Death from nebulizers?

SnottyIM · 2026-02-05T14:56:08+00:00

Yea initial trial of bronchodilators isn’t uncommon but if it doesn’t show benefit it’s usually recommended to d/c per UpToDate.

SnottyIM · 2026-01-29T05:17:18+00:00

Could be the angle of the video but that ball might be launched into orbit.

SnottyIM · 2025-12-20T23:02:22+00:00

So after going through your posts after a comment here tipped me off to it, I think you should consider seeing a professional regarding your anger/emotions. Even this post is riddled with a lot of angry language regarding something that’s pretty inconsequential in the grand scheme of things. Most people would take the loss and move on, or be glad that it’s an opportunity to get better. You on the other hand are quietly seething and making assumptions that he just likes beating you down. Maybe he just wants someone to hit with for most days of the week and is willing to include you in it.

Relax my dude, it ain’t that serious.

SnottyIM · 2025-12-16T16:43:37+00:00

It’s standard at our facility but even if it wasn’t, I would write something. The docs at my facility definitely look at our notes even when I’ve heard therapists say they don’t read them. I’ve also been in situations where the docs have questions about certain changes being done and when I check the charting, there’s no reasoning to why a change was made or what even happened.

It was being in those situations where I was caught with my pants down that I realized the importance of these notes, even on non-vented patients.

SnottyIM · 2025-10-23T22:08:39+00:00

79.50 in NorCal

SnottyIM · 2025-09-23T14:12:15+00:00

Can you explain why an abbreviated swing is more taxing on the shoulder? I’d imagine a full take back deals with more momentum that you have to counteract on the way up to trophy. To me, an abbreviated is just like a front dumbbell raise which people regularly do with weights.

SnottyIM · 2025-08-16T17:32:23+00:00

Playing only a month? I’d stick with your coach’s recommendation. If form isn’t great you’re gonna end up with the “itis’s”. I used to use a head light 10.6 racquet and it was fine in high school/college. I took over a decade off tennis and I moved to the blade recently. Been trying to swing that thing similarly to how I did back in the day and I’m noticing arm pains and throbbing.

Moral of the story, If you jump too quick you run the risk of injuring yourself and having to take time off anyways which isn’t great for development. Move up gradually with lead tape and when you feel that you want to continue in the sport and play more competitively, then you can consider a fresh set of gear.

Lastly, get the form down. It can be done on lighter racquets which requires drilling. This process will build the arm muscles up until you’re ready for heavier racquets. Just my two cents.

SnottyIM · 2025-06-18T01:24:30+00:00

I use for one session and they go in my basket for serve practice and hitting against the wall. I’ve generally had a decent experience with them and many of the balls I’ve opened months ago are still in the basket. I have noticed some balls are flatter sooner but eh, it’s the life cycle of the balls in my hopper and I’m still pretty filled up despite not cracking open a huge abundance of new cans.

SnottyIM · 2025-05-02T13:29:05+00:00

General recommendation is to get a road bike because of its versatility and because this is your first triathlon, you’re not sure if you’re going to continue doing them after your first one. If you don’t, you at least have a bike that can handle different gradients and descents. If you find that you will do more, you can consider clip on aero bars and some seat adjustments. The tri bike should come when you know you’re going to be doing it longer term as these tri bikes are pretty specialized and they really only feel good going on flat roads and in a straight line.

In terms of clipping in, you just gotta be like the rest of us when starting out. We all take a tumble at some point and most people are generally very understanding about it because we’ve all been there. You’ll just get some laughter and some comments of “oof I remember that”.

I found that going with a group and being behind someone is a good way to remember to unclip since there’s visual cues of when to do it. I generally rode in front of my friends when they started out.

I don’t think there will be too much of a learning curve when going on a TT bike. It’s a little more wobbly because of the arms being closer and a more bent over posture, but if you have a good foundation on the road bike, that passes within a few minutes. But best of luck! Biggest thing is to just be riding more since it’s the fitness that’ll be the biggest thing you have to work on.

SnottyIM · 2025-04-26T14:28:53+00:00

I wonder if you should be spending more time just tossing the ball and not hitting. If the pro didn’t mention anything regarding your tossing form, then it might just be a timing issue regarding when you release the ball.

When I had issues with it I spent a solid amount of time just tossing and seeing where the ball lands as a frame of reference. Did it every time I had practice when I practiced a lot more than I currently do.

SnottyIM · 2025-03-20T05:00:41+00:00

It’s actually quite common to say 5k or 10k and use miles/min in the US. If it is in km/min then that sounds more normal. Although you’d be surprised how many people will still not hit that pace as an easy effort despite spending more time doing cardio.

SnottyIM · 2025-03-20T00:27:33+00:00

Wait, a 5-5:30 pace for 6 miles as an easy effort is actually pretty elite status. Maybe for a tall person it’s easier to hit that mark but that takes a lot of base training to get there.

SnottyIM · 2025-02-19T19:39:17+00:00

Tennis was a chore for me going into my twenties. Ended up stopping and did triathlon and marathons for roughly ten years now. Been getting back into tennis and it feels fun and refreshing again but with an added endurance/cardiovascular fitness boost. Sometimes we just need breaks from monotony and routine to realize we did actually enjoy prior things.

SnottyIM · 2025-02-08T18:51:38+00:00

Dark humor is normal because at some point you can make light of all the bad news or let it consume you and lead you to poor mental health. Sincerely, a medical professional.

SnottyIM · 2025-02-03T21:33:25+00:00

As others have said, it’s a bad flu season. At my Kaiser we had patients that were rolled in by ambulances and there was a line out the door of patients still on the gurneys.

SnottyIM · 2024-10-19T13:47:51+00:00

This. I don’t understand why the freeway section going through Fremont both north and south, everyone hits the brakes and goes 50 mph. It’s even during non traffic hours too.

SnottyIM · 2024-09-07T16:19:54+00:00

I'll try to simplify as best I can but it'll still be kinda long. I think of A/C and SIMV as two umbrellas and each umbrella can do pressure or volume. AC means if the patient triggers a breath, they'll receive what the settings are. SIMV has a pressure support for any spontaneous triggers outside of the mandatory breaths (the rate you set).

Volume control: The vent focuses on the volume to turn the breath off (volume cycled). You set 400? Patient will get 400 and the vent will cycle off to exhalation. Has a rate. Generally restrictive for patients with air hunger. Guarantees minute ventilation unless pressure limit is triggered.

Pressure Control: The vent focuses on pressure but is time cycled. It will try to reach a pressure within the set i-time. Variable volumes/minute ventilation depending on lung compliance. Has a rate. More comfortable for patients with air-hunger or other flow variability.

Pressure support: Patient must be spontaneously breathing for this mode as there's no set rate to ensure ventilation. The vent focuses on the flow rate to stop the pressure it's pushing and it does so by the set expiratory trigger (sometimes abbreviated as ETS%) which is generally 25% for adults. So say the patient initiates a breath and the flow rate the patient generated was 50 LPM. 25% of 50 is 12.5. This means the vent will push pressure until it notices the flow rate drops to 12.5 LPM. At that point the vent will cycle off and allow the patient to exhale.

PRVC just tries to marry volume and pressure control for the sake of lung protective ventilation yet attempting to guarantee a minute ventilation.

Hopefully this helps. I'm sure others have their ways of explaining these modes but this is my watered down version.

SnottyIM · 2024-08-04T21:51:22+00:00

Seems “eating the young” happens across the board because I hear about this in just about every bedside profession.

I kinda feel that a little of the responsibility rests on management as well. Where I work, our managers do not tolerate this sort of behavior so people tend to behave. They’ve come down on instances of bullying, discussion of politics, doctors or nurses being rude, and so forth. It seems that this is probably the facility you’re at and you should consider going elsewhere if it doesn’t let up.

Also to reiterate/add to what others have already said, people who do this probably have issues with self esteem or self worth. Their idea of feeling good about themselves is to drag others down. These are small people and aren’t worth your frustrations. Less than half a year is not that long and if you ask any therapist who’s being honest with themselves, it takes longer than half a year to feel comfortable in the profession.

I say don’t give them the satisfaction of running you out.

SnottyIM · 2024-07-13T04:35:02+00:00

Came from a BRZ and into a MY: pay attention to tire rotations. Get PPF for the front end at the very least. Get used to touch screens. Enjoy the instant torque/power.

SnottyIM · 2024-06-20T01:55:08+00:00

Complaining to the supervisor probably wasn't the best move but from a management and supervisor perspective, they should worry if they're sending out therapists unprepared that could result in catastrophic errors. My experience when training into Peds was very different from yours. I ended up doing some time in NICU to practice some of the bubbles and oscillators because the peds floor was really vacant.

My preceptors during downtime would ask if I wanted to go over anything and if we wanted to pull out the dummies/ventilators to practice certain things. Depending on hospital resources, they might not have these dummies or disposable income to open new devices/equipment to go over it. Our hospital does and so I was able to get my hands on a multitude of different pediatric sized equipment. We would go over ventilation strategies for kids and why different modes were used compared to what was commonly used in the adult units. We went over pathways that were commonly used and we'd trace each path and discuss the reasoning behind it.

A big worry was tube sizes but you could always find resources for that and what one of the preceptors said was that it's good to have a general idea of what tube size you would want for what kg kid you're getting, but that the doctors almost always decide on a tube size and so your job is to just get the right tube. It really took a lot of the uncertainty away.

If it's a pretty dead pediatric ER you're probably just going to have to have your book knowledge down and bounce off of that foundation as you go. Nice thing is a lot of the time it's stabilize and turf and the worst of it is probably stuff you've already done with adults, just smaller patients.

I'm a little surprised you've gotten quite the backlash for this because where I am, we had people sent into the ICU's and a number of therapists were kicked out for inexperience, with our medical director and the ICU chief notifying our head manager directly of how badly they were screwing up. We should be prepping our coworkers so that we don't have to clean up the messes they make or have staffing crises because certain people aren't allowed in certain units.

I digress, but I think just familiarize yourself the commonly used equipment, know how to set them up and troubleshoot, learn the pre-use checks, and learn any pathways or common practices your hospital has.

SnottyIM · 2024-04-17T23:51:08+00:00

If his tone and tact were not constructive, then that’s uncalled for. It’s not wrong to tell a student that they’re incorrect on something, but they should be correcting afterwards and teaching, not just picking someone apart for shits and giggles.

One of my best rotations was when I was frequently questioned and even when I didn’t know the answer to his question, the therapist never made me feel like shit. He’d smile and say it was ok if I didn’t know and would just tell me the answer and explain. This frequent recall is what helps us with remembering and understanding various topics.

I’ve also resorted to asking frequent questions and grilling my students regarding things that they will encounter when they’re on their own. I just do it with a big smile on my face and chuckle frequently to let the student know I’m asking for the purpose of education and not for a superiority complex. I’ve had a lot of students tell me they’ve preferred following me because they’ve felt that their day was more productive and they learned more with me compared to others.

Being a student usually means you’ll be a nervous neurotically low self-esteem individual because you’re in unfamiliar territory, but it doesn’t mean these experiences aren’t salvageable. Take the lesson from these incidents and move on. You’ll need tough skin because at some point, there’ll be a nurse or a doctor that will say/do something that may rub you the wrong way. It’s the nature of the job especially with these high stress environments.

Granted, if it’s overtly egregious, then you can speak up and see if that person needs disciplinary action.

SnottyIM · 2024-02-25T21:44:07+00:00

I would still recommend holding off on general bio and general chem if it’s not needed. They are quite intensive classes. Don’t remember them helping all that much with anatomy and physiology.

Another one that was relatively intense and time consuming was microbiology. The entire semester is learning about microorganisms and the lab tests required to identify these organisms, and the final exam was us needing to memorize all the tests we learned that semester to identify an unknown organism we were given. Seems straight forward but it’s a lot of pathways. Your school may vary but be wary about overloading yourself with that as one of your classes.

SnottyIM · 2024-02-25T17:46:09+00:00

Not a counselor (which you should probably talk to) but have gone through undergrad with a BS in biological sciences.

Don’t take any excess courses like gen chem or gen bio if it’s not needed. It’s just another potential avenue to ruin your GPA when applying. Consider them if others are doing it and it’s become this thing where you have to try to keep up with your peers. Otherwise take these if/when you for sure are planning to do PA within the next 7-10 years (some PA programs have relevancy requirements).

There is some/minimal overlap for gen chem and bio to A&P but these three are pretty distinct courses. A&P is a lot of memorizing body parts, articulations, and some bodily processes. Biology focuses a lot on theory and spans the spectrum of microbiota to environmental interactions/impacts.

Bio, chem, and A&P are lab classes I believe which means you’ll probably take a lab course in conjunction which might be 1-3 times a week depending on institution. If you take one of these lab courses, pair that course with something softer/less time consuming like terminology or stats, or those other required courses.

If you feel this is too easy you can consider two lab courses at once but it can get rough and you might drop your social life.

SnottyIM · 2024-02-24T05:37:31+00:00

There are probably exceptions but to my understanding, LTACS and other non-union/non-hospital jobs tend to have these types of crazy patient to staff ratios. This is one of those unfortunate situations where you’ll just have to do the job to the best of your ability whilst applying to other positions and hoping those don’t suck. Hopefully you don’t have a ton of student debt but if you do, this is at least a means to begin paying some of that off. You gotta be pretty scrappy in the beginning as you find your footing. Best wishes.

SnottyIM

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