Latest Comments by MunoRN

MunoRN 35,454 Views

Joined Nov 18, '10. Posts: 7,736 (69% Liked) Likes: 19,058

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  • 3

    The linked article claims that the Sandy Hook shootings were fake, so I'm not sure it's really the opposite of "fake news".

    The gist of the 60 minutes story was that there are still at least 1 million Remington rifles out there that can spontaneously fire, Remington doesn't dispute this. I get that would Remington would prefer 60 minutes portray the story in the same way their PR department would, but if they did then that would be "fake news". Remington's main complaint seems to be that the story didn't more clearly state that the court, particularly in the first case, didn't find that the rifle had failed because they couldn't replicate the failure, although that seemed pretty obvious to me when the story pointed out that the "it was an accident" defense was denied and he was found guilty.

    The problem with Remington's argument is that according to Remington's own findings, it was often possible for rifles that had known problems with spontaneous firing to be tested and the results could not be replicated, which disproves the basic argument of their response of the story which is that if the rifle had failed then it surely would have failed in forensic testing.

  • 0

    The current recommendation of the Sepsis Consortium (Sepsis 3) is that these broad screening tools like the ones commonly used to screen ED patients should no longer be used, which includes just giving fluids based on the screening alone. There needs to be some sort of assessment of volume status (IVC collapsibility, etc)

  • 2
    KelRN215 and Here.I.Stand like this.

    Being the patient's next-of-kin POA, the husband can choose to withdraw treatments including artificial feeding on behalf of the patient. Declining medical treatments that artificially prolong life are not unusual in cases of advanced dementia, as it's not a particularly pleasant condition.

  • 1
    elkpark likes this.

    Quote from Spidey's mom
    I'm not giving him a pass. I'm saying, he had a valid point.

    I'm watching more of the videos . . . I had no idea this rape culture was so strong in Sweden.

    The Feminist Government That Hates Women - YouTube
    I'm not sure what "rape culture" you're referring to. Sweden has a strong anti-rape culture, which is why there's a high rate of reporting incidents of rape, and also why they have changed how they define and count incidents of rape differently there; we generally count a single sexual assault encounter as a single rape, while in Sweden various aspects of the encounter are treated as different individual incidents of rape.

    While Trump did get his story from an actual news story that appeared on Fox, it's one that was generally debunked about a year ago.

    Donald Trump admits his 'Sweden attack' comments were based on debunked Fox News report | The Independent
    Trump asked people to ‘look at what’s happening … in Sweden.’ Here’s what’s happening there. - The Washington Post
    Trump baffles Sweden with crime comment, says it was based on TV report
    | Reuters


    A White House spokeswoman told reporters on Sunday that Trump had been referring generally to rising crime, not a specific incident in the Scandinavian country.Sweden's crime rate has fallen since 2005, official statistics show, even as it has taken in hundreds of thousands of immigrants from war-torn countries like Syria and Iraq.
    Trump's comment confounded Stockholm. "We are trying to get clarity," Foreign Ministry spokeswoman Catarina Axelsson said.

  • 2
    SmilingBluEyes and chare like this.

    I don't think it's unreasonable to pay less for a product that falls well below average quality.

    What the HCAHPS survey essentially asks patients is whether or not the facility is staffing properly for their workload and providing the necessary support to provide adequate care; Did the staff have time to teach you about new medications, discharge teaching, answer call lights, etc.

    The way HCAHPS surveys work, is that even if your scores are "poor", you don't lose any reimbursement as long as they are about as poor as everyone else's, if a facility is doing a significantly worse job at providing patient care, then they get paid less, I don't see any reason why they should get paid the same as those providing a better, or even just average product.

    There's certainly some improvements that could be made, but as a basic premise I don't see a problem with payers providing financial incentive for facilities to provide more support for those providing care.

  • 0

    Have you ever had a license to practice nursing? It's sounds as though you haven't, which means you can't practice independently as a nurse.

  • 2
    toomuchbaloney and herring_RN like this.

    Quote from PMFB-RN
    Not in Wisconsin. It says you have to be a citizen, but the only proof required is a Wisconsin drivers license or state ID and there is no requirement one be a US citizen to get either if those.

    Voter Registration in Wisconsin | DMV.org
    While a driver's license is used to facilitate the registration process, it doesn't replace it, the Wisconsin Elections Commission still verifies that you legal to vote (citizen status, felon status, etc).

  • 3
    RainMom, Horseshoe, and KatieMI like this.

    I know there is supposedly increased risk of postoperative respiratory complications in patient's who have received bleomycin, and that it's usually associated with excessive supplemental oxygen peri and postoperatively, so that may be the concern. I guess the main question in an outpatient surgery would be how quickly this becomes apparent after surgery, my impression is that it's immediately obvious post-op, but if a patient could appear to be in-the-clear in first few hours after surgery and then go into respiratory distress more than a few hours later then I could see the anesthesiologist's concern in doing this as an outpatient, where they won't be monitored anymore a few hours after surgery.
    Risk factors of anesthesia and surgery in bleomycin-treated patients. - PubMed - NCBI
    http://www.anaesthesiawa.org/bleomycin.pdf

  • 8
    elkpark, Lil Nel, Ted, and 5 others like this.

    The Obama-run "shadow government" seems to refer to the fact that most government employees are not Trump political appointees; they work first and foremost for the US government and will generally side with basic principles that our government is based on when there is a conflict between that and a President, for instance. Government is like a living organism, threaten it's existence and it will get defensive, often in the form of "leaks" to ensure that the people (those who the government is accountable to) are able to exercise their role. Complaining about leaks is like complaining someone is kicking and hitting when you try and smother them with a pillow.

    I don't know that we've had a president who has so aggressively tried to replace our basic democratic system with authoritarianism. What our government is based on is checks and balances, and governing by the consent of a well informed public. In only a month Trump has actively tried to delegitimize one of the main checks and balances; the Judiciary branch, as well as the people's main mechanism to oversee our government; a free press, and on top of that he's basically called us a fake democracy in claiming massive voter fraud despite having absolutely no evidence to support this.

    Those whose job it is to keep our government alive will most likely continue to do CPR on it when necessary, if Trump wants there to be less of that then he should stop trying to smother it with a pillow.

  • 6
    toomuchbaloney, margin261, heron, and 3 others like this.

    Quote from tntrn
    If you have not been using the name-calling method of referring to the new President, then this did not apply to you. In this case I don't think I am exaggerating....but I see a LOT of name-calling...maybe from just a few, but it is enough to taint the barrel.
    I agree that issues should debated based on reasoned arguments and without name calling, using name calling and putdowns but avoiding a reasoned argument shouldn't be tolerated. Unfortunately there are those who as a standard response use name calling and putdowns as a replacement for a reasoned argument, this is one of the defining differences of Trump compared to many other political leaders.

    Quote from tntrn
    But WE can set a good example....and that isn't happeing here or anywhere.
    A poster here recently enthusiastically shared their agreement that a group of women he has political disagreements with are witches and morons, without attempting to make any sort of reasoned argument to support this. You didn't condemn this, which is fine, but instead hit the "like" button. Maybe we could all help maintain a better tone.

  • 1
    offlabel likes this.

    The signs of ischemia that we would be using a 12 lead to look for don't vary based on electrolyte levels. They can be obscured by electrolyte levels that are severely out of range, for instance if severe hyperkalemia (greater than 7 or 8) was causing an idioventricular rhythm then the 12 lead could not be read properly, although if that's the case then you've got bigger problems than a hard to read 12 lead. If the ability ischemic changes on an EKG had to be corrected for electrolyte levels then no 12 lead would be useful without taking simultaneous electrolyte levels and adjusting for them, which isnt' how it works.

  • 0

    It's supply and demand, night shift nurses don't get paid more because they are superior nurses, it's because extra pay is required to offset the fact that nurses don't generally like to work nights. The same is true for ICU vs floor nursing. I wouldn't willingly work on the floor for the same pay as I get as an ICU nurse, in fact I wouldn't switch to the floor for more money, at least not until you got into the range of $5 or more an hour increase.

  • 0

    Quote from Wile E Coyote
    18 years ago, my tele floor charge RN used to get a daily list of all 'missed charges' from the previous day. An IV catheter was $18, a bag of fluid was $56 (prices charged to the patient, not the negotiate rate paid by any insurer). Currently, I sit on two different committees that discuss price on every product or device we evaluate.
    Now, that doesnt specifically speak to your question, but is in the ballpark.
    I think this gets confusing because for some reason there are still some hospitals that track these sorts of things for internal purposes, but there are no longer any payers (insurers, CMS, medicaid) that pay for any of these things individually, all billing is now bundled based on acuity and DRG.

  • 0

    I sort of doubt that you're going to get a response from someone who sets prices at the Cleveland Clinic, and there is no one single price, different payers negotiate different prices. But Cleveland Clinic does post their chargemaster prices: http://my.clevelandclinic.org/ccf/me...in-charges.pdf
    An EVAR stay is typically 8 days for the daily rate pricing on that last, and this doesn't include the endograft itself which is typically about $10,000. It also doesn't include billing by Physicians which may account for the majority of the cost.

  • 0

    A lot depends on who essentially owns the meds in the facility's stock. The type of facility you're referring to can't require patients to provide their own meds, or provide the service of aquiring and storing meds that are billed to the patient, your medication administration and stock is the same as that of an inpatient hospital, where patients are administered medications from hospital stock. So how you take in, store, and track medications that are facility stock would depend on state specific regulations.


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