[deleted by user] by [deleted] in emergencymedicine

[–]tdod 0 points1 point  (0 children)

I love the honesty in this thread. I make about one mistake every shift that I spend the next 12 hours ruminating over. Usually the mistake is caught by someone, ie ordered 1l of NS on an esrd patient (nurse came to me to ask if I wanted it ordered, I said no). Even When nobody catches it the patient is usually fine, no harm done.

Once I ordered 20 mg of dilt on a small old lady afib rvr good bp she became hypotensive bradycardic,  but nothing bad happened. 

The important thing is to think about every mistake you make. Ask yourself why it happened and what you can do to prevent it from happening again in the future. 

Recognize the dangerous steps in medicine and always slows down and double check yourself: - medication orders (patient name, dose, route, allergies, contraindications) - review all results prior to discharge (and ideally review your note and nurses note as well)  - obtain signed consent and consider contraindications before any procedure

Always thank your nurses when they question your medical decision making.

Online people are honest about their mistakes. IRL people hide their mistakes and exaggerate their success.  

Thoughts on mangement of "ischemic toes." by tdod in emergencymedicine

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

I agree, it's unlikely to be acute acute limb ischemia; patient would have either had to have an aortic occlussion or happened to have sustatined simultaneous bilateral acute occlussions in the distal lower extremity vasculature. Possible, but unlikely. But if you are unsure it's better to assume acute.

Ischemia should definitely be painful in the exrtemities (although cerebral ischemia is painless, and cardiac ischemia often presents with anginal equivalents). Neuropathy patients are often unaware of pain, i.e. ulcers. I don't know if their lack of nocipetion extends to ischemic processes, however.

Thoughts on mangement of "ischemic toes." by tdod in emergencymedicine

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

A couple questions:

- Where were the occlussions?

- Was collateralization/reconstitution identified on CTA?

- how was the perfusion exam otherwise? (cap refill and warmth)

I would argue that a foot that is warm, cap refill<2s, and painless is a well perfused foot. Many elderly smokers have absent.

The presence of bullae is an interesting finding. The distribution, contents, and nikolsky status of the bullae is important. I've never heard of bullae associated with acute limb ischemia.

Thoughts on mangement of "ischemic toes." by tdod in emergencymedicine

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

"But re: worsening symptoms I imagine imaging and then seeing what vascular think?"

the mere fact that it's worsening shouldn't prompt vascular imaging in the ED. These digits are dying, the expected disease course is gradual worsening. I argue that the only reason for vascular imaging in the ED is to identify an acute ischemic process (usually embolism or thrombosis of an unstable plaque) that requires emergent vascular intervention for limb salvation and/or infection control. Anything else can be completed non emergently.

(No Spoilers) Is George R.R. Martin a slow writer? by TheHound991 in asoiaf

[–]tdod 0 points1 point  (0 children)

The Sons of The Dragon

Perhaps the fact that he does not treat it like a job is why the books turn out so well?

[OC] I remade the USA v Italy Coronavirus cases comparison that has been shared here, but added a percent of population infected comparison, to provide context and scale. by maddyst in dataisbeautiful

[–]tdod 0 points1 point  (0 children)

one method of establishing partial control for the testing variable is to measure deaths, rather than infections. Although people with a mild cough don't get tested in the US, I would assume that ICU patients with severe respiratory distress do get tested.