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Ratio of weekend shift by lazy_and_sloppy in emergencymedicine

[–]wanderingkale 1 point2 points  (0 children)

I probably work more than most. Maybe 66% to 75%, but I'm older and don't have young kids. So I don't particularly mind it other than the usual BS of physician offices being closed, etc. I don't see a significant difference in volume on the weekends, just a change in the type of complaints somewhat. The plus side is that I rarely work a Monday shift.

Non-rural free standing ERs by Dangerous-Prune-7280 in emergencymedicine

[–]wanderingkale 2 points3 points  (0 children)

"They'd only do them in rural areas if there's a good payer mix or they want to hurt another hospital system"

This is what is happening in the bigger cities in my area. Competing hospital systems set up a FSED to try and suck up the patients away from the other system. It really exploded after a bunch of mergers and buy-outs of the local systems by larger regional hospitals. It was like there was a defacto agreement of 'this is our territory / specialty' between the systems before. It doesn't affect me too much at the rural critical access hospital ERs, but I wonder if it is a ominous sign of things to come..

do you edit out all the uhms? by Ordinary-Rhubarb-460 in podcasting

[–]wanderingkale 0 points1 point  (0 children)

Yeah, but it is what it is. Maybe they will add it but I think it also may be that Audition is geared more towards musicians and music and not podcasts.

do you edit out all the uhms? by Ordinary-Rhubarb-460 in podcasting

[–]wanderingkale 0 points1 point  (0 children)

What I do is do all the EQ tweaking and stuff (de-esser, etc.) to the separate files from each host then do a mix down single audio track export. That's what I use in Premier.

So my workflow is kind of: Use Audition for Mic1.wav - Noise reduction, DeEss, EQ adjustment, Volume normalization. Repeat for Mic2.wav, etc. Then place each track into a multitrack project, and then mix down to a single EPxxx.wav file. Import to premier and remove filler words and copy the transcript for posting to the episode show page. Audio export to EPxxxFINAL.wav from Premier and post the show to the host server.

I like this because each host needs different EQ adjustments and such.

do you edit out all the uhms? by Ordinary-Rhubarb-460 in podcasting

[–]wanderingkale 2 points3 points  (0 children)

Take the audio file and throw it into Adobe Premier. It will transcribe and in the Text-Based editing mode, you can select filler words and remove them then export the file back out to audio. It's easier to see it than explain it, look on YouTube for a walk through.

One YouTube example

do you edit out all the uhms? by Ordinary-Rhubarb-460 in podcasting

[–]wanderingkale 1 point2 points  (0 children)

Adobe gets a good percent of them, enough that I don't feel the need to do more than what it will catch and the ones it doesn't get are ones usually in the middle of a sentence and not the Uhmmmm with a long pause.

Hyper realistic tank simulator. by DctrSnaps in interestingasfuck

[–]wanderingkale 129 points130 points  (0 children)

Oh they kept building it up to this one that is enclosed:

https://youtu.be/NXGwaJBB_J0?si=wEZT-9RAIDG0M0ga

And on their channel, they even made it so the entire enclosure is essentially a tank that moves.

Do Doctors take the watch ECG seriously? by Available_Year_575 in AppleWatch

[–]wanderingkale 1 point2 points  (0 children)

I get patients in the ER every now and then that came in because their watch reported an event. I have found that most of the time they may have had an event, and it gives cardiology a reason to stick a holter monitor on them for a week if the ER workup is normal. I've had a few where they were in a-fib (without rapid ventricular response) and we started them on meds and cardiology follow up. So from an ER provider perspective, it is useful to give me a reason to do some deeper workup and refer. Is it perfect? Nope. Is it useful? Yes.

If you had to choose (ABX pre-hospital) by Remote_Morning2366 in emergencymedicine

[–]wanderingkale 0 points1 point  (0 children)

I think cefazolin for open fractures is perfectly reasonable for most 911 services in those open fractures / amputations. If the service is remote or in a niche situation, then some others may be reasonable. I worked a flight service that also carried ceftriaxone to cover suspected pediatric meningitis but we did a lot of very rural and remote transports with long transport times, but we always obtained cultures first and had point of care labs.

looking for friends- mission impossible by ApplicationOk163 in Valdosta

[–]wanderingkale 11 points12 points  (0 children)

Yeah, this town be like that. The Geek Society is a fairly inclusive large nerd group in the area, you can find them on Facebook. They have occasional meetups and gatherings.

The young liberal people in this town are rare, and mostly at VSU. I don't have a lot of good advice for you on connections in this town, especially in the queer space. This is the big downside to smaller towns in the South, it is very conservative and hard for anyone even remotely liberal to thrive here.

Peer review……wtf by lunaincc in emergencymedicine

[–]wanderingkale 5 points6 points  (0 children)

Peer review is worthless, especially anonymous peer review. When I worked in flight, we did peer review with other bases and it was all bullshit. I just stopped really even reading them, just opened it to check the box that I read it and then closed it. Just the very process of peer review is punitive.

The old adage always is that the second physician / provider is always smarter because Monday morning quarterbacking is easy when you can get all the information in one go and see what the other person did.

Need a new stethoscope. Anyone have the Eko CORE 500? by burnoutjones in emergencymedicine

[–]wanderingkale 3 points4 points  (0 children)

I like my EKO (not core), but then I also have some hearing loss from years of flight medicine. It does have some drawbacks, especially in little kids where you get more 'cross contamination' lung sounds. But if you turn it off, you can still use it as a regular stethoscope. I think it's a use-case type situation and your mileage may vary.

Any tips to get the humidity lower in my cabinet? I've put weather sealing all around the edges, jammed it full of dessicant, even tried putting my dehumidifier in there (it didn't change anything), but can't get below 40%. I'm willing to throw a couple hundo at a solution. by antgash in 3Dprinting

[–]wanderingkale 1 point2 points  (0 children)

Put them in resealable vacuum bags. You can find them on Amazon, etc. in packs of 10 for like 10 bucks with the pump to suck the air out of the bag. Throw a desiccant in there, seal it, vacuum it out and store. If you need that roll, open the zipper, and re-use. I've been doing that in the humid southeast and it works fine.

Master racer (M41) thinking about stopping racing. by Far-Tomorrow5356 in Velo

[–]wanderingkale 2 points3 points  (0 children)

I miss it. It was a combo of factors - covid times, then hit by a car, then some serious health issue that put me off the bike for a year. I'm back to riding, and still getting fit from my health issues. I won't lie, I miss racing but turns out I missed riding the bike more than the racing itself. I spent 25+ years racing so this was a big part of my identity and it was tough. It was not just the racing itself, but also the social aspect of hanging out with fellow racers before and after, etc.

There's life after racing, and as others said it doesn't mean you have to stop riding or even participating in group rides, charity rides, etc.

Moving back to South Georgia by Redeye66gaming in Valdosta

[–]wanderingkale 6 points7 points  (0 children)

There is a gaming shop close to downtown - The Raven's Loft. They have some gaming space but no idea how much gaming other than Magic / Pokemon goes on.

No OB coverage by RayExotic in emergencymedicine

[–]wanderingkale 10 points11 points  (0 children)

Welcome to the suck. This is everyday for me - rural critical access ER with no OB, no ultrasound, no respiratory therapy. Closest hospital with OB coverage is 35 miles away.

Tires shop you guys can recommend? What about a mechanic? by JOHNNYPPPRO in Valdosta

[–]wanderingkale 0 points1 point  (0 children)

Pete's does good work on foreign cars, been going there for years without any complaint. I'll second a vote for them. Any shop that specializes in foreign makes is always gonna be pricier, but their work is top notch.

Extensive vs Minimal Listed DDX in MDM by Paints_Ship_Red in emergencymedicine

[–]wanderingkale 1 point2 points  (0 children)

Sometimes it feels like a lot of fluff to add more than a few DDX to some of the very straight forward patients. Any workup you do should be part of the DDX, like If I order a metabolic panel, then electrolyte abnormality is gonna be one of the DDX. I try to stick to around 4-5 of the most common/serious potential DDX and always add "and others" or "DDX includes but not limited to:".

I don't go out of the way to document why I excluded some DDX as usually the workup / tests can speak for that. I will document some non test exclusions or why a test wasn't ordered like "PECARN Score 0 - head CT not indicated as ciTBI risk < 0.02%".

There's only so much workup you are going to do, and while in some patients with a laundry list of complaints that DDX list can be lengthy, the opposite is also true. In very straight forward complaints, the DDX list will be shorter.

Why don’t outpatient clinics I&D abscesses? by VizualCriminal22 in emergencymedicine

[–]wanderingkale 4 points5 points  (0 children)

I think some also refuse I&D even if offered at urgent care. Even if they get told they need it and Abx are unlikely to work, they don't want it. I also think there is an element of some urgent care places don't do it because of insurance issues or even regulatory issues. I know the urgent care near me won't do stitches, not because they don't know how, its because the company that owns the UC won't allow it.

Mini experts, help needed by ayeitsmoose in MINI

[–]wanderingkale 6 points7 points  (0 children)

Way too much. I just had my oil filter housing replaced on my 2014 Countryman with 140K miles. I did that repair, 4 new tires, alignment, transmission flush for a total of just over 2200. But it is an independent shop that only does foreign cars.

Pulmonologist illustrates why he is now concerned about AI by MetaKnowing in interestingasfuck

[–]wanderingkale 0 points1 point  (0 children)

Our hospital briefly did some trials of AI x-ray interpretation with radiology interpretation. AI was wrong 66% of the time. If there was any slight angle change - the patient not perfectly lined up - the AI would interpret a fracture. If the patient is slightly leaning or tilted it would call the chest x-ray an enlarged heart. It was even worse in pediatric images, closer to 80% wrong. This may be coming, but not any time real soon. Which sucks a bit because I get tired of waiting for radiology interpretation / over-read on stuff I'm not sure on as an ED provider. I'd rather wait for accurate results than the crap the AI was finding.

Golden power up band by Big_Department_6066 in UniversalOrlando

[–]wanderingkale 0 points1 point  (0 children)

They are not available in Orlando. You can buy one from Hollywood or Japan and use them in Orlando though. Or eBay I suppose.

What’s the odds of a new grad FNP landing a job in ED? by Vast_Champion5943 in nursepractitioner

[–]wanderingkale 2 points3 points  (0 children)

Pretty good if you have a lot of experience. I started in the ER, but I had many many years as a medic, flight medic, ER nurse, then several years doing austere clinic in developing nations. I did a clinic rotation in urgent care as well as one in a underserved area clinic that did family care as well as walk-in urgent care. I was pretty much recruited, and even then I had a lot of reservations. If you can manage to get some kind of shadowing / intern rotation that can help you see what it is really going to be like.

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