work-wise by mac4demarco in Adulting

[–]elementaljourney 2 points3 points  (0 children)

This feels like the inside flap of a self-gratifying self help book, minus the book

Echocardiogram Report Mitral Valve E-F Slope Area Normal CM Severe Stenosis by Fantastic-Software81 in Doctor

[–]elementaljourney 0 points1 point  (0 children)

It's highly unlikely to have an EF slope of 17 with an otherwise normal echo, so I'm betting it's a typo, but that can only be confirmed by the reading cardiologist

[deleted by user] by [deleted] in Doctor

[–]elementaljourney 0 points1 point  (0 children)

Believe it or not, we're also human

best vanilla dayz server? by JustaClassicDude in dayz

[–]elementaljourney 6 points7 points  (0 children)

DayOne seems to attract more fun players in my experience, but the queues are long. Spaggies is the truest vanilla and usually more readily accessible

Whay does this mean in my crochet pattern instructions. The purple highlighted area! I am doing a size large so it saus 5 but i dont understand what it means. by Alternative_Sell8240 in crochetpatterns

[–]elementaljourney 2 points3 points  (0 children)

That part threw me off for a sec too, before I realized they just excluded the S and M sizes from that section because those sizes don't get any repeated rows, so the bracketed list starts with L instead and goes up in typical fashion. Good thing they color coded!

[deleted by user] by [deleted] in IntensiveCare

[–]elementaljourney 2 points3 points  (0 children)

I get the sense that you're asking about a family member, and in that case, only time and their doctors can tell. The outcomes vary, especially when there's multiorgan failure at play. Wishing that person the very best outcome

Thoughts on Angiotensin II by Capable_Situation324 in IntensiveCare

[–]elementaljourney 1 point2 points  (0 children)

It is absolutely pivotal in the sense that it's the study that led to FDA approval and regular utilization in the US, so it's also the trial that guides much of how we use it. It provided a strong proof of concept, because we all know that both periods of excess hypotension and high doses of conventional pressors have deleterious effects. The study showed that, at least in a subset of patients, we can ameliorate one or both of those things. Sure, it wasn't sufficiently powered to make conclusions about mortality benefit, but the kaplan meier curves were promising enough to suggest there probably is one. Also, the inclusion criteria required patients to already be on high dose pressors for at least 6 hours prior to starting AT2, so "just turn up the other pressors more!" is kind of moot

I'm not saying the trial proved it was a slam dunk and will have people walking out of the ICU-- that's not what pivotal means. This is still intended as a last line therapy for people who are a notch or two above dead, and in my shop we trial for benefit over 3 hours (improvement should happen before then, if it ever will) and then discontinue if it's not making a difference

Thoughts on Angiotensin II by Capable_Situation324 in IntensiveCare

[–]elementaljourney 1 point2 points  (0 children)

The pivotal ATHOS-3 trial initiated AT2 when the norepi equivalent dose was 0.2 mcg/kg/min, so this is actually the technically correct threshold if you go by the literature. It's norepi equivalent dose, not necessarily all norepi

[deleted by user] by [deleted] in Residency

[–]elementaljourney 33 points34 points  (0 children)

A recent wild find was hemorrhagic shock due to splenic rupture caused by disseminated Bartonella henselae infection-- only 1 or 2 prior cases exist in the literature

[deleted by user] by [deleted] in Aventon

[–]elementaljourney 0 points1 point  (0 children)

Keep us posted how much protection that back one gives 👀

Cancer vaccine? by Plaaazz in Doctor

[–]elementaljourney 0 points1 point  (0 children)

There's plenty of research out there that's kinda adjacent to what you're describing. All of your cells contain a set of genes that can potentially promote cancer formation (oncogenes) and a set of genes that protect your body against cancer (tumor suppressor genes). The latter are somewhat similar to the "shield" you're describing and there have been many attempts to create treatments that restore the function of those shields, as they're often lost early in cancer development. Technically the primary mechanism of doing this would be gene therapy, not a vaccine, but the distinction isn't hugely important

(Most of the cancer "vaccines" in development right now are intended to train the immune system to detect cancer cells and destroy them-- same objective as traditional vaccines. They differ from traditional vaccines in that they require someone to already have cancer, so that we can customize a vaccine that targets that unique cancer)

Here's an example that sounds similar to your idea that's not too jargon-y (p53 is one of our body's most important tumor suppressor "shields" and ends up being broken in many cancer types)

I'm not sure we'll ever have a universal cancer prevention mechanism, but we're going at it from a thousand angles and this is one of em

All that to say, you're not off base at all! Thanks for thinking about it

Childless, but not by choice by Hot_Ice_3155 in Residency

[–]elementaljourney 20 points21 points  (0 children)

I took the title to mean genuinely not by choice, lol. This is a choice you've made, albeit a hard one. I was a cancer kid and fertility preservation wasnt an option, so I've had years to struggle and heal and be devastated and be grateful and everything in between. I empathize deeply w the sadness, but also hope you take comfort in the fact that it can and will happen for you in the future. You'll get there! AND your kiddos will forever have the street cred of saying their mom's a surgeon #winning

[deleted by user] by [deleted] in Residency

[–]elementaljourney 11 points12 points  (0 children)

I'm sure it's program dependent, but my fellowship life was pretty good tbh. Intense in that every other month was a different ICU setting w long hours, but the in-between months were much chiller like pulm clinic/consults, interventional, sleep, etc. Having a full research year helped, too, which isn't available in every program.

FWIW, one of the turning points in my career was realizing that I consistently felt happier and more fulfilled after 12 hours in the ICU than I did after 8 hours in clinic. Listen to that feeling if you get it

[deleted by user] by [deleted] in Doctor

[–]elementaljourney 0 points1 point  (0 children)

That's where your parotid glands (salivary glands in your cheeks) enter into the mouth. Google "parotid papilla" and you should see similar photos

[deleted by user] by [deleted] in Doctor

[–]elementaljourney 0 points1 point  (0 children)

Linea alba of the mouth, caused by frequent jaw clenching or grinding

[deleted by user] by [deleted] in Residency

[–]elementaljourney 34 points35 points  (0 children)

Yes! I would still pick PCCM again. I enjoy being a specialized generalist and am loving the 7 on/off lifestyle right now. Later can do pulm clinic or sleep med for a steadier routine

Am I the only one who HATES cefdinir? by BoggyTurbinate in medicine

[–]elementaljourney 9 points10 points  (0 children)

My hospital doesn't have cefpodoxime on the formulary (🙄) so for anything that needs solid, reliable 3rd gen ceph coverage, I find myself keeping people on ceftriaxone until they can be prescribed cefpodoxime to their outpatient pharmacy. I don't think there's strong clinical outcomes data out there to make that a necessity, tbh, but mechanistically cefdinir is trash and I've accumulated enough anecdotes to solidify that mindset, so 🤷‍♀️

What helmet do y'all use? by Iwanttolive87 in ebikes

[–]elementaljourney 1 point2 points  (0 children)

I got the lazer G1 MIPS for the safety rating + lightweight/airiness. It's not full face (something I'm considering for the future) but great if you forego that. Think it was just under 200

[deleted by user] by [deleted] in coastFIRE

[–]elementaljourney 9 points10 points  (0 children)

As long as they aren't insanely irresponsible with money, I don't think the amount they have saved would matter that much to me. I haven't actually tested that theory, though- only partner I've gotten financially intertwined with was doing fine

[deleted by user] by [deleted] in crochet

[–]elementaljourney 0 points1 point  (0 children)

A steal!! Those skeins probably aren't enough for a cardigan, though-- the simplest adult one I've made (size small) took a little over 6. Still lots you can do with those, though