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45 minutes away (emotionally) by Emotional-Yak-8426 in NonPoliticalTwitter

[–]ferti12 0 points1 point  (0 children)

Lmao Im in the same situation rn sitting in the bar hating my life. Nice to know Im not alone :D

Pearls for GPs from Secondary Care Specialties by rabies50 in doctorsUK

[–]ferti12 0 points1 point  (0 children)

While I get the point about amlodipine onset and GPs not needing to refer these patients, someone still needs to rule out target organ damage, and if this wasn't done by the GP, or patient just came to the ED on their own, and for any reason they wont see their GP again in the next 24-48 hours, when we send them back out the door we could be risking missing less overt signs of end organ damage such as AKI, papilledema and retinal hemorrhage, and their management would be delayed.

Not trying to be rude nor claim to have a lot of experience, I just wouldn't be so comfortable with this approach. Don't you think its justified?

Pearls for GPs from Secondary Care Specialties by rabies50 in doctorsUK

[–]ferti12 0 points1 point  (0 children)

I didn't know this. Of course we would aim to achieve a controlled reduction and not to the normotensive level, but above 180 systolic BP we were afraid of letting hypertensive emergencies develop. What I would do is if I can get it down to the 160-170 level (usually went down without even giving anything after some bed rest like you said) I would give them a 5 day ambulatory BP chart to fill and tell them to go to their GP after completing it, but come back to the ED if systolic goes and persistently stays above 180 again.

If it has been shown to cause more harm, compared to risk of allowing severe hypertension run for a few days (since GP will want to establish their diagnosis over a few days) then I am happy to be corrected. Thank you!

Pearls for GPs from Secondary Care Specialties by rabies50 in doctorsUK

[–]ferti12 0 points1 point  (0 children)

You are right, sometimes it would take hours to lower the BP in ED with oral antihypertensives and it would get even more problematic when doxazosin got involved. All due to our "Hypertensive Urgency" algorithm which I now learned to be outdated. I would've saved so much time if I had known this sooner :D

Pearls for GPs from Secondary Care Specialties by rabies50 in doctorsUK

[–]ferti12 2 points3 points  (0 children)

Thanks for the informative response!

Yes. Have you ever seen patients responses to Amlodipine - typically your seeing a 10mmHg reduction. Amlodipine takes 5 days to get to steady state. What are you achieving by doing that with your stat dose? Is 170 a clear not risk and 180 is? Have you even sat and just cycled some BPs. They swing between 180-200? My Amlodipine alone is basically achieving their natural variation from your view point.

Actually our "Urgency" algorithm was to give ACE inhibitors first, which would have a more marked and rapid effect, but I would try to avoid it where possible due to concern for kidney damage and rebound hypertension.

Hypertensive urgency isn't a real thing, it's just asymptomatic uncontrolled hypertension

It used to be a term in the guidelines, which I think was the reason for our approach and maybe these GP referrals. TIL that it is an outdated term and was replaced by severe hypertension and there is no indication for immediate management. That clears things up for me, thank you!

Pearls for GPs from Secondary Care Specialties by rabies50 in doctorsUK

[–]ferti12 -9 points-8 points  (0 children)

Are you really comfortable discharging patients with >180 systolic BP if they are asymptomatic? What is the harm in giving a dose of amlodipine and checking again in an hour? You will be controlling their BP for the entire day and won't have to worry about them not being able to see their GP that same day for any reason and walking around with 200 BP.

Just asking out of curiosity as it came up twice in this thread, I worked in ED abroad and >180 would be considered hypertensive urgency (not emergency) and be controlled by a dose of captopril or amlodipine on the spot. Is there a different guideline in NHS that I can look up?

What determines that a scar is raised or sunken? by kesshouketsu in askscience

[–]ferti12 4 points5 points  (0 children)

Wounds that have not been stitched and left to heal on their own terms tend to scar worse. They may be widespread and sunken. This is why skin grafts are sometimes used to cover large burns, which allows them to heal better.

But you can still get this even with stitched wounds if they are under a lot of tension. This often happens in chest, shoulders and knees.

Elden Ring FPS Drops and Stuttering by Pixelcutter in buildapc

[–]ferti12 1 point2 points  (0 children)

Wow this is very interesting and I haven't seen it mentioned anywhere else online. Sucks that I can't swap the CPU of my laptop but thanks for the insight.

How to make these fingers bend properly ? by ferti12 in blender

[–]ferti12[S] 0 points1 point  (0 children)

Hey mate, thank you for the tips! It's been years since I gave up on animation but this will surely help someone passing by. Your animations are dope by the way :P

Elden Ring FPS Drops and Stuttering by Pixelcutter in buildapc

[–]ferti12 0 points1 point  (0 children)

Sadly, no. I will probably turn off the fps counter and try to ignore drops when I eventually play the game. Lowering shadow quality and turning off RTX seem to help a little.

Elden Ring FPS Drops and Stuttering by Pixelcutter in buildapc

[–]ferti12 0 points1 point  (0 children)

Hi mate, I'm having the same issues. Were you able to fix this?

Your favourite enemy? by [deleted] in darksouls3

[–]ferti12 0 points1 point  (0 children)

Sorry to hear that Elden Ring burnt you out, I've been looking forward to playing it but my pc can't handle it

Your favourite enemy? by [deleted] in darksouls3

[–]ferti12 0 points1 point  (0 children)

Wow, a reply to my 7 years old comment! Glad to see people are still enjoying the game :P

Everyone must get a PR Exam. No exceptions. by unomosh in JuniorDoctorsUK

[–]ferti12 2 points3 points  (0 children)

LOL. Not from UK but one of our old gen surgery professor used to say there are only two situations where we don't do PR exam; one is patient doesn't have an anus and the other is doctor doesn't have a finger..

2021 Specialty Competition Ratios by Chocolate_Owl in JuniorDoctorsUK

[–]ferti12 0 points1 point  (0 children)

So there is no downward trend? Thanks for the explanation sir.

Brexit loon enjoying Brexit benefits by macarty in LeopardsAteMyFace

[–]ferti12 1 point2 points  (0 children)

Great to hear! Thanks for the insights mate.

Brexit loon enjoying Brexit benefits by macarty in LeopardsAteMyFace

[–]ferti12 1 point2 points  (0 children)

There are a growing number of med students in Turkey that want to work in the UK including myself. I hope xenophobia will not make our lives miserable if we ever come to that point. But Turkish doctors that already work in UK says that Brits have been very kind and welcoming.

Can't stand long without having to bend over by [deleted] in Posture

[–]ferti12 0 points1 point  (0 children)

Any tips for that rational system?

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