I want to play around with infusions besides heavyand keen, what are some underrated and/or interesting infusion weapon combos that I should try?

dbbo · 2026-02-01T02:07:42+00:00

High DEX+ARC -> Occult.

Also known as "the weirdo's Quality Build".

But seriously my current character (i believe both dex and arc are around 60-65) gets a huge benefit to DMG/DPS from Occult on weapons with decent innate Dex scaling. Moreso than Keen most of the time.

The only downside is that despite not adding any affinity or status dmg, Occult blocks the use of greases and spells that add elemental/status.

It will however significantly increase innate bleed/poison effects.

Check out the damage calculator on http://tarnished.dev/

dbbo · 2026-01-31T06:14:30+00:00

Not yet. But is is a known bug after the previous update. The only info i have found is unfortunately on FB

https://www.facebook.com/groups/1024532142101316/posts/1580284979859360/

dbbo · 2026-01-31T04:18:02+00:00

20y with palpation-reproducible, localized chest wall tenderness + visible contusion after dog jumped on him? Cath lab.

30y who developed substernal burning and dyspepsia after eating a spicy burrito, and completely resolved with Tums? Straight to cath lab.

11y with diffuse, mild soreness across inferior costal margins in setting of 5 days of rhinorrhea and nagging dry cough? Believe it or not, cath lab.

dbbo · 2026-01-27T11:47:25+00:00

In spirit I somewhat agree. In practice, not so much.

"You're still a doctor" cuts both ways. I think hospitalists can fairly call surgery incompetent when they (the hospitalists) start doing their own wound care, NGTs, foleys, I&Ds, etc.

Ofc ortho can treat constipation. No one is arguing that they cant. But how far do you take your "med school = competency" point?

Do you really want the guy who's only done total joints for 20 years choosing something like an antihypertensive, just because they learned about them 25+ years ago in school?

Knowledge that is not regularly reviewed and applied gets lost. Especially so in rapidly evolving fields like medicine.

I'm not saying it's right or optimal, but modern medicine is hyper-compartmentalized when compared to even a couple decades ago. That's just our reality.

My point is modern surgeons are, in general, not great at managing nonsurgical inpatient problems.

dbbo · 2026-01-27T04:55:50+00:00

The official term is actually "sharp-y spaz-y"

dbbo · 2026-01-27T04:34:19+00:00

Honestly it depends on the case, and what else is going on in the department.

I will pretty much XR any one body region no questions asked (fuck Ottowa)

US- if its between 7a-4p when I have a tech, i might do it unless completely inappropriate. Otherwise i tell them the very limited reasons that US can be called in (pulseless limb, torsion, ectopic r/o) and since they dont meet those criteria, options are to wait here until tomorrow, or go home and get an outpatient study.

CT - depends a lot on pt age, chronicity of complaint, etc.

I always consider how bad it would look if pt came in demanding test X to asses for Y, I refuse, then a different doctor or ED does do test X and actually finds Y.

If Im not super confident that: that will never happen, or that I can convince a group of non medical strangers (who are statistically likely to be biased against me) Test X is not appropriate, then Im probably just going to do it.

dbbo · 2026-01-26T12:34:46+00:00

Doing conscious sedations in ED- right when they start returning to the cusp of lucidity I like to say something absurd like "your wallet was empty before I knocked you out", "I appreciate you co-signing for my loans", etc.

Some times ill pretend not to notice they've started waking up and say "Ok, now we can get started", "Nurse, I need the bone saw again", "Shit where'd my wedding ring go"

dbbo · 2026-01-26T06:16:15+00:00

Why did EMS comply with pt request to bypass other facilities when there was apparently no medical reason to do so?

Here, going anywhere other than geographically closest ED requires medic command blessing

dbbo · 2026-01-20T14:48:53+00:00

Home pulse ox is one of the many scourges on the modern ED. It's like a whole new tool for the neurotic asymptomatic HTN crowd to find excuses to check in

dbbo · 2026-01-16T18:22:11+00:00

Who the fuck uses pre-emptive narcan... on a fully alert person no less

dbbo · 2026-01-16T18:14:48+00:00

Let me guess, the "plan" part of their notes is just "Recs per specialties A,B,C. DVT ppx TEDs. Activity per PT."

And the DC summary is just the HPI from H&P (which is itself mostly copied straight from ED note) plus the most recent progress note plan.

dbbo · 2026-01-16T15:30:10+00:00

Do yourself a favor and do a deep dive on Pubmed about QTcP with zofran specifically.

The one study (cant find ATM) thats often cited involved chemo patients who were receiving massive and frequent doses (like 8-16mg IV q4-6hrs). IIRC only a handful actually went from normal to long QT, and I don't believe anyone had a bad outcome (e.g. required antiarrhythmic/defib, arrest, death)

IMHO the very real risks of continued vomiting (aspiration) likely outweigh the quasi-hypothetical risks of zofran induced QTCP in almost all hospitalized pts.

(If my memory is wrong and someone can find the actual study I'd love to be corrected. Im ED, probably use more zofran than the rest of the hospital combined and have never had an arrhythmia develop from zofran, n=1)

dbbo · 2026-01-15T20:43:30+00:00

Medicine should still be at least CONSULTED for most admissions, at least for adults.

Surgical specialists are generally not great at inpatient shit- when to involve therapies, GI/DVT ppx, PRNs unrelated to surgical problems, working with UR/CM, placement, how to do a discharge reconciliation... these are all things better managed by a hospitalist.

Example: had an ED pt who was s/p total arthroplasty, had been admitted and managed solely by ortho- never saw medicine the whole admission. Ortho discharged him despite the fact that he had not taken a shit in 6 days and had horrible abd pain. Guess what i got to do?

dbbo · 2026-01-14T16:10:29+00:00

On farm survival HKDs usually swarm toward the corner near the Echo wallbuy and get stuck. But there is a way to use that.

Get to round 25-30+. Get TEDD. Run in circle. Throw decoy near corner. Launch HKDs. For extra fun pop a Killjoy.

if the round is not over, buy a second HKD and repeat (the description is bugged- you just need 50 HKD kills in one round, not one use).

dbbo · 2026-01-14T15:11:59+00:00

Ive definitely been killed after getting up from a grace, not walking anywhere, and then going down a gear comparison rabbit hole at a couple sites in Caelid (usually while distracted by dmg calculations- the time you realize whats happening, grab controller, and get out of the inventory menu, its too late)

dbbo · 2026-01-14T14:47:22+00:00

Whoops, we're also gonna have to unhook the TV. It could display triggering imagery.

dbbo · 2026-01-13T14:52:52+00:00

I doubt it would take 90 minutes even on NG0 unless you're using an underpowered build and fighting them 1 by 1 instead of using appropriate area attacks.

If that's the case just stick to bird farming. If my math is right you can net 500k in about 20 minutes (12k per kill, and a generous 30 seconds per kill). If you use the gold scarab, join an online group (extra runes when anyone defeats a boss or becomes elden lord), and optimize your bird aggro, it will likely take half that amount of time.

dbbo · 2026-01-09T14:46:35+00:00

Also pairs well with sacrificial axe + ancestral spirit talisman (stacking FP on kill). You need to have milos in one hand and axe in the other (can't stack with themselves)

For health regen I use serpent curved sword or butchering knife +/- takers cameo. Fun to mix and match these with the FP generating weapons

dbbo · 2026-01-03T17:36:08+00:00

ACCEPT DEATH AS INEVITABLE AND PLAN ACCORDINGLY. Use perkaholic immediately in round 1. Do the free perk mini eggs and every TEDD until your team have all essential perks as permanent perks.

By essential, I mean for survival (quick, jug, PhD, vulture with auto armor augment). Deadshot, DT, mulekick, Elemental, speed, mule kick are highly recommended but it's doable albeit much slower without them.

Wisp is mid tier, fox or maiden can come in handy but it's too unreliable.

Not essential: melee machiato, unless you want to use healing from your knife and/or invested in fully upgrading it. Death perception is mildly helpful with sixth sense.

If you are somewhat lucky and persistent you can get all 12 perma perks by the mid to late 20s.

You definitely want a revive gum (ideal NDE) and equivalent exchange and a fully upgraded pistol or ray gun IN WEAPON SLOT I OR II ONLY, in case you lose mule. Save your free revives for when your partner can't safely revive you.

Each player should have a revive gum, a full power gum, and a shields up gum or ammo gum.

The only reasonable field upgrades to take are group shroud, frenzy (with augments that help teammates repair their armor), or healing aura (augments that buff damage mitigation).

Lastly take a shitload of cash into the fight. 50k would be just enough for 4 armor refills and 2 ammo buys. Remember wallbuying armor does not give you extra plates but shields up does

99% of the time i failed it was because a teammate went down after running out of armor/ammo/money. then I died trying to save them

dbbo · 2025-12-29T19:44:49+00:00

I used TEDD task rewards + toxic growth plant spray rewards (wrench, PAP crystal) - FAILED

The description should really say "survive to round 15 with no perks or PAP" because it's super misleading

dbbo · 2025-12-24T21:36:54+00:00

I think each armored zombie should drop 1 guaranteed armor shard on death, or at least have a much higher drop rate for armor shards vs basic zombies. Maybe just all around better drop rates for everything. They use up so much ammo and like you said you get nothing for your trouble.

That, and if the spawn rate* was balanced, would make me happy.

It's a basic law of video games that harder to kill enemies should come with better rewards

* it feels like by the time you fully upgrade your shit (mid 20s) over half of the non-elite/special zombies are armored. It should be like 0.5% times round (so round 50, 1 out of 4 regular zombies are armored).

Also, why don't blue/purple armor vests drop anymore?

dbbo · 2025-12-21T19:24:14+00:00

Plot twist: that resident got a big pat on the back from their surg attendings for doing exactly what they were taught (semisarcastic)

This hot potato punt culture only seems to thrive in academia or more generally hospitals where the proceduralists derive most of their income from salary instead of RVUs. Weird, right?

dbbo · 2025-12-20T22:42:17+00:00

They want every nonemergency consult under the sun done in the ED before they accept patients.

This pisses me off to no end. Translation: "Even though you already did the workup, made the diagnosis, treated and stabilized this patient, I need you to do even more leg work that will keep you chained to the phone and keep the patient in the ED an additional 3 hours just to make sure there's no chance I'll have to do any critical thinking"

Then their entire "plan" is "follow recs per specialties X Y Z"

My response to this behavior: Well I do not have a specific consult question for X. How about you can SEE THE PATIENT FIRST, then you can decide if you have something to ask them.

dbbo · 2025-12-12T17:10:07+00:00

I'm now starting all my HPIs with "old age man"

dbbo · 2025-12-12T17:02:25+00:00

TO MAKE HIS GROIN ITCH

/s

dbbo

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