1. I usually tell them this is how it works and they are welcome to seek care elseware, if they get vocal I tell security to just sit by them and mean mug them. of course then when I do see them in traige they get an 18 and I miss twice but maybe I'm just vindictive.

  2. usually the charge function does not charge the patient but more used for inventory. they will then use the stats from that to do things like "your average old febrile patient used 4 wipes, one foley etc so that's all you get" it is a problem for a ton of reasons. 1. so executive gets paid hundreds of thousands a year who never set foot in a hospitals tells me their is a limit of supplies i should be using to treat a patient (fuck yourself) . 2. to police nurses who go over that limit and shame them in being cost effective (again fuck your self twice) 3. prove to Medicare and private insurance the cost load v reimbursement rate. it can be useful if your unit is not supplied with what it needs but sucks butt overall.

  3. I was a perfusion tech (running cell saver and assisting open heart perfusionist) like others have said you make bank and not a lot of people go into the field. There is a limited amount of schools and you often have to be where a cardiac program is well developed. So locations are limited education is limited. not much jumping off points either. Also not a lot of Hospitals have in house perfusion. Which means you do private company which has its ups and down. With that being said the different machines and the operating of them makes you feel bad ass. However, sitting all day doing open heart or running 10 cell saver machines for all the ortho spines gets boring quick. There’s not much variation to the day and it’s draining walking into an OR and leaving 14 hours later. Nursing is more location friendly and allows you to do something else if you get bored. I ultimately chose nursing because you got more communication with patients and staff. The only time I talked during surgery was for EBL return or when some jerk thought the cell saver line was waste and id be swearing in the corner changing out the line.

  4. Thanks for your insight! That makes me feel a lot better. Most of the time when I bring up on already on the path to the perfusion and thinking about changing I get encouraged not to because I already got in. But it's refreshing to hear from someone else who was headed down that path and made a switch and are just as happy.

  5. I have a lot of degrees and my path through medicine was not straight and narrow. For perspective I had a masters degree before going into nursing. Even if you decide later that perfusion is not for you nursing is always there :) I was also super interested in pharmacy school got a full ride and turned that down sooooo believe me people were trying to push me down plenty of paths but you gotta sit down make a pro con list and decide what’s best for you :) good luck

  6. Patient: how are you doing? Me: oooo living the dream Patient: that’s good Me: nightmares are dreams 2……

  7. One of the patients I had gave me the best response ever. I looked at his arm and blurted out before I every thought what it could be “what happened here”. He looked at me smiled and said “some asshole tried to kill me” stuck out his hand”hi I’m the asshole”. (For reference I worked ER nurse and in triage you sometimes don’t get a chance to look through the chart notes before you assess someone not good practice but very lucky this guy had a sense of humor)

  8. The problem is multifaceted but for one you just don’t have the knowledge base. Even if your the best student had medical jobs before nursing there’s always more to learn. Also nursing training is generalist so if you end up in an ICU their bread and butter antibiotic Ivs blood etc will be hard to do on top of just the normal vitals meds charting etc you did on clinal rotations. you get used to everything eventually and will soon be a rockstar. However, there is no shame going to employee health or hospital consular. We deal with messed up things all the time and I’ve gone through SSRIs and prn benzos during times of extreme stress. Also I know some hospitals offer sick time or bereavement etc time to take off when a loved one gets sick. Worse case call in sick, go see your mom, drink your favorite cup of tea and remember why you do this in the first place. There were always be more patients but you can’t help anyone if your not in the headspace.

  9. I think This attitude is common in burnt out nurses, and actually feel a little bad for this burnt out individual. Often times on the floor we stand up for our patients unfair assignments patient loads etc. admins fuck our days up anyway our nurse managers are just there to keep us appeased and with new jobs plentiful right now it’s easy to just find a new job (in most areas of the US, sorry cali grads). Not to mention we all have crazy shit going on in our lives. I remember being at work hearing my dad went to the ER and I was stuck working in the ER already short staffed. Was I the most therapeutic nurse ever in that situation…. No but my coworkers helped me out got me out early. But she may just not feel comfortable sharing her issues and if this becomes and recurrent thing I think a one to one with charge is a good move.

  10. NNP? I assume you mean neonatal nurse practitioner. for this you would need an RN and then two years labor and delivery and then a masters degree. Nursing is not easy and there are no shortcuts you can do accelerated programs but that will cost time and money and won’t be easy. A direct entry MSN still ends you with an RN. Now you can do a post masters cert after and it’s sometimes quicker. ( I graduated msn program and went on to post masters program). Yes NPs are midlevels so you won’t be doing crazy endocrine tumors but in alot of states you can Be independent. This means your managing CHF diabetics kidney disease pts etc by yourself. The learning curve is also pretty steep and involves a lot of study and dedication. I had a major minor and masters degree not in nursing before going into nursing. My experiences and other knowledge helped immensely and all education is good education. You need to earn your stripes and go through nursing because that’s where you learn to become a good practitioner. The years fly by quicker than you think and if it’s something you truly want you will make it happen.

  11. Also if you think nursing is it change your major…. It be like taking accelerated BSN but would shorten your timeline. Or go to a graduate level mental health consular program you get the patient facing side without all the other stuff.

  12. Half life works pretty simply if I take 50mg and half life is 6 hours let’s say after 6 hours 25mg is left. Now to truly understand what that means we have peaks and troughs. Peaks are obviously when drug reaches a max concentration trough is when it decreases. These are often controlled via dosing. So we make sure drugs stay in a therapeutic range. Sub therapeutic it does nothing and toxic well it’s toxic. So the drug is active until that half life reaches basically subtherputic lebels so it has no effect and eventually is excreted. Toxic doses of antihistamines is usually 5x normal dose so this should be fine but I wonder why your combo these in the first place?

  13. Sub therapeutic levels are not toxic. Toxicity comes from high doses. Like beta blockers for example. In therapeutic doses they slow heart rate, in toxic doses they eliminate the heart rate. In sub therapeutic doses they do nothing to heart rate.

  14. Take a look at the ACNP programs as I believe these are what you are talking about if you are interested in pursuing your NP but want to stay in emergency medicine and see more than mumps and bumps as you put it.

  15. Problem with acute care is you specialized population which makes non specialized ERs not want to hire you. Almost all the acute care NPs I know end up ICU and other high acuity floors. I like the treat them and street them not mange 55 conditions in an icu. Get old your still running around the icu cause you can’t do clinic or anything with acute care soooo fnp tends to be the jack of all trades but literally master of none.

  16. Yeah to be honest I have never even met a ACNP all the NP’s I have ever seen in the ED are FNP but they are also the only providers on duty in the ED so they handle all cases that come through wether they need intubation or Tylenol but then I’m in a rural area where they are more willing to train providers after school. I was a RN that worked years in the ICU and ED and just got my FNP recently. My plan is to work urgent care a few years then see if I can get one of the facilities near me to train me for ED if I’m still interested. I mean I already see quite a bit at the urgent care I’m at we work up CP, MVA’s, assaults, and other things you would normally expect to come into the ED as we are attached to a large hospital and we have most of the resources our ED does.

  17. I wish you luck! It really depends on hospital culture and etc. a lot of the hospitals by me are big teaching hospitals so there are always residents wanting to learn and do big cases (as they should). But that means the scut of detoxing, simple broken bones, and sore throats tend to be PA NP work. Urgent care is a good way to get your feet wet and I feel a good mix of urgent and ER care

  18. It’s really for high stress anxiety individuals. It helps you not focus on the little things and almost sleep like trance. It also makes stress easier to deal with bitch to kick though.

  19. In this current market a lot of jobs are opening up that we’re not available to new grads before. For instance ER is hiring new grads by me where it used to be med surge was a requirement before going to a specialized unit. I find people fine their niche early on. I was in EMS and was a perfusion tech so I found myself loving the OR and ER life. With your background as unit security I would hire you on the ER cause dealing with irate assholes is part of the gig.

  20. It depends on a number of factors but it becomes lethal when your bodies sympathetic response is 2 much to sustain life. So your on stims take a shit ton. Your HR skyrockets right let’s just call it 275 BPM. Normal heart rate is 60-100 (can be lower if your an athlete can be higher those with a-fib). So 2x 3x normal, we know that our heart fills during diastole and pumps during systole. When you up the heart rate that much it does not give your body time to adequately fill and pump oxygenated blood out. So what happens? Well you go into shock your body is crying out for oxygen and tells your heart hey I need blood so is vasodilates small vessels to increase return to heart and vasoconstrics other vessels to increase your blood pressure and heart rate. You already inflated heart rate gets increased even more your pressure is super high and most likely you end up with a heart attack, arrthymia, stroke, aneurysm etc.

  21. The MDMA can cause high blood pressure and higher heart rate and the beta blocker will actually help lower both of those. I don’t think the beta blocker will interfere with the high and unless you have a lot of Complex issues you should be able to meatbolize just fine. I will say MDMA increases blood flow to the brain so it may lead to a killer cluster headache following the come down.

  22. Lithium is a very hard drug to dose properly and has a narrow therapeutic range. By taking other drugs it can prevent metabolism and elimination of lithium making it easier for toxicity. So I would not recommend anything :(. Also a lot of the serotonin modulators or stims that increase dopamine tend to not have an effect on people on SSRIs maybe it’s cause the antidepressants prevent reuptake so theirs a bunch of serotonin already and receptors can’t further be activated maybe some other complicated reason. Basically get yourself healthy and maybe look into other drugs to manage your conditions but just like your buddy who has a heart problem it may suck but he just can’t do coke how it goes.

  23. You should change your name to undereducateddrug.

  24. …… to potentiate means to make an effect stronger. So yes it can mean opioid with Benadryl for example. But it also means if you take one nsaid and another nsaid there effect potentiate meaning higher level of pain relieving activity when taken together….. if your arguing semantics of potentiation has to be between two non related drugs that’s not accurate but as always do you my man I’m just here to do my thing :)

  25. Hydrocodone and oxycodone do not potentiate each other.

  26. They are both opioids so they will. You take shot of vodka and then a shot of whisky= more drunk even if different forms

  27. How would I order one in Ireland? "A shot of Bailey's, a shot of Jameson, and a Guinness?"

  28. Boiler maker is classic whisky beer name so prob that and name the beer and shot. Best guess

  29. It’s fucked up but also the way of the world. “If it bleeds it leads” type of reporting. Drug stories are fun (check our dopey podcast) but theirs also a realness to it. It’s funny to hear a buddies story of barley making it home after accidentally driving his truck around a golf course and side swiping a police cruiser. Or your buddy trying to convince the pharmacist he needs clean needles for his diabetic cat. But theirs also a sad reality that these people are sick right? These guys are so fucked up that their nodding in the street. Really it’s just a lack of education and life experience. Like people in the states order Irish car bombs like it’s a funny thing where you try that in Ireland……

  30. The treatment for depression is finding things you enjoy doing, people you love, and surrounding yourself with that as much as possible while also exercising, eating right, and creating and achieving goals for yourself.

  31. ……. I’m not going to explain that even with diet exercise and etc. people will still be depressed due to a variety of factors. If you think depression is just people not doing it right, you must view addiction the same way?

  32. You’re talking to someone who battles with crippling anxiety, depression, and addiction issues related to both of these disorders. This has been my experience what helps more than SSRI’s.

  33. But I’m not here to fight do you. But saying antidepressants SSRI etc don’t work is like saying statins don’t work it’s just not factual.

  34. I'm curious to what this is. I can get anything I need

  35. Get the spinal analgesic bro fuck the juice and home remedy’s you can get a script

  36. Your fine, the guy running the sample could give a fuck as long as it’s in range.

  37. I mean that combo of weed caffeine and nic is basically the bartenders special when I used to work service. That will not really fuck your life 2 bad. Lol add a few vodka shots 2 if u need it. If you wanna chill out on a day a ambien or xanax is good for the got 100 people wanting a fucking kebab. However as you know don’t overuse keep it in check benzos are great but fucking bitch to kick.

  38. Because it’s expired it may have less potency (a lot of meds are still just as potent post expiration) 10 mgs would be fine. It may not get you to “nod” level. Careful going down opioid path my friend just smoke weed and drink like a normie if you don’t want it to fuck up your life.

  39. If you take kratom you should definitely make an EKG to check out your QT interval since kratom prolongs it.

  40. So do most antibiotics and lots of other drugs unless you have cardiac history or are taking drugs with lots of rx drugs a very low risk. (Just adding some info, your safety concern is amazing)

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