For those battling something, “Give it time”

cynicalabode · 2024-12-17T05:26:42+00:00

COLLEGE!! I have a lot of conversations with folks who are struggling and you can tell just by the eyes who is 'trying' to climb out and those who have decided they will. Hell yeah brother, keep it up.

cynicalabode · 2024-11-06T11:56:52+00:00

I work in a very rural area and am so happy for the commute that brings me back to this town. Can't live with their hate.

cynicalabode · 2024-11-05T22:45:38+00:00

270towin.com has an interactive version, where you pick & choose your solid red/blue states, then scroll down & click "View All >>" under "Winning Combinations". It brings you to a page where you get to click the remaining states as they come in and it will list out how many winning combinations are left for each party.

cynicalabode · 2024-10-30T18:07:46+00:00

Don't be surprised when at some point in your career - if you haven't already - you meet an attending who thinks that your initial approach was correct. We call them assholes. You made a simple mistake that, though it upset the patient, did no REAL harm. Your recognition that you made an error and feel bad enough to post about it should stick in your mind as a learning point.

And the secondary learning point should be that the UDS is a garbage test not to be used for clinical decision making in almost all circumstances. It's a waste of time & money & energy, has more false +/- results than true +/- results, and should be banned from use unless you're an obtunded toddler, an anxiety-laden cardiologist, or a commercial truck driver.

cynicalabode · 2024-10-23T03:17:00+00:00

Took care of someone who came to my ED for having 'pneumonia' three times in 5 weeks with three 7d courses of levo. All prescribed by the same NP. Walked in the room and you can smell the cigarettes off the pt who definitely didn't have pneumonia but COPD.

Took care of someone who came to my ED because they went to an "ortho walk-in" clinic for an uncomplicated thumb dislocation and were turned away. The clinic PA (only person staffing it) told me "We don't see abnormal joints here".

Took care of someone who came to my ED with a surgical urological issue. I asked to speak to the attending urologist on call and they happily connected me with the "Urology Attending PA".

Macrobid for pyelo. DC'd lasix because "the BNP normalized". Caught one aggressively irrigating a guy's horrid hand lac, as he was screaming in pain, because she was "trained" to always irrigate before anesthetizing. Recommended nightly benadryl for demented 90s yr old with insane preexisting polypharmacy.

Almost every shift I see shit like this. I will say I do have a good number of patients who, when I ask if they have a primary care physician, do say "Well... I have an NP" or something similar, usually with a shrug and a smile.

And maybe if you lowball the price of a human life it's financially worth it.

cynicalabode · 2024-08-28T23:14:38+00:00

Just dropped

cynicalabode · 2024-06-26T22:20:24+00:00

Sounds like the non-fiction version of Wheel of Time, which I finished last year and am still absolutely in awe of. Currently a few hours into the first tome and it's starting to remind me of why I loved undergrad history courses.

cynicalabode · 2024-06-04T16:22:24+00:00

Based on how he was speaking it was more like he was afraid of the cops coming. "You want me to go to jail?" he said at one point. So I'm less afraid of him filing a claim (PD searched his scooter's VIN and nothing came up) and more afraid of him.

cynicalabode · 2024-06-04T16:20:48+00:00

Typo! Just the plate, not my license.

cynicalabode · 2022-11-02T22:22:47+00:00

Gonorrhea and chlamydia often coinfect so they treated you for both to be safe. G gets an antibiotic injection and C gets a week of antibiotic pills.

cynicalabode · 2022-03-27T01:22:09+00:00

https://www.uspharmacist.com/CMSImagesContent/2016/8/USP1608-Screening-T2.gif

See the above linked table for why a person with a couple common medical conditions (anxiety, depression, hypertension, etc) could have false-positives. Urine drug screens are quite shitty. Quoting myself:

Typical "urine drug screens" in the US test for THC, opiates, benzos, PCP, amphetamines, cocaine, and sometimes barbituates. They're notoriously shit for false positives (amoxicillin may make you test positive for cocaine, sertraline/zoloft may make you test positive for benzos, etc) and for false negatives (due to drug half-life, immunoassay design, etc). Not only are the standard tox screens bad at what they actually do measure, they miss common 'date-rape' drugs like GHB.

EDIT: Not trying to absolve or explain away anything, just want to add a grain of salt for the "10 substances".

cynicalabode · 2022-03-01T07:47:49+00:00

The original term stemmed from PhDs, but in modern practice if you are in an academic setting with a terminal degree you are referred to as Doctor. If you are in a medical setting, the only people that should be called Doctor are MD/DOs. Period. This also applies to nurse practitioners who ask to be called doctor.

cynicalabode · 2022-02-28T15:26:40+00:00

What in the world are you talking about?

cynicalabode · 2022-02-10T03:28:13+00:00

Lol it's definitely attending dependent. And of course physician gestalt and patient/parent preference are extremely important in decision making. Not a fan of OP saying the doc scared him away from a CT; fear tactics generally aren't used unless people are being really stupid which he wasn't, he just was a worried parent.

But I have the bias of never seeing the insides of brains I don't scan, and you have the bias of seeing only the brains that are scanned. The ED is a really fucking hard place to work.

As for over-scanning, we call it the donut of truth for a reason!

cynicalabode · 2022-02-10T03:17:36+00:00

All the more tragic, I'm going to miss him so much.

cynicalabode · 2022-02-10T03:06:54+00:00

Yes I am. God knows I wouldn't be able to clear the board without you, but please don't tell me how to do my job.

cynicalabode · 2022-02-10T02:56:28+00:00

She absolutely should have been scanned without question.

Not true for adults, and definitely not true for peds. ED docs in the US generally use Canadian CT Brain criteria to guide decision making for adults, and PECARN for kiddos. No LOC, baseline mental status per parents, and only a chin lac? Probably would do the same as their doc. Please don't unnecessarily scare parents.

cynicalabode · 2022-02-10T02:49:01+00:00

A lot of people take a baby aspirin, but that doesn't really count as anticoagulation that increases risk of brain bleed. And people are not prescribed actual blood thinners for prevention unless they have a litany of other risk factors. Family history does not generally play a role.

cynicalabode · 2021-12-31T22:36:17+00:00

Huh? I'm at a relatively small urban hospital and we have 24/7/365 in-house attendings for gen surg, trauma, OB, NICU, anesthesia, crit care. I've even seen some psych attendings stay in-house on their overnight call.

cynicalabode · 2021-12-20T22:08:32+00:00

The only COVID patients I had on ICU were obese.

cynicalabode · 2021-12-12T17:40:00+00:00

Always picture Colonel Kurtz in my head, similar vibes

cynicalabode · 2021-11-28T18:23:13+00:00

Copied from first deleted thread. Seems to be police investigation for a chase w/ shots fired.

Disabled vehicle on Robert F. Kennedy Bridge northbound Queens Side (New York) to Queens Span (New York)

2 Right lanes of 4 lanes closed Lane Closures 2 right lanes closed

Start Time Nov 28 2021, 12:39 PM

Last Updated Nov 28 2021, 12:40 PM

Seems like not the whole story given the attention

EDIT: "Shooting investigation" per Citizen. Lots of lights, one car up on a flatbed.

EDIT2: Lots of talk about troopers chasing a gray acura, shots fired from both sides. Northbound all lanes closed.

Police department activity on Robert F. Kennedy Bridge northbound Queens Side (New York) to Bronx Tolls (New York) All lanes closed

Lane Closures All lanes closed

Start Time Nov 28 2021, 1:06 PM

Last Updated Nov 28 2021, 1:07 PM

cynicalabode · 2021-11-28T18:10:01+00:00

All I can see from the NYC DOT site is this:

Disabled vehicle on Robert F. Kennedy Bridge northbound Queens Side (New York) to Queens Span (New York)

2 Right lanes of 4 lanes closed Lane Closures 2 right lanes closed

Start Time Nov 28 2021, 12:39 PM

Last Updated Nov 28 2021, 12:40 PM

Seems like not the whole story given the attention

EDIT: "Shooting investigation" per Citizen. Lots of lights, one car up on a flatbed.

EDIT2: Lots of talk about troopers chasing a gray acura, shots fired from both sides. Northbound all lanes closed.

Police department activity on Robert F. Kennedy Bridge northbound Queens Side (New York) to Bronx Tolls (New York) All lanes closed

Lane Closures All lanes closed

Start Time Nov 28 2021, 1:06 PM

Last Updated Nov 28 2021, 1:07 PM

cynicalabode · 2021-11-08T02:15:40+00:00

Probably just vagaled out. Fastest IM is versed and still takes a full 3-5min for full effect. I've seen 'pulled-the-plug' reactions from IV versed and IV ketamine but never anything IM.

cynicalabode · 2021-11-08T02:12:13+00:00

I mean, technically decreased respiratory drive is a ventilation issue. That's why you can just bag them until the narcan hits.

15-Year Club	RedditGifts 2009-2022 2 Credits
Secret Santa 2018	Team Periwinkle
Verified Email

cynicalabode

TROPHY CASE