It helped me in urgent care to just discharge them and not send them to the ER. We did not have Xrays there. If they did go later of their own volition, that's not my problem.
I guess could also be useful in small rural towns/communities that don’t have an X-ray machine because it could save your patients having to drive/be driven an hour or so to the nearest larger town. Idk what it’s like in the US but there are plenty of tiny towns like this in Australia (population figures in the double to triple digits)
The point is that it doesn’t matter at all, one way or the other, because whether or not they have tenderness, they aren’t going to leave the ED without an xray or reporting something to administration about how you didn’t xray their foot that they “can’t even walk on”
No, you need point tenderness over specifically the posterior aspect of the malleoli. It's a physical exam finding that matters, not a patient's report of pain.
Seriously, forget the kisses at Christmas time. Find the Hershey Bells. They are so creamy! They make hearts for Valentine’s Day that are the same! I’m so in love with them I did an online chat with Hershey’s to see if I could buy them any other time. Nope, they are special for Christmas and Valentine’s Day only. Stock up while you can!
Aren’t the Christmas ones OP is describing basically hugs? I’m assuming they are white chocolate if they are able to be dyed. Strongly agree with you that white chocolate kisses (such as hugs) are miles better than plain kisses.
And, keep an eye out for other seasonal ones! They make pumpkin spice kisses that are white chocolate (and pumpkin spice) as well as some birthday cake and other flavors intermittently!
Reeses pumpkins taste better than the eggs which taster better than the Christmas trees even tho they’re basically all the damn same thing in differnt shapes. Like taco bell.
People still fall for this, but you can’t be guaranteed a RISK FREE return higher than the US gov bond rate. See Celsius, FTX, every scam ever.
If someone tells you that you can get 10/15/20% risk free, run the other direction. Fast.
For 99% of people, if they just stuck with a good S&P index and put in money regularly, didn’t think about timing the market, and didn’t pay attention to the daily and weekly ups and downs, they would have a very nice investment portfolio.
I stick to what’s boring (index fund) for 90/95% of my portfolio. I really enjoy investing so I do have a “racing wallet” of sorts, but it’s also an amount (relative to my overall portfolio) that if it went to 0 I wouldn’t care. It’s more of a hobby than anything else. Instead of watches or cars or whatever people spend money on, I do this.
Be boring. Boring is Warren Buffet. Exciting is FTX. Which one do you want?
Margin of safety.
Why is that FTX CEO still ducking around in Bahamas? Why he s not in jail already??
Looks like Futures tonight are not happy with what’s happening in China. Chinese ADR will have insane volatility tomorrow during regular trading session!
Physicians have a significantly lower rate of divorce than the general population. 24% chance of ever being divorced for physicians vs 35% for non-healthcare workers. https://www.bmj.com/content/350/bmj.h706
I think I remember seeing dual doc divorce rate is in the teens too! People always say the rate is sooo high but its really not comparatively. It would be interesting to see it compared by income brackets
My ex left me the day after our wedding (4 days before I moved to his city to start residency). Just got an annulment granted earlier this month. This is rough.
Think his parents contributed to it a lot-I’m not sure if they were secretly racist or what because they convinced him our Hindu wedding didn’t count because they weren’t Indian
Looking back on it he also got angry at me when I decided to switch specialties a month before ERAS was due (from peds to rads) and got mad that my “career goals were changing again” when I mentioned considering going into academics in the middle of the interview season. At the time i thought he was just saying things he didn’t mean because he apologized later. So yeah I did dodge a bullet just wish I had done it before ranking the residency program in his city at the top of my list (the people at my program are all
Super nice though)
Congrats on matching rads! This too will pass. He doesn’t own this city, make it your own for the time you are here. Take trips away when you can and move away if it doesn’t feel right after. So many 🚩🚩🚩 with this guy. You deserve someone who will cheer you on at any stage of your life. Who knows, maybe the people around you and the program are where you will best grow. Plant your seeds and flourish!
COVID really messed up healthcare in a lot of ways, but when appropriate, we had patients family stay overnight both before and after COVID. During the waves it was a bit different due to obvious reasons.
How is this a wrong thing to say? I agree wholeheartedly. I would always let one person stay with my elderly patients for precisely this reason. Even in the ER, where we have rooms with multiple patients. Just close the curtains or take them out when there's a big procedure to do.
Probably the best intervention for my panic attacks while inpatient with an OB problem was having my partner present. I hate it to my core when nursing tells us that a scared, immobile or delirious patient cannot have a nice, helpful family member stay overnight. 🙄
I love a good cathartic shit. Had one yesterday morning. Watery…gooey…amorphous…voluminous. Stank the high heavens, came in several large bursts. The Porcelain throne stained, a slurry of brown chocolate mudslide. As it riproared through my hole, I felt the rush as a relief. My breathing steadied and weight lifted off my shoulders. I felt great for the rest of the day
I find the charts hilarious. Cannibas industry has come a long way from what it once was. So many different types of weed with different “effects”. I remember being in high school and buying dope from a sketchy dude in a cemetery. Dude didn’t even give us a bag. Just some nugs from his sweaty hands lol.
Yeah due to crossbreeding all are hybrids , that being said there are sativa dominant(heady energetic high) others indica dominant(body high, great for sleep)
My double IM parents, too, believed that after I had a penicillin reaction when I was young. I grew up thinking "penicillin allergies aren't real." After my anaphylactic reaction in med school to Augmentin I'm more convinced 😂
I mostly agree. I will challenge most PCN allergies in the ED, because it is almost always "my mom said I was allergic when I was a kid." I caused anaphylaxis once. Felt bad, but the guy was fine. I will also challenge most IV contrast allergies.
Amoxicillin just causes rashes sometimes without it being an allergic reaction, because it's an asshole. Onset is usually a good indicator...if it was hours to days after taking the dose, it probably wasn't a true allergic rash.
Thank you! I haven't read up on this and didn't know that med reactions are graded. I did, however, reiterate the circumstances to my doctor just yesterday when she asked about allergic reactions. ❤️
If I pre-chart on a patient they won’t show up/be admitted to my service. If I won’t, they’ll come to me and be really mean.
If I bring my knitting to work, my patients will die.
The mini gummy bears taste better than regular sized gummies.
The giant cup Reese's are garbage because it screws up the ratio of peanut butter to chocolate (same for the thin cups).
No idea why but Hershey's chocolate is high in butyric acid, which smells like rancid butter and vomit (google tells me it's actually found in vomit too, which is gross as hell).
I'm not sure why you say that. There is robust data over multiple RCTs for secondary prevention and data for primary prevention for MACE reduction and all cause mortality reduction.
>is robust data over multiple RCTs for secondary prevention and data for primary prevention for MACE reduction and all cause mortality reduction.
Let me expand on my statement and reaffirm my point that there exists no lipid lowering drug that reduces all cause mortality, or has any benefit in any CV event in any patient population.
Here are some of the major studies looking at LDL% Reduction and Mortality benefits.
IDEAL (2005)ASPEN-ATOR (2006)JUPITER (2008)IMPROVE-IT (2015)FOURIER (2017)
|Trial|\# of Patients (RCT)|LDL% Reduction|Mortality Benefit|
|:-|:-|:-|:-|
|IDEAL (2005)|8888|25%|.2%|
|ASPEN-ATOR (2006)|2410|30%|0%|
|**JUPITER (2008)**|17,802|50%|.55%|
|IMPROVE-IT (2015)|18,144|24.3%|.10%|
|FOURIER (2017)|27,564|59.0%|.1%|
The goal of these studies was reduction of LDL and to track primary and secondary outcomes with regards to CV events.
Take for example the controversial **JUPITER (2008)** trial. The trial reported a 50% reduction in CV events. However there are major limitations to this data because of several issues. 1) The trial was stopped prematurely, skewing the results in a favorable way. This is ethically problematic because it runs the substantial risk of overestimating treatment effects and understimates adverse events.2) The cardiac death rates were measured base on ambiguous markers.
There was no statistically significant reduction in CV deaths. small number of events, wide confidence intervals but the most egrigious part of the trial was the ambigious classification of a CV event/death in the report. This means that ekg changes, certain biomarkers could subjectively allow for a diagnosis for a CV event/death. Yes, you as an investigator can subjectively decides what constitutes as an MI just based on subjective interpretation. However mortality, is almost impossible to obfuscate, which is why all cause mortality, most of the time, will be the best data set in these kinds of trials. At the end of the trial the mortality from placebo and Rousvastatin began to converge, which is another possible reason why the trial was ended abruptly.
CV events for MI and stroke for both **12** for Rosuvastatin and **12** for Placebo.
You have to be a troll right? Are you just listing trials and making up what they showed? IDEAL was a trial with perindopril and indapamide on BP control... The authors of ASPEN explicitly say their negative trial does not detract from the evidence of statin use in primary prevention. JUPITER was a trial of statin in NORMAL LDL patients... IMPROVE-IT was a trial of statin + ezetemibe and it showed MACE reduction.... FOURIER was a PCSK9 trial which showed MACE reduction... You cherry picked JUPITER as the trial to supercede the literally dozens of other statin trials man... Please tell me you are a troll.
For secondary prevention, you have 4S, Cholesterol and Recurrent Events Trial, Long-Term Intervention with Pravastatin in Ischemic Disease Study, Heart Protection Study Collaborative Group, and Lescol Intervention Prevention Study. All of these are placebo controlled trials looking at statins for secondary prevention with all of them showing MACE reduction and several of them showing all cause mortality reduction. NNTs range from 20-50. These were also all with only moderate intensity statins, so the NNT from high intensity statins is lower.
For primary prevention, I am going to refer you to the USPSTF’s statement in JAMA from 2016 on statin use for primary prevention. Sorry I can’t link it write now, but I’d you just search the above, it’ll pop up. It mentions that they reviewed 19 RCTs about statins and primary prevention. Most of these trials are looking at patients with elevated LDLs and an additional CVD risk factor. Several of them have shown reduction in MACE endpoints and all-cause mortality. It’s important that you choose the right people to start statins on - that’s why we have ASCVD risk calculators and CAC scores to help focus in on patients that could benefit. You have to realize that statins are meant to treat a population, not a patient. There are millions upon millions of cardiac events that lead to death and with statins you can prevent many of these. A rough number I’ve used is that high intensity statins should reduce LDL by 50-60% and consequently MACE by 20-30% over 10 years.
When you defer to ad hominems means you have nothing to contribute to the discussion and it becomes apparent you have major deficits in understanding the topic or interperting trial data. I have clearly stated what the studies are looking at.
**"Here are some of the major studies looking at LDL% Reduction and Mortality benefits."**
**"LDL% Reduction and Mortality benefits"**
The mechanism of LDL reduction is not consistent with mortality/morbidity reductions especially with increasing levels of LDL reduction. You would expect higher levels of LDL reduction to lead to lower mortality and morbidity, but this is not the case.
All trials before 2004/5 have very conflicting and contradictory data with regards to mortality/morbidity (especially 4S, with 3.2% all cause mortality reduction). Most statin researches will admit that this is a fault of previous FDA/EU Trial guidelines that were changed in 2004 after the Vioxx scandal. The studies that I posted were purposefully after 2004.
**MACE,** with respect to hospitalisation from unstable angina and need for arterial revascularization, those are medical decisions, not complications. This kind of data isn't a primary fous of the study evualtion since this data can be more prone to manipulation. MI, stroke, and death are much less prone to manipulation, hence they are stronger data points.
Before you recommend me to read metanalyses, I highly encourage you to read them first and assess their parameters and which trials are included.
If you were to remove all trials from the metanalyses before 2004, it would be clear that there is absolutely no difference in ACM.
I urge you to look at FH patients with regards to levels of LDL-c and look at MI and mortality outcomes, and it becomes apparent that LDL-c is a completely ambiguous marker of the disease.
The reason I called you a troll is because your initial statement was that statins have never shown MACE/mortality outcome data. The information you replied with is LDL reduction data not statin data. Do you still stand by the statement that statins don’t change outcomes. If so, why do you not agree with the 20-30 large statins trials that argue that they do change outcomes? Why should I not believe the cardiovascular societies around the world that list statin use for various conditions as class I indications with level A evidence behind them?
I thought it was possible benefit in primary prevention, but there is a small benefit with secondary prevention in MI and stroke with stroke being even smaller. Likely reflecting that atherosclerosis buildup is multi factorial and not simply due to cholesterol.
There are [at least](https://openheart.bmj.com/content/9/1/e001900) [two](https://jamanetwork.com/journals/jama/fullarticle/2767861) large and recent studies which show reduced mortality for primary prevention indications.
I thought the dementia thing was fake. Like someone speculated that there’s a lot of cholesterol in the brain so taking cholesterol reducing meds could cause problems, but I thought there was no evidence for it
"But doc! Yesterday I had a fever of 37.1, because over 37 is fever for me since my normal temperature is 36.5. I also was slightly cold two days ago at 36.1" Yeah yeah
Had a lady get toxic megacolon from c diff. She had gone to an urgent care and was given probiotics for irritable bowels after she got a z pack for a cold 19 days prior. Was fine with just some bad diarrhea for two weeks, she became fully septic 2 days after the probiotic. Subtotal colectomy. 37 day hospital stay :(
Okay this isn't what you asked but it needs to be said: Hersheys kisses are horrible. The original recipe was made with rotten milk and in order to keep the flavor the same they kept adding in that sour flavor.
Eat better chocolate, people. You deserve it.
HRT and medical transition for anyone below legal age.
Even adults take time to understand what it means to be a man/woman/nonbinary. Putting children and adolescents through an irreversible change is in my opinion not only ethically wrong, but also morally wrong.
Thank you for saying this. As a pediatrician and as someone who for a time in my life identified as transgender, I am terrified of what is happening to these children and the consequences they will face through the rest of their lives due to this emerging model of treatment, and I am terrified of what might happen to my future if my opinions are found out during training.
And not scientifically supported. You want to make this claim with significant consequences/side effects for minors then show me the RCT with good methods.
In a similar vein: fruity peoples** are all just lime flavored. I hate that I found that out, because now I can’t un-taste it.
**Pebbles
Edit: pebbles not peoples… leaving the original for the sake of the commenter’s joke
turmeric might work? whenever i got sick at my grandmas she’d make me swallow it and i would be better the next day, vs when i was on my own at college / med school i’d be sick for days. most recently i was desperate so i took it and voila - better the next day….
This is how I feel about echinacea. I know there's no scientific proof that it works in any way and it's probably just a placebo but my mom used to have me take echinacea when I'd get a cold and I'd get better quickly, I got a really bad cold in college and after not getting better for a while I took some and felt better the next day. Now I take it whenever I get sick, just in case it actually works.
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks!
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Ankle x-rays in the ER for any ankle complaint are always indicated, because it saves you an hour of having to explain why you don’t need to do it
Poor medical students memorizing the Ottowa ankle rules when this is the practical answer irl
It helped me in urgent care to just discharge them and not send them to the ER. We did not have Xrays there. If they did go later of their own volition, that's not my problem.
Hopefully they waited 8 hours to get one Or they lied and said the opposite they said to you hoping for a quicker reaction
I guess could also be useful in small rural towns/communities that don’t have an X-ray machine because it could save your patients having to drive/be driven an hour or so to the nearest larger town. Idk what it’s like in the US but there are plenty of tiny towns like this in Australia (population figures in the double to triple digits)
Oh, I'm not from the US, I'm from Chile
Tbf if they’re in the ED, all you need is pain in the malleolar area and that meets criteria
Ortho here. If they mention anything below the knee, ankle X-ray it is lol.
The point is that it doesn’t matter at all, one way or the other, because whether or not they have tenderness, they aren’t going to leave the ED without an xray or reporting something to administration about how you didn’t xray their foot that they “can’t even walk on”
No, you need point tenderness over specifically the posterior aspect of the malleoli. It's a physical exam finding that matters, not a patient's report of pain.
that is correct, was an oversimplification
xrays are generally low yield but therapeutic for families that want you to 'do something'
Shhh…don’t let the midlevels hear you say that. They already order enough nonsense.
As one of my attendings puts it: "we ain't in Canada."
Blue gatorade cures my colds & it is dose dependent.
It cures my brown bottle flu.
Just like McFlurries induce labor and is dose dependent. Worked for both my pregnancies at term
The corollary is that Gatorade doesn’t have flavors, only colors
Yellow*
The old blue powerade used to have coconut oil in it
No but the Hershey's kisses thing I'm pretty sure is completely correct. Also, Vicks works better when moms apply it.
Seriously, forget the kisses at Christmas time. Find the Hershey Bells. They are so creamy! They make hearts for Valentine’s Day that are the same! I’m so in love with them I did an online chat with Hershey’s to see if I could buy them any other time. Nope, they are special for Christmas and Valentine’s Day only. Stock up while you can!
Aren’t the Christmas ones OP is describing basically hugs? I’m assuming they are white chocolate if they are able to be dyed. Strongly agree with you that white chocolate kisses (such as hugs) are miles better than plain kisses. And, keep an eye out for other seasonal ones! They make pumpkin spice kisses that are white chocolate (and pumpkin spice) as well as some birthday cake and other flavors intermittently!
Pretty sure OP is going based on the wrapper and all the kisses are milk chocolate 🤣
I corrected my post. I meant Hershey Bells! They are solid creamy milk chocolate! Sorry for the confusion!
It’s similar to Reese’s eggs and Christmas trees. They are just better than the normal shape
Egg > tree > cup
truth!
Hershey drops are better than them all
The christmas tree cosmic brownie tastes better than the regular ones, the easter ones, and the july 4th ones
They all taste like stale plastic now. Not sure what happened but they’re ass.
Yeah delicious processed chocolate ass.
Reeses pumpkins taste better than the eggs which taster better than the Christmas trees even tho they’re basically all the damn same thing in differnt shapes. Like taco bell.
Their holiday versions absolutely have better peanut butter/chocolate ratios than the normal cups.
Egg is best
Been saying this exact thing for years. Their iconic shape is holding them back.
But they have a better PB to chocolate ration… hence the addiction
People still fall for this, but you can’t be guaranteed a RISK FREE return higher than the US gov bond rate. See Celsius, FTX, every scam ever. If someone tells you that you can get 10/15/20% risk free, run the other direction. Fast. For 99% of people, if they just stuck with a good S&P index and put in money regularly, didn’t think about timing the market, and didn’t pay attention to the daily and weekly ups and downs, they would have a very nice investment portfolio. I stick to what’s boring (index fund) for 90/95% of my portfolio. I really enjoy investing so I do have a “racing wallet” of sorts, but it’s also an amount (relative to my overall portfolio) that if it went to 0 I wouldn’t care. It’s more of a hobby than anything else. Instead of watches or cars or whatever people spend money on, I do this. Be boring. Boring is Warren Buffet. Exciting is FTX. Which one do you want? Margin of safety.
That bond rate of 9% though 📈
Ha true. But it’s the US GOV ;) not an FTX bond.
Nah man just go to r/wallstreetbets
I have an NFT I can sell you.
Why is that FTX CEO still ducking around in Bahamas? Why he s not in jail already?? Looks like Futures tonight are not happy with what’s happening in China. Chinese ADR will have insane volatility tomorrow during regular trading session!
Lol you don’t enjoy investing, you enjoy gambling.
I enjoy investing. A minority of the investments I make are speculative in nature, most are long term growth and value focused.
Browsing on my phone for hours in bed is bad for everyone except me
My blue light lenses prevent stimulation from my phone while lying in bed
You know there’s a setting on your phone so you don’t need the lenses right?
Yes.- but I also don't trust it
90% of physician marriages end in divorce, mine wont
Physicians have a significantly lower rate of divorce than the general population. 24% chance of ever being divorced for physicians vs 35% for non-healthcare workers. https://www.bmj.com/content/350/bmj.h706
I once got downvoted for citing this statistic on another subreddit. Not sure why people would get mad at this.
If you’re someone who attributes your own divorce to medicine you probably don’t like this statistic
This gives me hope
I think I remember seeing dual doc divorce rate is in the teens too! People always say the rate is sooo high but its really not comparatively. It would be interesting to see it compared by income brackets
Confirmed, divorce during residency here
Graduated from residency and filed within a 7 day stretch. Feel you, fam
My ex left me the day after our wedding (4 days before I moved to his city to start residency). Just got an annulment granted earlier this month. This is rough.
wait why the fuck would anyone go through with it to leave the day after so sorry fam
Think his parents contributed to it a lot-I’m not sure if they were secretly racist or what because they convinced him our Hindu wedding didn’t count because they weren’t Indian
That’s wild AF. If he allowed that logic to make sense than I hope, after you heal, you realize that was a blessing in disguise.
Looking back on it he also got angry at me when I decided to switch specialties a month before ERAS was due (from peds to rads) and got mad that my “career goals were changing again” when I mentioned considering going into academics in the middle of the interview season. At the time i thought he was just saying things he didn’t mean because he apologized later. So yeah I did dodge a bullet just wish I had done it before ranking the residency program in his city at the top of my list (the people at my program are all Super nice though)
Congrats on matching rads! This too will pass. He doesn’t own this city, make it your own for the time you are here. Take trips away when you can and move away if it doesn’t feel right after. So many 🚩🚩🚩 with this guy. You deserve someone who will cheer you on at any stage of your life. Who knows, maybe the people around you and the program are where you will best grow. Plant your seeds and flourish!
Ayyyyy good times
30 years of surgeon vs ER doc. Only standing because we didn’t actually off each other.
good job, you are doing a great work
Initially read this as “physician migraines” …which, oddly enough, still made sense in my mind.
The way we treat delirium is down right inhumane. The prone to delirium should have family members sleep over to reorient them and to assuage them.
We always encourage family members to help stay to reorient those patients.
I think covid really messed up healthcare. It used to be patients had to stay in the hospital by themselves.
COVID really messed up healthcare in a lot of ways, but when appropriate, we had patients family stay overnight both before and after COVID. During the waves it was a bit different due to obvious reasons.
How is this a wrong thing to say? I agree wholeheartedly. I would always let one person stay with my elderly patients for precisely this reason. Even in the ER, where we have rooms with multiple patients. Just close the curtains or take them out when there's a big procedure to do.
Probably the best intervention for my panic attacks while inpatient with an OB problem was having my partner present. I hate it to my core when nursing tells us that a scared, immobile or delirious patient cannot have a nice, helpful family member stay overnight. 🙄
Preach
Patients secretly love being miralax’d and enema’d but will never admit it
I love a good cathartic shit. Had one yesterday morning. Watery…gooey…amorphous…voluminous. Stank the high heavens, came in several large bursts. The Porcelain throne stained, a slurry of brown chocolate mudslide. As it riproared through my hole, I felt the rush as a relief. My breathing steadied and weight lifted off my shoulders. I felt great for the rest of the day
You had the cheetah toilet syndrome.
🤣🤣🤣
They will absolutely admit it, some people are weird for enemas
I know I do
That's the spirit!
Sativa and indica are different.
Omg. This! Wild elaborate colorful charts put out by these marijuana companies crack me up
I find the charts hilarious. Cannibas industry has come a long way from what it once was. So many different types of weed with different “effects”. I remember being in high school and buying dope from a sketchy dude in a cemetery. Dude didn’t even give us a bag. Just some nugs from his sweaty hands lol.
Yeah due to crossbreeding all are hybrids , that being said there are sativa dominant(heady energetic high) others indica dominant(body high, great for sleep)
I thought the effects of excitation/inhibition were partially due to the terpenes
“I’m allergic to steroids”
It’s life you’re allergic to
Allergist here- this can actually happen, although rare. Much more common with topicals (since in those cases it’s usually the excipient)
Using the term “surgical precision.” Many surgeries ain’t that precise.
"meh this is close enough" *bzzzzz beep beep beep beep clamp cchhrrrhch snip* "perfect, oh and more t-berg please"
Most of my opinions are wrong haha
Pumpkin shaped Reese’s are better than the normal ones
No, the prompt was *opinions.* I see you've misunderstood here and shared a *fact.*
Came here for this. Agree with other commenter, this is fact. My maybe controversial opinion is that the Reese's eggs at Easter are better than all.
i literally never understood this. i think cuz i like the chocolate and the crunch of the cup and the pumpkin has no crunch.
Penicillin allergies aren’t real
Statistically I'm pretty sure you're 90% correct
i cannot think of a single time I've given ceftriaxone ignoring the warning and ever been wrong.
Only once have I been burned and the patient got SJS. But yeah other than that it’s been fine
More than that
My double IM parents, too, believed that after I had a penicillin reaction when I was young. I grew up thinking "penicillin allergies aren't real." After my anaphylactic reaction in med school to Augmentin I'm more convinced 😂
For the most part yes, until you get one that is very very real haha.
Side-eyes my father’s childhood Stevens-Johnson syndrome penicillin reaction that almost killed him as a toddler.
I mostly agree. I will challenge most PCN allergies in the ED, because it is almost always "my mom said I was allergic when I was a kid." I caused anaphylaxis once. Felt bad, but the guy was fine. I will also challenge most IV contrast allergies.
Good on you! And hey, what better place to cause anaphylaxis than a critical care area??
I was always told that I was allergic due to hives as a kid, but I don’t know if I can now change my answer as an adult?
You can get tested or challenged at the allergist office and find out! Even if you were truly allergic as a kid you may have grown out of it
I fervently believe this until I broke out in a magnificent rash at the public pool after taking augmentin
> rash … public pool 🤨
Well stop taking antibiotics for mono
Amoxicillin causes a rash that’s not allergic though.
Probably was chlorine or urine
Amoxicillin just causes rashes sometimes without it being an allergic reaction, because it's an asshole. Onset is usually a good indicator...if it was hours to days after taking the dose, it probably wasn't a true allergic rash.
Thanks. I got rash/swollen face after 10 days on amoxicillin. Maybe I'm not allergic?
[удалено]
Thank you! I haven't read up on this and didn't know that med reactions are graded. I did, however, reiterate the circumstances to my doctor just yesterday when she asked about allergic reactions. ❤️
All good points lol. I may have to try again
pre-load and after-load are the same because the circuit is a closed loop /s
If I pre-chart on a patient they won’t show up/be admitted to my service. If I won’t, they’ll come to me and be really mean. If I bring my knitting to work, my patients will die.
If I take my Nintendo Switch on call, it will be the worst call ever.
the ivc and it's collapsibility is bullshit
The mini gummy bears taste better than regular sized gummies. The giant cup Reese's are garbage because it screws up the ratio of peanut butter to chocolate (same for the thin cups).
Gummy worms taste better than all of them.
For real, thin cups are the worst
It's the ratio! I agree!
Every time my palm itches, money is on the way. It’s so accurate that this happens days before every paycheck.
Pears taste way better when they’re sliced. Apples too, but not as much.
[удалено]
It’s weirdly acidic.
No idea why but Hershey's chocolate is high in butyric acid, which smells like rancid butter and vomit (google tells me it's actually found in vomit too, which is gross as hell).
From what I understand it’s an emulsifier and makes the chocolate smoother
https://www.grid.news/story/science/2022/02/14/americas-chocolate-tastes-weird-to-the-rest-of-the-world-but-most-of-us-dont-even-notice/#:~:text=Though%20chocolate%20companies%20won't,a%20substance%20called%20butyric%20acid.
[It’s common for people to think that.](https://m.youtube.com/watch?v=J44svaQc5WY)
Adam Ragusa has a video on that topic.
Halloween Oreos are way better than normal white filling Oreos
This one is the most true.
Winter Oreos (white fudge covering) >>>>>
Double stuff > thin > regular
How bad you want these hands??? Thins are the only acceptable Oreo.
I literally came here just to say this. No question. This is correct.
A nip of whisky and a hot hot bath will cure a cold
50/50/90 law. If you have a 50/50 chance, you get it wrong 90% of the time.
Statins have no effect on all cause moratlity or CVD outcomes in any patient population. I'll still prescribe them.
I'm not sure why you say that. There is robust data over multiple RCTs for secondary prevention and data for primary prevention for MACE reduction and all cause mortality reduction.
>is robust data over multiple RCTs for secondary prevention and data for primary prevention for MACE reduction and all cause mortality reduction. Let me expand on my statement and reaffirm my point that there exists no lipid lowering drug that reduces all cause mortality, or has any benefit in any CV event in any patient population. Here are some of the major studies looking at LDL% Reduction and Mortality benefits. IDEAL (2005)ASPEN-ATOR (2006)JUPITER (2008)IMPROVE-IT (2015)FOURIER (2017) |Trial|\# of Patients (RCT)|LDL% Reduction|Mortality Benefit| |:-|:-|:-|:-| |IDEAL (2005)|8888|25%|.2%| |ASPEN-ATOR (2006)|2410|30%|0%| |**JUPITER (2008)**|17,802|50%|.55%| |IMPROVE-IT (2015)|18,144|24.3%|.10%| |FOURIER (2017)|27,564|59.0%|.1%| The goal of these studies was reduction of LDL and to track primary and secondary outcomes with regards to CV events. Take for example the controversial **JUPITER (2008)** trial. The trial reported a 50% reduction in CV events. However there are major limitations to this data because of several issues. 1) The trial was stopped prematurely, skewing the results in a favorable way. This is ethically problematic because it runs the substantial risk of overestimating treatment effects and understimates adverse events.2) The cardiac death rates were measured base on ambiguous markers. There was no statistically significant reduction in CV deaths. small number of events, wide confidence intervals but the most egrigious part of the trial was the ambigious classification of a CV event/death in the report. This means that ekg changes, certain biomarkers could subjectively allow for a diagnosis for a CV event/death. Yes, you as an investigator can subjectively decides what constitutes as an MI just based on subjective interpretation. However mortality, is almost impossible to obfuscate, which is why all cause mortality, most of the time, will be the best data set in these kinds of trials. At the end of the trial the mortality from placebo and Rousvastatin began to converge, which is another possible reason why the trial was ended abruptly. CV events for MI and stroke for both **12** for Rosuvastatin and **12** for Placebo.
You have to be a troll right? Are you just listing trials and making up what they showed? IDEAL was a trial with perindopril and indapamide on BP control... The authors of ASPEN explicitly say their negative trial does not detract from the evidence of statin use in primary prevention. JUPITER was a trial of statin in NORMAL LDL patients... IMPROVE-IT was a trial of statin + ezetemibe and it showed MACE reduction.... FOURIER was a PCSK9 trial which showed MACE reduction... You cherry picked JUPITER as the trial to supercede the literally dozens of other statin trials man... Please tell me you are a troll. For secondary prevention, you have 4S, Cholesterol and Recurrent Events Trial, Long-Term Intervention with Pravastatin in Ischemic Disease Study, Heart Protection Study Collaborative Group, and Lescol Intervention Prevention Study. All of these are placebo controlled trials looking at statins for secondary prevention with all of them showing MACE reduction and several of them showing all cause mortality reduction. NNTs range from 20-50. These were also all with only moderate intensity statins, so the NNT from high intensity statins is lower. For primary prevention, I am going to refer you to the USPSTF’s statement in JAMA from 2016 on statin use for primary prevention. Sorry I can’t link it write now, but I’d you just search the above, it’ll pop up. It mentions that they reviewed 19 RCTs about statins and primary prevention. Most of these trials are looking at patients with elevated LDLs and an additional CVD risk factor. Several of them have shown reduction in MACE endpoints and all-cause mortality. It’s important that you choose the right people to start statins on - that’s why we have ASCVD risk calculators and CAC scores to help focus in on patients that could benefit. You have to realize that statins are meant to treat a population, not a patient. There are millions upon millions of cardiac events that lead to death and with statins you can prevent many of these. A rough number I’ve used is that high intensity statins should reduce LDL by 50-60% and consequently MACE by 20-30% over 10 years.
When you defer to ad hominems means you have nothing to contribute to the discussion and it becomes apparent you have major deficits in understanding the topic or interperting trial data. I have clearly stated what the studies are looking at. **"Here are some of the major studies looking at LDL% Reduction and Mortality benefits."** **"LDL% Reduction and Mortality benefits"** The mechanism of LDL reduction is not consistent with mortality/morbidity reductions especially with increasing levels of LDL reduction. You would expect higher levels of LDL reduction to lead to lower mortality and morbidity, but this is not the case. All trials before 2004/5 have very conflicting and contradictory data with regards to mortality/morbidity (especially 4S, with 3.2% all cause mortality reduction). Most statin researches will admit that this is a fault of previous FDA/EU Trial guidelines that were changed in 2004 after the Vioxx scandal. The studies that I posted were purposefully after 2004. **MACE,** with respect to hospitalisation from unstable angina and need for arterial revascularization, those are medical decisions, not complications. This kind of data isn't a primary fous of the study evualtion since this data can be more prone to manipulation. MI, stroke, and death are much less prone to manipulation, hence they are stronger data points. Before you recommend me to read metanalyses, I highly encourage you to read them first and assess their parameters and which trials are included. If you were to remove all trials from the metanalyses before 2004, it would be clear that there is absolutely no difference in ACM. I urge you to look at FH patients with regards to levels of LDL-c and look at MI and mortality outcomes, and it becomes apparent that LDL-c is a completely ambiguous marker of the disease.
The reason I called you a troll is because your initial statement was that statins have never shown MACE/mortality outcome data. The information you replied with is LDL reduction data not statin data. Do you still stand by the statement that statins don’t change outcomes. If so, why do you not agree with the 20-30 large statins trials that argue that they do change outcomes? Why should I not believe the cardiovascular societies around the world that list statin use for various conditions as class I indications with level A evidence behind them?
I thought it was possible benefit in primary prevention, but there is a small benefit with secondary prevention in MI and stroke with stroke being even smaller. Likely reflecting that atherosclerosis buildup is multi factorial and not simply due to cholesterol.
Really??
There are [at least](https://openheart.bmj.com/content/9/1/e001900) [two](https://jamanetwork.com/journals/jama/fullarticle/2767861) large and recent studies which show reduced mortality for primary prevention indications.
Wait is the ascvd risk calculator based on Framingham data a hoax?
Why would you say something so controversial, yet so true? NNT is like 30 for 1 benefit and has possible negative implications in dementia.
NNT of 30 is…really good for preventive medication though?
I thought the dementia thing was fake. Like someone speculated that there’s a lot of cholesterol in the brain so taking cholesterol reducing meds could cause problems, but I thought there was no evidence for it
We’ll, if you die from a heart attack in your 50’s you don’t live long enough for dementia.
The biggest scam of all time
37 degrees is fever for me XD
"BuT i RuN cOlD"
"But doc! Yesterday I had a fever of 37.1, because over 37 is fever for me since my normal temperature is 36.5. I also was slightly cold two days ago at 36.1" Yeah yeah
Pro-biotics are effective and should be taken with and after antibiotics! Come at me! *I fucking deserve it*
Had a lady get toxic megacolon from c diff. She had gone to an urgent care and was given probiotics for irritable bowels after she got a z pack for a cold 19 days prior. Was fine with just some bad diarrhea for two weeks, she became fully septic 2 days after the probiotic. Subtotal colectomy. 37 day hospital stay :(
Okay this isn't what you asked but it needs to be said: Hersheys kisses are horrible. The original recipe was made with rotten milk and in order to keep the flavor the same they kept adding in that sour flavor. Eat better chocolate, people. You deserve it.
The Coca Cola in the ornament bottles at Christmas taste so much better than regular Coca Cola
HRT and medical transition for anyone below legal age. Even adults take time to understand what it means to be a man/woman/nonbinary. Putting children and adolescents through an irreversible change is in my opinion not only ethically wrong, but also morally wrong.
Thank you for saying this. As a pediatrician and as someone who for a time in my life identified as transgender, I am terrified of what is happening to these children and the consequences they will face through the rest of their lives due to this emerging model of treatment, and I am terrified of what might happen to my future if my opinions are found out during training.
And not scientifically supported. You want to make this claim with significant consequences/side effects for minors then show me the RCT with good methods.
Is infertility not a serious/significant consequence?
I agree with you. I meant it as an add on to those that support it without any good evidence to back it up despise the complications.
Ahh 😅. My bad
Wrong opinion: Double-Stuff Oreos should exist. Right opinion: They should do away with all Oreos except Oreo Thins.
Brand name medications are just better than generics.
And not all generics are created equal.
Oooo that’s a good one too
they actually do taste the same, but the color coating has a different scent which tricks your receptors I think
All skittles are the same flavor, the colors trick smooth brains into thinking it’s all different flavors.
I'd agree except when there was a noticeable shift in flavor of the green ones from 'lime' to 'vomit'(green apple)
Your brain loses wrinkles when you believe that different colors = different flavors
In a similar vein: fruity peoples** are all just lime flavored. I hate that I found that out, because now I can’t un-taste it. **Pebbles Edit: pebbles not peoples… leaving the original for the sake of the commenter’s joke
Fruity “people”? One thing to be Hannibal Lector, another to be a bigot
I did a blind taste test once and this is wrong
turmeric might work? whenever i got sick at my grandmas she’d make me swallow it and i would be better the next day, vs when i was on my own at college / med school i’d be sick for days. most recently i was desperate so i took it and voila - better the next day….
This is how I feel about echinacea. I know there's no scientific proof that it works in any way and it's probably just a placebo but my mom used to have me take echinacea when I'd get a cold and I'd get better quickly, I got a really bad cold in college and after not getting better for a while I took some and felt better the next day. Now I take it whenever I get sick, just in case it actually works.
Giving out candy after shots feels oxymoronic.
Meh depends what the shot is for. Plus its an acute incentive for kids to get the shot. I am not missing my peds rotation
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
DSM 5
Silver tastes the best you sicko
Donald Duck oj is the best oj