GoodOldNe

Cardiac arrest is an incredibly heterogenous condition. A witnessed VF arrest in a young person with an inherited electrical type heart condition who gets compressions and a shock on a gym basketball court can wake up and walk away normal. A 98 year old who codes from sepsis or a fentanyl OD who is profoundly hypoxic or acidemic who gets enough Narcan and CPR to start having a heartbeat again after 15 minutes is very different. The statistics reflect this but you can’t generalize from the general to the specific in this case.

They're already working on it:

https://www.tvline.com/news/the-x-files-reboot-ryan-coogler-...

This is Sick-Tok's greatest hits. I am a former special education teacher and current emergency medicine physician and have tremendous compassion for those who are truly dealing with life-limiting conditions like ASD and real EDS (the kind that causes aortic dissections among other very serious kinds of pathology). I simultaneously have compassion for those who are suffering physically and psychically and who want an explanation and a label and for some reason find their way towards wanting to identify as chronically ill / disabled.

It's a tough thing but from what I have seen, pursuing the diagnoses on this list makes life worse for the vast majority of people who choose to do so. There is a rapidly expanding cottage industry of charlatans who will diagnose and treat these things, and others who post about them online and feed the cycle. I'll admit spectrum bias, since I see the ones who come to the ER with concern about these issues and they skew hard in a certain direction but this is overall not a good thing.

Sean Evans. :)

Cardiologists pride themselves on the best acronyms in study titles I think. There's a lot of good ones out there.

This is a trash study and the title implying that this is an AHA statement is misleading. It was a data dredge associational study with minimal controlling for other covariates / risk factors for heart failure. The implication that melatonin has a causal relationship with CHF based on this alone is a pretty big jump.

It's complicated. Physicians can own imaging equipment, for example, but they can't require you to use it for the radiology tests that they order. There are weird carve-outs for in-office ancillary services (e.g. you're an orthopedic surgeon who uses x-rays in your office, which is common and arguably necessary).

There's also rules regarding things like percentage ownership of physician owned facilities and the percentage of referrals to that equipment that come from the physician owners.

Urine drug screens in an in-office "lab" are another big source of revenue for certain specialties that involve referring patients to your own tests, or doing your own pathology on biopsies as a dermatologist or whatever. My understanding is that most of those things, and many like them, are not Stark law violations.

Excellent article in Bloomberg on this subject: https://www.bloomberg.com/news/features/2024-07-24/is-the-nu... (non-paywall'd link: https://archive.ph/03f4u) -- not the standard r/noctor drivel, but a well-researched and sources cited article exploring this phenomenon. Not discussed in the article is the phenomenon of more unnecessary testing with less trained providers doing the ordering which has downstream effects of cost and overdiagnosis.

I agree with a lot of the critiques of our healthcare system and as an emergency department doctor share them, but I doubt LLMs or NPs are going to fix our system. I also have a lot of concerns about broader societal trends in looking for pathologies / diagnoses in ourselves to justify or validate not feeling "well", repeatedly asking for more and more tests or self-identifying with a nebulous diagnosis and then incorporating that into identity as one who is perpetually sick. Particularly with younger generation, this is a really big issue and I don't see it getting better.

You need to have the sugar because it is required to transport sodium across the cell membrane in the intestine. Without the sugar you will not absorb the salt, which is what helps maintain hydration and electrolyte balance. This discovery has possibly saved roughly as many lives as antibiotics.

This is an oral presentation by a medical student at a meeting. I wouldn't change your life or approach to ASCVD risk reduction based on it.

Yes but it is the cause of many gastric ulcers and is undertested for at least in my community. Where I can easily do the test in the ER, I diagnose and treat many people with previously-unexplained epigastric abdominal pain syndromes.

My Halligan bar is my favorite tool I own. I've never used it for its intended purpose but it's super fun to hold and show people.

Cold water helps even more!

Fun thing to find on HN. I just cited this study in a presentation given to our local paramedics on syncope / passing out.

The corresponding author on this is a very serious scientist, most of whose work is in metabolic resuscitation and cardiac arrest. It's cool to see him applying his skills to this leading cause of disability and suffering. I guarantee you it isn't just "woo".

That's great feedback. Thanks! I agree, icons would be helpful and could fit nicely into the aesthetic.

I love that CookingForEngineers site. The original name I had suggested to her was Recipes for Engineers, since that was the vibe the table/nested flow layout gave me, it's cool to see someone else doing a similar thing.

I love the open source model, and there's some good looking recipes here!

Along similar lines, with similar goals, my wife and her dad have been building this as a pandemic project: https://www.recipereform.com/ -- I (who am admittedly biased) think it's pretty great. She inherited this style of recipe organization from her grandmother, and I love the formatting it of it, how clean the recipes end up looking and how fast / ad-free the site is.

I've been trying to get her hooked on HN for years. I showed her this thread and maybe this will convince her to make it open-source. Any feedback would be appreciated and helpful!

I can't believe they used the anal scan. This is too much like SmartPipe to be anything other than hilarious. It's where satire and reality meet back on the other side.

Pedantic point: If you’re intubation the esophagus, you’re doing it wrong. :-)

Yes, and in theory could be rigged to serve as a very simple ventilator.

Am doctor. Routinely prescribe 1000 mg of Acetaminophen.

Thought for a second someone had posted this on HN: https://fridababy.com/products/windi - Which is a bit of a hack in itself, and one that I'm sure would have generated some interesting responses.

This is an interesting study but I have several methodologic concerns and feel like nobody is discussing conflict of interest here. This is done at an institute owned and managed by one researcher, recruited from attendees of a seminar on lucid dreaming, approved by the ethics committee of that institute, and using a gold standard self-report rating scale that the primary author also invented. I am very curious about what they used for their active placebo. I suppose research on dreaming and the interaction of drugs with dreaming is pretty interesting and sparse, so I'll take what I can get but it would be cool to see this replicated in a more generalizable way before anyone starts trying this at home.

You're going to work as a "GP" with at most one third of the training of almost every other doctor in practice? Seems like you're shorting your future patients a bit. My advice as someone who sees a lot of patients who were incompetently managed at urgent care is to avoid going this route. You're setting yourself and your patients up to fail with potentially devastating consequences.

I disagree with some of the above posters.

This is often confused with, but is not the same thing as, physician aid-in-dying or euthanasia. People do talk about this in hospitals, and it is appropriate treatment for many patients at the end of life if they are suffering.

The ethical principle of double effect makes this permissible in these contexts. If the aim of the treatment with a benzodiazepine or opiate is to reduce suffering, the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications to achieve the first aim of relieving or preventing suffering.

Suggesting that this is a "workaround" for euthanasia distracts from the fact that this is not available as a treatment for most, if not almost all, dying patients. It is very different from physician aid-in-dying and is not a replacement for these other forms of end of life care.

Please consider some kind of roll cage if you're going to put a 2-3 year-old into this. In the United States we see a tremendous number of toddlers who are very, very badly injured (or killed) in ATV rollover injuries. Obviously an ATV is a much bigger and heavier vehicle than what you're doing (which is cool) but the mechanism itself of rolling a vehicle over onto a child can lead to a very devastating injury pattern.

Came here to post this. My favorite caricature of SV culture.

What pain relievers are much more effective than acetaminophen, and much higher in terms of safety? NSAIDs are a huge cause of bleeding and renal insufficiency. Tylenol is actually pretty good at treating pain in appropriate doses. Definitely a bummer when people overdose on it, fulminant liver failure is very unpleasant, but we have a great antidote for it.

Their website looks like it was designed in FrontPage 2002: https://www.ambrosiaplasma.com - The whole thing is super weird. As someone who has an interest in transfusion medicine, I would absolutely not do this.

There is also a very cool chalk drawing robot installed at the SF MOMA.

"Higher doses will lead to headaches and, paradoxically, tiredness and drowsiness — not stimulation."

False. You're right in that it won't help them very much -- specifically because taking overdoses of amphetamines tends to lead to things like insomnia, tachycardia/dehydration, and mania/psychosis.