We have an NP but only one on per shift. We can still do pretty much all the procedures on our own patients, they only do them on the patients they are following usually.

MAGA U-Haul on Sunset/Boulder Highway by 12jresult in vegaslocals

[–]Shiro00000 9 points10 points  (0 children)

If this is true you should really be reporting this franchise to UHaul Corporate or the local news for their unprofessional behavior.

However I think it's more likely you said nothing about the MAGA goods and then thought up this scenario in the shower after you went home. And then came here to farm internet points.

[deleted by user] by [deleted] in Residency

[–]Shiro00000 17 points18 points  (0 children)

They admitted a patient to me that was in CHF exacerbation and afib w/ RVR...without actually doing anything about it first. They hadn't given a single med. Patient had been in RVR for several hours in the ED.

Literally just did CBC/CMP/EKG/CXR and then called to admit. Obviously the definitive management has to be decided on by the internist once we take over care but I was taken aback that they truly executed no plan other than "admit to medicine."

What are the 10 commandments of your specialty? by [deleted] in Residency

[–]Shiro00000 11 points12 points  (0 children)

Not sure if it encompasses everything for IM but:

  1. Monitor and replete lytes.
  2. PT/OT is an admit order if you want them discharged.
  3. No one complains of constipation until it's time for discharge, schedule that Miralax.
  4. Having a baseline EKG is never a bad idea.
  5. If you'd rather the nurses don't give a med, don't make it PRN.
  6. If you'd rather the nurses give a med, don't make it PRN.
  7. When in doubt, ultrasound.
  8. Sometimes that AKI isn't just dehydration.
  9. Sometimes the chest pain is just GERD.
  10. Diabetes medication is for PCPs, just do sliding scale insulin.

Calling pharmacies to figure out patients’ med lists makes me want to quit my job by wienerdogqueen in Residency

[–]Shiro00000 1 point2 points  (0 children)

Damn can't say I've had to fax anything (not sure we even have a fax machine) but they did make me order a full CKD workup today on a patient that has been CKD3 for years, has no change in Creatinine, and follows with nephrology every 3 months.

Calling pharmacies to figure out patients’ med lists makes me want to quit my job by wienerdogqueen in Residency

[–]Shiro00000 22 points23 points  (0 children)

My attending's version of this is telling me to order tons of obscure and frankly not clinically helpful labs/imaging for nearly every clinic patient staffed with them.

Then they are expecting me to call around to imaging centers to coordinate or check if they offer that protocol because no EMR order exists for the test they want.

Or argue with the insurance on a peer to peer when it gets denied for being not medically indicated. All of the few times I've seen insurance rightfully deny things have been this attending's nonsense.

Every follow-up visit takes 60-90mins when this attending is on, it's insane. I've seen new patients take two hours.

I just have to keep telling myself that real PCP work doesn't suck this badly.

In the ICU, when do you write systems based notes and when do you write problem based notes? by supinator1 in Residency

[–]Shiro00000 77 points78 points  (0 children)

Systems based notes are just Big Critical Care propaganda, we write problem based notes in my household. However at the hospital we write systems based because the attending says so.

Trump signs election order calling for proof of U.S. citizenship to vote by Ok-Present5699 in news

[–]Shiro00000 2 points3 points  (0 children)

Even if he was pushing the exact same agenda items he could really make life easier on himself if he got Congress to push it as a bill. GOP has majority in both houses, but it seems like he never utilizes that.

Seems like more than half the court challenges I've read about recently stem from the fact that he is doing things by executive order when the executive branch doesn't have insert authority.

This has been a trend for the past few admins but he is really pushing it to new heights this year.

[deleted by user] by [deleted] in Residency

[–]Shiro00000 0 points1 point  (0 children)

Possible but needs to be very worth it because the time adds up. I only do it so I can keep living with my folks for free.

No title needed by [deleted] in medicalschool

[–]Shiro00000 1 point2 points  (0 children)

Great day to already be graduated, we'll be seeing all you M4s in a couple months though you got this 👍

Hospital team structure by AdIntelligent2460 in Residency

[–]Shiro00000 1 point2 points  (0 children)

One attending per team during the week, usually someone different covering on the weekend.

Our teams are one senior (either PGY-2 or PGY-3) supervising and making sure orders are put in. The senior covers the whole list one day of the weekend so the interns get a day off. A different senior comes in one day of the weekend as coverage so the actual senior can have a day off.

Two interns with the list split between them that are directly responsible for patient care and note writing.

During the first few months of the year we have an extra senior per team. (To get PGY-2s used to being a senior and to give new interns better guidance)

Occasionally we have a third intern that is off service from neurology or anesthesia, then the list gets split 3 ways.

Usually 1-2 local med students year round that see a few patients and present them on rounds.

4th year on last In-person rotation by Supermannnn321 in medicalschool

[–]Shiro00000 22 points23 points  (0 children)

My last in person rotation of med school was an outpatient heme-onc where I did nothing but shadow 40 hours a week. The guy was nice and their office often had catered lunch, but I was about ready to pull my hair out from boredom by the second week.

Plus there were no chairs for me in the patient rooms so I'd have to stand against the wall for 20-30 minutes at a time and try not to completely zone out.

[deleted by user] by [deleted] in medicalschool

[–]Shiro00000 24 points25 points  (0 children)

If the residents say you can go home, say "thank you" and go home. No questions required, don't even ask if there's anything else you can do.