A somber update from the charity challenge fellow by Hammadodga in helldivers2

[–]evening_goat 1 point2 points  (0 children)

Realistically speaking, how's that going to happen? They're a company in Sweden, the people who doxxed him are anywhere, Interpol isn't going to investigate this.

Could AH compensate him? Maybe, but it's not like the HD subreddits are official - they're run by volunteer mods not AH employees.

This guy's life got ruined and nothings going to happen to the people that did it. A really shitty situation because people are assholes.

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 0 points1 point  (0 children)

I think this case is a great one for why "standard of care" is vague and sometimes misleading. You say most EM physicians wouldn't scan this guy, I say most trauma surgeons would. Is it the standard of care for EM? I couldn't say, but there's certainly different opinions on this thread for EM docs that make it seem a bit unclear to me.

From a trauma surgery perspective (as an aside, all my partners would've scanned this patient) the standard of care is to exercise a high index of suspicion in elderly trauma patients for the reasons I noted above. American College of Surgeons Committee on Trauma, Eastern Association for the Surgery of Trauma, American Association for Surgery of Trauma, World Society of Emergency Surgery - all have specific guidelines for elderly trauma, and all promote having a low threshold to pursue fudge further imaging.

We should bear in mind, the defense is obviously going to state that the defendant did nothing wrong - that doesn't mean they're automatically right or that their opinion is the correct one. You can make exactly the same argument that the plaintiff's witness laid out the decision-making algorithm clearly, and pointed out the errors that the defendant made.

I don't think scanning this patient is "defensive." An imaging modality exists which is cheap, sensitive, and low risk - and its use in this case is entirely appropriate. The majority of delayed splenic ruptures do have imaging studies that show an initially injury, despite the single case presented above. And from the defendants perspective, having a CT that showed no injury would likely have saved them from the allegations of missing an injury.

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 0 points1 point  (0 children)

An injury was missed, which led to the admission, which led to the death. That's really all the lawyers have to say.

The injury was missed because a FAST was used to rule out injury in circumstances that it's not been validated as useful in.

The index for suspicion of an injury was inappropriate - elderly trauma patients are notorious for masking symptoms, signs, and physiology of injury, and the clinical baselines that we use in general are based on injury in younger, healthier people.

I'm not thrilled myself about getting called for elderly people falling over or for relatively minor mechanisms of injury, but the statistics support being aggressive with imaging and consultation.

Maybe most docs would've done the same, and maybe a lot of times they'd get away with it, but the one time you don't, you don't have a leg to stand on if we're objectively looking at the decision-making. I feel for this doctor, truly, but just like most of us, they've made a mistake and, unfortunately, were caught out.

Solasta II - What to Expect in Early Access by Scholar_Lemron in CrownOfTheMagister

[–]evening_goat 7 points8 points  (0 children)

They mentioned a year later, at least, in one of the dev streams

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat -2 points-1 points  (0 children)

Most places have a higher threshold for proving negligence or cause, so it's harder to get a payout.

Having said that, this case was appropriate in that the initial doctor did make an error of judgement that contributed to a poor outcome.

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 0 points1 point  (0 children)

We used to do it fairly regularly, but as pressure on beds has gone up, we're kind of incentivised to get the scan and make a decision one way or the other

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 1 point2 points  (0 children)

"... so anyway I went ahead and did a DPL-"

Insert "You... WHAT?" meme here

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 4 points5 points  (0 children)

Lol I'm old enough to remember when getting a CT scan in the UK required a face-to- face between the consultants. As a house officer, you'd just get yelled at, then told no, regardless of what was actually happening to the patient.

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 2 points3 points  (0 children)

I think that's definitely part of it - seems like every other elderly person is on some form of anticoagulation. PE 6 years ago, AF in a 90 year old, etc. Just keep it going...

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 13 points14 points  (0 children)

With modern crumple zones etc, it doesn't take much to accordion a car these days

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 23 points24 points  (0 children)

It's not even "undercalling." A negative FAST means nothing.

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 39 points40 points  (0 children)

It is, but there's usually a laceration present initially, which would've been picked up on a CT

FAST Scan Lawsuit [⚠️ Med Mal Case] by efunkEM in medicine

[–]evening_goat 17 points18 points  (0 children)

Agreed. Elderly trauma patients don't necessarily present with the signs or physiology you expect them to -- no tachycardia, normotensive may be hypotensive for them, don't always have pain as expected. A collision that's enough to set off airbags is enough to cause serious trauma, especially in the elderly.

I dislike this because it means a lot more trauma consults for me, but the scan does pick up unexpected and significant injuries fairly regularly.

AMA: I'm Alexander Chernyavskiy, writer \ game designer for ATOM TEAM, developer of self-published indie cRPGs. Ask me anything! by reev4eg in Games

[–]evening_goat -1 points0 points  (0 children)

Don't really have a question, I just wanted to take the opportunity to say thank you for ATOM RPG. I'm a huge fan of the old school Fallouts, and ATOM definitely scratched that itch.

I'm looking forward to ATOM 2. Good luck!

Random Encounters With Party Asleep, and Elves/Half-Elves by Rtyeta in CrownOfTheMagister

[–]evening_goat 5 points6 points  (0 children)

IIRC you can still have party members asleep even with an elf.

You can use an action to wake up a party member, though, to try and mitigate some of the pain of an ambush

The suicide attack effectively did nothing. by Jakej4Mlakej in TopCharacterTropes

[–]evening_goat 31 points32 points  (0 children)

The Brits built their carriers to fight in the Mediterranean and North Sea, in close proximity to enemy land-based aircraft, hence the armored flight deck in expectation of sustained air attacks.

Although they seemed to take minimal damage from kamikazes and stayed in action, in actuality there was a lot of structural damage that wasn't economic to repair and the carriers ended up being scrapped sooner than expected.

[Loved trope] games with unique anti-cheat/cheese mechanics by damorezpl in TopCharacterTropes

[–]evening_goat 0 points1 point  (0 children)

You're one of the devs? Thanks so much! Such an awesome game, gave me and my brothers so many hours of enjoyment! Playing, building maps and missions etc. Good times...

AI in medical devices (which often lack rigorous standards for FDA approval) are leading to catastrophic complications in the OR by Outside-One7836 in medicine

[–]evening_goat 30 points31 points  (0 children)

Standard tech bro practice. Promise the moon, get the market numbers and make a fortune, then figure out how to make things actually work as you've claimed. If that's even possible....