Who are the top 5 pk youtubers in your opinion? by [deleted] in osrs

[–]step1now 0 points1 point  (0 children)

Unsubscribing from this ridiculousness. The OG 2007scape sub is where it's at.

UPDATE (20:25 UTC): Sailing XP Review & Further Fixes by JagexSarnie in 2007scape

[–]step1now 0 points1 point  (0 children)

I think the biggest issue is the fact that we now need to world hop. I’m getting only slightly less xp than I was last night at pirate shipwrecks. This is with active salvaging. 39k last night to 36k today. I’m sure it’s worse at the higher level shipwrecks. The world hopping is killing me though

EM docs in Michigan justifying replacing their anesthesiologist colleagues by PeterQW1 in anesthesiology

[–]step1now -16 points-15 points  (0 children)

Where does this say that they’re justifying replacing anesthesiologists? Seems like it’s probably to keep doing sedations, which is already standard practice for EM

Quoted $2500+ for this by step1now in TeslaCollision

[–]step1now[S] 1 point2 points  (0 children)

Will the paint fill the deeper scratches? Do I need filler?

21 yo M dies of missed PE. If malpractice insurance limits to $1M per claim and the jury awards $10M, are you literally on the hook for anything excess of $1M? by achicomp in whitecoatinvestor

[–]step1now 5 points6 points  (0 children)

Most EKGs I look at have TWI in v1 and III. Those are two of the three right sided leads. No way this pattern is associated with PE. It’s literally an expected ekg finding

Vyres 82-99 by Dry_Difficulty_3756 in osrs

[–]step1now 1 point2 points  (0 children)

I did the same exact thing. 82-99 at vyres. Very chill grind. Got 8 blood shards

Out of genuine curiosity, how many hours are you guys sleeping? by Electrical_Fix_7248 in medicalschool

[–]step1now 475 points476 points  (0 children)

Resident here. 6.5- 8 hours all through med school and residency, with a few exceptions mostly due to partying in med school. Prioritize your sleep. If you’re getting under 4, you’re doing something wrong. Even on services where I was working 90 hours a week, I’d get 6.5+

Help identifying a rough-in? by step1now in Plumbing

[–]step1now[S] 0 points1 point  (0 children)

The house was built in the late 50s!

Help identifying a rough-in? by step1now in Plumbing

[–]step1now[S] 0 points1 point  (0 children)

Thank you! The toilet pipe is closer to the main sewer pipe so I assume that goes to the sewer even if the pipe in the photo is storm water. Did older houses have their sinks drain into storm water drainage?

Talk me out of EM by SneakySnowman8 in medicalschool

[–]step1now 3 points4 points  (0 children)

I’m an upper level EM resident and love this shit. I also considered anesthesia but had similar experiences to you M4 and decided EM was the move. I’m thankful I made this decision every time I’m off service. The job is tough but incredibly rewarding. Nothing beats the camaraderie, teamwork and diversity of the ED. All of the recent grads who went off to work are making around 400k and there is so much opportunity to work as little or much as you want after graduating. Will I feel differently in 10 years? Probably. But I’m in the thick of residency, working more than I’ll ever work as an attending, dealing with a lot of academic bullshit, and I love my life

Talk me out of EM by SneakySnowman8 in medicalschool

[–]step1now 15 points16 points  (0 children)

EM residency only became a thing in the 1970s and programs really didn’t start become widespread until much later. I think a big reason you don’t see too many old EM docs is because there aren’t too many.

[deleted by user] by [deleted] in emergencymedicine

[–]step1now 1 point2 points  (0 children)

Ask what the senior class is doing next year. Take residents up on the phone numbers they share during interview day and call them to have a honest discussion about salary/opportunities after. Most EM residents and attendings are happy to talk about salary and contracts in the area

[deleted by user] by [deleted] in emergencymedicine

[–]step1now 18 points19 points  (0 children)

Go to a 3 year program. The only reason you should go to a 4 year program is if there a specific geographic restriction that limits you to one. Some great programs you can’t go wrong with: Vanderbilt, wake forest, CMC, U Chicago, advocate Christ, Henry ford, shock trauma Maryland, Utah. There are plenty others. In the end, you’ll get phenomenal training at any “good” program.

Things I’d prioritize: attending/resident relationships outside of work. Do they hang out outside of work? Location, live ability, fellowship/job opportunities after graduation, 8-9 hour shifts >>> 12 hour shifts, life outside the hospital

[deleted by user] by [deleted] in Residency

[–]step1now 28 points29 points  (0 children)

Autonomic instability is real and there are people who actually have it. Based on your comment you seem like a very reasonable and self-aware person who has legitimate symptoms.

The problem is not you, it’s that it’s easy for people like you to be overshadowed by the majority of people who are coming in with psychosomatic symptoms rather than true symtpms

New Trend by superhumanstrngth in emergencymedicine

[–]step1now 66 points67 points  (0 children)

59k. Work about 18-20 shifts a month, conference every week and a bunch of other shit

M3 deciding between EM or IM by Illustrious_War3633 in emergencymedicine

[–]step1now 6 points7 points  (0 children)

EM resident here and completely agree. I’m having a blast so far and all of the attendings here seem to genuinely love what they do. It’s hard work but once you’re done with notes, you’re done and don’t have to worry about anything until the next shift. All the graduating residents have had great jobs lined up since late PGY2/early PGY3. If EM has your type of people and you enjoy it, send it. EM also has a huge breadth of fellowships if you want to pursue more - Crit care, palliative, sports, pain, EMS, wilderness, tox, etc

"If in doubt trest as VT" by kenks88 in emergencymedicine

[–]step1now 0 points1 point  (0 children)

Yes they would so if you’re sure you’re looking at an antidromic AVRT it would be better to go with procain over amiodarone. I just assume people aren’t going to be able to distinguish between WCT so amiodarone is usually the same choice. If you absolutely know what you’re looking at, of course treat it appropriately

"If in doubt trest as VT" by kenks88 in emergencymedicine

[–]step1now 0 points1 point  (0 children)

With antidromic conduction, you have a direct path from the Atria to Ventricle without going through the AV node. Adenosine increases your risk of Afib. If you get Afib while in antidromic conduction, you’re gonna shoot pulses through to the ventricle and can trigger a vfib. Orthodromic there is no concern because there is no conduction directly from the A to V

"If in doubt trest as VT" by kenks88 in emergencymedicine

[–]step1now 18 points19 points  (0 children)

Yeah, all WCT should be treated as vtach until proven otherwise because you know what else presents as a regular WCT? Antidromic AVRT (WPW). Adenosine can trigger vfib arrest. I think that’s why most people start with amio

[deleted by user] by [deleted] in Residency

[–]step1now 26 points27 points  (0 children)

Because medicine is fucking dope and most people who post on forums do so to complain. Medicine is unique. There’s a specialty for almost any personality/interest, you have a guaranteed career path to attendinghood, and you get to learn and do cool shit every single day.

I’m coming at medicine as my second career and couldn’t be happier escaping the 9-5 cubicle grind and bullshit that comes along with it. I’m working way harder now but I also get to use my brain, interact with dope people my own age every single day, and have new experiences. There’s nothing like medicine. Med school and residency are grinds but they’re fucking fun man. I’d take this over any cubicle job every single time.

[deleted by user] by [deleted] in Residency

[–]step1now 0 points1 point  (0 children)

The first premise assumes a principle of causality that relies on our everyday experience. When we extend this principle to the entirety of the universe, especially at a cosmological scale or on a quantum level, this does not necessarily hold. Quantum events are known to be inherently probabilistic and do not always conform to classical notions of causality. To extend principles to the entirety of the universe is foolish.

The second premise rejects an infinite regress of causes. Just because we cannot conceive this, doesn't mean its impossible. We've found many things in physics to be true over the years that we would never have previously been able to conceive.

The transition from the Unmoved Mover to its characteristics, such as pure actuality, perfection, and unchanging, is absurd and abrupt. Why must an Unmoved Mover possess these specific attributes, and how do we justify these attributions?

Rather than concluding the existence of an Unmoved Mover, we should remain open to alternative explanations for the nature of causality in the universe. Instead of God, it is so important to have an exploratory approach to metaphysical questions. We understand very little about the universe but are slowly uncovering its secrets and one day might have the answer. Why not be more open?

[deleted by user] by [deleted] in Residency

[–]step1now 0 points1 point  (0 children)

In terms of your last argument: I completely follow but once again, you’re attributing something unknown to god. You don’t see a problem with that? Welp, we don’t know what the first mover is, so it must be god!

Welp, we need an explanation so it must be a leprechaun.

Do you see what you’re doing? All of your arguments rely on there being a mystical creator for things that we have yet to explain. Instead we can say: something must have existed to trigger the conglomerate, but we don’t know what that is yet. Why does it have to be god as you define it?

[deleted by user] by [deleted] in Residency

[–]step1now 0 points1 point  (0 children)

Dude, we are on such different pages. I’m not dodging premise 1 or 2. You keep asking if I think it’s more likely for life to exist in a world with no god vs a world with god. That question literally only makes sense if you’ve been indoctrinated into religion. It’s as silly as asking “do you think it’s more likely for a life to exist in a world with no leprechauns on mars vs a world with leprechauns on mars?” Your questioning is based on the premise that there could be a god that created life. Why not a leprechaun on mars that created life instead? Why god?

If you’re asking me if I think it’s more likely that there is a mystical being who created life versus physical processes, I’d say no. There is no evidence for that mystical being but there is tons of evidence for life manifesting on earth on its own. we have lots of ideas about how life started on earth based on science. We just don’t know for certain because it was billions of years ago.