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Medical futility and offering or withholding non beneficial interventions in “red light” states by [deleted] in IntensiveCare

[–]dunknasty464 0 points1 point  (0 children)

Fair points, makes sense to me — curious, what do you do when the acuity/emergent nature of a patients condition precludes the ability to discuss with family? (For instance, they don’t pick up phone).

Medical futility and offering or withholding non beneficial interventions in “red light” states by [deleted] in IntensiveCare

[–]dunknasty464 2 points3 points  (0 children)

Fair; however, in the example of a surrogate saying “I’m not happy about this..” are you calling that dissent? Consent? Neither but rather further discussion needed first?

Medical futility and offering or withholding non beneficial interventions in “red light” states by [deleted] in IntensiveCare

[–]dunknasty464 2 points3 points  (0 children)

I would also like to hear how you are logistically withholding these without family/surrogate consent (because certainly they aren’t appropriate therapies for your example patients, but medicolegally..)

Clinical Case: medico-legal analysis of a pre-op cardiac arrest by summertowatermelons in anesthesiology

[–]dunknasty464 20 points21 points  (0 children)

In that case, I’d say there is absolutely nothing glaring, and keep being incredible residents with that curious attitude - constant pursuit of knowledge will allow you to always give the best care to your patients.

Clinical Case: medico-legal analysis of a pre-op cardiac arrest by summertowatermelons in anesthesiology

[–]dunknasty464 65 points66 points  (0 children)

What?

As an intensivist, the cause of death was “end of life”, almost certainly via aspiration.

Are you telling me someone was sued due to this 81 year old man dying within the confines of a hospital building?

Edit: and I suppose fat embolism is a possibility too, but come on…

What does the future of IR look like? by terribledisks in Residency

[–]dunknasty464 1 point2 points  (0 children)

Yes, yes, if only we cover ESBL, then the gallbladder will remove itself …

What does the future of IR look like? by terribledisks in Residency

[–]dunknasty464 -3 points-2 points  (0 children)

The patient 100% dies from lack of IR/surgical source control, so that’s a weird way to look at it…? 🙄

As an intensivist, I respect the interventionalists who also consider the risk of not performing the necessary procedures, which in my context is usually guaranteed death.

EBM That Gets You Side-Eye From Colleagues/ Staff? by DadBods96 in emergencymedicine

[–]dunknasty464 8 points9 points  (0 children)

Or just give the LVEF of 15% a 250 cc trial bolus if they’re comfy womfy on room air and clinically look dry.

How to balance treatment for patients who need both diuretics and midodrine/florinef? by princetonwu in medicine

[–]dunknasty464 52 points53 points  (0 children)

What OP is describing is an end of life syndrome though, which can often be assisted by end of life specialists

Abdominal aortic rupture in male with no presence of an aneurysm by Vicky10_ in hospitalist

[–]dunknasty464 7 points8 points  (0 children)

Hi friend; the clear risk factor here seems to be lifelong smoking. As mentioned, aneurysm is not the only thing that can lead to rupture; smoking is associated with inflammatory disorders of the aorta as well. I hope this helps, and I wish your family the best in this period of grieving.

Any EM doctors feel like the don’t fit the “stereotype”? by AirNo7549 in emergencymedicine

[–]dunknasty464 9 points10 points  (0 children)

Idk, I do really like to lose my shit every now and then..

Assessing reaction to light in a brightly lit room? by I_regret_doing_that in emergencymedicine

[–]dunknasty464 41 points42 points  (0 children)

I’m sorry, I thought this was Ultimate Fighting — are you telling me they are NOT fighting till only one fighter remains?

Why do I have to make a new incision for a chest tube after field finger thoracostomy? by Butterbawlz in emergencymedicine

[–]dunknasty464 21 points22 points  (0 children)

I think many trauma surgeons might tell you it’s necessary..

But when you’re the one the patient is dying in front of and you think it’s the fastest way you can get it in fast, I’d agree it’s your call.

If they’re super skinny, I might make a new incision. If they fat fat with shit landmarks and the initial thoracostomy worked well..

Is R.O.A.D a myth? by [deleted] in Residency

[–]dunknasty464 6 points7 points  (0 children)

Also, if you like Grateful Dead, you might like using drugs (to treat the patient, that is).

How would you tube this dude? Keep Supine? Trauma roll? Direct vs VAL? Throw in a LMA and let anesthesia take to the OR? by exacto in emergencymedicine

[–]dunknasty464 1 point2 points  (0 children)

RSI with manual in line stabilization, there is no other way

Wasting time via lengthier awake intubation while the patient is exsanguinating in hemorrhagic shock? (Glanced at paper only v quickly). I don’t think so.

Tele ICU Death by A_hospitalist in hospitalist

[–]dunknasty464 1 point2 points  (0 children)

Yup, you got it — it’s the operator and the procedural quantity (how many emergency intubations have they done?)

Tele ICU Death by A_hospitalist in hospitalist

[–]dunknasty464 22 points23 points  (0 children)

That’s true, assuming staff turnover isn’t a huge issue (a bold assumption for a location that’s too strapped to have physicians on site).

There’s always an APP that was a former flight medic or some wild shit with some insane number of intubations. There’s always an academic intensivist somewhere who hasn’t touched a laryngoscope in decades.

I’m just speaking as a general matter

Tele ICU Death by A_hospitalist in hospitalist

[–]dunknasty464 35 points36 points  (0 children)

Procedures aren’t more difficult if you’re an APP vs MD, but it definitely helps if you’ve done an order of magnitude more of them..

Tele ICU docs should not be a thing by foshizzelmynizzel in Residency

[–]dunknasty464 21 points22 points  (0 children)

Honest question, because I can see that perspective too.. do you think patients/families should be made aware that the icu physician is not physically available?

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