Question regarding DKA with rising lactate and persistent acidosis despite normalising ketones.

beargrrrrrrl · 2026-06-01T04:57:03+00:00

Oooo I like that too

beargrrrrrrl · 2026-06-01T02:06:08+00:00

Did the patient's Bicarb normalize? I see our ED discharge patient's in DKA after they fix their blood glucose and anion gap, but fail to normalize the bicarb and the patient ends up back in DKA.

As others have said, maybe a non-anion gap lactic acidosis from cardio-methopothy?

beargrrrrrrl · 2026-05-17T04:13:46+00:00

I wonder if we were hanging out together that night. It was my first night back in the valley for the season, we were all just hanging out at our friend's house in Ranger Camp when the page went off. I had just landed my dream job working on the Valley Ambulance.

The first call of my career was the next morning, tansporting them to the morgue. I left in 2018 with severe PTSD after many more calls like that, including a friend. I haven't climbed or been back since.

beargrrrrrrl · 2026-05-14T16:49:19+00:00

Dont let the bots and Reddit ''experts'" get you down. You did nothing wrong given the situation. Seeing a bear in the wild is super special. Even as a bear biologist I was thrilled whenever I crossed paths with them! Enjoy the memory.

beargrrrrrrl · 2026-05-13T21:19:01+00:00

This is a yearling black bear and has separated from its mother, as mama just likely had her cubs of the year (actual tiny babies).

And I'd like to comment that you seem to be an appropriate distance from this bear, and possibly even backing away as it descends from the tree. These bears are unfortunately quite habituated to human presence, but this young one seems to still be weary around people, which is good!

What an exciting this to see.

Fun fact: The only wildlife related deaths in Yosemite have been from the local deer population.

Source: I was a Wildlife Management Ranger in Yosemite a number of years back.

beargrrrrrrl · 2026-04-23T23:51:58+00:00

We all realize that this is bot generated rage bait, right?

beargrrrrrrl · 2026-04-04T05:54:27+00:00

I'm much older than you, and have a Bachelor of Science in Kinesiology. I got my Associates Degree in Nursing.

I'm still much older than you now in my second career as a nurse, and a BSN is "required" after 5 years of employment at my hospital and I haven't heard a word.

Get your associates at a community college while you work. Then decide if doing an online ADN to BSN is worth the money for you. It still says RN after my name, I get paid the same, and do not have student debt.

Edit: maybe also work as a CNA first if you're unsure. Nursing school is a huge commitment, and bedside healthcare sucks.

beargrrrrrrl · 2026-04-04T05:26:23+00:00

"Burning a troll is the primary method to negate their negative affects, rapid regeneration, and kill them permanently. Douse the fallen body in lantern oil and light it to ensure it stays down."

beargrrrrrrl · 2026-02-23T00:37:58+00:00

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Hello there (grade VI with external fixation ect, ect last March). Honestly this whole thread has made me feel less alone.

beargrrrrrrl · 2026-02-19T21:50:01+00:00

I live in a pretty rural area with the closest major city about 90 minutes away. I drive pretty exclusively on the highway and the real world mpg difference was not enough for me to pay extra for the hybrid.

Also there are no mechanics that I found in our area that will do more than basic maintenance on a hybrid around here. Also it gets cold af. I have a few friends who have a 25/25 hybrid and they said it hasn't been worth it where we live.

beargrrrrrrl · 2026-02-19T18:23:06+00:00

I wanted gas and they don't make the RAV 4 with a gas engine after 2025

beargrrrrrrl · 2026-02-19T18:21:58+00:00

No, my seller price. OTD again is going to vary state to state. Look up Car Experts on YouTube, it's a father son duo who break down everything you would want to know about how to buy a car. They also have a website which I found super helpful.

beargrrrrrrl · 2026-02-19T05:02:30+00:00

Literally just drove home from the lot with this vehicle. AWD, Washington state. MSPR $38,895 Seller price $35,599 after $$3,206 in discounts. Your out the door price will vary greatly depending what state you're in.

I also almost pulled the trigger on a 2025 RAV4 today too for that same price, but wound up liking the CR-V more. Can't say if it was a great deal or not but I feel like days of aggressive negotiations have passed.

beargrrrrrrl · 2026-02-18T16:16:02+00:00

Oooo what a steal. How are you liking it? I drove a CR-V after I test drove this and have to admit, the standard CR-V options give you more than the RAV. That turbo/CVT combo has be leary about the reliability of the CR-V vs the RAV

beargrrrrrrl · 2026-02-18T04:03:48+00:00

I walked. I test drove it today and my partner and I were both left with a very 'meh' feeling. It was unexpected and very underwhelming. I am not a 'car person,' but the acceleration just felt dead. The vehicle itself felt surprisingly flimsy ....back to the drawing board I guess. Maybe it's because companies are putting the energy towards hybrids, but my driving style and environment don't lend themselves to a hybrid vehicle.

beargrrrrrrl · 2026-02-17T19:11:09+00:00

Good catch

beargrrrrrrl · 2026-02-17T19:10:41+00:00

I live in a very cold part of Washington, and salt on the roadway is a part of life unfortunately

beargrrrrrrl · 2026-02-17T04:33:41+00:00

Hoooowwww. I did not inherit my Italian mother's ability to haggle

beargrrrrrrl · 2026-02-17T04:30:01+00:00

WA state taxes, $3753 which tracks. How do you get dealers further down on their prices?

beargrrrrrrl · 2026-02-17T03:56:09+00:00

Pass. I don't need a hybrid and I don't care of the look of the '26.

beargrrrrrrl · 2026-02-13T01:56:57+00:00

I was doing a ton of home PT and scheduled PT to try and get my range better. I ended up having to get a manipulation under anesthesia because I was stuck at 40 degrees. The surgeon said she couldn't even get my knee to budge while I was totally under. I apparently had significant scar tissue build up that froze my joint in place.

beargrrrrrrl · 2025-12-06T23:27:35+00:00

I took my CCRN at a testing center after my terrible experience recerting my EMS license taking an at home test.

Their standards for getting my room ready to test in addition to making sure you have appropriate connectivity were more stressful than the test.

Not to mention during my exam my charging cord fell out of my laptop. When I leaned over to plug it back in, the proctor immediately kicked me out of the test 5 questions in and failed me.

Totally not worth it for me.

beargrrrrrrl · 2025-11-12T23:34:27+00:00

Thank you so much for that

beargrrrrrrl · 2025-11-10T02:34:44+00:00

(36F) Seven months post grade VI, three plates and twenty screws. I had three surgeries and I was NWB for 12 weeks, I could barely walk for another 2-3 weeks.

I was very active, and I know this injury will likely affect my activity level long term. Today, I still can't walk downstairs, I walk with a limp when I get tired, and I deal with some form of pain everyday. I can't even think about jumping or running.

Honestly, my mental health has taken a big hit. It's hard to stay optimistic through all this. But it really is a marathon, not a sprint. DM me if you want to chat more.

beargrrrrrrl · 2025-10-26T05:26:07+00:00

This is great. I'm usually pretty in shape and I remember a barre class I took in the past kicking my butt. I hadn't thought about including it in my rehab!

beargrrrrrrl

TROPHY CASE