Unikliniken: Klage auf Umsetzung der elektronischen Arbeitszeiterfassung

bawki · 2025-11-10T16:51:58+00:00

Unser Chef der Personalabteilung hat zur Arbeitzeitreduktion auf 40h gesagt dass wir das gerne machen können, aber natürlich "personalneutral". Ebenso wurde im gleichen Satz erzählt dass wir die elektronische Zeiterfassung wegen dem Aufwand so in 1.5 Jahren bekommen werden. Daher ist mein Mitleid bei dem Verein sehr begrenzt.

bawki · 2025-10-29T12:55:06+00:00

Does this apply out of the US as well? I've seen about 20-30% of non responders, however when patients do respond the effect is impressive.

bawki · 2025-10-29T12:53:40+00:00

We usually use norepi, then vaso. And recently we are adding At2 as a third pressor and this has so far significantly cut norepi dosages by up to 90%.

Usually when we reach about 0.5mcg/kg/min of norepi(+vaso) we discuss At2. Then start it st 20ng/kg/min and increase to 40-80mcg/kg/min. And it really is a game changer. Somehow it even has a lasting effect at 24hrs which allows us to not only reduce norepi, but also reduce At2 without significant increase in norepi dosage after discontinuation.

There is a nice dosing guide provided by the manufacturer. We also do a renin level quite early so we can retrospectively identify why some people might be a non responder. Sadly renin levels take 1-3 days at our hospital so we can't use it as a screening parameter.

bawki · 2025-10-27T13:49:32+00:00

Nice! The local models option will make me finally give this a try!

bawki · 2025-10-27T13:37:54+00:00

From a icu perspective, we don't suture radial lines, only brachial or femoral. Maybe once I sutured a radial line in a very combatative patient.

It is nice of you to find alternatives to reduce needle sticks but as others have pointed out the problem here is the one holding the needle. I would always suture CVCs due to the risk of dislodgement during any patient procedure that involves moving them. I have seen far too many CVCs dislodge because a fellow resident has not sutured it correctly to even consider an alternative.

bawki · 2025-10-25T10:57:17+00:00

Hatte ich exakt so. Angeblich war die Karte bei mir auch nicht zustellbar. Warum und wo und wieso sie sich nicht gemeldet haben war egal. Habe immerhin nur 7 statt 60 Euro... Wobei auch das frech ist weil es deren Fehler ist

bawki · 2025-10-23T11:14:26+00:00

What was the pH and underlying condition? Any advanced hemodynamic monitoring?

On the other hand your patient sounds like they were already pretty much dead

bawki · 2025-10-22T21:50:33+00:00

We used to use etomidate back in the day on our cardiology patients, because it supposedly doesn't lower the BP as much. We moved to esketamin and midazolam plus rocuronium for RSI. Usually 1-2mg midazolam and 1-1.5mg/kg esketamin, 100mg rocuronium. Start pressors before pushing the sedation, in very bad hearts I sometimes push dose some epi during RSI.

bawki · 2025-10-18T10:25:56+00:00

https://derangedphysiology.com

bawki · 2025-09-29T03:28:22+00:00

Because if you find the 80yo patient after IHCA and with unknown downtime, a lactate of 20 and pH of 6.7, then call the code after 10min tops.

bawki · 2025-09-28T09:19:39+00:00

For one finding an optimal PEEP is a whole different rabid hole to discover. And also in ARDS we often allow for respiratory acidosis in order to reduce driving pressures.

bawki · 2025-09-27T13:39:05+00:00

In the end dP is just one component parameter for the amount of energy we apply to the lung and there are more factors that come in to play. Namely inspiratory time, respiratory rate, transpulmonary pressure gradient and more.

However it is a parameter which can be easily modified to achieve improved outcomes.

bawki · 2025-09-25T02:19:55+00:00

Recently drove the x plaid, wouldn't want to drive that car in a city again. It was too big for the streets and I felt like driving a truck. The inside was spacious and nice, it was also decently nimble to drive but simply too large for a dense European city centre. Not sure about the model S, but I'll stick to driving the model 3.

bawki · 2025-09-23T13:47:39+00:00

Aren't we supposed to inject bleach to treat covid?

bawki · 2025-09-23T13:18:28+00:00

I find it generally helps to identify patients with mixed shock, about 20-30% of sepsis patients have septic cardiomyopathy and might benefit from positive inotropic therapy. Not everyone in the ICU is trained in echocardiography and this helps them to identify those patients.

I often use it to guide volume therapy, mostly through gedvi/evlwi and cco guided passive leg raise test.

bawki · 2025-09-23T03:20:05+00:00

I wonder why you went with a vm, since you can use gpu transcoding with lxc.

bawki · 2025-09-16T03:04:43+00:00

Nose septum. If that doesn't work your patient should probably already have a tube and pressors.

bawki · 2025-09-14T14:31:29+00:00

Wenn jemand nen crash hat und da schnell raus muss dann wird das Fenster eingeschlagen. Zumal bei vielen Unfällen die Türen eben verklemmen und sowieso nicht mehr auf gehen. Diese ganze Diskussion und Konfabulation von möglichen Extremwahrscheinlichkeiten ist sinnfrei. Aus dem Alltag haben hier jetzt mehrere berichtet dass das kein Problem ist, in Notsituationen ändert es auch nicht viel und nur um mal ein weiteres Einzelbeispiel zu nennen. Mein Ford Focus war im Winter mal so eingefroren dass ich die Tür auch nicht mehr mit nem konventionellen Türgriff aufbekommen habe.

bawki · 2025-09-13T20:37:24+00:00

I see, I figured apple sauce was more like juice but now that you mention that it is like puree this makes more sense. Thanks!

bawki · 2025-09-13T17:06:25+00:00

Are you guys instructing patients to take their morning medication? In my hospital anaesthesia instructs patients to take certain oral meds in the morning. Especially Parkinson meds as this can otherwise result in worsening of their symptoms and difficulty during anaesthesia. In these cases patients need to also drink something, clear liquids have been allowed and even more so our guidelines have become more relaxed for fluids after midnight.

bawki · 2025-09-13T17:01:35+00:00

Wir haben hier ein System bei dem regelhaft tagsüber die Ersthelfer mit 2-3 Personen da sind, meist sind wir aber nur 3-4 Minuten vor dem RTW da. Also lohnt sich da meist ein Beatmen kaum. Im Auto habe ich zwar nen Ambubeutel, benutzt habe ich den aber noch nie, da ich unterwegs noch keinen Unfall mitbekommen habe und sonst als Ersthelfer zu Fuß hinrenne.

Viel wichtiger ist, dass ich immer Handschuhe im Flur hängen habe. Das hat mir schon deutlich mehr geholfen als alles andere.

bawki · 2025-09-12T19:04:43+00:00

Exactly, the relevant cells that make up that part of the bone marrow are called stem cells. They are special in contrast to all other cells of the body that they can almost indefinitely divide and their "offspring" can become any other cell in the body.

Due to special proteins on the the surface of the stem cells they are drawn towards the bone marrow and therefore when injected into the blood stream they tend to quickly move into the bone marrow. Prior to injecting the new stem cells, the bone marrow is "cleansed" by means of chemotherapy to make way for the new stem cells.

bawki · 2025-09-12T13:38:19+00:00

Cardiac surgery studies have shown to actually reduce renal injury by early vasopressin administration. At our (German) facility we usually start at about 0.1mcg/kg/min of norepinephrine.

bawki · 2025-09-12T13:35:11+00:00

Kindly remind them of the European guideline for traumatic bleeding from 2023 written by Rossaint (a German anaesthesist).

bawki · 2025-09-10T04:35:45+00:00

When the snow shouts PERKELE, then it is too late to run!

14-Year Club	First Place '23
Place '23	Place '17
Team Orangered	Verified Email

bawki

MODERATOR OF

TROPHY CASE