philpo
@philpo@feddit.org
- Comment on Awooga 2 days ago:
Well,patients do get asked for consent before these pictures are taken (and usually are again asked for approval again when the whole thing is layouted).
But,tbh, most patient I got to know with similar, rare, cases are often more than happy to help science and help other patients who experience the same right now or in the future.
I personally had a case I worked with peripherally where a breast implant basically exploded after a road traffic accident and the poor, rather young, patient suffered from a catastrophic infection and bodily reaction before that. As in: “She nearly died,was on ecmo, needed her sternum replaced”-catastrophic. (And no, not a cosmetic breast implant, just making sizes equal)
Tbh, despite extensive plastic surgery the final result was…really grim. I have seen third degree burns with a better cosmetic result… Especially for such a young woman. Further correction would need to be done much later, at least 5 years from then. She was nevertheless very keen on appearing in the case report and did willingly take part in photos(and even provided pre incident photos), appeared in front of medical students and interns, etc. It was part of her way of dealing with it,of making sense out of this freak occurrence.
- Comment on Awooga 3 days ago:
Shit. That’s a terrifying case in so many aspects.
- Comment on Awooga 3 days ago:
My condolences to your spine.
- Comment on Not trying to disparage first responders on 911. Why aren't nurses included with fire and police departments? Did we not take care of people on the backend of the rescuing? 3 days ago:
I don’t know where you live,but as you are mentioning 911 I guess it’s the US - there are a shitton of ambulance services that use nurses as BLS or ALS providers around the world. (The netherlands, sweden, Italy, Spain, just to name a few. I intentionally do not name the US here,see below)
For the US, UK and to a lesser extent Germany there is a simple reason: You guys did fight tooth and nail not to do so.
But let’s go back a bit further: If you look into the history of EMS it’s not like that the fire departments were that happy to do so (and to this day I am a staunch opponent to them doing so. It’s an all around bad idea) and in many parts of these countries police, cab services and funeral homes did provide the first ambulances, other than charity organisations.
When it became clear that prehospital care was needed in these countries the fire departments or independent “transport only” ambulance services had become the norm in most areas and there indeed were some people that pushed for nurse staffed ambulances - as nurses during the war had shown to be beneficial in that role.
But they were basically scolded, often even publicly insulted, by nursing associations:
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Nursing back then was far from an independent profession like it is today. Back then actual medical skills were largely dependent on doctors orders with very little leeway for interpretation. (From a nursing book in 1958 “if the blood pressure of a patient is too high or too low must,under all circumstances,be decided by the doctor and it’s not upon the nurse to decide this.”) Asking someone who is fully dependent on another profession for decision making to now make independent decisions without that profession and in the worst possible environment and use skills that the same person wouldn’t be allowed to use in their regular workplace understandably was a major cause for concern, dissent and resentment back then. And to some extent this is understandable.
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The second factor was based on the issue of gender and “morals”. Nursing back then was a mostly female profession. Putting them to the scenes ambulances need to respond to (brothels, crime scenes, etc.) would, according to a female nursing director in a UK hospital “corrupt my girls”. Additionally, due to the fact that heavy lifting would be required(see below) and the ambulances would need to be driven by someone, the “poor nurses” would need to work alongside male ambulance drivers and that would also lead to immorality. (Their words, not mine. In case of the UK somewhat insulting to their Queen,imho)
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Another factor was surely the fact that “transport only” ambulances already existed and that (also due to the lack of proper equipment) it was (rightfully so) considered backbreaking work - patients did need to be lifted far more than today, lifting equipment was primitive and medical equipment was far heavier. (I remember defibrillators that had 40kg…and I am not that old). So adding a third person would mean extra cost while you still need men (according to their reasoning back then). And as the first paramedic provides little more than BLS+ it was not that resource intensive to teach the people already doing the job.
Nowadays nursing has developed a lot. But so has paramedicine and it is an independent health care profession in the more professional systems (CAN,UK,IR,AU,NZ,GER,POL,etc.). Because skills,mindset and approaches towards patient care are different. The US with it’s abhorrent EMS system uses nurses in some roles,but tbh, the main reason is a lack of proper paramedic training standards, standardisation and oversight and the results are, well, underwhelming.
And why are nurses not named in line with other first responders in the US and similarly in a lot of other countries?
Because they aren’t first responders. The issue with being a first responder is not the level of care, it’s the “unknown”. Hospitals are, to a certain extent a controlled environment. Even in the ED you most of the time know what’s happening next, even if the next patient is a multi system trauma and comes in without prior notification it’s still your playing field. You have light, it’s warm/cold, you are rarely alone, you have your equipment where it was the day before and the day before. On scene it’s different. The next call might be a mansion. Or in a ditch. Or a methlab. It’s the same people you see in the ED, but now it’s their home turf. I have resuscitated an almost naked 12 year old in -20° C alone (as a in “single responder”) in a park known for it’s shady people. That’s different.
Don’t get me wrong: Nursing has it’s own challenges - I worked both sides long enough to know that I sure as hell won’t ever work another hour in nursing. As a para you have 1 patient most of the time. Not 25. Once you know your call,you can be almost sure that you won’t have another patient until you complete the call there won’t be another patient suddenly taking away your attention. You can leave the patient after like an hour max. And you rarely see them again.
All these things are different in nursing. Multiple patients, changes in priorities, seeing patients day after day - it is its own beast. But it’s different.
I am happy for everyone who does nursing. So am I for every midwife. Or every guy and gal that takes up paramedicine. We all have our place in this hellish trade.
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- Comment on How to Decide what an Appropriate Medical Response is for Loved Ones 5 days ago:
Good, that makes it a bit better. Sorry if I am a bit salty about this topic, but I literally had to attend a 13 year old girl who got hit by a car due to someone “racing to hospital” once - was not a pleasant call and ended with life altering injuries. (And the reason for the “emergency” absolute bullshit).
The “drive safely” is relative,btw - even for professionals, believe me. There is a small study that compared the driving skills of regular first responders (lights&siren drivers) in a simulated family/partner/work-partner emergency under regular driving conditions (no lights and sirens) to their normal driving skills. It’s between 4 and 7 times more likely to commit a potentially accident producing traffic infringement.
Anyway: Just because we can send these resources doesn’t mean we always do - emergency medical call takers generally know what they are doing and will ask you the right questions. It won’t be “I need an ambulance, by kid got stuck by a bee in the neck” “okay,we send one,bye!”.
And even if they decide to make it an “all out” call there are plenty of people along the way who can stand resources down once they reach you and assess you. But we would rather send resources 10 times and be not needed 9 times than have the one call that actually needs that response not getting it. So… Don’t be mortified. In doubt,call us.
- Comment on How to Decide what an Appropriate Medical Response is for Loved Ones 6 days ago:
First of all: Stay calm. It’s extremely rare for people to go to the doctor to late just due to “not caring enough” unless it’s old (mostly rural)folks. (One of the first things I learned: When a farmer calls an ambulance, always take full ALS gear with you) Or caused by mental health issues or financial constraints. People are far more resilient than we generally think.
Then: Most industrial nations have “medical helplines”. In Australia it’s 1800 022 222, in Canada 811, in Germany 116 117, etc. Resesarch your local number and if unsure: Call them.
Then: Look at the so called ABCDE Scheme.(Extended version of blood goes round and round and air goes in and out and any deviation from that is bad)
Airway: Anything that fucks up an profoundly airway for more than 30 seconds is an issue - call an ambulance. Aspiration, foreign body obstruction, anaphylaxis reaction with airway issues. Extremly runny noses (as in RSV) and associated breathing problems warrant an ED visit. (But seriously people, get your kids vaccinated)
B: Breathing: Anything that continuously makes breathing problems is a “go to the ED” or “call an ambulance” thing. Continuously (!) is the point. It’s normal for someone to have a coughing fit or breath a bit heavy when having a flu. But there is a difference between “my lungs are gonna kill me, i need to stay on the sofa and watch netflix” to “breathing has become so bad I actually have to focus on it and one flight of stairs slowly would make me feel woozy” to "okay,now I really really need to fight to breath enough ".The second one is a reason for an urgent care visit, the later one for an ambulance call. Also: Look for the lips and the area around it. Does it look blueish? If yes: Seek help. There are countless examples online. With children it’s a bit more difficult, to be fair. But as a parent you often will know when - when you manage to stay calm. Signs of acute need to seek help: Children whose chest kind of “cave in” between the ribs need an ambulance. Children who can normally focus on you or other things and don’t due to being focused on breathing? Call an ambulance. Children who are having audible breathing problems (as in: you hear them in a quiet room and it’s not their nose) will need an ED visit. And again: If they become blueish/whiteish. But again: There is scientific proof that parents who manage to remain calm and get a calm observant look on their kid identify urgent and critical cases better than healthcare professionals. The staying calm part is hard,though.
Circulation: In adults: For fuck sake people: If you have chest pain that is not triggered by a certain action (e.g. a pain to the wall of the chest when breathing in deeply, a slight pain when coughing, etc.) call an ambulance. And especially for women: Strange abdominal pain, neck, arm or jaw pain counts. Especially when paired with shortness of breath, when it gets worse when you exert yourself. Or when it stays more than a few hours. Or is paired with very low or high blood pressure relative to your normal blood pressure. If you feel something pulsating in spots where normally nothing should be pulsating maybe see urgent care. Previously unknown dizziness when standing up? ED.
With children again it’s a bit more difficult. The good news is: They very very rarely are compromised circulation wise,they hold themselves together for a long time (and then crash). But: It takes a lot for the latter to happen. Generally: Massive and sustained vomiting or diarrhoea are an indication to go to the ED, sooner than you would do as an adult and the smaller the earlier. A very good indicator is the recap test, look it up online.
D is “disability” in this scheme and meant in the sense of “neurological issues”. They are actually easier than most people think. It’s obvious that an unconscious person should get an ambulance, as well as a seizure (please also call for febrile seizures). If someone is showing neurological deficits by either being disoriented, absent or having sensory or paralysis-like issues don’t wait,call an ambulance. If someone is suddenly vomiting uncontrollably and having a headache or any other neurological issues: Get to the ED. Likely a migraine,but there is a slight chance for a very very bad other reason. (And migraines aren’t fun either).
In children look up meningism signs - can happen due to fever as well, but that’s a good reason to go to the Urgent care clinic.
E is meant here as exposure,but covers bleeding,trauma, abdominal issues and infection as well. Seek help for scaldings/burns and any bleeding that you can’t stop within minutes or that requires more than a large bandaid. Seek help for anything that does belong in the body. Sustained abdominal pain that makes a child unable to be calmed down for more than 1 hour is a very good reason to go to the ED. A bladder infection in a child is a good reason to go to urgent care. An abdomen that gets hard as a brick when a little bit of pressure is applied is a reason to call an ambulance.
Fever is a bit of a hit and miss situation, especially in children: First: Fever and sepsis are NOT the same. You can have a bad sepsis and have zero fever. (The last guy I nearly lost to fever had 34.5°C and never went beyond 36.5° before). Second: Fever sadly has the issue of causing febrile seizures and putting a lot of strain on the circulatory system. Which is bad. Third: But a bit of fever is nothing bad per se and there is more and more scientific evidence that an too aggressive approach to reducing fever is a bad idea as well in children. So…in the end it’s a bit of a question of moderation. Give something when the child is actively “sick” and unable to do most things due to that. Give something when the fever goes beyond 39.5° C. Fever itself is not a reason to go to ED or call an ambulance - the symptoms that go along with it might. (And please get a proper thermometer and not one of these “forehead” or touchless ones. And don’t try the house remedies of lowering fever like putting cold wet towels on the patient…they have all been proven to make it worse)
This is just a little bit of advice. And you don’t know if I really know what I am talking about. So please read up yourself. Get a first aid course and a children’s first aid course. Check local resources and where urgent care options are. The ED and ambulances are the worst options - both in treatment quality, resources and often comfort.
- Comment on How to Decide what an Appropriate Medical Response is for Loved Ones 6 days ago:
Critical care Paramedic here: The reaction above is the worst one basically. Worse than doing nothing. Don’t do that.
Yes, anaphylaxis is bad and kills people. If it is that bad ,you will know that something is wrong within 60-120seconds. (That’s why epipen exist)
But: There is a shit load of things that can be done in between “getting stung” and “cardiac arrest” in terms of first aid - and emergency medical dispatchers can and will tell you what to do. None of them can be done properly in a moving private vehicle.
But what happens - more often than it should is people doing these stunts risking the lives of others, having an accident themselves or simply delivering a dead patient to a hospital that could have easily been saved by basic first aid and an ambulance.
And to make matters worse: You will very likely be in a even worse spot. EDs in a lot of countries(it is surely the case in Germany)are not necessarily staffed by people who are experienced with paediatric anaphylaxis patients and only a minority of hospitals deal with any paediatric patients at all. If you’re unlucky an intern with 1.5 years of post graduation experience who didn’t even see an adult anaphylactic reaction so far will staff the ED, has no equipment to deal with paediatric patients and one can only hope the intensivist/anaesthesiologist on duty is not currently dealing with other stuff. While ambulance staff get trained in this shit regularly, it has more than enough equipment available, and can bring in specialist staff (critcare, physician response units, helicopters) - and believe me,most ambulance systems will make that a “send everyone” call. (For my neck of the woods: Neighbourhood app alarm to send off duty personnel, volunteer first responders from a charity or closest BLS ambulance, ALS resource, physicians response car, potentially helicopter with paediatric intensivist)
So…for fucks sake people,call an ambulance. In most industrial nations they will be faster, they will know what to do, where to transport and you won’t risk crashing into other people or having a dead patient in the backseat by the time you arrive.
(BTW: It’s extremely rare for an sting into the skin of the neck to actually impede the airway due to it’s location - there are very few tissues where this can become an issue. Totally different for stings within the airway and mouth, but most stings outside that lead to airway obstruction would have led to the same result for a sting into the arm. The location does not have direct causation for the location of the systemic reaction)
- Comment on Water Boil Advisory 1 week ago:
I literally told you the actual scientific approach that is currently used by disaster response management professionals. The methods used in OPs case are utterly insufficient and potentially dangerous. I also gave you an example why.
So…
- Comment on Water Boil Advisory 2 weeks ago:
That can easily be done by cell broadcasts (which can absolutely have different stages of priority nowadays), mass-SMS (every cellphone that first registers in an affected area gets a SMS, via designated disaster management apps, by placing handouts on peoples doors (you usually do that by identify people at risks e.g. homecare patients, then you go by high to low risk areas - depending on the search of the contamination) and last but not least a few trucks with loudspeakers (even regular cop cars do) do wonders.
What happens here if someone is not at home when called, is not an actual customer of the water company, etc.?
There are dozens of better ways than how this was handled in OPs case.
Source: I consult community and disaster response organisations on this stuff.
- Comment on Who is the enemy? 2 weeks ago:
Nah, you’re good. True methheads are… something else… That stuff really fries brains.
- Comment on Who is the enemy? 2 weeks ago:
Paramedics hate methamphetamine. And alcohol. And high voltage electrical current.
But we love people who injure themselves creatively.
- Comment on Guess I'll just die 3 weeks ago:
I just leave that here:
- Comment on Um... I'm not even using a VPN... Fuck you reddit. 4 weeks ago:
Fair enough!
- Comment on Um... I'm not even using a VPN... Fuck you reddit. 4 weeks ago:
For the Mozilla users: There is a shitton of Tampermonkey (an extension) scripts that automatically redirect you to old.reddit.com.
- Comment on Do gangs that collect protection money actually do any protecting? 4 weeks ago:
From what I understand,yes, but she said “they showed us a guy they beat to pulp, he said he is sorry. But the guy wore a ski mask when he robbed my aunt. How should we know if it was him or if that was just some homeless person?”
- Comment on Do gangs that collect protection money actually do any protecting? 4 weeks ago:
I know someone whose family founded a small retail chain (with like 5 shops or something, each operated by another relative) in an east European country shortly after the fall of the iron wall that is, well, pretty much associated with mafia-like structures.
According to her after the initial mayhem they did have a group establish themselves that was more “mafia” like. Think black suits,old Mercedes Benz cars,etc. They actually had a “emergency number” they were supposed to call and where someone picked up 24/7. And according to her someone actually came - unlike the police back then (who also wanted money). They responded fairly fast - and to them it seemed like they actually at least tried to find perpetrators. But they were never quite sure if some of the people who robbed them were actually sent by these groups themselves to prove how much the shops needed protection. Over the times things got more extreme and the “group” only wanted money to protect people from themselves - possibly because drugs got involved and the “thugs” got younger. But at least then the police stepped up their game and did more.
- Comment on Why are there so many german communities on Lemmy? 5 weeks ago:
Yeah. For an “eingetragener Verein”. For a Vereinsgründung of a non registered association two members are enough. So if you want to be a Klugscheißerle, read your BGB first. Micdrop
- Comment on Why are there so many german communities on Lemmy? 1 month ago:
Verdammte Autokorrektur!
Verdammte Grammatischeafdler!
Verdammt!
- Comment on Why are there so many german communities on Lemmy? 1 month ago:
I know. But an Austrian one.
One could say they are more German than the Germans, but… well…that didn’t work out well before…so we don’t say that anymore I think.
- Comment on Why are there so many german communities on Lemmy? 1 month ago:
Yeah. Personally I try to visit non-American subs for that quite often here. Australia, Canada,etc. provide different views and influences as well and are English speaking.
- Comment on Why are there so many german communities on Lemmy? 1 month ago:
Yes and no. The zealousness of Germans to stick to rules but also to create rules is the issue.
Just a few mid 50 friends kicking a ball once a week in a public park to stay fit and have an excuse for a beer afterwards? Nope, that’s regular use, join a club, get into a 50+ team and kick there, but don’t forget that you need a player pass, pay club fees and often have to do 24 work hours per year.
Or even worse: Allotment gardening. Heavily regulated in most clubs by a few boomers (think HOA2.0) that will cite you for fallen leaves. And if you have the wrong type of hedge in your garden. Or if it’s to high. They will then mandate that you cut it. Which you aren’t allowed from March to October due to environmental protection laws. And of course if you sleep more than one (or two) nights in your garden it’s also forbidden. And beware if they find another salad in that part of your patch,that one is only for flowers. (It’s so bad that it is a meme in Germany)
There is a German word for all that, of course: “Blockwartsyndrom”. A Blockwart(officially Blockleiter)was the lowest position with (very little) power during the Nazi times - they were literally responsible for a building block (around 40-60 flat). They were the ones who spied on their neighbours, organised the Volkssturm later on(aka sending poor kids and old folks to their death) and generally pestered their neighbours. Blockwartsyndrom simply means: Give a little man a little power and he will everyone’s life hell.
- Comment on Why are there so many german communities on Lemmy? 1 month ago:
Germans have a tendency to associate in a formal association (called Verein). From sports clubs (often even the smallest rural villages have multiple), allotment plot gardening, hiking, environmental protection, neighbourhood based one, as parental associations, cars owners, professional ones to old folks and widows, etc. etc. These are all registered with the local court (e.V.), have a formal operations charter,etc.
As people tend to be multiple clubs/associations there are far more club members than people in Germany. Germany holds the world record in that regard since 1945. (Personally I am a member of…12 I think. Maybe more. Car, School of the kiddos, sports, sports of the kiddos, a few very niche professional ones, environmental ones, a local food one,etc.)
This tendency to formalize things also sometimes is visible online in terms of subcommunity formation.
- Comment on Why are there so many german communities on Lemmy? 1 month ago:
To give a more serious answer:
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Germans are a bit more privacy focused than most other nations (if you want to know how much read up on the google street view controversy). Germans tend to be much more aware how Meta/Google,etc. abuse their data (and while the average German won’t care there are enough of them that you actually note it)
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There is a very strong “antiITestablishment” subculture that is very active since the 80ies. The Chaos Computer Club and its congresses,etc. but also the recent trend toward digital sovereignty has increased the amount of people who see Reddit and (to a much much larger extent) Twitter in a critical light - and due to the close links of Mastodon to Lemmy that helps both.
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German speaking people, especially in the,on Lemmy, overrepresented Tech field tend to understand English fairly well (but underestimate their ability to speak it themselves often). That enables them to consume English speaking content as well, not forcing them into other media formats that do cater more for smaller languages.
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And let’s face it: There are a freaking lot of German speaking people. Around 100 Million people speak German in Europe - and while that of course is nothing compared to other India or China it’s the largest non-english language block in Europe. That gives one a large enough “crowd” to actually find an audience for a sub - while it’s rather hard to get enough people for an Italian speaking niche sub it’s far easier to do so if it’s German speaking.
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There are also some cultural issues at play - to quote an old German saying that says: “Three Germans meet - they found an association (Verein)”. Germans tend to self-organise extremely proactively. Which is often tiresome, believe me. Additionally some Germans tend to find the Americocentrism on Reddit, but also to a lesser degree, on Lemmy, boring and at times nerve wrecking.
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Lastly the German main instance, Fediverse.org is operated by a pretty robust foundation who knows what it is doing. Which of course keeps the community more stable and hosts a lot of European (non German) subs as well.
Source: Am German, lived abroad for quite some time.
Yes, I am fully aware this question wasn’t totally serious.
No, contrary to common believe we don’t have to go to the basement to laugh. Germans go to the basement for sauerkraut and to watch German dungeon porn, Swiss to clean their bunkers and Austrians,well, I’d rather not talk about that.
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- Comment on Scifi question about time travel: 2 months ago:
Dude, just read the fucking manual, it’s on page 95 right under “What to do when a Gloridian chokes you through the time window?” And just before “Things you should report to the Time Cops”
- Comment on Krafton Issue Statement Regarding Subnautica 2 2 months ago:
There is also the possibility,like always, that both sides are assholes, btw.
- Comment on What is the funniest insult / joke you've come up with on the spot? 2 months ago:
Not me, but a friend. She got insulted by a drunk female nazi who happened to be… Ugly as fuck,not only because her ideology.
Very calm and mannered she simply told her:"Excuse me, Ma’am, as I midwife I feel professional inclined to forward an important piece of advice to your dear mother: Usually you throw the afterbirth away and keep the baby,not vice versa. "
- Comment on Uniciv (open-source android/desktop 4x game) 4.17 release! 2 months ago:
If we ever get a proper open source version of a city skyline like game…I need a sabbatical or early retirement.
- Comment on Can it take months to get over being laid off? 2 months ago:
First of all: As a healthcare professional but not your healthcare professional: What you describe has strong signs of a depressive phase and you should first and foremost seek professional help - don’t trust the internet on this and more importantly don’t start to self treat yourself in any way besides behaviour based measures.
Secondly: It can take ages. I’ve been there. Especially when your new job is similar to the old one it is quite difficult, as you “in theory” know what to do but in reality you still have to find your place in the new company. It will take time. But it will get better.
- Comment on Doctor Debates 2 months ago:
Well, just to be clear, that is meant for mechanical things…
Fluids,not so much. For obvious reasons.
It’s a hell of a lot of work to actually dilate it.
- Comment on Doctor Debates 2 months ago:
It does so over multiple months. It is very averse to so spontaneously, as every OB/GYN might tell you. Always causes stressful situations in the OR.
(Beside…the cervix is more or less a one way device. That would surely make it rupture. )