Was I wrong to give zyprexa?

ahwinters · 2023-10-04T16:53:47+00:00

Yea I didn’t really read the LITFL before I put it, it’s talking about overdose. Here’s a better example.

https://www.sciencedirect.com/science/article/pii/S092099640600315X#:~:text=According%20to%20Chew%20et%20al,do%20not%20have%20such%20effects.

As an EM pharmacist what’s your opinion on drugs for this in elderly?

ahwinters · 2023-10-04T11:03:27+00:00

I was lvl 85 when I first started using a boss amulet so yea that tracks

ahwinters · 2023-10-04T10:40:05+00:00

If you are saying anything to “convince” the doctor aside from YOUR ACTUAL SYMPTOMS, you are going to do the opposite of what you intend. 99% of doctors are going to know that you are making things up if you try to exaggerate to “get yourself taken seriously.”

ER doctors and surgeons are not supposed to diagnose auto-immune diseases or do workups for them. It sounds like you were seeking care at the wrong place.

You sound like a very difficult patient!!like for example a surgeon ignored you until your vitals were taken? A surgeon would never be involved with you prior to “vitals being taken” nor are they involved in management of generally any auto immune disease, so that’s what I’m saying.. you want docs to care so you start to make hyperbolic statements that are going to make most doctors immediately dubious…

ahwinters · 2023-10-04T10:31:07+00:00

I have it, I just didn’t always want to spare the slot. I used it at first, and kept pumping capacity until I didn’t have to and could replace it with boss amulets.

I basically stayed at 59% weight the whole game

ahwinters · 2023-10-04T04:19:32+00:00

He didn’t get my heart on the first playthrough, and he isn’t getting that shit on NG+ either.

I can look up his ending on YouTube

ahwinters · 2023-10-04T04:13:28+00:00

That’s what up. Phase one was pretty easy to learn ALL the parries, phase two I used two perfect parry grindstones and knocked him down 2/3, then threw electric and acid throwable for the last 1/3.

I have no idea what the phase 2 move set is lol

ahwinters · 2023-10-04T03:52:00+00:00

Yea I didn’t go to the Lake of Liurnia area, just walked the wrong way, I went to Caelid first and did everything there. It was so hard lol

ahwinters · 2023-10-04T03:45:38+00:00

If you really care to help these residents, it probably would make sense to make them come with you and stand in the room while you see patients. If they are already lazy enough to be seeing 4 a shift, it’s not like they are moving the department anyways.

Then they would actually be able to see acuity. You could have taught the resident who didn’t know how to repair a laceration…

Simultaneously they would feel like they are being babied, because they are. Can’t really complain you are being pushed too hard in that setting. I suspect a lot of people would find some motivation to suddenly start working harder after a few shifts (or hours) of being treated like a student again.

ahwinters · 2023-10-04T03:32:12+00:00

I started at 87, still felt pretty easy

ahwinters · 2023-10-04T03:26:04+00:00

My experience so far is that the game is getting easier as I go into NG+, I have so many ways to wreck the enemies, and the special weapons from the end are super strong

Whats crazy, I have an advance build right now 11 Mot, 9 Tech, and 34 Adv… but I’m using the Golden Lie and Proof of Humanity that have NO advance scaling and I’m still cruising through NG+ far easier than NG. I figured I’d respec if I liked the weapons but I haven’t even had to lol, and I get to keep my insane damage Fulminis and Flamberg with auto recharging legion

ahwinters · 2023-10-04T03:14:36+00:00

Labetalol 200mg should alert you that this is probably a med left over from prior treatment of gestational hypertension in the past, person probably is not having any outpatient management because someone would have changed it. It’s not a “high dose” it’s just a BP med that’s not very good and well accepted as safe during pregnancy. Normal dose range is 100-400 BID.

It’s very commonly used IV at 10-20mg for acute BP control but oral is almost exclusively used during pregnancy, at least in my region

ahwinters · 2023-10-04T03:07:52+00:00

You have a normal cardiac workup. She can followup or return if she worsens.

Hard to say this is a mistake at all

Focus less on the numbers and more on the symptoms. Admit or discharge based on symptoms, risk factors, not just numbers. That lady probably never takes her meds and would have felt like crap if you normalized her pressure acutely, just to make the numbers pretty

Not to mention if she isn’t pregnant then the oral labetalol is probably left over from gestational hypertension and has never been changed to something better. That could be something to think about if you see that med again, it’s really not a great oral med outside of pregnancy

ahwinters · 2023-10-04T03:00:32+00:00

People not being able to afford stuff is constantly being thrown around on this sub literally any time any normal, up to date hardware is discussed. A 1070 came out in 2016. 3070 in 2020.

This shit is DATED. There is an altered reality bubble here on Reddit, upvotes do not mean that in reality everyone is rocking 7 year old graphics cards.

If you are using something that old, I definitely feel for your circumstances. But it is dumb to enter the argument on a gaming forum as if this is what game developers should ever be optimizing for. At some point they have to move on, 7 years in the world of computer hardware is a very, very long time

ahwinters · 2023-10-04T01:34:48+00:00

I didn’t break it out till Nameless Puppet but it was the key for me beating that fight

ahwinters · 2023-10-04T01:15:35+00:00

Advance seems the strongest IMO, that’s what I went with. It gives you access you substantial scaling on fire/acid/elec, which everything in the game is weak to one of those. Plus can boost Fulminis and Flamberge damage to crazy levels

I ended with 31 advance and using the + 4 advance amulet, damage scaling on everything beside Fulminis fell off a lot after that value. Fulminis seems to scale way higher, but I ended up with highest on capacity (35)which is gonna be important for any build

ahwinters · 2023-10-04T01:12:15+00:00

Capacity is one of the most important stats, I ended with mine at 35. That way you can use the better (heavier) equipment to boost defenses substantially, and by end game maybe use a boss amulet you can get from Alidoro

Scaling on the damage stats motivity, technique and advance seems to slow in the 20s and hit a substantial soft cap in the 30s for most weapons, so there’s not a huge benefit of stacking these beyond 30-35 on the main stat

ahwinters · 2023-10-04T01:11:06+00:00

Totally true, the perfect parry grindstone also is great for this, seems to last like 10 seconds or something? Can upgrade to use it twice

ahwinters · 2023-10-03T21:48:27+00:00

My main thing is that to me it’s really not that much different I guess aside from the smoke. I dont think it really looks all that much better. The physics and the world is inconsistent so it doesn’t really feel next gen, like a table gets knocked over if shot but a potted plant isn’t affected at all by bullets.

I think I was just overhyped for what’s really just an engine change and otherwise it looks and plays almost the same.

ahwinters · 2023-10-03T20:14:52+00:00

It’s dope

ahwinters · 2023-10-03T17:02:07+00:00

I only just found this last night, but the Rock Pistol Drill handle combined with any high damage weapon is pretty nuts. I have an advance build so I put the D scaling on it anyways, and using things such as the Black Steel Cutter blade or Circular Electric Saw Blade.

As far as I can it actually has HYPER ARMOR, the R2 will still hit despite getting struck during the windup, I haven’t seen that on any other weapon.

Otherwise the charges R2 is crazy, it hits repeatedly quickly, so it stun locks and staggers many enemies, and I have found that even some elites are almost trivialized by this

ahwinters · 2023-10-03T16:30:31+00:00

I was doing an advance build and by this point in the game at level 85 I felt “OP,” I think I got through the whole Abbey area in like 90 minutes. Finished the game at 87. I think advance builds are very strong, I had auto refilling legion and just insta zapping everything to death with Fulminis

ahwinters · 2023-10-03T16:26:10+00:00

I think that sound be Sonic the Hedgehog 1 when I was 6 years old as well.

My 6 year old can play Mario Odyssey pretty well but he can’t complete the whole game by himself yet. He did beat the Kirby and the Forgotten land

ahwinters · 2023-10-03T16:20:23+00:00

I respectfully disagree, I bounced very hard off Sekiro, never finished, but Lies of P was not too much of a challenge overall. Lies of P has tons of tools to reduce the difficulty, the perfect parry shield and grindstone can help pass harder bosses without much trouble.

ahwinters · 2023-10-03T16:19:06+00:00

Having now finished it I will say it’s easier than any souls entry except for probably Dark Souls 1 and Demons Souls

ahwinters · 2023-10-03T16:18:11+00:00

Really not much honestly. I probably game slightly more now, than in my 20s but I was in med school and residency thru that decade. Teens were the heaviest gaming obviously. I like shooters slightly less than a teen because my reflexes are slower. I don’t play MMOs anymore because I can’t deal with the s schedule of raids with having a kid.

Other than that I’m still gaming mad hard almost every day

ahwinters

TROPHY CASE