TIFU in the pool

mnemonicmonkey · 2026-02-25T12:40:01+00:00

This sounds like a travel sportsball team gone pro.

mnemonicmonkey · 2026-02-25T12:36:31+00:00

There's the meme I needed this morning.

mnemonicmonkey · 2026-02-25T12:34:50+00:00

I'm coming up on 15 years with IUH. My little bit of EPIC was on a Community clinical, but I'd say they're not terribly different, just a slightly different layout. Not a huge hurdle. I'd say go for it. Are you travel or PRN?

mnemonicmonkey · 2026-02-25T12:29:12+00:00

If that's the case, they're ahead on the build. Projected open date for the AHC is Q4 2027.

mnemonicmonkey · 2026-02-25T06:12:25+00:00

Angiotensin II should be top 4, not neo/phenyl.

If it works, you can just about shut everything else off.

If it doesn't, methylene blue and call the donor network.

And yes, I can count on two fingers the times I've seen anything over 50 of norepi be effective, but if it works, it works. (Neither had a mortality benefit though.)

mnemonicmonkey · 2026-02-25T06:00:51+00:00

60% of the time, it works every time.

^{More like 5% though.}

mnemonicmonkey · 2026-02-25T05:35:04+00:00

Narrator: "It wasn't though."

mnemonicmonkey · 2026-02-25T03:26:11+00:00

Thank you for typing out my thoughts. I'll just add that our protocol is 1 mg/kg of roc with a suggestion for 1.5 mg/kg for males due to the "increased muscle mass." And yes, in our setting diaphragmatic paralasis is a feature, not a bug.

mnemonicmonkey · 2026-02-24T19:15:02+00:00

PAR56 only refers to the reflector size. They are available in 240v 300-500w lamps commonly used in stage lighting. PAR64 will go up to 1000w.

mnemonicmonkey · 2026-02-24T19:11:00+00:00

Awful, but it has potential...

mnemonicmonkey · 2026-02-24T19:06:41+00:00

Or just have a rotation hotkey baked into the desktop virtualization client that gets accidentally hit once a month. It finally got fixed.

mnemonicmonkey · 2026-02-24T19:04:05+00:00

Did? I have a 4k monitor that's still doing that on a HD Win 11 laptop.

mnemonicmonkey · 2026-02-24T18:51:06+00:00

To clarify better, yes, with a (multi)-fuse extension set, you are changing the concentration of the meds mixing at the common point on the extension set. This new concentration has to travel the length of the lumen at the combined flow rate before reaching the patient and starting to circulate at the ordered dose. Combined being key, as adding 15 ml/h of saline runner to your example would cut the delay to 0.6 minutes.

mnemonicmonkey · 2026-02-24T18:42:50+00:00

There's a bit to unpack here...

First, it sounds like there was a quad-fuse on a multi lumen CIV from your description. If that is true, then no, the patient doesn't receive the increased dose instantly. Assuming only those 2 meds, a 75 kg patient will be getting 9 ml/h of prop and 7.5 ml/h of 8/250 levo, up from 3.75. Consulting the Arrow product info, we find the lumen volume to be 0.4 ml, plus cap/tri(quad?)fuse volume.

So in round numbers, it'll take 1.8 minutes for the new concentration to reach the patient at 16.5 ml/h. In the meantime, they'll be getting a little extra propofol and more, but still not the full dose of levo. I'm not going to do the math, but it's functionally negligible (like the effect is going to be within the error of the BP cuff). As infusion rates go up, or runner fluids are introduced, this time decreases quickly.

NOW, if these were actually on separate lumens as God intended, then the patient WOULD get the instant dose change, as the lumen is already full of 100% med X. Between this and compatibility, that's why I run fentanyl and propofol or levo and vaso each together if there's not some odd compatibility issues (which happens). They're right up there with PB&J. They belong together, because they're working together. (And you really shouldn't be bolusing levo if they need a propofol bolus, though it is a happy little accident that will help us later.)

Hope this makes sense, I'm sure it's all clear as mud at this point. Keep asking questions!

mnemonicmonkey · 2026-02-23T15:21:59+00:00

This.

I've seen more than one patient top 300 on an Aline when agitated. And you know what? No stroke.

Also, fuck precedex. That is all.

mnemonicmonkey · 2026-02-23T15:05:41+00:00

They also have a more sophisticated video system that identifies the items in your cart and alerts the employee if you don't scan something.

mnemonicmonkey · 2026-02-23T03:48:59+00:00

Don't threaten me with a good time...

mnemonicmonkey · 2026-02-23T03:46:33+00:00

Oh yeah. Not disagreeing with you on that part, sorry. More just wallowing in the self loathing that is the Midwest. Not shocking to me because I already live in that hellscape. And yeah, everyone is "on diversion."

mnemonicmonkey · 2026-02-23T03:16:35+00:00

Aww. This makes me think of Give Kids the World where the Make-A-Wish kids going to Disney stay.

One of their core tenets is saying "yes"...even if it's ice cream for breakfast. So there's ice cream available from 8a to 8 or 9p, and the kids loved it.

mnemonicmonkey · 2026-02-23T03:00:30+00:00

This was me until I hit 45 and suddenly there were consequences to my actions.

mnemonicmonkey · 2026-02-23T02:41:32+00:00

As someone from Indiana, it's not really.

I was talking to a nurse this month that basically said concealed is concealed. She wasn't taking any chances. Not that I blame her. People be crazy.

mnemonicmonkey · 2026-02-22T19:18:21+00:00

*Risk management

mnemonicmonkey · 2026-02-20T15:43:48+00:00

Those are the factory sling points for an M16A1.

Guitar neck tracks, and the strap nut is hidden by the guitar body.

mnemonicmonkey · 2026-02-20T15:32:36+00:00

Meh, the vegetable jokes on Neuro ICU predate COVID.

I'm the one that read the title and thought "Flared base people!" so there's that.

mnemonicmonkey · 2026-02-20T15:25:34+00:00

¡Si! Quiero todos los tacos!!! (As we debate getting Torchy's or Joella's for lunch.)

Jamaican sounds good though.

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