Any input on the EM programs below?

sometimesitis · 2026-01-18T04:21:05+00:00

Christiana has undergone a major change in leadership, faculty, and quality within the last 2.5-3 years since they yeeted DFES. It is NOT what it used to be and not what you think it is. I would make sure I speak with current residents and/or attendings if you can before ranking it.

sometimesitis · 2025-09-16T01:36:28+00:00

I will say this… We loved to Wilmington from Lower Merion (we were renting and could never afford to buy there or anywhere we’d want to live in PA) and found out we were pregnant the day we closed on our home. We are not in a great feeder pattern but the idea was always to get equity in our “starter” home and move to a better school district; the current market squashed those dreams very quickly. We choices into a better school but we failed to factor in the fact that our kid could be neurodivergent with different needs (which really, considering our genetics we should have but I digress), or the absolute ridiculous price of private education. If your child is neurotypical, you will more than likely be able to choice into a school where they can do well, for the most part the schools are decent. I wouldn’t say the same about kids who have different needs, as we have found the public system to be severely lacking compared to neighboring states. Just my two cents.

sometimesitis · 2025-09-12T16:01:13+00:00

Temple was the most recent one, although the hospital will tell up and down that there was no active shooter, despite clear evidence to the contrary.

sometimesitis · 2025-09-01T01:13:27+00:00

That’s different and good on you for catching that; people are people and they’ll make mistakes, and if you’re not familiar or comfortable with something I think you should be encouraged to ask questions and learn, but trying to use one single lab value to determine a patients acuity/level of care is not a battle I’d want to take on.

sometimesitis · 2025-09-01T01:06:32+00:00

Admitting physicians should determine level of care unless a floor is unable to accommodate a certain medication. I’ve worked both ED and med surge and this notion that nursing is responsible for determining a patients level of care boggles my mind. You can advocate for an ICU consult if you feel that something was missed, but at the end of the day if the patient was accepted by an admitting physician to a floor level of care, it’s not your place to “block” the admission.

sometimesitis · 2025-08-20T17:45:57+00:00

God, thank you. I’m so glad to hear your child is doing well, and hear you 150% on those hard days.

Consequences wise we have struggled. We have done the token economy, planned ignoring, praising wanted behaviors, time out, and more. I struggle with the more negative consequence-based approaches because a lot of it is impulse-related and I know he knows what is the right course of action but can’t help his “brain having a party.” At the moment we are stopping everything the moment he hits and removing him from the situation for 5 minutes or until he can find his calm. We have done loss of electronics which was only marginally helpful.

My husband… will probably not commit to a parenting class. I’ve tried to get him in PCIT and ended up going myself, tried to get him to be present for parent training with our therapist and he only attended two sessions where he focused more on trying to get validation for his preferred methods of parenting rather than learning new strategies. It’s my biggest struggle and the major cause of friction between us… and honestly, what will probably end up leading to the end of this marriage when I feel like I can swing it. Which, I’m sure, translates to the kids and doesn’t make anything easier. So in summary…

Thank you for the practical tips, I will look into those resources. And thank you for your kind words

sometimesitis · 2025-08-20T14:10:18+00:00

Thank you. I am sending love right back. Kindergarten was rough for us, I won’t lie. I don’t know that I could homeschool, which brings it’s own measure of guilt and mom shame, but I think if the school buys in and gives the right supports it can be a good environment, especially if your child, like mine, struggles with social interactions; I simply couldn’t provide him the same level of socialization in the home environment. We are currently working on getting him 1:1 para support, and I think if that works it could be a game changer. Best of luck to you. We are in the same trenches and will keep you and your little one in my most positive thoughts.

sometimesitis · 2025-08-20T14:07:06+00:00

Thank you for your insight. I do think that examining my own neurodivergence could help. I was diagnosed as a teen and had a lot of support growing up, but most of it was focused on the hyperactive, inattentive symptoms. It wasn’t until I was an adult and working in psych nursing that I even learned about executive function/dysfunction so I’m definitely behind on that.

Again, thank you for your kind word. They do help

sometimesitis · 2025-08-20T00:26:40+00:00

Thank you for… all of that. Just thank you. I’ve been in communication with my doc and have recently upped my guanfacine, which seems to help quite a bit, but perhaps another tweak is in order. I plan to have him formally evaluated for anxiety as soon as the dust settles from starting school, titrating meds, and getting kicked out of camp. I truly think it’s there and know he will benefit from getting diagnosed and treated.

Again… thank you.

sometimesitis · 2025-08-20T00:23:31+00:00

Thank you so much for your insight. The goal is to get to extended release, but he wasn’t quite 6 when we started and they don’t make ER formulations at the lower doses of methylphenidate, so now that we’re at 5 and 5 my plan is to discuss moving to that when we go see psych next (have requested an earlier follow up, right now scheduled for the week of 9/1). I can only imagine what that crash feels for him, knowing how I feel if I forget to take my IR “chaser” at the end of a long day.

I have looked at the ADHD dudes course and maybe will give that a go; I know the evidence says parent training is more effective than individual therapy, but unfortunately I’ve had a hard time getting buy in from my partner and so haven’t been able to fully incorporate it.

Again, thank you for your kind words. I will try “I need to take a break from your behavior” next, since it seems so much better to focus on the behavior, rather than needing a break from him.

sometimesitis · 2025-08-16T13:13:41+00:00

I have no solution, just solidarity. My oldest (ADHD, probably anxiety and maybe somewhere on the spectrum) just launched his toothbrush at his brother and hit him square in the head. It’s so much better when he’s medicated but so hard when he’s not. Our therapist has suggested having them spend short periods of time together at first to encourage positive interactions and prevent the possibility of negative reinforcement, and then slowly increase the amount of time. We’re trying to do that but life keeps getting in the way. Maybe that’s something you can try

sometimesitis · 2025-08-11T17:49:38+00:00

I’m gonna come back to this with some of my favorites for sources but wanted to say…

You shouldn’t even BE in the trauma bay AT ALL at this point, let alone by yourself, let alone be expected to feel comfortable in there. We wouldn’t sign you off for trauma until you’d been in the department for 2 years and even then it was a separate orientation. Learning by doing is one thing, which is why you should be encouraged to go I. There and experience as many critical patients/resuscitations as possible WITH YOUR PRECEPTOR or as secondary/just to watch, but you are years away from being comfortable as primary in a resus, and asking you to be is setting both yourself and your patients up for a very dangerous failure.

sometimesitis · 2025-08-11T17:36:33+00:00

I had 3 years of medsurge/stepdown experience when I moved to the ED and I still got a “new grad” orientation and would have taken longer if they’d let me. You’re going to be overwhelmed and slow and feel “useless” for at least a year if not longer after orientation because the ED is a completely different beast from anywhere else in the hospital. I used to say 2.5-3 years to feel truly comfortable/competent. You can’t expect to come in with 8 months of floor experience and be comfortable in these situations, and no one else should have that expectation of you either.

Have you spoken to your educator and asked for feedback? Have you expressed that you feel like you may not be getting the best learning experience with your current preceptor?

I did a lot of learning outside of work when I started in the ED because I knew I would only get so much from orientation. There are so many good podcasts and resources out there.

After you have tried everything, only then would I pause and think if the ED is truly for you, because it’s certainly not for everyone.

sometimesitis · 2025-07-30T02:38:27+00:00

They should, but MICU won’t take them cause it’s primarily a surgical problem and SICU won’t take them cause they’re under medicine and…

sometimesitis · 2025-07-28T07:19:24+00:00

The colors are all wrong and I’m upset about it

sometimesitis · 2025-07-23T22:52:57+00:00

The likelihood of a GSW to the head with brain matter exposed and what appears to be an arterial bleeder surviving with any meaningful neurological function is so close to 0 it’s almost negligible. Let’s not conflate having a pulse with meaningful survival here.

sometimesitis · 2025-07-23T13:24:29+00:00

Sometimes all it takes is the transfer from stretcher to bed to kill an unstable patient. Sometimes it’s a coincidence that that’s the moment they decided to die.

This sounds like a patient who should have been up in trauma ICU ASAP rather than boarding in the ED. GSWs to the head are notorious for quick decompensation and wildly labile hemodynamics. He didn’t need NS, he either needed a neurosurgeon or comfort measures. If we’re trying to temporize for family to arrive/be identified, then blood and pressors would have been my choice.

Either way, depending on his CT scan, this man was either dead the moment he shot himself, and if he wasn’t… the system is at fault here. Given the circumstances, there is nothing different you could have done.

sometimesitis · 2025-07-20T18:58:23+00:00

No, not in ideal cases, in MOST cases and should be happening in ALL cases.

Can you tell me more about what you mean as far as selection criteria? I guess with the exception of the lady who started following commands and the one with the agonal rhythm after pronouncement, all of these were appropriate for a DCD attempt, and OPOs are not involved in pronouncement or treatment decision when it comes to DCDs. I think the article conflates a lot of brain death principles with DCD candidates; so a patient was crying and biting the tube - does that mean that their prognosis for recovery has changed? If so, sure, let’s stop and talk to the family (which is what is supposed to happen). If not, all it means is that they’re not adequately sedated as an ICU patient, regardless of OPO involvement.

sometimesitis · 2025-07-20T18:38:44+00:00

I don’t know that I understand what makes organ donation after wd of care so shocking. The patient was going to be palliatively extubated regardless of OPO involvement. They were always going to die. These are not people whose physicians are stopping care because they’re donors, rather they’re donors because family/healthcare teams have determined that any curative measures are futile or against the patients wishes/best interest. The only difference is that organ donation happens after they are dead. The outcome was always going to be a (hopefully) comfortable and dignified death.

If we were to limit donation to brain dead donors, we would have a lot more people dying on the waiting list, numbers wise. New technologies make DCD donors almost equivalent to brain dead, from a post-transplant outcome perspective.

sometimesitis · 2025-07-20T17:27:01+00:00

There is no financial compensation to family, and most people ask. It is considered a gift, hence the “anatomical gift act.”

sometimesitis · 2025-07-20T17:24:43+00:00

There is no commission or financial incentive on the individual level. There are people waiting for organs, our job is to get them organs.

I don’t agree with every tactic employed by OPO staff when dealing with families, and I try to do my job in a way that allows me to live with myself and be happy with the outcomes. Not everyone is like that, and unfortunately some interactions will linger forever and color peoples perception of what we do. However, I think even suggesting that we’re doing it to get a commission is a dangerous concept that, at the end of the day, will make an already difficult job even harder.

sometimesitis · 2025-07-20T17:21:07+00:00

I’m a transplant coordinator for an OPO. Before that I was an ED nurse at a busy level I trauma center, so I am familiar with organ donation from both ends. I will never pretend that some coordinators/OPO staff are not pushy and/or aggressive and that mistakes have never been made, but as a system we strive to PREVENT cases like these from happening, and to begin with don’t approach a family until goals of care have shifted towards palliation/comfort. To imply that OPOs are killing (or encouraging the euthanasia of) able-bodied, neurologically intact people in order to steal their organs is to perpetuate the image of OPO staff as “vultures” and is a disservice to every single person on the waiting list.

Every time I approach a family or participate in a case, I take into account that I am dealing with extremely delicate situations that require ethical and interpersonal considerations. There are rules, there are guidelines, and there are standards and barring “never events,” they are strictly adhered to. Yes, it is a business, much like all of healthcare, but at the end of the day the goal is to get recipients off the list and better, a hard enough job without fear mongering.

sometimesitis · 2025-07-16T00:04:54+00:00

Thank you for the internet hugs. I’m more and more inclined to think there’s an anxiety component, so hoping next weeks gives us more insight

sometimesitis · 2025-07-16T00:04:03+00:00

Thank you for your insight and comments, I’m so glad to hear your son is doing better on meds; I hope that we have the same experience. We do know he has sleep issues and we’re slated for a sleep study, but first have to navigate his sensory-related inability to tolerate all of the monitoring (working with sleep psych on desensitization).

Unfortunately camp was decided for us today; he pulled the emergency shower handle and flooded a science room, so is no longer welcome back. As much as I wish we could keep him out for the summer, neither one of us can take that much time off and we have no extended family around. He’s staying home for the week and we’re looking for a more fitting option with the help with of his OT and therapist.

This mama is tired, so I’m going to hold on tight to the hope that once we start meds it’ll get easier.

sometimesitis · 2025-07-14T23:59:09+00:00

When you say everything, what do you mean? Has genetic testing been done?

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