offlabel

And it reduces fever which, in a child, reduces the risk of febrile seizure and the morbidity that comes from that as well and the harm from just having a high fever aside from seizures....so....there's that...I mean, norepinephrine isn't an antibiotic either but it is critical in the treatment of severe sepsis...

Afib with RVR very frequently doesn't cause cardiogenic shock either.

I'd just say don't take coagulopathy for granted. Really understand TEG and what it indicates for treatment of bleeding in terms of which products, protamine etc. Not talking about the coag cascade, just the practical, day to day management. What derangements in PT/PTT/INR call for etc.

Sure did during Covid. Teacher Unions were the biggest proponent of that. Don't see why it couldn't be done here.

Prolly energy drinks in play too, I'd be willing to bet....

Poor kid...sure didn't ask for this...

Not sure how a doctor's note will help the kid. He/she will have these episodes wherever he/she is and if it's at school, so much the better IMO. If the kid is symptomatic enough from hypertension with/without tachycardia to come to you, it's a trip to the hospital every time until there is medical clearance. Don't see how keeping the kid out of school helps the situation.

It's because you're still learning. When you become a complete expert at putting in IV's you don't have 'bad IV' days. You just have really hard IV's.

This is why your faculty hacks on you so hard for med math and pharmacology. When you hear somebody say, "it's all unit dose / controlled by the pump / in the Pyxis / set up by the pharmacist / etc., etc.” you can remember this one. (5cc does NOT equal 5 mg. …) This kind of thing has nothing to do with being able to do the simple arithmetic of nursing medication administration. It has to do with being able to read. Same thing with the Vandy nurse giving vecuronium instead of versed. Says what it is and the concentration right on the label. No math required.

Yep, defending it. Did not 'build' it. Healthcare just followed the same trajectory as any other US industry in the 20th century so I guess that's how it developed it's profit motives. Whatever the disparities are, what is not really debatable is the speed with which technological advances occur here that the rest of the world benefits from and at a lower cost to them in the long run. Medical innovation occurs in the US for the profit motive, of course. It is what it is and the rest of the world depends on it and we benefit from it, generally. Lots of waste and futile care, for sure. Wouldn't want to be really sick anywhere else. I've seen tertiary lever care to John Doe homeless to state government level VIP's.

Which Americans? And what did they build?

That's nothing new human history. Not at all specific to American culture. You and I both value money as the devices we're communicating on are worth enough to provide nutrition to a 3rd world family of 6 for at least 6 months. I see you have the NICU in your history. Those units are disproportionately large (like 100 beds) in metro areas with high low income/minority populations. NICU care is among the most expensive in the system. And it can't exist in a vacuum. When you need your knee done, it has to cost more at least in part because of all of those NICU's saving the lives of meth and opiate addicted preemies. We agree on the 'society' thing. More to the point, society-cultural. SC LA, SS Chicago, NYC...all of them have populations whose conditions from the 60's to now have gone from not good, to bad to catastrophic...all because of well intentioned but failed from the start social policies. Don't deal with that, those populations will just continue to crater. And health care cost will increase or just eventually leave those populations our altogether.

That 2 realities exist at the same time doesn't mean that the two realities have causal relationships. That's a logical fallacy. It is indisputable that health care here is expensive and that metrics like obesity, maternal/fetal morbidity etc. show rises, but to ignore factors that are completely outside the medical care delivery system just serves a narrative that is outside the topic at hand. For example, the maternal/fetal health aspect....violence and other crime in those areas where morbidity is on the rise, drug use, pregnant women with no partner....these are all cultural issues that contribute to higher mortality, not the 'system' per se.

"Meritocracy as practiced today n the US just incentivizes cheating. Think Enron and WorldCom. So, riddle me this: what merits are demonstrated in American meritocracy?" Nope...I was quoting you. I'm happy to discuss as long as you're comfortable with it.

A moderator can move the posts if they want. Just declaring healthcare economic points without any context is not defending a position (and I thought we were just talking about America, not world wide health care.) I can just say 'lying' but that doesn't support my position. None of these things are peculiar to the American healthcare scene. You brought it up in a bullying thread, I just responded.

Merit, in the worldly sense which I assume we're talking about, has to do with material gain and the freedom and satisfaction of pursuing a way of life. So ask any small business person who works hard, makes a passable living and says they never 'work' a day in their life and you have at least a general idea of American meritocracy. I know very well that the above idea is offensive to many people because it is rooted in ideals of the American Revolution and displaces the power of ideas from the powerful to the person on the street willing to sacrifice, defer gratification and succeed. It is what it is... Oh...and if it's cheating you're concerned about, look no further than the Soviet Union or the CCP. Yes, there are evil people. Health care? Compared to 50 years ago, the mortality from cancer and heart disease (just to name 2) has vastly decreased. What metric are you using when you say the quality of health care is declining?

Well, name a better one. If you're just talking about socially engineered 'meritocracy', I'd agree. Public education, much of the military, many city, state and national government offices, heavily federally regulated health care institutions. Horrible. You're right. The NBA? NFL? NHL? Private industry/business (to include some areas of healthcare)? It's the best example of 'meritocracy' in the history of civilization.

Institutional culture. Getting GA for less/non-invasive procedures like bronchoscopies, some EP procedures etc. where co-morbidities are low and the patient will be going home can go to phase II. ERCP's are generally sicker patients and higher risk so ought to go to phase I. But GA in itself is not a reason to have to be in phase I.

I'd be careful about pointing out the extra 5 mins/ using that as a rationale against the NP rooming his/her own patients. 5 mins per patient is still way less than salary/benefits of another MA, or even half of one. Losing time for 2 or more patients per day? Different story.

Ah...

Pretty positive @heron is a 'Mainah'...LOL

What profession would you recommend that is free from self interested motivation that undermines colleagues to elevate self? Probably happens at Buddhist monasteries in Tibet. Not a person on earth that isn't capable of that. The trick is knowing the person capable of it is looking right back in the mirror.

Why does being a passive aggressive, manipulative toxic *** need a contrived, meaningless label like weapon whatever? If there are bad players on a team, it should be apparent enough to the leadership and the rest of the team. I think a more appropriate label would be 'incompetent leadership'.

This whole conversation is a category error. The only thing police and nurses really have in common is that they both go to work and get paid, many in shifts. Might as well compare horses to tuna fish, they both swim, after all...

In the end, it's not your responsibility to take care of the patients, its the nurses'. Specifically the charge nurse sending and the charge nurse receiving. It's 100% on them. You just make the calls and let them duke it out when patients start backing up and its the RN's that start feeling the pinch.