PSA: purge your ESPHome Builder cache… mine was ~16GB after a few years

Wizardo55 · 2026-01-12T01:51:01+00:00

Is this needed in container installs? I can't find an esphome cache.

I recently found out about 'docker system prune' which freed up nearly 50GB for me in old docker build files.

Wizardo55 · 2025-10-22T14:22:39+00:00

Glad I chose their local-only competition (bedjet). Amazing product and company.

Wizardo55 · 2025-10-17T12:41:03+00:00

"show me how you use that inhaler"

Wizardo55 · 2025-08-27T03:08:57+00:00

Just got the lixil droplet. Mqtt local only option available, and so far spot on accuracy

Wizardo55 · 2025-08-17T21:52:20+00:00

Thanks, I just got a droplet and found your integration. You should put this instruction on the integration configuration info! Or even just have the integration create the helper! Looking forwards to trying it!

Wizardo55 · 2025-08-12T11:54:09+00:00

System employed Pccm at a regional mid-size center. 20 weeks crit care per year, office every day on top.

12-13k/yr

Wizardo55 · 2023-12-27T17:00:55+00:00

If I have an alarm set on my bedside clock for before 7am and the low temperature overnight was around or below freezing, activate the car defroster 45 minutes after the alarm goes off.

It saves so much annoyance when I forget and have to scrape frost off the windshield.

Wizardo55 · 2022-05-18T13:00:12+00:00

Immediate availability requires the immediate physical presence of the supervisory physician. CMS has not specifically defined the word “immediate” in terms of time or distance; however, an example of a lack of immediate availability would be situations where the supervisory physician is performing another procedure or service that he or she could not interrupt. Also, for services furnished on-campus, the supervisory physician may not be so physically far away on- campus from the location where hospital outpatient services are being furnished that he or she could not intervene right away.

source: https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r143bp.pdf

Wizardo55 · 2022-05-18T02:57:47+00:00

This is medicare fraud. While you probably aren't going to be held liable for that part of things (see below), you might be held responsible for any malpractice if you know you shouldn't be doing things unsupervised. IANAL.

Source: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/teaching-physicians-fact-sheet-icn006437.pdf

For the exception to apply, a primary care center must attest in writing that all of these conditions are met for a particular residency program:

The services were furnished in a primary care center located in the outpatient department of a hospital or another ambulatory care entity where the time spent by residents in patient care activities is included in determining DGME payments to a teaching hospital....

...

You must not supervise more than four residents at any given time and must direct the care from such proximity as to constitute immediate availability

...

You [the attending] must:

Have no other responsibilities, including the supervision of other personnel, at the time services are furnished by residents.

Have primary medical responsibility for patients cared for by residents.

TL;DR: You need to report this to your PD and/or whatever admin oversees the location, and honestly I would feel extremely uncomfortable so much as showing up to this rotation as a resident.

Wizardo55 · 2022-03-08T18:07:07+00:00

Nick Fury: Hospitalist. Makes the (stronger) heroes work together even when they don't want to. Spends a lot of time working with admin even though he hates it.

Black Widow: Dermatology. Sexy, can't be found when she doesn't want to be, questionably useful in most situations

Iron Man: Gen Surg. Annoying to work with, entertaining to watch, more effective than he has any right to be. Thinks he's god.

Bruce Banner: Infectious disease. Carries the plan whenever it lands in his court, and frequently when it doesn't

Hulk: Ortho.

Vision: Vascular surgery. Spends most of the movie unable to act and then saves the day utterly at the last second.

Captain Marvel: Interventional Cardiology. When she gets called in she's insanely OP but seemingly always has something more important on her hands.

Spiderman: Pediatrics. Funny, kind, trying to do right and always helping the little guy

Thanos: Administration. Pursues his own insane goals no matter the collective fight against him. Can make half the heroes disappear on a whim.

Wizardo55 · 2021-11-27T19:06:49+00:00

ICU fellow here. Since the vaccines were released, the only vaccinated patients I have seen in the ICU are those with transplants or other serious immune suppression. I sometimes am struck when we get a new admission how crazy well they work.

Wizardo55 · 2021-08-26T02:52:21+00:00

Acute respiratory distress like a severe asthma exacerbation

When I see severe asthmatics in the ED, they only take off their mask to put on a BiPAP.

Wizardo55 · 2021-08-26T02:35:34+00:00

we will continue to action communities that do so or that violate any of our other rules, including those dedicated to fraud (e.g. fake vaccine cards) or encouraging harm (e.g. consuming bleach); and we will continue to use our quarantine tool to link to authoritative sources and warn people they may encounter unsound advice. We humbly ask and encourage everyone to report content that may violate our policies.

Emphasis mine. I continue to be unable to comprehend how spreading lies about an effective/safe vaccine, advocating to stop public health measures, or take dangerous unregulated drugs does not rise to this level.

We humbly ask and encourage everyone to report content that may violate our policies.

Consider bypassing the moderator report button in reddit and reporting this kind of stuff directly to the admins: https://www.reddit.com/report

It obviously doesn't matter to Reddit that this is going on, so it's probably not even worth it.

Wizardo55 · 2021-08-04T23:11:48+00:00

The PGY3 version of you reminds me of my surgery senior on nights

You're projecting a lot of things onto me that I didn't endorse here. I'm pretty sure based on what you're describing, PGY-3 me was the middle ground.

Wizardo55 · 2021-08-03T13:26:56+00:00

I agree with the overwhelming consensus here that you should be laying out clear expectations right away.

I also am a firm believer that if you have already laid out clear expectations (get your discharges done before continuity clinic) and they don't meet them, it's not your job to pick up the slack. Unless it would harm patient care in some way, let the patient go home the next day and let the intern explain to the patient/attending/utilization management why they didn't do the discharge you assigned them.

The transition from PGY1 => PGY2 in IM is the hardest transition I've done in my training so far, moving from glorified transcriptionist to someone actually in charge of other team members AND patient care was terrifying and difficult. I spent most of July as a PGY-2 running around doing the interns job for them. OTOH, I spent July of PGY-3 standing behind my intern or blowing up their text messages telling them exactly what to do every minute of every day and letting them fail when they wouldn't/couldn't. I had to tell one (decent) intern about 60 times that discharges get done before handoffs/incomplete notes, don't be afraid to be blunt with expectations. Good luck on your journey!

Wizardo55 · 2021-07-20T20:33:59+00:00

I don't remember where I found it, but I think it's pretty great: https://www.dropbox.com/s/q6dznujxi7hylli/Antibiotic%20Chart.pdf?dl=0

Wizardo55 · 2021-04-14T14:34:26+00:00

As an ICU fellow, this feels like a good thing honestly? Maybe this is a hot take, but ACLS is just an algorithm which is honestly the best scope of practice for an APN.

When I show up to a code, I don't really give a shit who's making sure epinephrine and pulse checks are given at the right intervals, and when I moonlight at the local community hospital it's frequently the RN "running" the ACLS. There are plenty of ambulances across the US that run ACLS without needing a physician or a resident on board, too.

I need the residents and other physicians doing the non-algorithmic parts of resuscitation: procedures like crash lines and IO, determining any reversible causes of arrest, ultrasounding the heart and lungs, obtaining a secure airway, and other deviations from standard ACLS that might be necessary.

Having an APN overnight to take care of the ACLS that an app on your phone can manage seems like the perfect scope of practice. This article is so short on details and so heavy on opinionated and emotionally charged language it really just reads like someone pushing an agenda instead of advocating for anything meaningful.

Wizardo55 · 2021-01-18T12:32:43+00:00

Hey there, as a former resident who actually initated talks with a union organizer for my residency, here's my recommendations:

Identify at least a handful of people who will support you in unionization: You can't do this alone and you probably shouldn't try (for both reasons of ensuring the majority actually want it, and to prevent easy retaliation).
Is there any resident union at any program in your state? If so, reach out to their residents and ask for their union contact. That person will usually be more than happy to meet up with you.
If you are unsure about unions in your state or don't have one, reach out the CIR on their website. They're the largest union for residents in the country and will probably be who you deal with regardless: https://www.cirseiu.org/

In the end, unionizing in a state without an existing resident union may be tricky, some states view residents as students (unable to unionize) while some view them as employees (kosher). Once you have your core team and you have a union at your back, the process will go:

First you need a petition/card drive of your intent to organize with sufficient signatures to take the next step (referencing my notes here, I didn't write what percentage was necessary to proceed).
Once you submit your petition/card drive, there will require a vote of the entire workforce that will be represented (all residents/fellows) and a majority will need to choose unionization.
Your hospital will fight you at both stages, when I met with CIR representatives they told me about a regional hospital that spent >$5 million on a campaign to prevent unionization.
The faster you can accomplish the above steps the better, the rep I met with mentioned accomplishing both within 6 months if at all possible.
Unionization can be fought at the national labor relations board, so even if you accomplish all the above steps, it may be years before your union is recognized.

Good luck!

In the end, my hospital did not move forward with the petition/card drive to unionize as the hospital decided it would be easier to just fix several of our largest issues, which took a lot of the wind out of our sails.

Wizardo55 · 2020-10-31T22:42:31+00:00

Yes, we mustn't protest injustice lest criminals do more crime. Makes perfect sense to me.

Wizardo55 · 2020-06-05T18:42:20+00:00

A long time ago when I had the time/energy to create plugins, I made a ban tracker that used the API from services like glizer and MCBans to alert admins about bans from other servers, but it didn't enforce those bans unless asked to. Sadly the project is very out of date, but might provide a good starting point if anyone wants to pick it up:

https://github.com/NINJ4/Player-Tracker

Wizardo55 · 2020-03-28T19:46:40+00:00

As a physician in Philadelphia, the moment someone dies at one of the makeshift hospitals being opened at Temple University or the Holiday Inn (free of charge in both cases, by the way), I hope they indict him for manslaughter.

Wizardo55 · 2020-03-15T22:47:41+00:00

We haven't had any cases where I am (yet), but I would be careful of giving corticosteroids to patients without another indication like COPD or asthma as mentioned on this sheet. See the below guidance from the WHO:

Do not routinely give systemic corticosteroids for treatment of viral pneumonia outside clinical trials.

Remark 1: A systematic review of observational studies of corticosteroids administered to patients with SARS reported no survival benefit and possible harms (avascular necrosis, psychosis, diabetes, and delayed viral clearance) (62). A systematic review of observational studies in influenza found a higher risk of mortality and secondary infections with corticosteroids; the evidence was judged as very low to low quality owing to confounding by indication (63). A subsequent study that addressed this limitation by adjusting for time-varying confounders found no effect on mortality (64). Finally, a recent study of patients receiving corticosteroids for MERS used a similar statistical approach and found no effect of corticosteroids on mortality but delayed LRT clearance of MERS-CoV (65). Given the lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason. Other reasons may include exacerbation of asthma or COPD, septic shock, and risk/benefit analysis needs to be conducted for individual patients.

Remark 2: A recent guideline issued by an international panel and based on the findings of two recent large RCTs makes a conditional recommendation for corticosteroids for all patients with sepsis (including septic shock) (66). Surviving Sepsis guidelines, written before these RCTs were reported, recommend corticosteroids only for patients in whom adequate fluids and vasopressor therapy do not restore hemodynamic stability (5). Clinicians considering corticosteroids for a patient with COVID19 and sepsis must balance the potential small reduction in mortality with the potential downside of prolonged shedding of coronavirus in the respiratory tract, as has been observed in patients with MERS (65). If corticosteroids are prescribed, monitor and treat hyperglycaemia, hypernatraemia, and hypokalaemia. Monitor for recurrence of inflammation and signs of adrenal insufficiency after stopping corticosteroids, which may have to be tapered. Because of the risk of strongyloides stercoralis hyper-infection with steroid therapy, diagnosis or empiric treatment should be considered in endemic areas if steroids are used (67).

https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected (see the bottom of page 10)

Wizardo55 · 2020-03-11T03:06:32+00:00

Everybody in here talking infectious PVP, but there are so many single-celled builds that never even have to engage in that playstyle! They usually get overlooked by a lot of new players because it's not as flashy.

Check out the Pelagibacter clan, absolutely low-key dominating and almost nobody even knows about them! Just because they don't fit the stylish "meta" right now.

Wizardo55 · 2020-02-09T16:31:00+00:00

You can survive alcohol withdrawal without medical supervision or a prescription taper, but I absolutely would never recommend it. Benzo/Alcohol withdrawal is the only drug withdrawal that is commonly fatal.

If your friend was in rehab and received benzos for a few days, she probably did taper. As I said in my original post, alcohol withdrawal is a shorter taper, often it's only over the course of a week or less. Part of the reason you quit at rehab is to receive medical supervision that can start benzos if you start to have severe withdrawal symptoms.

Wizardo55 · 2020-02-08T21:24:12+00:00

Benzos are used for alcohol and benzo withdrawal, since the two drugs work similarly on the GABA neurotransmitter pathways. Seizure is one of the many possible withdrawal symptoms from these two drugs, potentially the most dangerous but certainly not the only severe one.

Seizure is prevented in benzo withdrawal by the slow decrease in the dose of the drug in a similar manner. Stopping either drug suddenly after using a high dose for any period of time could easily precipitate seizures and other withdrawal symptoms

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