The way this really works in medicine is that they determine the solution that will result in the greatest number of quality person years. So if you have an older person with lots of health problems and a younger person who only has the current problem, obviously saving the younger, healthier one will have the greatest positive impact. This got used during COVID with the ventilators and is a consideration for eligibility for donor organs.

These were planted alongside trails and on the medians of the road. This is just down the road from my house and the land these trees were on is not useful for literally anything besides trees.

I’ve spent enough time around religious wingnuts to know that some of them just do it out of hate and disgust. It’s not always self-disgust. Sometimes they just buy into the propaganda so deeply that any deviance is simply abhorrent and must be eradicated.

I have personally dragged a couple of people out of that mindset and they are very straight, so it was never a self-hatred thing, just a brainwashing thing.

The bit right after that talks about how that was his MO for assaulting gay men and he kept a “profanity-laced journal” about his actions.

You do not have a good understanding of menstruation and gynecology if you think that’s always the case. There are so many variations of irregular menstruation that trying to exclude data based on irregularities would be very difficult or get rid of a lot of legitimate irregular data.

Irregular menstrual cycles are very common and happen for a lot of different reasons. Also, there are different kinds of “regular” periods. Someone could be said to have regular periods even if they happen on shorter or longer cycles than the typical 28-30 days provided that it’s a consistent pattern without significant deviation for that person.

Write it down on paper or put it in a word document or excel spreadsheet (or FOSS equivalent if you don’t have Office 365).

From a medical perspective, a handwritten journal with dates and notes about the amount/consistency of the flow as well as associated symptoms would be the most useful. Having irregular periods that last for 3 days with very heavy bleeding would have a very different diagnostic approach than irregular periods that last 3 to 5 days with normal bleeding and horrible cramps.

I blame my tech background for being intensely suspicious of pretty much all AI. The AI developed by MIT for early detection of preliminary stages of breast cancer on mammograms that was trained on an extremely rigorously vetted and sanitized data set is probably the only breed of AI I would actually trust in medicine.

I once had ideas about creating a learning algorithm (not quite as complex as AI and not a black box) that uses data from medical professional input to generate suggestions for triage and protocols in emergency medicine. My idea was to feed it the triage notes, vitals, labs, diagnosis, and disposition with patient demographics (and NO PII) to create a statistical model that would look at the triage notes and the intake vitals to make a suggestion for triage level and empiric labs/testing to expedite care.

Obviously, the triage nurse (or any other staff member, really) could override it and input a higher level of triage because there’s no good way to reliably teach a machine gestalt or heuristics. A really experienced healthcare provider will almost always have a good sense for which patients are currently just compensating and will be crumping shortly. I just think having a statistical model that puts in empiric orders to get stuff started while the patient is still waiting to be brought back could expedite care a lot.

The thing that made me think of this is the fact that every time I have seen a kiddo come through the ER with vision changes that were not fixed by glasses, they had some kind of intracranial mass, and it would just make stuff go so much faster if the head CT was already done by the time the physician could actually see the patient. (Or patients that are on the border of meeting SIRS criteria having a bunch of labs already done.)

I need to find a way to set up email alerts or something when there’s updates on this kind of stuff. Since I’m looking at emergency med or primary care, this would be super relevant to my future practice.

This has already started happening and the result is that there are growing swaths of red states where there is little to no access to OB/Gyn care. Women in places like Idaho are on waiting lists for OB/Gyns so long that their first prenatal appointment can be as late as 20 weeks into the pregnancy. The waiting list problem doesn’t even account for the fact that women are having to drive as much as 200 miles to get to appointments.

I was very grateful that none of the cadavers we had at my medical school were John/Jane Does, and that we have a memorial service for the cadavers every year and invite the families to express gratitude.

I worked as a scribe and as an ER tech in a Level 1 peds hospital. I’m not even done with med school and I’ve already punched that card more times than I care to remember.

I’ve played Judo, and I’m a licensed EMT, and I’ve worked in ERs, and I’m a third year medical student. I am quite confident in telling you that you are incorrect. Modern safety standards make it so that the seatbelt locks in a crash and limits your longitudinal inertia. Also, many dummies (and actual humans I have cared for) have “hit their head wrong” on the headrest due to their height, posture, or position, and they don’t break their necks. Did their scalenes, paraspinal muscles, and sternocleidomastoids hurt like hell? Absolutely. But they didn’t have broken necks.

Your body can compensate for a lot, but it was the introduction of headrests in cars that has been one of the biggest contributors to the drastic reduction in fatalities. The point of the headrest is the same as the seatbelt: to limit the range of motion your body goes through in a crash. Seatbelt signs and headrest concussions are real things that can cause some pretty significant problems, but those problems are easier to fix when the patient isn’t dead or quadriplegic.

Whiplash is from your head moving more than your neck can compensate for. The headrests are designed to prevent excessive backwards movement of your head to help your neck not get completely over-extended. Heads are actually quite heavy and there are a lot of very important things inside the neck that you don’t want getting fucked up be getting jerked around too much. The muscles in your neck can only do so much in a high-velocity situation like a crash.

You have to be very careful about “filtering” as well. It becomes far too easy to write off a legitimate concern if it has to pass muster with your “filter” before you consider it. The HPI and subjective portions of a note are explicitly for the things the patient (or their caretaker) tells you. It is subjective. Then you do your objective examination and testing, then you make an assessment, and if you can justify that assessment with the testing and history, then you can make a plan. SOAP notes go in that order for a reason.

That doesn’t mean you ignore them. You listen to what they’re saying, maybe take it with a grain of salt, and actually get a good history and physical.

Stories like this make me very glad that I got my pediatric experience in a good children’s hospital before starting medical school. The attending physicians made sure to drill it into everyone’s heads that if the parent is expressing concern about a change in condition or “something just not being right”, you report that to the patient’s physician and nurse ASAP. Everyone from the physicians down to the admin folks were empowered to challenge decisions they thought weren’t in the patient’s best interest.

Hell, I even had a case where, as the ER tech, I challenged a physician on her diagnosis of a child and refused to let her discharge the kiddo without looking at him again. The mom told me something was wrong, and even with just an EMT license, I was able to see something was subtly wrong as well. It turns out the mom and I were right and the physician changed her diagnosis and admitted him to the hospital for treatment instead of discharging him home to follow up in clinic in a couple days.

I thought the point was to be better than Hamas? Of course they mistreat detainees, but that doesn’t mean Israel gets a blank check to do the same. Also, many of the Palestinians currently being held by Israel without charges in indefinite detention are innocent civilians, including many from the West Bank. Israel has been illegally detaining and mistreating thousands upon thousands of Palestinians without any kind of due process or concern for human rights for decades. Pointing a finger at Hamas and saying “Look! They’re doing it too!! October 7th!!1!!” is not a valid argument for how Israel has been treating captive Palestinians for years.

The way that Hamas treats Palestinians is partially the responsibility of Netanyahu and the Likud given that they provided Hamas with material support to take power in the first place. Also, the fact that Israelis stormed an IDF base in protest of the punishment of IDF thugs that anally raped innocent Palestinians to death with rifles tells me a lot about what Israel thinks of all Palestinians, not just the ones that are actually part of Hamas.

Edit: Here’s an article describing the way the IDF treats doctors and paramedics. (Who are not members of Hamas) https://www.democracynow.org/2024/8/27/hrw_report

Half-normal saline would make hyponatremia substantially worse. Half-normal saline has half as much salt and is much closer to plain water. If he has water retention problems and issues with hyponatremia, he should be getting hypertonic saline which is 3% NaCl. For reference, normal saline is 0.9% NaCl, half-normal saline is 0.45% NaCl. Not enough NaCl is what can lead to “overhydration”.

Edit: Also, most ambulances carry normal saline and not much else. They might have Lactated Ringers solution, but they don’t have all the different concentrations of saline on the rig. There’s just not enough space when the vast majority of patients just need isotonic (normal saline) fluids.