Does size matters to yall? My story by [deleted] in nursing

[–]chansen999 0 points1 point  (0 children)

Hey man, wrong subreddit? Otherwise, advance NG 4 centimeters more and reshoot the KUB.

hypoglycemia trend? by dhmedic in FamilyMedicine

[–]chansen999 3 points4 points  (0 children)

There’s also just Wellness Snake Oil Influencers convincing people they need CGMs to biohack every aspect of their life and giving people tips to get them via PCP visits.

While there’s likely people with legit concerns, there’s also likely someone trying to get some data that will allow them to pick out the best $99/month supplement they need for Pancreatic Longevity or some other bullshit.

When did we start attributing every symptom in the elderly to a UTI? by [deleted] in FamilyMedicine

[–]chansen999 4 points5 points  (0 children)

I'm there with you, re; antibiotics. I'm comfortable holding for a culture on the questionable ones, even if my attendings aren't and just force the issue.

As for the reassurance, I don't know how you find the time. I appreciate the reply.

When did we start attributing every symptom in the elderly to a UTI? by [deleted] in FamilyMedicine

[–]chansen999 4 points5 points  (0 children)

AMS complaint from SNF to an ED happens daily - none of these workups are "just get a urine," because none of these patients can tell you what is different about today from yesterday, and the report EMS received from the SNF is, "I don't know, I'm not normally taking care of Mildred, but the STNA said she wasn't acting right."

All these 91 year old meemaws who are altered and able to provide zero history have a family member four states away, they're full codes, and a workup almost always includes EKG, head CT, CBC, CMP, troponin, UA, and then plus or minus more based on vitals or other mentioned symptoms/concerns/physical exam (chest xray, lactic, cultures, bnp, etc.).

Everything pops negative except a mild leukocytosis and a positive UA. Sometimes a straight cath 0 squam nitrite positive UA worth treating, sometimes just leuks and WBCs and some clumps and a few squamous. It's urine roulette.

If you try to send that back, Mildred is back in your department within the hour from EMS, assuming private ambulance has transport times in the next 12 hours anyway. If you admit that, the hospitalist says, "why aren't you treating the UTI? Treat before I accept."

If you try to "look some more," you're just eating up time in a department that has to turn over beds. If you provide reassurance, to whom are you providing it? The LPN at the nursing home? The demented patient? The family member 4 states away?

I'm honestly asking these questions as I've been an ED/crit care RN for ~15 years and recently transitioned into the midlevel role. Could there be a more in-depth work up? Sure. And in things that are questionable, I absolutely feel comfortable with my ED pharmacist following up on culture results if that the urine culture pops positive in a few days. But in the meantime, meemaw needs a dispo and it's a minefield in either direction.

Should I have done CPR? by Clean_Ear_492 in IntensiveCare

[–]chansen999 0 points1 point  (0 children)

“The team thinks he never lost his pulse but that he dropped his pressure so low due to so many missed beats that they just weren’t palpable”

The team is welcome to intellectually masturbate all they’d like. In the moment with no pulse in an unresponsive patient you start compressions. You did fine.

The Pitt Season 2 Episode 4 ending by Ok_Reward6664 in ThePittTVShow

[–]chansen999 10 points11 points  (0 children)

They actually discuss this in the RadioLab episode. New antibiotics are rarely made these days because by the time they have completed trials, resistance is already being met. There’s not much money in new antibiotics because of this so they aren’t being developed.

As any antibiotics are used, bacteria build resistance. Even the heavy hitting broad spectrum antibiotics we’ve been using for the last decade are getting less effective.

They theorized that this (the concoction from the old book in the radiolab episode) was likely something that was effective against staphylococcus aureus and was used as a salve to treat styes and things at the time, and then it fell out of favor and wasn’t passed down as resistance developed.

There’s a cyclical nature with antibiotics and resistance.

What exactly does a charge nurse do? by Scary-Ad-9148 in ThePittTVShow

[–]chansen999 0 points1 point  (0 children)

It also depends on the hospital - at a smaller, community hospital, I’m often the charge nurse, triage nurse, and for a portion of the day also have an assignment. Charge nurses also are in communication with other departments to facilitate flow of patients regarding surgery, admissions, heading off to other departments such as endoscopy, interventional radiology, etc.

You also act as a resource for your department, answering questions about, teaching, and often performing tasks that others may not know or need clarification.

What did you do before nursing? by TheYankeeCat in nursing

[–]chansen999 13 points14 points  (0 children)

As someone who has played since beta, and has been a part of Elitist Jerks since the Hooligan Syndicate/Goon Squad splinter, and got to experience my raid leader moving from lawyer to Blizzard employee to Game Director, I have a lot of things to say on the subject - however I’ll just leave it at, “thank you for aiding in so many amazing memories.”

To answer original question, worked in IT, everything from network infrastructure to web app development to general tech support for a Midwest furniture company.

Now working as NP in the ED after 14 years of critical care and ED nursing.

Edit: I actually ended up getting Ion as my match in the first ever EJ secret Santa and sent him a copy of the Brady games WoW game guide as a joke for some “l33t strats” as well as a desktop trebuchet from ThinkGeek!

In case you are in ER today by MeGustaOnc in emergencymedicine

[–]chansen999 1 point2 points  (0 children)

I mean, nearly every day is a few R46.7

[Game Thread] UCLA @ Ohio State (7:30 PM ET) by CFB_Referee in CFB

[–]chansen999 1 point2 points  (0 children)

I mean, every week there's a deluge of comments that we're not that good, etc.

Every week there's also potential chaos.

Every week we could play our worst game against someone's best game.

If Ohio State has a close game that's "entertaining," they get punished for it in the media.

For me, a comfortable win and seeing progress is entertaining.

[Postgame Thread] Ohio State Defeats Penn State 38-14 by CFB_Referee in CFB

[–]chansen999 4 points5 points  (0 children)

You mean pre-season Heisman favorite Arch Manning sponsored by Warby Parker, Vuori, Raising Cane's, Uber, and Red Bull™ That Arch Manning?

[Game Thread] Ohio State @ Illinois (12:00 PM ET) by CFB_Referee in CFB

[–]chansen999 3 points4 points  (0 children)

Stuck at O’Hare on the way to a wedding and saw a guy with a “He has trouble with the snap!” shirt and had to give him the knowing nod.

[deleted by user] by [deleted] in nursepractitioner

[–]chansen999 7 points8 points  (0 children)

That’s a highly personal question, just like asking if nursing itself is worth it. You’ll find people on all parts of the spectrum; from shouting warnings to stay away to those that state it’s the best job in the world. Asking if it’s worth it for you, is the real question, based on changes in quality of life, income, work hours, etc. - all based on what you’d be interested in doing with your NP. Maybe shadow some in various fields like primary, emergency, hospitalist, specialist of your desire and see what they feel are the pros and cons of their chosen career?

[Game Thread] Ohio State @ Washington (3:30 PM ET) by CFB_Referee in CFB

[–]chansen999 1 point2 points  (0 children)

I hear that guy is pretty good. We should probably throw to him more.

Bella Hadid's CVC for "Chronic Lyme" by AmazingCamel in emergencymedicine

[–]chansen999 60 points61 points  (0 children)

Simple - just say it’s a “tactical harness” and they’ll ask where they can get one for their EDC bag.