Safety net doc here. 90% of our patients are Medicare/medicaid/uninsured. Significant cuts to either, and I see no way us or any hospital like ours survives.

My wife (a pcp) has a huge uptick in patients who are having legit worsening anxiety/depression and mental health emergencies because of the currently political situation.

The PaCO2 differences surprises me. In my experience, APRV does a great job at improving oxygenation (particularly in high BMI individuals) but it comes at the expense of significantly reduced minute ventilation and occasionally prohibitive respiratory acidosis 🤔

It’s fine if you just think of it as seasoned beef and not smoked brisket.

It’s atrocious if you’re expecting actual smoked brisket.

Warheads (specifically black cherry). Burnt a layer of my tongue in elementary school going through an entire bag.

I tend to favor fixed dose doub (~5mcg/kg/min) at a fixed dose with usually non-invasive measures of CO response with norepi titrate to a map goal. I think it generally works for non-surgical micu patients. I’m open to learning ab more finessed options

Ugh. So sorry to hear that.

My favorite quote from MASH:

“a thousand other guys hustling out there - what are you going to do, change the world?”

Bj Hennicut: “nope. Just my little corner of it.”

There’s enough ugly shit going on that I can’t fix. As long as I’m still helping my patients, I’m doing ok.

A slow run is still lapping everyone on the couch.

Midodrine is already so abysmal for this, that just about anything could be better (I have once, in desperation, started scheduled pseudoephedrine).

Still hard to get it for more chronic use. I’ve tried without success to get it for cirrhotic patients needing a couple more months for txp candidacy