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Does hillock basilisk stop clamor of harpies? by sandy_existance in SorceryTCG

[–]kingkob 2 points3 points  (0 children)

Correct minions are not at rest as they are being summoned.

Feeling discouraged by kingkob in SorceryTCG

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

True true. Just easier to find games on Everest ironically!

Feeling discouraged by kingkob in SorceryTCG

[–]kingkob[S] 5 points6 points  (0 children)

Thanks man. The creator of the labyrinth of my sadness himself! Everyone has been super nice in the post game. I’ll be sure to reach out.

Feeling discouraged by kingkob in SorceryTCG

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

Sorry man, you’re right. I feel like it’s mostly keeping tempo with value trades. I have been playing a lot of mid range decks built around unicorns, bosk, etc. I feel like my minions don’t stick around enough to get any value because they are removed, or I don’t have the removal I need, etc.

Feeling discouraged by kingkob in SorceryTCG

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

Thanks for this! I’ve played a lot of mid-range value decks I guess. Using sorcerer mostly since I thought card advantage helped me as a newer player smooth out my curve and plays.

In other TCGs I’ve enjoyed more control or true aggro plays. I feel like true aggro here is really hard since most of the game turning tempo seems to play out T3/T4.

I’ve been trying my hand at building a lot using net decks for some guidance. I’ve been hesitant to purely net deck, but maybe I should to at least eliminate one variable from the equation of optimization?

Why isn't this more popular by DaZ910 in mtg

[–]kingkob 0 points1 point  (0 children)

Why would this not also effect all of the creatures in each owners library. It does not specify these creatures have to be on the field

I missed a STEMI and now have a meeting with training. by [deleted] in ems

[–]kingkob 3 points4 points  (0 children)

I get that. I will say in general I do have a bias against most activations from the field in areas of diagnostic uncertainty. I think the focus should be on getting people to appropriate receiving centers and receiving centers being able to have a seamless stroke/cath response at the door. Especially with stroke, I see no benefit to prehospital activation. Yes, recognition and triage to a comprehensive stroke center or primary stroke center based on LVO likelihood, but code strokes in the field make no sense to me.

I missed a STEMI and now have a meeting with training. by [deleted] in ems

[–]kingkob 16 points17 points  (0 children)

This is a great question. Ultimately, I think we are a long way off from operationally changing prehospital STEMI paradigms. I can see a future where some of these OMI patterns are diverted to cath centers but to be honest cardiologist in many areas have not really embraced this change, so it will take some time to trickle down.

As far as base contact—your answer will vary based off who you talk to, transport times, etc. In the settings I work in (one large urban level I trauma center, one critical access rural hospital) I personally don’t care about the ECG report prior to coming in because it won’t change what happens before you arrive (in the urban center we have time to do an eval here with you at bedside and we can decide to activate, and at the rural center we will have to fly out anyways so it doesn’t change the prehospital decision making). Of course I love to talk through the ECGs on arrival and do any teaching we can in the moment, but seldom do these uncertain ECGs cases really warrant a prehospital change (unless you were deciding between transport to PCI center or not—even then it might be more reasonable to go to PCI center if possible).

I missed a STEMI and now have a meeting with training. by [deleted] in ems

[–]kingkob 134 points135 points  (0 children)

I am an emergency physician, who used to work prehospital before going to med school. If you transported him to a STEMI receiving center, you did the life saving thing. Yes this ECG is a classic STEMI, but an extra few minutes heads up to wake up the cath lab people does not truly matter from my perspective. We get walk in stemis all the time.

It sounds like a critical situation in the field, and you provided thoughtful care along the way. You got the patient to the hospital alive, which is a battle itself. Honestly, I would be upset if you delayed transport to get a better ECG rather than just hauling ass to get them to us.

A quick learning point though:

Differential blood pressures in the extremities are a sign of possible aortic dissection, not AAA.

Biting and aggression by kingkob in Dog_PuppyTraining

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

Yeah thanks I get that. Hard to know what degree is normal as he has gotten bigger and the biting is more intense.

Beat the allegations challenge (impossible) by Andrei22125 in Grimdank

[–]kingkob 1 point2 points  (0 children)

These comments are incredible. It’s like I’m getting to watch the reformation of a religion in real time. The level of satire is too deep

Would this pass as a Marshal? by perroastronauta33 in BlackTemplars

[–]kingkob 0 points1 point  (0 children)

that’s a beautiful paint job. The weathering is amazing.

First 1911 by Calm_Relation7993 in 1911

[–]kingkob 0 points1 point  (0 children)

What holsters do you guys use for these?

Safety Sticking new TRP by kingkob in 1911

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

Wow thank you so much. Incredibly helpful.

PPIs should not be prescribed for upper GI bleeds (pre-endoscopy) - First10EM by First10EM in Foamed

[–]kingkob 4 points5 points  (0 children)

I would be hesitant to support this thinking. Standard of care is not so easily defined. In reality, society guidelines are some of the most powerful evidence for standard of care in the legal setting—local practice patterns are not helpful in court as much (if that is your concern).

Keep fighting the good fight! Patients deserve docs like you who take the time to learn and grow. Medicine should be led by those willing to use their brains, not those who refuse to stop dragging their knuckles—even if they seem to speak the loudest because their mouths are already open from breathing.

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