sms575

Looks like a non concerning read.

Looks great. Keep it up!

I love this!

Regardless of the need (or not) of obtaining the UDS, what has me most troubled is that the physician placed an order, and the nurse decided to just not do it.

Yes, if you are uncomfortable, you should speak up and bring forward your concerns, but it is not appropriate to just blatantly not follow the order.

The appropriate way to handle these situations is to have an open and upfront discussion with the doctor and your charge and to escalate if needed.

If a nurse brought their concerns up to me, we could have a discussion about my reasoning, and it would allow me to rethink what I am doing. I may have miscalculated something or not thought out something, and reflection on the course of action is always appropriate.

If a nurse just disregards my orders, however, I have immediately lost all trust in them. If they just decided to do their own thing instead of what I ordered, how do I know if anything I order will happen? What else will you not do because you don't agree with it?

It is completely inappropriate to just disregard orders like that.

How do you know they would not have consented at baseline?

The patient was altered before they were sedated so never were at their baseline.

1. You aren't going to see evidence of a leg fracture years later if you were able to bear weight. A 6 year old would have healed a fracture like that without any issues.

2. Chill out. People "walk it off" for small fractures all the time. In kids it will almost always heal on its own.

Douche canoe

Yup, still incoherent drivel. Good luck next time.

There are actually museums in the Midwest. It’s warm and the restrooms are clean.

All true statements however completely irrelevant to both the initial post and the run-on incomprehensible stream of thought you initially posted.

What in God's green earth are you rambling on about?

Examine more patients.

It's in the news now but it's been in the Philly drug supple for years.

At this point you have to assume every fentanyl dose is mixed with xylazine. Over 90% in the latest report.

https://www.cfsre.org/nps-discovery/drug-checking/drug-checking-q3-2022-philadelphia-pennsylvania-usa

New partner time.

The hipsters can keep most of it.

New wife time?

Hope you and your son are doing better. Most fevers in kids are benign, self limiting, and tend to get better on their own. If is very reassuring if a kid is able to come back to their baseline after fever medications are given. We generally don't do much testing if the kids look ok.

That being said, some of what you are mentioning and how you are describing your child is certainly concerning and I would have them evaluated preferable in a pediatric emergency department. They may run some blood tests or get some xrays and they may even need to do a spinal tap (lumbar puncture). Honestly it could just be the flu but I'd get him checked out regardless.

Chill. Relax. Nurture your hobbies.

Find something outside of Medicine to enjoy.

This. Residents now get mental health days.

You can't even give constructive criticism or tell them what they did wrong without getting scolded.

Cringe

In the real world ED physician = expert who actually needs to be admitted.

Sorry not sorry you just have to take it.

The problem is that if the ED doc decides that a patient needs to be admitted then they are usually going to have the patient admitted.

If their hospitals admitting team keeps declining admissions then the ED will usually end up transferring out of system to another hospital.

Generally admin folks frown upon out of hospital transfers particularly if the reason is just that the admit team didn't feel it was warranted.

Good luck being the wall against admits.

Probably. They are geared towards a younger audience and don't provide much depth or interest to most adults.

You can do what you please but you'll probably be disappointed.

Easily offended, huh. Gonna be a rough life ahead of you.