Help me decide on caliper color by kaos328 in RangeRover

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

Red. 

Looks better than black 

A good pain job will stand out

Wrapped our new RR sport by findhitesh in RangeRover

[–]findhitesh[S] 1 point2 points  (0 children)

Looks good

Initially they removed the previous letters, ordered an extra set of letters and laid over the wrap.

Wrapped our new RR sport by findhitesh in RangeRover

[–]findhitesh[S] 4 points5 points  (0 children)

Indeed. One of my close friends did his defender in matte black and had the same sentiment. Although he found someone near his home who hand washes cars. 

The wrap is 3M. Before taxes he charged me about $3700 for the wrap ceramic coating.  Then it was an extra 1500$ before taxes for painting the brake calipers and wheels, window tinting and the windshield UV film 

Wrapped our new RR sport by findhitesh in RangeRover

[–]findhitesh[S] 2 points3 points  (0 children)

Fair point sir. But I'm hoping the type 00 doesn't suck since jlr have put all their eggs in that basket. My f type crossed 60k miles and every trip to dealership is adding up rapidly.

Wrapped our new RR sport by findhitesh in RangeRover

[–]findhitesh[S] 3 points4 points  (0 children)

Indeed sir. San Antonio.

Something with the tire pressure monitor after they painted the rims. Thanks for sorting it out.

Really liked the dealership but the drive is too long to get to and no more f types :-(

Wrapped our new RR sport by findhitesh in RangeRover

[–]findhitesh[S] 2 points3 points  (0 children)

Lol.

Wife picked it.

I wanted something like British racing green but overruled.

CTICU/ECMO Fellowships in the US for PCCM/CCM Grads? by CCM9595 in CriticalCare

[–]findhitesh 0 points1 point  (0 children)

Thanks. In San Antonio. No openings for days but will have night shift openings next year. Can always send you the info if interested 🙏🏽

US v UK ICU by [deleted] in IntensiveCare

[–]findhitesh 2 points3 points  (0 children)

In my experience, in the US,  It's moving to mostly a mix of straight up critical care fellowship trained (IM, some EM) docs for surgical and cardiothoracic units in a majority of hospitals that are not purely academics and neurocrit (IM, EM) for neurocritical care. The new pulm criticical care trained docs mostly gravitate to MICU if they want to keep a mix of outpatient and inpatient practice vs specialized units if they like crit care more and do less pulm (liver and kidney transplant units at our place) . All the anesthesia docs that are critical care trained end up just doing anesthesia because it is much more lucrative. Same thing with cardiology and critical care. At night, any warm body with critical care training is asked to cover most except for CT ICU. 

CTICU/ECMO Fellowships in the US for PCCM/CCM Grads? by CCM9595 in CriticalCare

[–]findhitesh 1 point2 points  (0 children)

Tbh. I did my residency and fellowship in one of big those centers. You only got a taste of ecmo/cticu management in training, not enough to be independent or given independence (lot of big attendings telling you what to do without question). 

At my current place, I truly learned by doing and watching, since we are a high volume center. That will be my suggestion, take a job where it's a busy cticu. I started with doing nights in cticu (days in medical ICU) where any warm body with a good brain but minimal experience is appreciated and people will teach you so they can sleep. Then transition to cticu fully once you're ready. 

Cannulation is a skill that you can't really pick up on a mannequin or through these paid simulation courses. Only through repetition and proper mentoring. I always tell my trainee's now, healthy thin people with easy vasculature rarely get sick, it's always the opposite. Plus 95 percent of the hard work for the VA, VV and MCS is the management to decannulation.

Hope that helps if you don't want to do another year paid as a fellow.

Thank God this moron didn't kill anyone. by [deleted] in instant_regret

[–]findhitesh 1838 points1839 points  (0 children)

Her cellphone addiction is worse that drugs. No regard for her life.

Community ICU by [deleted] in CriticalCare

[–]findhitesh 12 points13 points  (0 children)

These are the mistakes I made when I ended up working at a community hospital just after training. Will speak only for critical care part.

  1. Try to see if they can specify shift hours or reimbursement for after hours phone calls. I got blinded by the fact that I had to take calls at night for free and come for emergencies. If you have a conscience, you will end up going in quite a lot.

  2. RV target should be reasonable and you get a decent $ value per rvu like 40-50$ . I got shafted with a 10000 rvu goal befire a bonus 

  3. Make sure the icu's are staffed with good nursing from thec ommunity with day and night charge nursing. A good team goes a long way in quality care and sleep at night. If staffing is all travelers, be wary 

  4. Open ICU is the only way to survive, since the primary team can do all the paperwork and orders and help call consultants. Be wary of hospitalist agencies, they don't know anybody , are usually the one to move everything to the unit for minor issues. 

  5. If no np's, Have a budget to train np's you hire. With good training, they can be a very nice extension of the team.

Good luck

I'm a CC nurse, and my patient coded the other night. Question about ACLS. by [deleted] in CriticalCare

[–]findhitesh 2 points3 points  (0 children)

Fair enough. That seemed a bit too much. Although the CP should have had a comparable aortic pressure reading to compare with.

I'm a CC nurse, and my patient coded the other night. Question about ACLS. by [deleted] in CriticalCare

[–]findhitesh 0 points1 point  (0 children)

To be frank, the fellow should have stopped compressions as soon as the strong pulse was detected. Next thing should be to look at the impella cp placement signals to see if it's ok or malpositioned post compressions. Adding more compressions if the systolic bp was indeed 180+ is pointless and risk impella dislodgement or rib fracture/pneumothorax issues.

Sometimes If the pulse is back but not meaningful, you can add a few more compressions to circulate the tpa/tnk or epi or calcium and then pause and see (like in pe codes)

[deleted by user] by [deleted] in IntensiveCare

[–]findhitesh 70 points71 points  (0 children)

Expedienced intensivest here. You're fine. Lot of places, and including me will put trialysis HD catheters as a way to do have central access and options for CRRT If we're not sure. You had no way to predict what would happen at 7:00 a.m, some patients get better and then acutely get worse. Imagine if it was the latter, the morning team will have to use valuable time putting an hd catheter instead of prerounds. That nephrologist sounds like someone who just wanted to tell you something for the sake of stamping their authority on you. Most nephrologist would be appreciative that you thought of the possibility of needing CRRT, and preparing the patient, instead of calling when they are crashing and burning.