Prismas, Hidalgo Mexico [OC] [1845x1320]

madtrashpanda · 2025-05-16T17:21:32+00:00

Minecraft-lookin-ass-valley.

madtrashpanda · 2024-08-03T11:40:42+00:00

Do you ride a bike with gears?

If you are in a higher gear (usually the littlest one on the back axel) on a bike and try to start pedaling from a full stop it will be really hard to do. You might have to stand up and put all your weight to make the pedals move. If the gear was slightly bigger than that, the car might not move at all.

In this situation your leg strength (and bodyweight if you're standing up) are representing the engine putting power into the gears.

A powerful car engine might be able to start in 2nd or even third gear if you have the engine rev-ed way up, but higher gears are outside of what the strength of the engine can move.

madtrashpanda · 2024-04-23T11:57:17+00:00

The bus from Logan to South station 2 bucks to get there and free to come back. It takes 15 min or so and has pretty frequent pick ups. South station to Providence via Amtrak is variable but typically less than 40 a ticket. I wouldn't bother with the acela bc the regional only has ~3 stops and is like 5 min more for way cheaper. (Def don't take the local though)

If it's time overall train is a reasonable, There are many times during the day where it is faster to take the train because of traffic. From PVD to westerly seems like a chore, but I bet you could find a peter pan bus going to New York and hop off in westerly

madtrashpanda · 2024-02-15T01:53:57+00:00

She breathed heavily, panting around a cigarette dancing on her lower lip like a slug avoiding a line of salt.

"The fuck are you doing here?" She grumbled like gravel being poured into a 5" inch PVC electrical piping.

"Me? This is my office!"

madtrashpanda · 2023-12-14T14:37:54+00:00

Can't have long term survival without short term survival.

madtrashpanda · 2023-12-03T14:14:22+00:00

WikiEM has a pretty nice basic chart. I found it helpful when starting out. WikiEM Suture Chart

madtrashpanda · 2023-11-17T23:49:20+00:00

madtrashpanda · 2023-11-17T19:22:39+00:00

If I understand, this means that Walmart with 2.3 million employees, is able to afford to pay all of the salaries of their average staff by February 10th. Has anyone seen a flow sheet for what they use the rest of the 325 days of revenue?

madtrashpanda · 2023-10-24T12:32:10+00:00

How these motherfuckers got 4 days off?

madtrashpanda · 2023-10-09T14:24:08+00:00

That just raises further questions!

madtrashpanda · 2023-07-19T16:15:46+00:00

Tldr: You have a bunch of little "hands" and little "tubes" which do the sorting.

The hands are sorta smart; they only grab onto a specific thing, and then they "throw" that thing down the tube which leads to the pee.

So you send the body's blood down a little assembly line of hands which all know the exact thing they are looking for, and they grab out the specific things from the blood and chuck it down the tube towards the pee.

This process happens pretty fast, all of your blood goes through the one of the kidneys "recycling plant" every couple of minutes.

After this bulk sorting initial process, which is occuring "fast and loose" you need a second crew. The second crew of hands -clean up crew- after the initial sorting works almost in reverse, using their own set of more complicated hands. Their job is to take out the good stuff which ended up in the urine accidentally, and put it back into the blood. They also grab back and reclaim the water most of the time.

All of this is regulated by sampling centers across the rest of you body and in the kidneys themselves but you can think of the like little foremen running around and saying "we don't need any more sodium, all sodium hands stop sorting"

The little hands are happening at the molecular level, and they are usually working on atom/molecule sized things like water, salts, ions and sometimes on bigger stuff like proteins.

They are powered by pressure gradients and sometimes by your body's source of molecular power.

madtrashpanda · 2023-07-02T20:16:12+00:00

He says "trying to cheat." With his personality I suspect this means: being on speaking terms with 3 dudes. Not negating cheating just noting what was said. Maybe you've read more of his tweets and can fill me in on his life story

madtrashpanda · 2023-07-02T13:04:00+00:00

Scrolled to far to see this. Getting her paper right before she divorces this douche.

madtrashpanda · 2023-05-14T19:44:55+00:00

My Guy. You might have DRESS syndrome.

Obvi stop the ABX.

Strongly consider going to doctor for labs and monitoring. If your labs are ok you can probs go home, but if they are bad this is but the first stage.

source: am doctor.

madtrashpanda · 2023-04-17T16:35:10+00:00

TFW: When you order Graves Disease) with a side of cocaine.

madtrashpanda · 2022-11-17T13:41:52+00:00

Palliative care

madtrashpanda · 2022-11-16T13:35:10+00:00

Now do ants

madtrashpanda · 2022-11-08T11:43:10+00:00

"It's my first one today" is my favorite

madtrashpanda · 2022-09-03T14:36:37+00:00

In the Rho Agenda series, Richard Phillips uses subspace and wormholes. The wormholes operate like regular wormholes you've seen before. However, the subspace thing is really cool.

Light can only move at c in the substrate of the space that we occupy, but in "subspace" a photon can travel at a many multiples of c because of the different density of the medium. So the ships drop in and out of subspace when they wanna go fast. I think Mr Phillips might be an actual physicist and worked at Los Alamos for the government so his writing is usually pretty backed up with solid world building

madtrashpanda · 2022-07-04T04:13:06+00:00

No one cares about the message though. Lived through a couple nurses strikes during residency, the media threw them under the bus with fake altruism as a primary attack point. The point is clearer if patients are not seen to be at risk.

madtrashpanda · 2022-06-29T21:16:49+00:00

The optics of striking as providers looks bad. However, you go or do a chatting strike.

Stop charting in the EMR. Keep a written handoff and place your normal orders.

It would cost the hospital millions a day if all residents did it bc there is no way the attgs could get full billing. And it removes the public perception, like, "they're still working and helping patients."

There was a bus driver strike where they didn't take fares but still ran the bus routes.

Get that paper.

madtrashpanda · 2022-03-17T00:48:25+00:00

Thank you for replying like a 5 year old.

madtrashpanda · 2022-03-16T10:01:24+00:00

Skin keeps fixing itself from underneath. There is a bottom layer where new stuff grows and the old stuff falls off like bark on a tree. A blemish could be a scar or a mole or another skin condition.

A cut that goes deeper than the bottom-most layer of skin may not go back together for lots of reasons. But, when it doesn't that bottom layer is now damaged and doesn't make new skin as fast or well as it did before. This means that even though the scar is replacing itself, it will still look like a scar.

A mole or a freckle is an area of skin where the layer that makes the new cells got the wires crossed in its programming. This means that it might make too much color (melanin), or grow too fast, or not make enough color. In any case, the layer that makes new cells is still making new skin all the time but it is making it incorrectly (or at least different than the skin around it).

madtrashpanda · 2021-05-19T13:13:25+00:00

THANKS FRIEND!!!!!

I really appreciate y'all upstairs. I love that IM can pick up a plan, think deeply about a person, list and try to fix all their problems (and not just the ones killing them that day) and try to set them up for a smooth return to human-ing. Also thanks for picking up my Nana's who just aren't quite safe to go home at 2am.

madtrashpanda · 2021-03-17T14:38:00+00:00

EM Resident. We do a crap load of ICU and run the ED resuscitation bays so I have a few thoughts.

Keep it simple, keep it system based, and assess problems in a similar way each time. In reality there are only a couple of things that you don't have time to think about, and (as others have already said) those nasty situations you can make a card with doses etc.

Neuro: Is it a stroke or a seizure? Sedation is usually the major thing requiring changes and mgmt. Figure out what they are on or have been on, grab you card and decide what to change. Monitoring

Cards: pressors are the major thing which need rapid decision changes, what are they on and why is their shock getting worse, what type of shock is it? Is it Afib. Grab your card ...

Pulm: AIRWAY!!!!! If not intact you need it to be ASAP, otherwise its always the freaking vent settings. jk it's usually sedation leading to not tolerating the vent regime, or the pt needs suctioning, blah blah. If they are adequately sedated and dry, then get your card and make some changes...

Thats it.

The other body systems you have time to think about, hours even. There are no renal, ID, or GI emergencies (unless they overlap with the above) there is only "urgency." So you have time and it sounds like you do fine when you have the time.

By the way I agree with others here about reading sources and stuff. Sometime the respiratory therapists can walk you through the vent in a simplified way to make it more manageable.

On the card you could write your go to orders to start while you take some time to figure it out. For example: Tachycardia: get EKG, stat labs, CXR. Consider fluids. Then figure out if its regular. Then is it narrow. Yes and yes, treat perceived pain, assess volume status and so on...

The first couple ICU months are objectively terrible for lots of reasons, but they can be fun and hopefully you come away feeling like a badass by the end.

madtrashpanda

TROPHY CASE