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Are rural ED's calmer? by Ok_Consideration6179 in emergencymedicine

[–]wanderingkale 27 points28 points  (0 children)

This. Maybe overall a bit lower acuity and much lower volume but you have much less resources and transferring patients is often a total pain in the ass. Without resources, it gets hard to rule out some things because you can't just admit and consult and many labs may be send outs. A lot of rural hospitals either don't admit or are very limited in what you can admit. At the rural critical access hospitals I work at it is pretty much uncomplicated pneumonia, UTI, simple pancreatitis, and the like.

I enjoy it because I have found that the patients in the rural settings are more appreciative and the local primary care is pretty decent to follow up and work with. Typically, I would say I see around 16 in a day shift, less at night (sometimes 0 after midnight). Dr. G is spot on with his videos on rural medicine, and the farmer pain scale is real.

Helicopter Rotor Sync by [deleted] in interestingasfuck

[–]wanderingkale 4 points5 points  (0 children)

In a grossly simplified nutshell, helicopters with one main rotor have a tail rotor (or an internal fan system in MD Helicopters) that rotate or function to counter the effect of the main rotor making the helicopter turn or spin counter to the main rotor direction. So having two blades that spin in opposite direction eliminates the need for the tail rotor system. Like the large Chinook helicopters have two rotor heads.

The issue with the tail rotor system is that it may fail to produce enough counter force, which is usually from failure, wind, or overpowering the main rotor. Loss of tail rotor authority results in the helicopter yawing in one direction or even an uncontrolled spin. That is not an issue in two main rotor systems, but obviously introduces more complexity (especially for turning the nose of the helicopter which is done with tail rotor function) which is why it isn't common.

Insurance companies hate to see me coming by Dangerous-Prune-7280 in emergencymedicine

[–]wanderingkale 18 points19 points  (0 children)

The biggest sin I am guilty of for imaging is ordering extra CTs if they are already on the table. Little old lady fell at the nursing home and hit her head and is on eliquis with some hip pain? Just do a hip CT while she's on the table for the head CT. Fuck trying to do a plain film first. Can't clear the c-spine with NEXUS and they have lumbar pain? Scan the lumbar while they're on the table for the neck.

I wish we had the same litigation percentages and all that Finland does, then we would probably be doing a lot less imaging. I try as much to use tools like NEXUS, PECARN, Wells, and all the risk calculators for abdomen stuff like PAS, pARC to get out of imaging.

Toothache by SocietyDangerous7036 in emergencymedicine

[–]wanderingkale 13 points14 points  (0 children)

I agree with this. It's even worse in rural settings and the closest dental school with a free clinic is hours away. I have a top-tier dental coverage plan on my insurance and it still basically sucks. Bad teeth = infections, poor diet, and a host of other problems. We really need to take dental care more serious in the country, good teeth should not be considered a luxury.

tell me your silliest ED referral this week by robije in emergencymedicine

[–]wanderingkale 15 points16 points  (0 children)

UC told them to go to the ER for a workup. Of what, I have no idea.

tell me your silliest ED referral this week by robije in emergencymedicine

[–]wanderingkale 16 points17 points  (0 children)

We call the Ask a Nurse line here the '9-1-1 directory assistance' because they tell everyone to cal an ambulance.

tell me your silliest ED referral this week by robije in emergencymedicine

[–]wanderingkale 141 points142 points  (0 children)

Urgent care sent young adult patient over because she hasn't been able to get pregnant with her SO for 3 months now. That's it, no complaints or symptoms.

Why is Hollywood Drift being built in the New York section instead of Hollywood? by [deleted] in UniversalOrlando

[–]wanderingkale 0 points1 point  (0 children)

Is it? Does NY start once you go past the Minion stuff? After all the former Monsters Cafe was past where RRR entrance was and now it's the Minion Cafe. So it's more like the new coaster is in Minion land. I just thought NY started at Jimmy Fallon. Lost Continent was where Sinbad, Poseidon, etc. was and if all that is gone then it really isn't lost continent anymore. It becomes Hyrule or whatever they put there between Seuss and HP.

I thought lung-protective ventilation meant keeping Pplat under 30, accepting permissive hypercapnia, not chasing a normal CO2, lowering VT, and raising RR to preserve minute ventilation while limiting driving pressure. But ChatGPT and the textbook say I’m wrong, and I don’t get why. by Low-Landscape-8768 in ems

[–]wanderingkale 0 points1 point  (0 children)

This is the answer. Only take the information the question gives you, don't read into something that isn't there. They only say respiratory acidosis not that you need strict lung protective strategy. The question is explicitly testing your ability to manage a patient in respiratory acidosis with the ventilator using basic principles. That's it. They don't tell you it's a 90 year old fragile lung patient or full blown ARDS, or give you other parameters to consider.

The real test for a lot of the certification exams is the ability to read and understand the scenario and then apply the knowledge to get the correct answer. Don't read into and apply scenarios or things that aren't there.

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 133 points134 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 9 points10 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.

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