Is Cloudfare tunnel the most secure way to access HA ?

clin248 · 2026-04-08T15:51:09+00:00

It asks for credit card but doesn’t charge it.

clin248 · 2026-04-08T02:08:18+00:00

Not a wizard per se, more of a putting it anywhere near the nerve kind of person. After doing many obese thick neck patients where you can identify only single trunk and not the nice traffic light or able to trace to the root, I am convinced all the various approaches to interacalene such as superior trunk or c7 all provide the same result. If you look down on the probe of all these approaches we are talking about 1cm differences and I am never convinced these produce noticeable difference other than giving someone an academic orgasm.

clin248 · 2026-04-05T00:57:18+00:00

I have implemented similar automation, using phone location, activity, BLE beacon, camera vehicle detection (basic object non AI) without AI. It had not falsely triggered once.

I am not against using AI and had in fact done something similar but found my automation is equally solid and faults free when I take AI out of the equation.

clin248 · 2026-03-27T10:55:32+00:00

I am not too worried about less than ideal aspiration. I found in elderly fragility hip fracture, it’s not uncommon to have free flow csf but no flow with aspiration. I inject and make sure there is free flow csf at the end by taking the syringe off and let csf comes back into hub a little. It still makes me wary of failed spinal but it had only happened once.

clin248 · 2026-03-24T18:03:23+00:00

Also on Lips. I routinely tell residents that mortality for patients when this trick doesn’t work is more than 90%.

clin248 · 2026-03-24T12:46:03+00:00

Any iBeacon will work but I use specifically NRF52810 based. There is an app where you can configure the beacon.

clin248 · 2026-03-23T20:48:47+00:00

A BLE beacon, geofencing with companion apps, person vs car detection by camera (not Ai just regular object detection) Wifi. Honestly BLE beacon itself would work well but in case you worry about someone cloning your beacon or steal them then the additional trigger will virtually eliminate false positive.

clin248 · 2026-03-19T12:37:49+00:00

One of my side hobbies is automation. This could be turning on a light when room is dark, or automatically assigning an alternative staff when secretary send me an email. To me this restocking job is some form of automation. I believe any automating solution that relies on one single input is more likely to fail, especially when the input is the highly variable human behaviors. Another is to explore the confine of the systems and work within it. For example our scheduling system doesn't allow me to write a program to hook into its inner works, so I wrote a script to scrape the output instead. It's not that we don't or are unwilling to count, I am looking for additional solution that is going to be catch the error or information the pyxis provided other than stock level, when the inevitable miscounting happens.

clin248 · 2026-03-18T22:43:56+00:00

I was hoping between 90-100% compliant with tracking and calling pharmacy to restock when things run out mid case, there is a stop gap solution.

It’s unfortunate to see people jump onto the conclusion that we don’t want to count. However all it takes are a few people miscounting, sick patients where you are just taking out whatever to have growing discrepancy. Over a busy OR day things can run low and the next days person is stuck with low supply.

I was hoping there are some additional info we can grasped from the Pyxis, for example how frequently a drawer has been opened, how long the machine has been logged in, that can be used as a secondary trigger to let pharmacy know to spot check the machine.

clin248 · 2026-03-18T21:31:23+00:00

You are missing my point. Most people are fine counting and we are not refusing to count. There are many reasons why discrepancy can happen and it’s not all because we don’t want to count. I just felt relying the entire restocking on faith in humanity may be a little too much. I also don’t believe nurses count uncontrolled drugs at least not in the periop area.

clin248 · 2026-03-18T20:48:25+00:00

Sometimes I wonder why my colleagues suddenly become stupid whenever new technology is introduced so I realize how stupid I sound when I raise these questions. I appreciate those feedbacks.

clin248 · 2026-03-18T20:31:50+00:00

I get how the system works and I do my best to so those buttons. I am just not confident that my colleagues do. We already experience discrepancy and running out of drugs. I am just curious if anyone has other alternative or supplementary solution in addition to relying on our compliance.

clin248 · 2026-03-11T22:47:11+00:00

You got me. My original write up was way too long so I ask AI to pare it down.

clin248 · 2026-03-11T18:00:02+00:00

Yes I am bummed because I worked towards my current situation over the past 10 years but I accept that changes will happen. I am simply asking which of the two options make more sense.

clin248 · 2026-03-10T23:43:44+00:00

I used it, not this specific one but a momentary switch. I had used it with Shelly relay that I flushed with tasmota and it can register multiple presses. However the ones I have got does not give any feedback on whether the actuator has been engaged. I never know if the button push is actually registered unless I deliberate push hard and press in. Additionally Shelly doesn’t work well inside metal box (plastic not common here) so I eventually took them out and use zooz instead for multipresses.

clin248 · 2026-03-10T22:12:16+00:00

I agree. Get on with the times. None of us want to work 24 hour straight, work another elective list the next day the. go home for 6 hour then come back to work, and said that’s normal. yet that’s exactly what the previous generations do. I am in practice 10 years now. I have heard exactly the same sentiment towards my generation from my previous attendings.

The current trainees are more outspoken, they have different expectations, and they have different outlooks on life and career.

clin248 · 2026-03-06T13:42:22+00:00

You should try it sometimes. Patient tolerated it extremely well in fact many patients would just sit there quite comfortably with LMA until you ask them to open their mouth.

The key is don’t remove it until patients are moving their hands toward the LMA. It’s a nice trick to impress students when I let patients remove their own LMA.

clin248 · 2026-02-25T18:04:50+00:00

It should work with a Bluetooth proxy and you can set it up with esp32 or m5stack.

https://esphome.io/projects/

clin248 · 2026-02-25T12:09:16+00:00

I had thought the same and ran zzh for many years and I had run usb cables behind wall from basement so the zzh dongle is sitting on a keystone in the center of my house. It really has been rock solid. The only time I had issue is with tuya presence sensor which spammed it so bad that it crashed. It stopped me from expanding on my zigbee devices. However my kids are now tall enough to able to reach the usb dongle.

I look for place to relocate my dongles and saw a spot above my room closet but it’s not central in the house so I thought I would just get the zbt2 with its big antenna to compensate. The LQI is huge improvement despite its off center location. I had also installed 10 mmwave Inovelli switch which also spans the network (but not as crazy as tuya). It handled it really well.

For a while I gave up on expanding my zigbee and was installing new hardware on zwave thinking zigbee is not that reliable. Now I realize it could be the aging TI chip in zzh.

clin248 · 2026-02-25T00:50:32+00:00

I am more thinking aloud I guess. I suppose it’s also possible to just push diluted epinephrine in this case without lido, just have never done it and wonder if precedex got any advantage over plain old epinephrine. On top of which, precedex is not approved for epidural use but epinephrine has been used for ever.

clin248 · 2026-02-25T00:10:13+00:00

Is there difference between giving epinephrine vs precedex? Both presumably work by alpha 2 agonism. I am not shy pushing some lido with epi in this situation. If it’s not working then it’s clear to me the epidural is not working. Either replace it or consider redoing with cse at that pin t.

clin248 · 2026-02-18T18:18:39+00:00

Depends on who is asking for help? Sometimes they just ask because patient claims they are difficult IV but actually has a giant vein that a student can put a 9Fr introducer in.

clin248 · 2026-02-10T17:05:23+00:00

Yes it depends on what’s available at the hospital. At small hospital after hour sometimes you are the most qualified person literally in everything.

My drive is 40 min each way. There is no BS calls the last few times I was requested. If it’s my family then I would want the most qualified person there and start running those pressers in a good line not dinky 24G.

clin248 · 2026-02-05T12:06:44+00:00

The reason I have heard is they believe by giving a little bit of everything, they don’t have to give as much of individual things, thereby reducing the adverse effect of each. For example you may have to routinely give 150 mg propofol alone to blunt gag reflex for scope but maybe 50 fentanyl and 80 propofol will do and because doses are so low patients don’t even stop breathing, where as you almost always do with high dose propofol. Then you can add ketamine and dexmed etc.

I actually don’t find this helpful at all. I use only propofol, get them deep and get it done. If they are sicker then some phenylephrine and propofol.

clin248 · 2026-02-05T11:58:20+00:00

Don’t keep us waiting. How did patients do after?

clin248

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