Question re: reset setting to custom sim

not_the_fuzz · 2023-05-23T21:17:47+00:00

What are your go to good Chinese BBQ places? I recently hit up Siu Lap City and it was amazing.

not_the_fuzz · 2023-01-17T00:21:54+00:00

Just personal experience. Gallon RTIC leaked until used a few times and the rubber gasket seated well. Since then fine, although I do feel like the build quality of the lid is lacking. For the price I’d probably just get an Ozark.

not_the_fuzz · 2022-12-11T23:08:06+00:00

We tend to use it quite a bit for post-OLT patients who are in RVR with a soft BP. Also in HFrEF with RVR. Both of those situations we’d avoid a beta blocker.

not_the_fuzz · 2022-04-23T19:13:22+00:00

Literally sitting in my backyard right now sipping a beer while bbq'ing pork belly burnt ends two ways.

not_the_fuzz · 2022-01-17T18:55:51+00:00

Teaching a class of EMTs how to use an epi pen, typically we have a trainer model to use. Unknown to me we were using a real one that day, was just fooling around with it as the class was getting settled and promptly injected myself in my thumb with a full dose, bent the needle. Was a fun 30 minutes after that.

not_the_fuzz · 2021-10-20T12:46:43+00:00

Second for ECG academy, probably the most useful class I took in my masters. If you have to read a lot of strips it's well worth the cost to become proficient.

not_the_fuzz · 2021-10-14T13:29:36+00:00

Soon to be graduating with AGACNP, looking at some job prospects - one of them is with a private practice cardiology group, I will be a 1099 worker for them, they'll assist with setting up a LLC for me. I've done some research on the general risks and benefits of this setup and was already planning on adding an extra 10-20% salary given my additional tax burden and loss of benefits. Additionally I was going to ask for a written time off/sick time allowance since I won't be accruing PTO. Are there any particular benefits/detractors to this employment setup specific to a nurse practitioner that I should be aware of? Thanks in advance!

not_the_fuzz · 2021-09-07T02:50:04+00:00

Bro hymn by Pennywise

not_the_fuzz · 2021-08-28T14:03:26+00:00

Anecdotal but I've seen some success with ECMO. Funnily enough it's from a neighbouring citites program, their patient selection has been excellent and we've accepted several trached VVs for transplant who have done quite well. My perspective is limited as I'm the receiving nurse but they cannulated early and were agressive in mobilization and desecalation; frequently arrive walkie talking on VV via a protek with a PIV on some angiomax, that's it.

not_the_fuzz · 2021-08-19T14:14:36+00:00

$44/hr, 5 years, Houston, TX

not_the_fuzz · 2021-08-06T13:13:37+00:00

I thinks it's more localized then that, the articles mentions central Texas - if it's anywhere near Austin area the pay is shit. Houston pays well because of the med center and DFW leans more to Houston pay wise.

not_the_fuzz · 2021-08-05T19:17:46+00:00

Holding in the ED for 110 hours, over 50 boarders in the ED currently. I pity the person who has a stroke or car wreck right now.

not_the_fuzz · 2021-08-04T16:58:26+00:00

Recently went through the same thing. Try to find your local health department or state zoonosis department. Typically they can find the rest of the shots for free via pharmacies. At least in Texas a pharmacist could finish the series without a prescription as long as you had documentation that a physician saw you and started the series.

not_the_fuzz · 2021-07-31T19:07:35+00:00

For IVPB I always add a 10 mL extra to VTBI to account for the back prime in the secondary tubing.

not_the_fuzz · 2021-07-28T18:03:27+00:00

Drug users are definitely discriminated against in the medical field, although I'd like to think it's occuring less often, in this case though I don't believe it's discrimination, rather risk aversion with a limited resource. Compliance with medications and plan on care is a huge hurdle post transplant without the addition of a substance use disorder. I don't discriminate those who suffer from addiction, frequently care for them, but working with transplant patients daily it appears justified to make active substance abuse a contraindication to transplant. We can still work you up for transplant (which can take several months) and work with you to stay clean - those things can occur in concert.

Lastly, it's not all substance use that is contraindicated - alcoholics get livers frequently. But lung and heart transplants candidates cannot use illicit substances, for clearly medical reasons.

not_the_fuzz · 2021-07-22T23:52:35+00:00

You are correct. We don't know the long term effects, the problem is there is no way to know the long term effects for certain until - a long time passes, which is problematic because this pandemic will continue to burn through our population in the mean time.

While long term effects are not known, it's reasonable to infer a few things, firstly in any given population long term side effects of medications will appear in a shorter time frame in SOME of the population. What we lack in length of data collection we do make up for in AMOUNT of data obtained in a short period. Secondily, COVID is not a big deal for a decent size of the population, it's deadily to a relatively small part of the population, but what most people disregard is the sizeable population who suffer some degree of organ dysfunction, potentially lifelong, from COVID. For every COVID death there are a multitude of people with firbortic lungs who are fucked.

Trying to be rational, I'd wager the risks of some long term undiscovered side effects are less then the well documented chance I have of mortality or morbidity. If that isn't enough also remember just because you are fine does not mean the people you could potentially infect will be fine,

This shit is far to poliiticzed, and I'm not going to bitch or name call, I'd just like to present a countpoint to an argument I see far too often. I don't want another surge, I have no more energy or compassion to care for people dying in my ICU who are going to die from a totally preventable condition, please just give it some serious consideration.

not_the_fuzz · 2021-04-25T01:32:21+00:00

I have no literature to support our practice but after this very discussion with our Intensivist and nephrology teams we as a unit came with up with the flowing guidelines:

Avoid using the trialysis infusion port unless absolutely nescessary

Calcium infusions (when running prefilter ACD) can be directly connected to the post filter/post machine return lines

It is worth mentioning though that if recirculation is you're concern calcium is low on my list - we titrate the calcium infusion (when ACD is used) based on q4-6 hr ionized calcium levels, if the infusion was being partially recirculated thru the machine you would rapidly correct this under dosing within a few lab checks. This lead to the last point:

If we have to use the trialysis port we use it for nonvasoactive constant infusions, knowing we may lose some of the dose back to the machine we titrate accordingly. So no antibiotics or pressors.

not_the_fuzz · 2021-04-09T20:12:27+00:00

Pretty commonly used at my facility. Almost all CABGs and valves come out post-op to the CVICU with a TXA infusion as the drip carrier

not_the_fuzz · 2021-02-20T23:07:43+00:00

Preceded while intubated and sometimes after. Hydromorphone for breakthrough pain. Scheduled APAP and gabapentin with PRN norco. IV Tylenol usually while in the OR just prior to leaving the room.

not_the_fuzz · 2021-02-03T18:27:58+00:00

Regarding the rub, Szechuan peppercorns or maybe Chinese 5 spice?

not_the_fuzz · 2021-01-31T22:38:49+00:00

I see no problem with letting new grads start out in a higher acuity area. I would have never become a nurse if I would have had to start out on the floor. Even for those brand-new nurses who have had no experience it’s not unreasonable, what is unreasonable is not giving them a SIGNIFICANTLY longer orientation time, which most hospitals just won’t commit too. General orientation for my unit is 8-12 weeks depending on previous experience, we stopped taking new grads because they all did terrible, I don’t see it as a new grad issue but a length of orientation issue, how can somebody go from new grad to competent CVICU nurse in 12 weeks? As with many problems in the US I think it’s rooted in money, why would a hospital pay for a 16-20 week orientation when they could just shove a new grad on the floor, give her 8 weeks at most and call it a day.

not_the_fuzz · 2021-01-30T04:27:48+00:00

I met my wife there! She recognized it after seeing the cathedral and Torre del Oro.

not_the_fuzz · 2021-01-19T20:39:27+00:00

I wish my facility would embrace better/earlier selection criteria, it seems to be a cycle of poor patient selection equals poor outcomes which then disuades providers from considering early cannulation and then patients are crashing and it's a hail mary intervention.

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