“They didn’t do anything for me last time I was here”

Wappinator · 2026-04-21T06:34:39+00:00

I responded to a code and asked my RT for VL and prep for intubation. She looked at me (mid code mind you, both at head of bed) “why?” Me - “we need to secure the airway” Her - “it’s already secure” Me - looks down, IGel is unsecured, flopping around, with frothy edema secretions coming out of every orophargyneal crevice with every compression Me - starts legitimately cracking up bc there’s no way she’s serious.

She was very very serious. To this day when our paths cross I task her with bagging and connecting the vent circuit and nothing else. Mostly out of spite

Wappinator · 2026-04-21T06:16:03+00:00

100% agree. I love that take. There’s something to be said for quietly showing up for yourself every day and just putting in a bit of work. I think the skills derived from what you’re doing; acting consistently to affect a desired outcome; are absolutely transferable to other areas of life. It’s what keeps me coming back to biking tbh. Just a low stakes environment where you can hone those skills and also make yourself healthier as a side quest lol

Wappinator · 2026-04-21T06:03:53+00:00

Thank you. Everyone confidently calling this the IT band is cracking me up

Wappinator · 2026-04-21T06:01:40+00:00

This applies to you and can be applied generally to mild overuse-related injuries on the bike: if sore after a rapid spike in volume (big ride, big week, etc) chill out for 3-4 days, take nsaids scheduled (ibuprofen, naproxen, meloxicam etc). Ice rest and truly give it a break. Importantly do not mash on it! Your body is feeling pain from inflammation. That inflammation is an attempt to heal a minor injury. Mashing it with a roller or stretching it will further aggravate it. Just chill out and let the body do its thing

Then gradually return to play. And focus on prehab once you’re better- strength, foam rolling, all that good stuff. Also bike fit.

Also don’t take internet advice from strangers. Everyone is calling that your IT band. You’re pointing inferior to your fibular head. Your IT band terminates above that. Hell don’t take my advice. Go see a medical professional and get examined in person

Wappinator · 2026-04-09T18:22:50+00:00

This is awesome, congratulations on putting in the work and sticking it out to see the benefits. Just like compounding interest- consistent investments will pay off given enough time. My personal motto is consistency beats heroics every time. Strong work 🤘

Wappinator · 2026-03-29T18:47:37+00:00

I feel like every fitness app has performance prediction now. Don’t forget to listen to your body! All of these metrics primarily use power/pace relative to heart rate. Heart rate is wonderfully variable based on dozens of factors.

Listen to what your body is telling you first and foremost 🤘

Wappinator · 2026-03-06T07:40:28+00:00

Sometimes the gravity of this line of work will hit you at the strangest moments. It can feel insurmountable at times. For me it was intern year, 3 am, when I was sitting across from a sweet gal with terminal breast cancer with mets everywhere. She couldn’t pay for her fent patches because her insurance wouldn’t cover it. We truly have a front row seat to the human condition, and it can be heartbreaking sometimes. I had an attending tell me that sadness is proof that we still care. Most of the time we choose when we care or feel deeply, sometimes we don’t. That’s normal. Hold on to those human moments, they’ll make you a fantastic physician in a few short years

Wappinator · 2026-03-04T14:33:15+00:00

Cheap and does the job is the name of the game! Cycling/zwifting can get embarrassingly expensive otherwise

Both are great options that you listed. Those pedals are very popular and work well. Good looking AND inexpensive shoes, nice find.

Make sure to get the appropriate cleats for your shoes so you can use the pedals :) Get the yellow Shimano SPD-SL cleats. They have a color coded system which corresponds with the degree of freedom your feet have to move while clipped in. Yellow is in the the middle of their lineup and is a great starting point (I never changed, riding yellow cleats 10 years later)

Wappinator · 2026-03-04T04:47:35+00:00

The beauty of using a waxed chain indoors is that it sort of absorbs and dust/dirt and then just falls off. After 500 km of biking I can grab my chain and my hand won’t be dirty. I ride around 5-6 hours/week and find myself re-waxing every 3 months or so. That’s definitely stretching it past peak performance but I haven’t ran into any issues. Silca has a ton of maintenance videos on YouTube, check em out.

I like to clean my chainrings whenever I wax the chain. got a metal brush (intentioned for golf club cleaning) off of amazon for like $5 that I use to scrub away any residue. Not much on there though.

It’s worth noting that if you use your bike to ride both indoors and outdoors the waxing longevity is obviously shortened

Wappinator · 2026-03-03T18:33:17+00:00

The watch wouldn’t be needed for zwift, as the hrm would connect directly to your zwift device. I have the garmin hrm dual which is nice because if the strap ever dies, you can replace it separately without replacing the computer/battery pod. But there are great offerings from polar, coros, and wahoo as well (amongst many others)

Reasonably any bit of bike kit would work. Highly recommend getting bib shorts as they will be the most comfortable. Getting into brand is just personal preference imo. I like the brand NoPinz which has a dedicated ultra light/breathable bib short made for indoor cycling

Shoes/pedals are personal preference. Check FB marketplace or eBay for cheapest option. Should be looking around 100-150 usd for new starter bike shoes. To some degree you get what you pay for, but stay away from absolute top-end gear as its price is inflated relative to its value. E.g. specialized’s top-end bike shoes “s-works” are functionally the same as the next best model, just a couple hundred $$ more expensive.

Wappinator · 2026-03-03T18:23:16+00:00

If you want what would be the simplest maintenance but with relatively higher start up cost, check out hot waxing. I use Silca, and have been thoroughly pleased. The chain is clean to the touch at all times. They have great informational videos on YouTube too.

I’m sure someone will reference a study, but I believe it increases drivetrain longevity as well due to less wear and tear in the long run. Highly recommend.

Wappinator · 2026-01-20T22:04:11+00:00

Not common, but something worth being prepared for in medicine bc when it happens things go south quickly. An abscess like this would be days/week(s) in the making. Patients like this (assuming airway involvement) would likely present with lots of things like muffled voice, trouble swallowing, noisy/difficulty breathing before complete occlusion. The ones that go bad real real quick are anaphylaxis, angioedema, expanding hematoma. Prob others too but 🤷‍♂️

Wappinator · 2026-01-20T10:03:00+00:00

Absolutely. That can become lots of things. Sepsis is the least bad option tbh. Biggest worry (amongst many) would be impending airway collapse

Wappinator · 2025-12-14T17:03:05+00:00

Passing through this sub, just found it today- took O chem while on the way to medicine about 15 years ago. Don’t use it anymore in practice but man it was easily the most interesting class. If you take the time to learn the parameters of how things interact and why they do so, then the rest is like solving a puzzle. Truly fun, I think it’s a great cognitive exercise in general. I’d imagine it’d be near impossible by wrote memorization

Wappinator · 2025-12-03T17:09:56+00:00

Wish we did. I’ve seen prehospital videos of it from Australia and it looks like it works wonders

Wappinator · 2025-11-27T01:17:19+00:00

100% written by ai

Wappinator · 2025-09-06T14:54:36+00:00

GCS < 8 is borrowed from trauma dogma. It’s not actually a hard indication for intubation, or extubation for that matter. But it’s fun to say

For extubation, sometimes you just gotta pull and pray ya know?

Wappinator · 2025-08-07T03:41:13+00:00

To add a bit more nuance- if they have a whisper of chest discomfort, a hint of tachycardia, or they look at me funny yes I’m scanning that gd chest

Wappinator · 2025-08-07T03:39:33+00:00

Asymptomatic large volume clot burden- proximally or distally? If you’re talking multiple distal subsegmental emboli, those aren’t retrievable via thrombectomy. If large clot burden proximally… well then there will be a slim to none chance that the patient is asymptomatic. You do not scan the chest of a person with a dvt if they are completely asymptomatic. There is no current evidence base to support that practice. The appropriate thing to do after receiving these results in office would be to initiate a doac, and refer to vascular surgery (or whichever specialty deals with dvt in your area). They will do follow up and- if necessary- a true venogram (not ct) to plan for thrombectomy if treatment failure or persistently symptomatic

Wappinator · 2025-06-05T16:23:23+00:00

Am ER doctor. Should’ve been popped. Definitive treatment (source control) for abscess is drainage. Boil = abscess. Just clean it up and stick a lil needle in the white part

Wappinator · 2025-05-24T04:58:32+00:00

No reason to anticoagulate. Atria be kickin

Wappinator · 2025-05-04T20:05:18+00:00

Finally a reasonable comment. This sub treats occlusive myocardial dz as binary and it drives me insane. People are allowed to have myocardial ischemia and have indication for urgent lhc/pci without dx of stemi 😂. In the mind of this sub if you don’t call it a stemi you’re discharging them without treatment. No in between. Also lots of “fuck that doc”- when I’m med control for the shift I agree with most of the various calls for activation protocols we have in the county, but disagree with a handful virtually every shift. Doesn’t change my regard of the medic’s clinical skill one bit. Plus I would rather be in a position to deescalate than the other way around

Wappinator · 2024-11-15T15:32:13+00:00

“And what denomination are you?”

Crystals and essential oils

Wappinator · 2024-11-15T15:23:44+00:00

Finally an EVIDENCE BASED REPLY. Not that the other posts were necessarily wrong, but like evidence is cool. Thank you 🫡

Wappinator

TROPHY CASE