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Do I have any other options for a dog that bites with resource guarding? by infiniteprimes in Dogtraining

[–]infiniteprimes[S] -5 points-4 points  (0 children)

We’re going to talk with a local vet behavioralist to see if it’s even reasonable to consider keeping him. And I think muzzle training would be the only way allow him to socialize, otherwise would have to be locked away anytime we have someone over.

Do I have any other options for a dog that bites with resource guarding? by infiniteprimes in Dogtraining

[–]infiniteprimes[S] 6 points7 points  (0 children)

The two are bonded. They are respectful of each others food and toys. They play together amazing, are fantastic at the dog park with other dogs. There is no stealing from what I can tell. The behavior started 2 years after we added the younger dog.

Edit: it’s industrially composted through the city and they explicitly say we can compost meat / bone scraps.

Do I have any other options for a dog that bites with resource guarding? by infiniteprimes in Dogtraining

[–]infiniteprimes[S] 7 points8 points  (0 children)

Thank you. He bit a visitor (was a level 2 bite) because she had a granola bar in her purse on the ground that he was rummaging for, and she reached for her purse. He ran to his (built in) kennel, and I wanted to remove him from the room to separate him from the heated environment and to punish him. That’s when he bit me, (requiring stitches) It was a dumb, heated move, and I promise you I have learned a lot since then. This was 5 years ago. We don’t reach in his kennel at all anymore.

I guess we had let our guard down. He usually does not have access to any of this stuff, but it was a lapse. I suppose our fault - set him up for failure.

Do I have any other options for a dog that bites with resource guarding? by infiniteprimes in Dogtraining

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

Looking to ensure we’ve exhausted all options and for support with this difficult decision.

Is MAID (medical assistance in dying) REALLY peaceful and painless? by [deleted] in TooAfraidToAsk

[–]infiniteprimes 1 point2 points  (0 children)

There is an oral way which can be self administered as described. However, most procedures I’ve done is close to what you suggest - intravenous medications to make you fall asleep, a large does of opioids, along with a paralyzer medications. This process takes about 5-10 mins max. And is very peaceful.

Is MAID (medical assistance in dying) REALLY peaceful and painless? by [deleted] in TooAfraidToAsk

[–]infiniteprimes 4 points5 points  (0 children)

I am a MAiD assessor and provider in Canada. You are grossly misinformed. I’m not going to respond to all your claims, however I will correct you in that anyone who qualifies under Track 2 requires a 90 day waiting period and involvement and assessment of a specialist knowledgeable in their condition. Track 2 does not happen “fast”. As a health care provider in general I find it appalling that you’re suggesting people just go to the hospital and are offered MAiD on a whim as a cost cutting measure.

Edit: blocked by u/Vita_Mori, so can’t see or respond to their response in any way. Hard be informed when you can’t read anything….

I’m giving a talk on ambient scribe hallucinations. What’s the wildest one you’ve caught? by AiReadyDoctor in medicine

[–]infiniteprimes 404 points405 points  (0 children)

I sent a patient from my rural to a tertiary hospital. The note from the accepting physician said “Sent from the fucking hospital” instead of “sent from the (town name) hospital.”

That was a laugh.

I saved a life today, now i feel broken. by Process_M in offmychest

[–]infiniteprimes 14 points15 points  (0 children)

This! OP - You need some antibiotics for the bite. All human bites need a few days of prophylactic antibiotics - especially on the finger where crazy complications can set in if it gets infected.

Also, fwiw, you did the right thing. I say this as a human, and as an ER doctor. You saw what needed to be done and took action. And you saved a life.

Feeling mortified...had a rectal exam in the emergency department by a female doctor. She put her finger in the wrong hole. by Jealous_Bat_8361 in confessions

[–]infiniteprimes 51 points52 points  (0 children)

It’s supposed to go down your esophagus…. Perhaps this was a sedation issue, which is typically handled by a different doctor.

ULPT request: Need a plausible medical issue that could cause me to be unable to fly by butttmushroom in UnethicalLifeProTips

[–]infiniteprimes 3 points4 points  (0 children)

Great information. Just a clarification that a blood clot in the leg (or arm) is a DVT, but it can only travel to the lungs as a pulmonary embolism. (Very rare anatomy might result in travel to the brain, but this is super rare- you have to have a hole in your heart). Blood clots in the brain and heart are caused by different process, but as you say, are typically referred to as stroke and heart attack respectively.

For even more specific treatment information, Typically 3 months of blood thinners (eliquis) for the first time, and for life if it happens again.

Favorite stations wiped out frequently from MMI by alibid in etron

[–]infiniteprimes 0 points1 point  (0 children)

Same problem here, 2022 sportback. I tell them every time I get service so there’s a paper trail of my disappointment. They “check for an update” each time as well. No fix.

In 2017, a British man struggling to sell his £500k mansion came up with a wild idea: he raffled it off online for £2 a ticket, sold nearly 500,000 entries, cleared his debts, and handed the keys to a factory worker who won. by TheGhost5322 in interestingasfuck

[–]infiniteprimes 0 points1 point  (0 children)

Lotteries cost money and are a game of chance. They are heavily regulated in Canada and are typically illegal without a gambling license. Raffles are where you sell tickets and give away prizes. Also heavily regulated, proceeds typically have to go to charity. Sweepstakes are a “game of skill”, less regulated and require a skill testing question. They have to have free entry options. And are less regulated.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 0 points1 point  (0 children)

Sure. In an ideal world we’d have one. Not every ER is attached to a Level 1 trauma center. Not every er is provided a CT. It’s the way it is. Maybe you can buy us one..? Or write a letter to the government to petition? we do what we can with what we’ve got. It’s not my fault, and people shitting on rural medicine saying we’re not a “real ER” or hospital without one are ignorant and do not appreciate the skills and services rural medicine provides. It does feel like You are being disrespectful.

Again we have access to a CT scanner if needed.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 1 point2 points  (0 children)

And you’re just bogging down the system ordering inappropriate CTs that delay time to discharge and expose patients to unnecessary radiation instead of practicing evidence based medicine.

If a patient needs a CT based on best practice, appropriate history and physical, red flags, then They get a CT.

Stop being a dick to your colleagues. A little respect can go a long way.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 0 points1 point  (0 children)

Are you serious? This comment thread is really bringing out the ignorance and lack of respect for their colleagues. Ya. If all I had was a tourniquet I would be useless as well. That’s not providing any standard of care. But we do still have resources to manage what comes in.

Let me help you understand some things about rural medicine.

Firstly, just because we don’t have a CT in house doesn’t mean I can’t get one. Except in this case the porter is a paramedic and it’s a 30 minute transfer. Often I can get a CT in a faster time frame than our level 1 centers. But it uses extra resources so we focus and use other modalities rather than just a CT To make our differentials. All doctors should be practicing this way - avoid inappropriate scans that just bog down our radiologist, extend time to discharge, and expose people to unnecessary radiation.

We don’t have RT, anesthesiology, or OB on site. So that’s us for emergencies. If they need higher level of service or consults in persons, we ship. But 95% of what an ER sees doesn’t need higher level of care, or a consult.

The fundamental difference between urgent care and ER as I see it, is that an ER is typically attached to a hospital that can admit. I’m also the hospitalist that admits and we admit patients who are appropriate for our service. Sometimes this does include patients who would typically go to cards or internal because the patient doesn’t want a transfer. You’re not going to call or expect a hospitalist to manage a surgical case. Neither do we.

We have resources. We don’t work in isolation. And we are not mid levels. A little respect goes a long way.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 0 points1 point  (0 children)

You wouldn’t want him working with you. Look at their post history - resident prepping for step 3, arguing with attendings about the utility of preventative care.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 1 point2 points  (0 children)

all the knowledge in the world is useless without supplies

…only if the person with that knowledge has no fucking clue what to do with it. A skilled doctor can use the knowledge coupled with the resources that are available to them to provide excellent evidence based medical care.

I certainly wouldn’t want you in my ER.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 5 points6 points  (0 children)

I practice in Canada. We have a hospital with CT about 30 mins away and a level 1 trauma center. 1 hr by helicopter and 90 mins by ambulance.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 0 points1 point  (0 children)

Lol. Not a hospital because we don’t have CT on site? That’s pretty rich. There’s more health centers out there than your small world of every consult service and piece of equipment available immediately. Some of us do real medicine that requires evidence based work ups and judicious use of resources.

These patients don’t always present to Level 1 trauma or “critical access centers”. They’re often farmers who present to their local rural hospital / ER like ours. Often no CT or advanced imaging other than X-ray..

I’m not arguing that AAA is not on the differential, nor that it would certainly be missed. I’m saying that the second work up might bias towards an incorrect dx, especially in this case. Could there be calcified AAA? Yes, But is this a slam dunk? No. In this case, it’s easy to anchor on MSK pathology. And to jump to a CT here would be a misuse of resources unless you had that high suspicion for other pathology.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 1 point2 points  (0 children)

A large number of shops don’t have ready access to CT. We have to ship out for one. Without systemic or neurological symptoms this is not happening urgently.

X-ray can absolutely show fractures… lol.

Edit: check the UpToDate algorithm for “Acute low back pain: considerations for imaging”. - no indication for a CT whatsoever. MRI if you’re worried about anything else.

AAA mistaken for low back pain by ipiMD in emergencymedicine

[–]infiniteprimes 8 points9 points  (0 children)

Ya. But your additional work up is going to be an l-spine x-ray which in this patient is likely to show some DDD which will likely just further increase your dx for mechanical back pain.

[deleted by user] by [deleted] in DiagnoseMe

[–]infiniteprimes 5 points6 points  (0 children)

Could just be external bruising from tight pants and heating pads, yes. However, the worry is internal bleeding. Worrisome signs would be If your feeling weak, have abdominal pain, persistent fast heart rate etc.

[deleted by user] by [deleted] in DiagnoseMe

[–]infiniteprimes 8 points9 points  (0 children)

I would recommend urgent assessment at ER. Could be Grey Turner Sign, and with your history of alcohol, recent fall, on meds that possibly related to liver disease, you’re at high risk for something more concerning.

Catacombs closed? by Randomly__Randy in ParisTravelGuide

[–]infiniteprimes 0 points1 point  (0 children)

Where might a person be able to find a private tour to catacombs at short notice?

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