domain:nunosempere.com
Throwaway05
13m ago
Ah, the innocence. While I'm more familiar with the bomber aircraft with that designation, you really need to visit /r/drugs, sort by top all time, and just see the RIDICULOUS things people do with or on benadryl. Who thought people could get addicted to a bad time?
Oh yeah Benadryl use? Absolutely, with Haldol? That I haven't seen. You see a lot of Benadryl abuse in a correctional setting in the U.S. And really abuse of anything. Apparently Oxybutynin is popular in the women's prisons. And licking pesticides off the walls is popular whenever the prison successfully cracks down on drug imports. If it's at all anticholinergic life, uh finds a way.
Zyprexa is decently sedating. Benzos are sedating. That's probably it. You get a bad outcome and then it generates a black box warning or whatever and we get stuck with it (see: SSRIs increasing suicide risk).
While I usually like to complain about the lack of EBM in this case it's probably just defensive medicine. Be curious to see if they teach it in the U.K. which obviously has a different regulatory environment.
BahRamYou
21m ago
Oh ok cool. Thanks for clearing that up. I mean, you didn't really make any logical argument or cite any sources but you're here on the internet so I'm sure you're a trusted authority figure. I trust you. All those southerners selling slaves at high prices were just idiots I guess. There's just no use for a free labor source, might as well just kill them all.
On another note, do you have any advice on where I can hire a good gardener? I've been paying a Mexican guy, but I feel weird paying a guy who's obviously here illegally. I'd like to hire an American, but the going rate is way too high and there's just no way I can afford that.
self_made_human
Kai su, teknon?
21m ago
Excellent! Using the knowledge we just discussed, which PRNs would you administer to yourself for that aggression???
Haloperidol 😌
Then again, maybe I have PTSD from exams, and therapy (CBT, if memory serves) is first line in the UK.
B-52 is the medical slang for that PRN regimen, don't see people abusing it (if that's what you meant by that comment).
Ah, the innocence. While I'm more familiar with the bomber aircraft with that designation, you really need to visit /r/drugs, sort by top all time, and just see the RIDICULOUS things people do with or on benadryl. Who thought people could get addicted to a bad time?
Medical beer works great! We need to bring it back.
Especially for us doctors. Sadly, the glory days of the NHS when doctors smoked cigars in their chambers and they had a bar in the doctor's mess were over before I was born.
On paper you have a risk of increased adversed events (most notably respiratory depression) when those two agents are mingled.
What ChatGPT won't tell you is that is likely not real and just a recommendation generated by an abundance of caution. Origin was probably adverse events in people with comorbid substance use, including alcohol.
Hmm.. A lack of evidence based practice? In medicine? Never imagined that was a thing.
I'd be rather surprised to see respiratory depression on that combination, unless they were the kind more fit for the ICU, but I'm just a baby doctor and I'm here to learn.
Throwaway05
31m ago
It's a good thing I took my Ritalin and have a psych textbook open, or I'd have permabanned for the aggressive attack with education at a vulnerable juncture /s
Excellent! Using the knowledge we just discussed, which PRNs would you administer to yourself for that aggression???
-Lowkey I use the generic vs. brand name basically based off what's easier/quicker to spell.
-B-52 is the medical slang for that PRN regimen, don't see people abusing it (if that's what you meant by that comment).
-Medical beer works great! We need to bring it back.
-In the U.S. we have sandwiches on deck for just this reason.
I see your other reply with chatbot Charlie but I'll ignore it because why more word when less word good.
On paper you have a risk of increased adversed events (most notably respiratory depression) when those two agents are mingled.
What ChatGPT won't tell you is that is likely not real and just a recommendation generated by an abundance of caution. Origin was probably adverse events in people with comorbid substance use, including alcohol.
coffee_enjoyer
☕️
31m ago
When I looked into this, I came away with the idea that scholars had zero evidence for the view that “male love” was homoerotic rather than platonic. In cultures that rebuke homosexuality, like Arab culture, men traditionally held hands and have even written love poems to male friends. Even terrorist groups were doing that. Male handholding and lap-sitting was also common in England and America before homosexuality became a valid thing in anyone’s minds — can find lots of 19th century photos of this. The most evidence that I have found for homosexuality accepted in Greece are that there are some depictions of it on vases, like 0.01% of vases depicted it. But this may very well have been vases made as jokes or insults.
So when you read about “the sacred band of Thebes” formed by elite military pairs of lovers, it’s silly to think there were any homosexuals in it. In no culture do homosexuals comprise the top fighters.
zeke5123a
32m ago
Re point 3
As between gold and T bills, the only asset with intrinsic value is gold (it is used frequently in electronic manufacturing).
hydroacetylene
37m ago
Human trafficking is mostly aiming at sexual slavery, prison labor is horrendously economically inefficient and mostly exists because you have to do something with them rather than for the output, and sweatshops are mostly employing free people who can quit their job and go get a different, equally shitty one.
BahRamYou
40m ago
Weird how sweatshops, prison labor, and human trafficking are still things then.
Pasha
Defend Kebab
40m ago
This guy might be the most stereotypically Turkish Turkish man I have ever seen. His way of thinking is the Turkish mindset perfected. Also his phenotype and accent is just spot-on
these myths may have been subversively introduced to undermine the revival of old European religions.
Not quite- think of it more like Spiderman or James Bond. You get many reboots or episodes with different writers, who all have different artistic interpretations and motives. And "what becomes canon" often becomes hotly debated among the followers of that mythological figure. And characters change with the time, Juliet is going to be black in an upcoming movie.
If some writer gave James Bond a male lover in a new James Bond "myth" that would also become "canon", but a lot of followers of James Bond would consider that to be a subversive myth within the broader myth body. It's entirely possible that James Bond, created with the intention to be a masculine symbol of English chauvinism, gets transformed by writers in the future who do not like that original message. It happens all the time.
So if someone wanted to reboot James Bond and reset the canon, they would pick and choose what remains canon and what does not because it was not created wisely, or it was created subversively. In practice this happens all the time, for example a huge amount of Star Wars canon was ejected because it wasn't aligned with Disney's plan for the mythos. There's no contradiction there as they openly admit this is what they are doing.
It should also be noted that the Old Testament is another example of comic-book literary fiction becoming religion. Their observation of the way symbols and myths inspire us and direct our behavior is a powerful one. How can we harness it? I doubt a revival religion around Apollo is the answer but I think it's the right question.
hydroacetylene
41m ago
The US government doesn’t need minuteman ICBMs to pacify urban centers. The regular police could easily do it- these aren’t cartels.
Political will is the reason these places are the way they are.
self_made_human
Kai su, teknon?
42m ago
I'm not that lazy so I asked GPT-4:
A senior doctor likely provided this advice based on several important considerations regarding the safety and effectiveness of treating acute agitation in patients with psychosis:
-
Effectiveness of Current Medication:
- If a patient is already on a medication that is working well (like olanzapine, which is Zyprexa), it often makes sense to increase the dose of that medication for breakthrough agitation. This approach minimizes the introduction of new medications and potential drug interactions.
-
Drug Interactions:
- Mixing intramuscular (IM) olanzapine with benzodiazepines can pose significant risks. One of the main concerns is the potential for additive central nervous system (CNS) depression, leading to profound sedation, respiratory depression, and potentially life-threatening consequences.
-
Safety Concerns with IM Administration:
- IM olanzapine and benzodiazepines, when used together, have been associated with severe adverse effects, including respiratory depression and cardiovascular instability. This combination can lead to excessive sedation, increasing the risk of aspiration, and can complicate the clinical management of the patient.
-
Clinical Guidelines and Best Practices:
- Many clinical guidelines and pharmaceutical recommendations explicitly advise against the concurrent use of IM olanzapine and IM benzodiazepines due to these safety risks. These guidelines are based on evidence and case reports of adverse outcomes.
-
Minimizing Polypharmacy:
- Increasing the dose of an already effective medication helps avoid polypharmacy, which can complicate treatment plans, increase the risk of drug interactions, and make it harder to determine which medication is responsible for any side effects.
In summary, the senior doctor's advice is grounded in clinical safety, evidence-based practice, and the principle of minimizing harm while effectively managing acute agitation. By using more of a medication that is already working, like Zyprexa (olanzapine), and avoiding the combination of IM olanzapine with benzodiazepines, the approach aims to optimize patient outcomes while reducing the risk of serious adverse effects.
I suppose that's the gist of it?
Pasha
Defend Kebab
45m ago
You say that weaponization of the dollar was bad policy, but then you give examples of a long list of bad policy decisions the US government would not have been able to pursue if it couldn't borrow infinite dollars.
To me it sounds like the Western governments would in general be better managed if they faced some budgetary constraints.
BahRamYou
46m ago
Maybe it's to filter out guys with low social skills who don't know how to read non-verbal social cues?
Also: https://youtube.com/watch?v=Y6NWDBFo0gQ filters out guys like that
hydroacetylene
47m ago
Yes, they could be- but they also opposed things like gradual emancipation as happened in parts of Latin America, government buy back schemes, repatriation, etc.
self_made_human
Kai su, teknon?
49m ago
It's a good thing I took my Ritalin and have a psych textbook open, or I'd have permabanned for the aggressive attack with education at a vulnerable juncture /s
Thank you, while you Americans have an abominable addiction to brand names, I can understand that those are principles that'll come in handy.
Do not mix IM Zyprexa with benzos however.
I can Google that, but you're in a teaching mood, so might I know why from the horse's mouth?
Unrelated question to check reading comprehension (this is a joke). Do they use hospital prescribed alcohol to manage withdrawal in India? It's so stupidly effective and simple and I don't know why we don't do it more anymore.
Never seen it happen, and I've been here longer than I'd like. It's the usual benzos to cover the acute withdrawal, and it matches up with NICE guidance to boot.
Go assess the patient (skip if the bandwidth isn't there, admittedly). Nursing and ancillary staff are seldom reliable narrators for if a patient needs meds. Bonus points if you can learn which staff and teams are reliable for this. Sometimes you can save everyone trouble by throwing a pissed off person a sandwich. Also be aware of the risks of sedating someone you need to interview or examine later, can easily cause downstream workflow problems especially if it's a hospital setting and you are pulling in consultants.
Good stuff. I'm taking notes, albeit with the cafeteria being the way it is in the NHS, I might be tempted to steal the sandwich. Certainly not paying for one out of pocket, do I look like I make US money haha. I do prefer practical and common sense interventions where possible, Scott's story about the lady with OCD and hairdryer stuck with me.
Haldol/Ativan/Benadryl (B-52! If you've never heard the term) works well and is popular for a damn good reason. It's fine as a default.
More from hanging out in /r/drugs to watch in sheer awe at the people who choose to abuse deliriants, in the case of Benadryl, but Haldol? That's good old haloperidol and I love it like me mum.
hydroacetylene
49m ago
Slavery, in general, is mostly useful for low-skill labor-intensive industries. The amount of rote, menial labor needed or wanted in society has been on a downward trend for centuries.
Slavery could have held on a little longer, but there’s a reason that even in the Islamic world where slavery is regarded with a wink and a nod you have to go pretty deep third world to find lots of slaves doing things that aren’t sex work. One bulldozer with a trained operator is more efficient than literal dozens of slaves with shovels.
Throwaway05
1hr ago
Unsolicited teaching time!!!!!!
I know your comment is meant somewhat facetiously but it's important to establish good PRN habits early, especially as you move to a higher resource community.
Some pearls.
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Haldol/Ativan/Benadryl (B-52! If you've never heard the term) works well and is popular for a damn good reason. It's fine as a default.
-
Other PRNs exist however and you should be familiar with them and try and think about when to use them. Droperidol is big in the ED in the U.S. Thorazine is more popular as a pediatric PRN because it's thought to be more sedating.
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If the patient is on something that seems to be working (like say Zyprexa) you can consider using more of that for breakthrough agitation. Do not mix IM Zyprexa with benzos however.
-
If you ever work in a consult setting or otherwise with medically ill patients you'll want to have a few tricks. QT related concerns are big in the U.S. even if they are questionably real so you have a lot of elderly dementia/delirium patients who need clever agitation management - low dose depakote can work for this.
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Know what's happening with the patient. Patient like the above will generate requests from idiotic physicians for benzodiazepines recs. Obviously that makes delirium worse. I believe all doctors who deal with agitated patients (read: basically all doctors) need a full length version of this rant for that reason. Less common problem (especially outside your field) are pure "behavioral" patients. If the agitation is all volitional antipsychotics aren't going to do shit.....choose more sedating regimens (but be aware of the risks of such).
-
Unrelated question to check reading comprehension (this is a joke). Do they use hospital prescribed alcohol to manage withdrawal in India? It's so stupidly effective and simple and I don't know why we don't do it more anymore.
-
Go assess the patient (skip if the bandwidth isn't there, admittedly). Nursing and ancillary staff are seldom reliable narrators for if a patient needs meds. Bonus points if you can learn which staff and teams are reliable for this. Sometimes you can save everyone trouble by throwing a pissed off person a sandwich. Also be aware of the risks of sedating someone you need to interview or examine later, can easily cause downstream workflow problems especially if it's a hospital setting and you are pulling in consultants.
BahRamYou
1hr ago
The long-term picture isn't much better. Since the end of the gold standard in 1971, gold has outperformed U.S. treasuries. Simply buying and holding a lump of rock is better than holding the debt of the U.S. government. And the government was actually in good financial health for most of those years, unlike now.
Gold Bugs love to talk about the price of gold since 1971. But the performance really depends on what year you start in. Turns out 1971 was an exceptionally good time to purchase gold, as it had just been deregulated and could be bought for like $50 an ounce because no one was paying attention. By the end of the decade it had already boomed to a price similar to what it is now, like $2000 an ounce. And there have been several boom and bust cycles since then. It's (ironically) not really a long-term, buy-and-hold investment, but something that can maybe save you during a big market crash but can just easily tank. Treasuries have outperformed over almost any period other than starting in 1971.
Incidentally- treasuries right now have a great interest rate and are still rock-solid safe. This might be the time to just park your money in bonds.
BahRamYou
1hr ago
When America was founded, slavery was on the way out: turns out it wasn’t that profitable of a system for tobacco farming, and sugar couldn’t be grown in the continental US. Many northern states abolished slavery and then the south followed suit. If there was a time for the peaceful national abolition of slavery it was then.
I've always heard that as the conventional wisdom, but I wonder if it's really true? If you put aside all morality and politics, it seems odd that they couldn't find some profitable use for literally free labor. Especially in the rural south, where a natural resistance to both the sun and malaria would have been huge. Maybe tobacco farming would have gone out, but they could have grown something else, with black slaves working on peanut farms or whatever. And of course house slaves would have been useful anywhere.
More empirically: Jefferson famously tried to free his slaves on his death, but he couldn't afford it. The cost was too high. If slavery was really "on its way out" it seems odd that the price of slaves was still so high.
It seems more like this is a "just so story" that we tell to simplify things. But it didn't have to be. Slavery was always a choice. They did it because it was profitable, but only for a select few, and they were mostly growing things like tobacco and sugar that did nothing of any economic use. But there was also no particular reason it had to end, except that people started to feel bad about it. It had endured for hundreds of years, and could have gone right on into the present day if people hadn't developed a conscounce about it.
This is the first time I've ever heard about that "Knights of the Golden Circle" thing. Kind of a big hole in the American education system I guess. But I can see why they leave it out... it brings up too many awkward questions. Why didn't the US take over the caribbean? It would have made sense. Both for money/realpolitik (those caribbean islands were producing crazy amounts of cash, much more then the US did for a long time) and arguably would have been better off ruled by the US instead of distant European monarchies or "Ok you're free now" suddenly putting slaves in charge of everything, like Haiti. But instead we just took Puerto Rico and nothing else because... that's just the way it is, I guess.
The_Nybbler
Does not have a yacht
1hr ago
B knows what A is gesturing at, but doesn't know what A means because A doesn't either, and that's the point of the objection.
self_made_human
Kai su, teknon?
1hr ago
They bear almost no medicolegal responsibility, as long as they do their job, which is being largely useless. Seriously, if you, as a random doctor on the ward, ever get called over while harried to death in the middle of your shift and they ask you to sign off on their suggestions, then it's all on your head if something goes south. And if you refuse, well, you better be ready to face the ire of your seniors, who'll tell you to be a team player.
Fucking, hell they make more money than I do for my first year as a CT1 trainee. Matching my salary next year to boot. Maybe a quarter the time in education, exams where it's ridiculously difficult to flunk, and then they rake in the big bucks and have stable postings without rotational training and can coast until they often end up poached into managerial positions that were once expected to be done by doctors.
It might be a clown world where you're at, but here, the inmates are running the asylum. The UK has a massive shortfall of actual training positions, so it's both a miracle I made it on my first go, and people who don't are SOL till next year around while yet more medical students are pumped out. (I note the conflict of interest as an IMG, but I don't care, they have it easy compared to the shit I go through, and if they want to protest the erosion of pay and scope creep, I'm with them in the picket line)
2rafa
1hr ago
Because it's completely unclear that predation by China or (in some regional cases like Central Asia/Middle East/Caucasus/Baltics/Eastern Europe) Russia would be any better, when in fact it would likely be much worse. Sure, you can be a free agent with no permanent alliances, but that leaves you like the Philippines would be if they went full neutral; completely open to Chinese aggression. Much of the Pacific prefers the US to China. India is obviously fearful of China. In Africa and Latin America the factions are more mercenary, as we see. In Europe the bargain is that being part of the US alliance vs China is necessary to guarantee American support versus Russia.
2rafa
1hr ago
iPhone has 80% marketshare among 18-24 year olds in the US, and well in excess of 80% marketshare among high income millennials too. Phone retailers (including carriers) love Android because they make more margin on their phones (a deal Samsung etc readily agree to in exchange for store space). For reference, after the iPhone X (2017), Apple cut margins for resellers (which obviously include carriers) to sub-4% in many cases. Samsung resellers make more like 6-7%, so it's a huge difference for the retailer if you sell 10,000 $1000 iPhones vs 10,000 $1000 Samsungs.
I expect it's somewhat less litigious than the US, though of course it still keeps people up at night.
I've read that the SSRI and increased suicide risk is a real phenomenon, when they start working enough to overcome the lethargy and apathy, which lets users finally find the energy to apply those lovely suicidal thoughts lurking in their heads. Not that I've seen that stop anyone prescribing them, there's nothing better for the majority. Maybe jump to ECT if the depression is severe enough/psychotic?
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