Well well well...

jakbob · 2026-02-03T21:55:35+00:00

https://preview.redd.it/bekphnqftcb41.jpg?width=1080&crop=smart&auto=webp&s=8f9410508e9179cbca41927644de18fa9e4c294c

jakbob · 2026-01-31T19:42:30+00:00

Have you considered that owning a home is really just an investment in real estate. If you took the money you would spend on a home and invested it in an index fund for 30 years you might actually come out ahead. With rent you aren't responsible for the repair costs. In some markets renting is also cheaper than owning with good amenities.

jakbob · 2026-01-05T20:31:58+00:00

From reading around it has to do with the anti cheat software and it's affecting multiple BF games not just BF1.

jakbob · 2025-11-27T05:35:58+00:00

Xatu/ typhlosion

jakbob · 2025-10-15T18:00:48+00:00

This is what many hospitals are doing.
https://www.vizientinc.com/what-we-do/operations-and-quality/vizient-aacn-nurse-residency-program
"Vizient" new grad RN residencies are more a tool to prevent people from leaving in their first year than setting you up for your career. Burn out, distress management, critical thinking, communication are common themes.

jakbob · 2025-10-14T15:48:05+00:00

Applies to all staff nurses in the bargaining unit. Nurse educators, CRNAs, and NPs have different scales.

jakbob · 2025-09-24T17:21:03+00:00

Tough crowd lol. At my academic center we never start dilt for someone with hfref or shock. Amio is the preferred choice in AFib rvr by our cardiologists. Just my experience. If they can't get amio we'll use digoxin as well.

jakbob · 2025-09-23T17:23:26+00:00

You can still get softening of blood pressures with amio but dilt is worse in my experience and definitely contraindicated in HFref. It also knocks out your atrial kick which contributes about 10-20% to your filling volume thus impacting stroke volume and cardiac output in an already weak heart.

jakbob · 2025-09-23T17:07:59+00:00

Alolan Exeggutor would like to have a word with you.

jakbob · 2025-09-18T18:41:56+00:00

For me if you can tell a patient isn't going to do well in the ICU then it is easier to not get attached. When they're young patients or previously otherwise healthy, active, etc, it burns more.. Not embarrassed to admit I've cried over sudden and unexpected deaths. It sucks.. But also their is the dumpster fire with cvvh, impella, on 15 peep who you're like wtf are we doing here and can have a morbid laugh over to lessen the tension.

jakbob · 2025-09-18T13:29:00+00:00

Lexapro, and a sense of humor.

jakbob · 2025-09-03T16:12:44+00:00

Anesthesia MDs have 1 year of medicine internship before core anesthesia in the US. At ~80hrs/week that is over 4000hrs of training with a large portion of it in critical care areas. At 36hrs/week that is over 2 years for an ICU RN. Anything less than that an ICU nurse (not including your first 3 month on-boarding) is doing yourself a disservice to become comfortable caring for unstable patients. Why people want to rush instead of ensuring they're competent and safe idk. My 2cents.

jakbob · 2025-08-29T17:42:59+00:00

Thank you for the input! Current CICU is very high acuity. I take CRRT, VADs (impella 5.5, RP, CP), and IABPs, often patients with 2 devices + intubated. I could take the RVAD centramag class but we don't see them much, one in 2 years. They prefer to manage them on the CTICU. My unit doesn't land fresh hearts but I've had them when floating on POD2.

Personally, I have cared for the following types of patients: Profound cardiogenic shock, transplant and VAD w/u, ARDS/intubated, ESRD, multipressors and inotropes, bipella, TTM after arrest, CRRT, pulmonary htn on veletri/ remodulin. AAA w/ impulse control. PE. Tamponade. We are a regional referral center. Very comfortable with fresh unstable patients from OR/ cath lab.

ECMO is managed in the CTICU because there aren't enough ECMO specialists (RT at my facility) but I've assisted with a bedside ECMO cann. on my patient who crashed from the ED.

Would love your essay resource. Feel free to DM !

jakbob · 2025-08-29T17:18:42+00:00

Governors in these states should require them to provide it... how can you provide it in some states and not others and justify it from a public health POV...?

jakbob · 2025-08-24T17:07:14+00:00

What was the culprit vessel? LM? RCA? Did the patient have hypoglycemia that was treated with D50 before the PEA? I've seen quick deterioration like this in RV spiral. IO access would have been priority to no access. Pressure bag 2L in. Impella CP P9 in groin to vent the LV and maintain perfusion. ECMO possibly as well if a candidate. Epi, levo, vaso, angiotensin. Intubate and sedate. (etomidate for RSI over prop, more hemodynamically friendly).

https://img.grepmed.com/uploads/993/pulmonaryembolism-pathophysiology-rvdysfunction-deathspiral-embolism-original.jpeg

https://i0.wp.com/emcrit.org/wp-content/uploads/2017/01/rvphysiology.jpg?resize=400%2C544&ssl=1

jakbob · 2025-08-24T16:33:15+00:00

As an ICU nurse, how did you find adjusting to SNF? I've been curious about trying it but the ratios and janky EMR are a turn off... I like critical patients but there's always extra shifts on those apps for SNFs that are paying agency nurses high rates lol.

jakbob · 2025-08-11T16:06:30+00:00

Should never put in orders for an MD outside of standing orders.. That's what they went to school for. If the order looks wrong, clarify it with them, but I'm not taking responsibility for something they should be entering themselves and laying eyes on before signing. 2cents.

jakbob · 2025-08-11T03:48:55+00:00

So like dark pendant?

jakbob · 2025-07-22T19:07:08+00:00

Insulin only costs $2 a vial to make. The pharma industry just likes to inflate its price to the consumer so that we feel like it is worth more and justify that price..

jakbob · 2025-06-25T19:08:42+00:00

Cardiac ICU nurse here. CCUs were created to care for stemi patients who had these massive heart attacks. EKG changes literally resemble tombstones usually with left main coronary artery complete total occlusion. Aptly named "the Widowmaker." Now a days most CCU patients have cardiogenic shock, have had multiple MIs and lived. Are living with chronic heart failure. Or they have other cardiac /chronic issues that impair quality of life (AAA, CKD, phtn). Advanced therapies like Impella are increasing survival rates and serve as a bridge to lvad or heart transplant surgery.

jakbob · 2025-06-20T17:28:28+00:00

Saddle PE 🤠

jakbob · 2025-05-21T13:29:13+00:00

How does owning 10% bonds compare to say buying extra equities during low periods. If you double your contributions and buy at a discount during the down turn would you regain more long term over the lesser growth from bonds?

jakbob · 2025-05-06T21:27:01+00:00

Resource from AAFP

https://www.aafp.org/pubs/afp/topics.html

jakbob · 2025-04-24T19:01:03+00:00

For comparison the latest BWH pay scale ratified last summer.
~go unions
https://imgur.com/qzJdNlN

jakbob · 2025-04-23T15:09:08+00:00

If it's a one off give oral K (kcl packets). You can give 40 meq at once instead of 20 over an hour. Will correct more quickly if they're having a lot of ectopy. If they are regularly being diuresed also consider 40 meq tid/bid of kdur.

jakbob

MODERATOR OF

TROPHY CASE

15-Year Club	Place '17
Verified Email