My cat once brought in a North American shrew in the house and I thought “what a weird looking mouse!” So, I went to scoop it up in a dust pan and drop it out side and the little shit bit my finger! Anyways, got it outside and went to look it up and found out they (the NA shrew) were venomous! Luckily the bite was superficial and I only had slight redness for the night.

Fun fact about the shrew is apparently it is highly territorial and can defend a territory of > 1 square mile, and somehow my cat found the one shrew in a sq mile area in our backyard which is like a 1/16 acre neighborhood plot lol

Def not a math major (BS/PharmD), but your explanation was like seeing through a visual illusion for the first time! lol

I was always taught PEMDAS growing up, and that the MD and the AS was read left to right in an equation like above. But stating the division as a fraction completely changes my mind now about how this calculation works. I think what would happen in a calculation I use every day if the former was used.

Example: Cockcroft-Gault Equation (estimation of renal function)

(140-age)(kg) / 72(SCr) vs (140-age) X kg ➗72 X SCr

In the first eq (correct one) an 80yo patient who weighs 65kg and has an SCr ~ 1.5 = 36.11

In the latter it = 81.25 (waaay too high for an 80yo lol)

edit: calculation variable

KCl labeled as asa? As a critical cardiac care nurse, I am duly horrified.

Trust me, so are we. Typically, the reason for the mislabel is due to the machine that is used for pre-packing from stock bottles. For the most case, standard meds are given their own containers for the machine, but when there was a KCL shortage going around something happened where a standard container was used for a non-standard medication and they didn’t make sure the old container was cleared before adding the new medication.

That being said the pyxis pharmacist checking, should have looked at EVERY pre-packed med (100 per batch typically) and see that they all looked correct (eg: no doubles, empties), and would’ve seen the size mismatch between the 2 meds lol. We have some great techs though and one of them caught it as they were doing their pyxis load.

Love my crit care nurses though! We have 5 ICUs (+ ER/Trauma) and most all those nurses typically have their stuff together, which makes my job much easier, when I gotta call with questions! So, thank you for being on the ball!

75-80% of the time. All the staff I work with will take initiative at some point, but some do it more/better than others. I have a certain level of trust with some co-workers that I do not with others.

As an example, We have 15ish pharmacists on staff (non-admin) and 25-30 techs… There are probably 5 or 6 pharmacists and 1/3 of the techs, that when I come in (rotating schedule btw) and I see “those people” are working I know I need to buckle down and really scrutinize what is going on.

Now, like I said in the first post, everyone makes mistakes. Including myself. But I think there is a difference between the mistakes and how they are handled.

There is this mentality of “I didn’t do it, So it isn’t my problem”. When really we should be looking at it as an “institution problem”, or its everyone’s problem! For example, the other day a doc called about starting a bicarb drip on a Hyperglycemia patient. We have a policy on hand to do 150 bicarb in 1L Sterile water. However, this one pharmacist doesn’t like using sterile water (because of HYPOtonic concerns), so instead talks the doc into doing a 150 bicarb in 1/2NS (well this makes it a HYPERtonic soln now and the patient only has a peripheral port AND their sodium is already 141)… OK well when it got to the IV pharmacist, they shouldve said WOAH what it going on here! Instead they let it through because another pharmacist did the order and it isn’t theyre problem if something goes awry. I would have called out there and said WTH are we doing? this isn’t policy! and got it changed.

In the grand scheme, the ordering pharmacist did talk to the phsycian and got the okay, but in the real world physicians are not as infallible as they are portrayed, and our pharmacist gave an inappropriate option for treatment, which the physician trusted was an okay treatment plan. Was the patient injured by a single infusion? no. However, it was a continuous infusion and when I saw the nurse was asking for a refill to start the 2nd dose, I said WTF is going on here and started digging.

Let me say though that this is a national problem, not just my hospital. Also, the things that usually go through when they shouldn’t is stupid things that never effect the patient. When it comes to dangerous medications, we have different procedures for checking of orders, or it goes through a specialist pharmacist first (eg: chemo pharmacist, pediatric pharmacist, critical care, infectious disease, etc you get the point). It is more of an annoyance on my part because I usually take the time to fix a problem when I see it, and other will let stuff slide because theyre not the ones who’ll get the variance, and it won’t hurt the patient anyways.

Just for posterity sakes, if you are curious, what is a “mistake that doesn’t effect the patient”?

Example: We have a NICU and those little babies will be put on continuous infusions sometimes like dopamine to improve their cardiac functioning. So, all our NICU orders are standardized to the weight of the baby to determine the size of the order. So let’s say that the order calls for 0.06ml/hr. That is 1.44ml/24 hr period. So, we would most likely send a 3ml syringe (to allow for titration). Well when the order is sent electronically to the pharmacy it always come stock as 1ml, and we have to change it to the appropriate size. If it isn’t then the nurse will be calling for refills more often than needed based on titration (1ml = 16.6 hour infusion). This is a mistake that is counted towards us.

Is it teachable? sure, pharmacy school rammed it down our throats. However, being short staffed makes people cut corners, and that become the learned state in those situations.

Ya know a lot of ppl think pharmacists are just about putting pills in a bottle… but in all honesty in the role that I work clinically in a trauma center, I would say what sets a good pharmacist from a mediocre one is being able to catch everyone’s mistakes.

Your fellow pharmacists, techs in the pharmacy make mistakes (150 bicarb in 1/2NS?? lol) (incorrect pre packing procedures and getting kcl w an asa label)

Your docs make mistakes (2000mg q12 vanc on an esrd pt with a bmi of 45 + Zosyn 4.5 q6)

Your nurses make mistakes (y-site compatibility, missing doses, losing meds, etc)

The issue is noticing the problem and taking initiative to fix it. Unfortunately, either by ignorance, not correctly verifying, or just plain laziness can lead to sub optimal care for our patients.

It’s not easy though. I easily go through 500-1000+ orders a day, while calling doc/nurses, double checking techs and other pharmacists work. It can be stressful, and it’s easy to put blinders on and just keep hitting approve, but the pharmacists who look at that 4th 40meq kcl bag of the day for 1 patient without a lab drawn in 18 hours and calls the provider to see if maybe they want to draw a lab before the next admin. Those are the pharmacists doing a good job. This can go for the retail folks too who have to put up with way more shit than I.

Not worried in the least, house is < 10 yo and don’t plan on moving anytime soon. I also think my houses “value” is over inflated anyways.

Now if I bought in the last 3 years? Yea I might be sweating a little bit about being under water, depending on price and location.

So unless you live in an area with fiber, asymmetrical speeds are pretty typical… I’m not sure if it is because it’s all coax so there are infrastructure limitations? But it’s actually gotten faster because 6 months ago my upload was only 30 mbit/s.

Once fiber is in my area I’ll switch to that, but symmetrical will add more cost…but of course it will lol

Since the day before the Reddit strike… so mid June?

pay $180/month for 1gbit down/100mbit up and it is unlimited… It would be $130 for 1.75TB, but I wanted unlimited and that is an extra $50/month

God Dammit! Now Im getting SponsorBlock ads in lemmy! When will it end!

There is honestly nothing I could say to make you feel better about this situation. Im sorry CFB bro. Im still holding out hope for you guys to maybe maintain the PAC name and maybe rebuild with you guys at the top! Youre right though about the money. Maybe there is still some money holding all the rights to the PAC name?

If you are using steam, you can just copy all the files from your device to hers. Then let steam validate the files and you are off to the races. My spouse and I do this all the time to save of bandwidth and time.

How do you tell you parents goodbye when the next massacre hits though?

If this was the deal that Kliavkoff had up his sleeves the whole time, it’s no wonder he kept pushing off telling the schools about it. Not only that, but other networks now know that’s the best he can get and he’s unlikely to get much more from other networks since the league looks desperate. I am very curious what Wash and UO are thinking rn, but I’m sure AZ is ready to jump if the coach is calling recruits to keep them interested in staying with their commitments.

Yep your right I miscounted … I still don’t see them wanting 18 or 20 teams in their league… you would never play every body and it wouldn’t make sense… you would have to have a b10 play off before the national playoffs lol

So, hypothetically, if the B10 doesn’t expand right now, and the B12 take all the 4 corners… What does Oregon, Washington, Cal, and Stanford do? Do they just go independent until another spot opens up?

The problem I see is the B10 already has 14 teams (starting in 24), so theyre only going to take at most 2 more teams, and one of those is left open for Notre Dame.

Stanford (and maybe Cal, but Cal is a Looooong shot) could possibly join the Ivy League.

OrSt and WaSt probably go to the Mt West.

That leaves Oregon and Washington - one goes to the Big 10 and the other does what?

This is on the assumption that a league max should be 16 teams… anything larger doesn’t make sense to me, but someone big will still be left out… Cal is possibly a last man standing as well, which is crazy with it being in the top 10 nationally in “overall” national championships (football though is dubious with 20-25 and 36) but still its no mountain west team.

Also, going back to the 4 corners, I read today that the B12 could possibly snub Utah because BYU already has the Utah market cornered, and for that matter one of the AZ school could be left out for the same reason (most likely ASU)… So, what if it was CU, AZ, UO, and UW? That would make an INSANE B12, I don’t think that is what will happen, but if just talking about market saturation and getting bang for buck, it would be the smart thing to go for.

OkSt - undergrad (Orange/Black)

CU - post grad (Black/Gold)

Black and Orange/Gold

LFG!! Both my alma maters are back together once again! Always bleed black & Orange/Gold!!

I think ASU is the strongest candidate to leave next, now that the ball is rolling. Theyve been very vocal about their anger with the conference. OFC that is just my guess and no one knows, but I have to assume that if the CU domino falls for real, then the others have to see some writing on the wall.

As an OkSt fan, I’m hoping this pulls the 2 AZ teams along with CO… Utah would be nice too, to be with byu

I’m sure Wash and Oregon will be jumping to the b10 as soon as a spot opens up anyways. So, it would be in the interest of those 4 getting a spot elsewhere sooner, rather than later. IMHO ofc.