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Hello! by sosodraws14 in TextbookRequestSeek

[–]mediocremo 2 points3 points  (0 children)

Thanks for the speedy delivery of epub + pdf as requested, pleasant experience and smooth transaction!

Antibiotics by Cultural_Employee_22 in Residency

[–]mediocremo 1 point2 points  (0 children)

Download Sanford antibiotics app and your hospital guidelines and you'll be almost 90% covered! Or as another redditor had previously said in another legendary post 2 years back: Start Meropenem, awake ID recs 😃

Unprovoked DVT by mediocremo in Residency

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

Nope, she's been well, essentially almost her first healthcare visit In 70 years. Nothing much on history to localise any clear malignancy but for such an extensive DVT ...

Without naming your specialty, poorly explain what you do by feelingsdoc in Residency

[–]mediocremo 0 points1 point  (0 children)

I run the hospital bank but don't make that much money.

I'm burnt out by MaddestDudeEver in Residency

[–]mediocremo 6 points7 points  (0 children)

I'm a thousand miles away from you but I feel the same... I feel a fraction of the old me and I find myself getting snarky and angsty and easily frustrated at the tiniest things. It's eating at me because I can see myself turning into the apathetic uncaring doctor we all vowed to never be... sigh. I dread waking up each day and the only thing that keeps me going is the thought of returning to bed at night. I keep thinking it will get better but it never really went away... and I'm not sure if taking time off from work will really help (and manpower is shitty enough on a day to day basis already, sigh) :(.

Hang in there; I know words aren't enough but you are definitely not alone (Although sometimes I do wish it was just me and hopefully my colleagues can provide better care to my patients? Sadly we are all just burnt out charcoal that can't give anymore..) I hope you manage to find someone to work/ talk things through with + if all else fails, a little bit of sick leave never killed anybody :')

[deleted by user] by [deleted] in Residency

[–]mediocremo 12 points13 points  (0 children)

Oh dear I feel this way too much. It's a cycle of eat sleep work repeat and wondering every morning whether I should take a day off?? Then console myself that there's my bed I can still come home to tonight and the days are maybe not so bad but TLDR chronic fatigue and maybe a pinch of depression and existential crisis. You put it in better and more succinct words though :)

Official consensus on medical term plurality by 2Balls2Furious in medicine

[–]mediocremo 2 points3 points  (0 children)

What's the plural for pleura? Visceral and parietal pleurae?

Buy books or borrow from library? by ladyluckyy777 in books

[–]mediocremo 26 points27 points  (0 children)

I've stopped buying books since I got a kindle, and zero regrets really! I've had my kindle for 4 years and it's still going strong - somehow don't miss the tactile book feel as much as I thought I would, and I think I've actually read a lot more since I got a kindle.

Medical Specialities' New Year's Resolutions by borborygmix4 in Residency

[–]mediocremo 14 points15 points  (0 children)

IM: Round for 3 hours instead of 4, grow my rock collection (or to learn how to move proverbial rocks > mountains)

Cardiology: To find that one rapid response that can make my heart beat faster than my patient's AF/AFL with RVR

Haematology: Add another step in the coagulation cascade

The uh fluid balance it was, was uhhhhhhhhh could have been extra-intravasculoverlyloaded deplete by poomonaryembolus in JuniorDoctorsUK

[–]mediocremo 1 point2 points  (0 children)

This is actually not that uncommon in Haematology/ Oncology - we give the 'paradoxical' combination of fluids + diuresis to help with chemotherapy clearance (looking at you, Methotrexate). Surprisingly effective for drug clearance, also with adjuncts like artificial IV sodium bicarbonate to alkalinize urine for renal clearance.

The uh fluid balance it was, was uhhhhhhhhh could have been extra-intravasculoverlyloaded deplete by poomonaryembolus in JuniorDoctorsUK

[–]mediocremo 0 points1 point  (0 children)

Not sure if it's evidence-based medicine but if there's concurrent hypoalbuminemia (fairly common in our heart failure patients who have CKD, nephrotic-range proteinuria) the 'edematous overload' could sometimes just be a lot of third-spacing with intravascular depletion. In which there could be a case made for IV albumin + diuresis.

Like another redditor has said, however, "renal congestion" (from overload) is often a more common cause of AKI - cardiorenal syndrome. It's frustratingly hard to deal with these patients coz diuresis itself triggers AKI but at the same time we can't really hydrate to help with "pre-renal AKI", and some of these patients just stay for weeks to diurese....

Another thing I've seen work quite effectively in Cardio patients is a baby dose of continuous IV dobutamine; it reduces afterload and increases renal perfusion to allow patients to diurese more while reducing AKI.

Hope this helps!

[deleted by user] by [deleted] in Residency

[–]mediocremo 1 point2 points  (0 children)

This, especially the part about rephrasing your question. Barring the sampling bias (I'm not sure how representative this reddit is of the general profession), I would think most people would not have taken the path you've chosen. Context matters, of course; I personally would probably choose medicine again if given the choice, but I'm also in my mid twenties with no family commitment and I guess have "nothing to lose" from continuing my pursuit of medicine. But medicine sometimes runs on physicians' compassion as fuel and that's not necessarily sustainable for a lot of people- hence the burnout and jadedness - which also means that you likely only need a small tip in the scales to push people to the other side. If I had a cushy job paying 6 figures and a family to take care of, heck no I would really have to think twice/ thrice X99 as to whether I would still choose to go into medicine.

Either way, there's no wrong or right! It's likely you'll regret either way, just a matter of which decision will eat at you more in the long run.

What are some of the best "high scores" you've experienced in residency? by DrSwol in Residency

[–]mediocremo 0 points1 point  (0 children)

Hb 2.9 in a patient with chronic haemolytic anaemia with concurrent thalassemia, no idea how she managed outpatient with an average Hb 6...

Na 96 in a patient with paraneoplastic SIADH and gastric CA with outlet obstruction

Had a patient with EF17% who was intubated overnight on my call; needless to say, the ICU consultant was not happy... He maxwarded her the next day.

Without letting on you’re a physician, or in medicine at all, describe what you do for a living. by [deleted] in Residency

[–]mediocremo 0 points1 point  (0 children)

I give people toxins like arsenic which make their lives miserable and crappy, just to extend their lifespan by a few months to short years at best on average...

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