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Outrage mounts in D.C. after man fatally shoots boy, 13, he suspected was breaking into cars

When laughter meets percussion

My valentine makes my heart beat out of my chest.

That looks so good

Well, are you?

*nudge, nudge*

An amazing showing.

Cool to the infinity

Party time, shower them with sparkly paper

I'm catching the vibration

King

For love at first sight. Gives %{coin_symbol}100 Coins to both the author and the community.

Innocent laughter

When the love is out of control.

I needed this today

When you come across a feel-good thing.

That's a little funny
















  1. No that is next month. This is national be condescending nurses week.

  2. Honestly from the attending side I'm not thinking "why didn't the resident do this," I'm thinking "how did I get involved in this conversation and please stop blocking my "sign orders" button with notifications about this.

  3. Don't be absurd she wants to use them to blow up migrant families.

  4. Hey listen up and show respect guys, this author has his master's degree.

  5. The examples you give show how poorly U.S. intervention goes in Haiti. It did not work out well in the 90’s either. I am not sure we can over a solution.

  6. I mean the prior efforts went poorly because they were morally dubious from the start. It was a toxic amalgamation of influence politics in the western hemisphere and trying to use force when our misdeeds backfire. This case is palpably different as there is to my understanding no meaningful controversy within Haiti that the gangs are a problem and they must go and a growing belief again within Haiti that outside assistance will be required.

  7. The hard part is defining what is a gang. Most of the police are affiliated or purchased by a gang. Former police form gangs as well. We would need a clear objective with a deadline to be of any help.

  8. Agree. They are intertwined with government there. You risk elevating and legitimizing so and so rich person's favorite gang saved calling it government, continuing rampant corruption. I think most people within and out of Haiti recognize this, but the intolerability is spurring calls for action. Either way, the United States seems like the last entity that should be trusted with determining winners and losers here because factual or apparent dealing in our self interest is too compromising.

  9. Calling male circumcision "genital mutilation" actually weakens the argument against it because fence-sitters see that as obvious hyperbole, and conclude if that is what one "side" needs to rely on, their argument against it must not be very strong.

  10. But it's not really obvious hyperbole. The only reason not to use the term is that it conveniently and luckily has a much lower complication and morbidity rate. The fundamental ethical principles are not much different. All of the "objective" rationales are fundamentally weak and deserve rigorous skepticism as post hoc justifications for a socially accepted practice. The social acceptability defense is the same fgm justification. I don't use the term for male circumcision but other than the incidental and irrelevant technical aspects of the procedure, how is it not an identical question?

  11. I mean is piercing infant ears a thing physicians agree to do? So there isn't really a major difference, other than circumcision is irreversible and I suppose pierced infant ears should heal. But I wouldn't pierce an infant's ears. I would find it unethical

  12. I mean, they get paid the same hourly rate whether they lie during the deposition or not, correct?

  13. I mean if you either out of ignorance, sincere belief, or lack of scruples tell a plaintiff lawyer that you will testify that psa is necessary for this case and you backtrack during the depo yes you will get paid but your referral will dry up real quick. That's why. These lawyers aren't just hiring random doctors to solicit an opinion, they are specially looking for people who will testify a certain way.

  14. not a blind spot. each of our eyes compensates for what the nose blocks from the opposite eye. try it - close one eye and then the other. our brains generally ignore the nose because it focuses on what both eyes can see.

  15. "we can fix that in post production" -evolution

  16. Impeachment doesn't require a violation of law.

  17. Isn't that the exact opposite of what republicans said after January 6th?

  18. Recklessly prescribing steroids causes invasive bacterial disease. Not every time, and maybe not this time, but sometimes. It is not a benign medicine.

  19. Steroids are an accepted treatment for CAP (which is what this patient died of), standard of care in strep pneumonia meningitis and pjp penumonia, and widely used in the most severe infections manifesting with shock. Numerous studies looking for the feared secondary bacterial infection when steroids are used for ards and septic shock have failed to find the expected uptick. Intuitively I feel the same way and am less steroid happy than many of my colleagues, but I don't think you have the data to back up that assertion. Certainly chronic steroid use demonstrates an increased infection risk.

  20. The crux of the question is whether or not at the time of presentation to the ed did he have a severe strep pneumonia. The linear path from presentation to bad outcome does not run through administration of dexamethasone, it runs through missing a pneumonia. If based on the presentation and workup done, if the patient can't be diagnosed with pneumonia on the visit in question then how does the relationship between steroids and pneumonia actually apply to this case?

  21. many JWs will bring an entire pamphlet describing non pRBC options for these situations

  22. And other than the stuff we know, it's all "don't make the patient bleed" and "stop sources of bleeding."

  23. None. And they will likely find it that way. Even if he threatened you, you'd still have to show a reasonable person could perceive there was great bodily harm to you or others. I don't think it's legal anywhere in the US to go out of your house with a gun to use deadly force to stop theft. Not only is it not legal it's not smart to just go around getting into voluntary gun fights with an unknown opponent with unknown weapons and unkown skill set.

  24. That's what I thought. It was a university anatomy course. I'm pretty sure the prof knew what he was talking about. It was a weird situation though. Sadly, I don't remember all the details.

  25. How do you suppose that scuba divers don't drown then?

  26. I'm not saying the entire thing would collapse, I am perhaps saying that we would not remain the superpower we are without it. It's more then just industries. The war on drugs pigeon holes certain sectors of people into manual labor jobs also. The worst jobs to most are the only opportunities for some after being labeled an addict or felon.

  27. We didn't need petty drug charges to create an underclass. America was doing that since day one. I don't see the causal relationship. Something can be associated with social oppression without being causative or essential to the existence of said oppression. The most I would say is it's been a tool of achieving the ends you describe.

  28. I imagine they're also passing along their expenses to their customers like every other business ever.

  29. Those "expenses" you speak of are liability expenses for the willful criminal negligence of the company that resulted from them siphoning off their revenue to shareholders and executive salaries instead of maintaining and upgrading their equipment to a modern standard. None of the people who make these decisions are in jail and none of those exorbitant payouts are coming back.

  30. I would like to register no objections to extradition

  31. I'm not sure how you tackle rising RSV/flu cases if they are due to naive immune systems and waning immunity due to a lack of exposure as a result of the Covid-19 policies...

  32. It would seem that now is not the time to start a massive wave of self-inoculation.

  33. I mean maybe? The 90's were wildly optimistic because media decided to just ignore suffering for a decade to see if it would go away so if you were ever gonna try it out...

  34. So people were pedophiles because they thought they could get away with it? And there are fewer pedophiles now because of the cynicism and scrutiny of our time? Do you think sexual predators act because of a permissive social climate?

  35. Seems like a healthy way to start a constructive dialog.

  36. Look at this guy who thinks he's so special just because he understands thermodynamics. Well I will have you know good sir, in AMERICA we do our own research and this story is found on several credible blogs run by experts who are not beholden to big science and their new world order agenda.

  37. I would be shocked if it weren't. I was at a suburban Midwestern residency (fairly well off area but nothing like the real money in NYC or Chicago) and we had a program for donors. Wasn't quite so built out but if you're nyu and you're competing for these whales I would be shocked if they didn't.

  38. Alright I don't normally get into these bashing festivals here but as a teaching ICU attending if you want some fireworks feel free to dupe any np, intern, or whoever into interrupting me while I'm teaching to tell me how inappropriate teaching is. That would be a 5/5 eval worthy prank.

  39. Out of all the problems to blame CVS for, this seems like a stretch. They aren’t responsible for the power grid.

  40. Again , do you think we need individual consent for every step of a procedure?

  41. I think there is a fair expectation that in general any time a member of the health care team is doing something painful, risky, or invasive there is a reasonable chance of that action being useful in the patient's care. If there is no such intent then it probably is worth mentioning as part of consent. As an example, you could let a student or junior resident attempt an art line, but the idea is they have at least been instructed and guided so that they might succeed and they aren't a day one M3 brutalizing your wrist in a futile effort. A resident or even a student can safely operate a laparoscopic camera. These gyn exams are purely didactic.

  42. As a general tip, ignore anything the ED does. If the ED gives 2L NS for a warm and wet CHF patient, that’s their plan not the teams. That’s a temporizing measure they thought was a good idea, the floor is now the primary team. Idk why they kept the 35 cc/hour fluids running, I probably wouldn’t, but it’s basically nothing. Overall the primary teams plan make sense, idk if I would have questioned it. If the ED residents read this they might get mad, but that’s fine because most of them are unable to read.

  43. The floor's plan was probably worse than the ED's plan since it seems to have involved doing nothing at all. At least the ed probably misidentified the patient as sepsis, which in combination with the inherently incomplete information, external pressures from higher up to never miss sepsis, and the fact that the patient had not yet developed frank respiratory failure on arrival is if not a good star at least understandable. Then this person gets admitted and for 12 hours medicine does functionally nothing, meaning either they likewise misdiagnosed the patient or failed to know how to treat heat failure. No decongestion was attempted. And then they get to the unit where the intensivist also apparently doesn't think decongestion in a patient teetering on the brink of intubation is necessary. Let's assume this patient actually had chf, and how jaded and nihilist do you have to be as an internist to read this story and say decide the real problem was the ED management of this situation. If you're the one intensivist in the world who hasn't given a patient fluid to subsequently learn they were in heart failure I salute you. For most people the key is responding to changes in clinical condition, which it seems nobody did here.

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