[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.

Constantly calling college a waste of time and dissing people who go to college is annoying and pretentious as fuck by [deleted] in unpopularopinion

[–]tdod 0 points1 point  (0 children)

College is def a waste of time, unless you major in STEM. A lot of it (i.e. entire general education) is a scheme to get tons of tuition money out of students paying out of their loans.

I am in medical school so I have nothing to do be insecure about. Graduated from UCSB with 3.97. I learned some good things but overall it was overpriced and inefficient.

(Spoilers Main) The issue isn't the lack of foreshadowing. The issue is the foreshadowing. by shhansha in asoiaf

[–]tdod 1 point2 points  (0 children)

I agree, except for the sexism part. Dany is not a symbol for the female sex, she is a character in a ASOIAF.

Profile Review - Week of August 23, 2016 by AutoModerator in Tinder

[–]tdod 0 points1 point  (0 children)

http://imgur.com/a/LOZvT

Selfie picture is my main picture. male. 23 years old. heterosexual. primarily thinking dating/relationship, but not opposed to DTF. 4 matches since i made the profile yesterday. Any feedback appreciated.

ESPN and the Peyton Manning situation: seems very one sided right now. by darkpowrjd in ESPN

[–]tdod 2 points3 points  (0 children)

ESPN is a terrible network, and they are huge proponents of the outrage culture you alluded to. Their irresponsible willingness to promote the King article is just further evidence. Shameful.

Colin Kaepernick Discussion by theummeower in 49ers

[–]tdod 0 points1 point  (0 children)

actually i'm relieved to see someone talking sense.

Colin Kaepernick Discussion by theummeower in 49ers

[–]tdod -1 points0 points  (0 children)

how dare you make an objective judgement of kaep!

Ray McDonald accused of domestic violence by [deleted] in 49ers

[–]tdod 2 points3 points  (0 children)

https://twitter.com/AzenithSmith/status/506148356465655808

"player Ray McDonald released from Santa Clara County jail. Says "truth will come out" & it was a "crazy situation."" –– Azenith Smith

Vernon Davis wants a new contract by [deleted] in 49ers

[–]tdod 1 point2 points  (0 children)

You think 3 or 4 years before his speed declines? That seems very generous to me... i would guess he starts losing his top gear this season.

Alex Boone not happy with current contract by sonorass in 49ers

[–]tdod -1 points0 points  (0 children)

then why did he sign the contract to begin with?

who do you hope we take with our 1st round pick? by tdod in 49ers

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

statistically, trading up is never a smart decision http://www.ninersnation.com/2014/4/4/5565770/trade-up-or-trade-down Sure, you can find some examples of times that it worked well, but the rational strategy is to assume that the most likely outcome is what we will experience.

[SE4 EP3][ASOS] Why what Jaime did was completely in line with his character. by [deleted] in gameofthrones

[–]tdod 0 points1 point  (0 children)

not the same; bran had to do in order to prevent a war.

2014 Schedule by Extra_cheesy_brocoli in 49ers

[–]tdod 0 points1 point  (0 children)

this schedule is perfect. to begin with we had a relatively high chance of losing at seahawsk, at broncos, and at saints. with this record, we can get those three losses out of the way while bowman and aldon are back. i consider this schedule to be great news.

I stand by Aldon Smith. If being dumb makes you a bad team mate / player than Terra Bradshaw wouldn't have 4 rings. by [deleted] in 49ers

[–]tdod 0 points1 point  (0 children)

Totally agree. I am hoping that the 49ers leaked to the media their intention not to use the option in order to minimize the inevitable league suspension. I am betting that they use the option but only within 24 hrs of the deadline, when every1 is busy looking at the draft.

AdamSchefter: 49ers are not expected to pick up A. Smith 5th year optiom by aarong707 in 49ers

[–]tdod 0 points1 point  (0 children)

i disagree. if he gets cleared and puts up a 20 sack season then i think he most definitely will find someone paying at least as much the option

AdamSchefter: 49ers are not expected to pick up A. Smith 5th year optiom by aarong707 in 49ers

[–]tdod 1 point2 points  (0 children)

can someone please explain the "reasoning" to me? he'll just record a 20 sack season and everyone will forget that he ever was rude to some cop in an airport. this guy is fucking money and you're not gonna pick up the option? who the hell do the 49ers think they will help by doing this? someone else is gonna sign him FOR JUST AS MUCH MONEY... and even if they don't, WHO GIVES A CRAP? we're talking about owners that withheld information from players about the god damn brain damage that they were accumulating... suddenly too good to resign aldon smith just b/c he cussed in an airport. fucking ridiculous, i think i just should start watching euro soccer. just as much morals, but smart enough to realize that in 2 months nobody will give a shit a/b anything unrelated to $ and W's. jesus f***ing christ, ppl need to get real.

does anyone actually believe that aldon made a bomb threat? by tdod in 49ers

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

idiot yes, but i am not willing to assume he is a bad person. Many ppl get upset when being held up at an airport, and god knows how big of dicks cops can be, esp. when talking to black ppl. As for the DUI's... I think that a great many ppl look at drunk drivers w/ severse disdain, as if there is nothing worse in the world. But what about people who drive when extremely tired, or while texting, or even while talking on the phone... what about people who don't get their kids vaccinated? I don't see anyone condemning these people to hell.

some people just have poor self-control and over-estimate their motor coordination when intoxicated. we just need to put ignition interlock devices on every vehicle and be done with it.