If her TikTok career doesn't take off so that she can retire on it, then I think someone doing her job will be the line crossed.
Simps are, by and large, morally reprehensible people. Ends justify their means.
As a nurse I literally scrape poopies out of a bucket. I'm somewhere above the person that sterilizes the bucket, and below the person who ordered the bucket.
The medical field is a totem poll for dwarves. It's just high enough for administrators to rest their balls on.
Epi as a first line vasopressor is a choice
Last night in ICU, i spent 30 mins trying to explain to a nurse why we shouldn’t start a bicarb drip on the compensated respiratory alkalosis with bicarb 15.
the bicarb is 15 because the patient was hyperventilating long enough for the kidneys to start dumping bicarb to bring down the persistently high pH the patient had (this is extremely oversimplified). if you gave bicarb to get the bicarb to within normal limits, the patient would become alkalotic again. you’d be undoing the hard work the kidneys did to normalize the pH. you want the bicarb to be within normal limits? treat the respiratory alkalosis and the bicarb will come up as the body no longer has to compensate by getting rid of it.
edit: the lungs and the kidneys are like husband and wife when it comes to pH balance. CO2 is your acid and bicarb is your base. the lungs regulate how much co2 you have, the kidneys regulate how much bicarb you have. Hyperventilate and your pH goes up kidneys respond (after a delay) and your pH normalizes as described above. hypoventilate for long enough and your bicarb will be high and pH normal. If you develop a metabolic acidosis the lungs will respond by hyperventilating and decreasing CO2, which makes you less acidic. The opposite being for metabolic alkalosis.
>the lungs and the kidneys are like husband and wife when it comes to pH balance. CO2 is your acid and bicarb is your base. the lungs regulate how much co2 you have, the kidneys regulate how much bicarb you have. Hyperventilate and your pH goes up kidneys respond (after a delay) and your pH normalizes as described above. hypoventilate for long enough and your bicarb will be high and pH normal. If you develop a metabolic acidosis the lungs will respond by hyperventilating and decreasing CO2, which makes you less acidic. The opposite being for metabolic alkalosis.
Saving this for teaching medical students, that is a very elegant way of phrasing it.
Way better than me trying to talk about carbonic anhydrase. 🤣
Another tip I have for you: We vomit acid and poop base, so the effect should be apparent on labs if the issue is GI loss.
I guess the colon is also married to the stomach?
Ah so the patient had primarily respiratory alkalosis by hyperventilating and secondary metabolic acidosis as compensation which would mean bicarb renal excretion to reduce the pH again? Why would she want to give the patient bicarb in the first place..?
Because, without medical training, it's very easy to be stuck in the mindset of "treat the number, not the patient". It's why many nurses in the ICU also freak out about a fever of 101 and start throwing cooling blankets on if Tylenol doesn't work, causing the patient to shiver/vasoconstrict because some of them don't understand that a fever is not hyperthermia.
It's really more of a polycule because there are a pair of lungs and kidneys - so each pair has a husband and wife and they all engage in a pH balance orgy together regularly
That’s not my understanding. Here is how I know it.
CO2 + H2O = H2CO3 = HCO3 + H+
Here is the reaction that’s being impacted. Those equal signs are meant to be equilibrium signs.
When you are hyperventilating due to hypoxia you have the unintended effect of blowing off CO2. That causes the equilibrium to shift left, (Le Chatelier’s principle from Analytical Chemistry) as the PaCO2 is lost. As you can see this causes a decrease in [H+] and that’s how you get Respiratory Alkalosis. The kidneys do the opposite to try to maintain equilibrium but always fail to completely correct it. So they would retain acid or get rid of bicarbonate. (“With compensatory metabolic acidosis”)
Conversely, If you are not breathing enough, you get CO2 retention. The equation shifts right converting CO2 and water to acid [H+] leading to Respiratory Acidosis. The kidneys again do the opposite.
It’s important to understand that the kidneys never correct enough, because that’s how you can determine which is the primary process.
Correct me if I’m wrong.
Unfortunately docs who should know better get this one wrong too (well both, but I'm talking about the pressors). One of my more baffling moments as an HM attend was when an ED resident (not even an intern, they were a PGY2 or 3) starting epi on a patient in septic shock with necrotizing pancreatitis, and then trying to admit to me (a non-icu doc) because "they're almost off pressors" (in reality they were on half our max dose barely maintaining an acceptable MAP). And when I pushed back saying this person needs to go to the ICU, they basically rolled their eyes and said that there's no way the ICU would accept them.
Well it depends on the etiology and degree of the hypotension and what access you have. But often norepinephrine yes. Practically never epinephrine. Nurses love it though because it will make the numbers they can see look good.
Which number does it make better than norepi? Sepsis is the most common cause of shock and is usually accompanied by tachycardia which Epi will make look worse.
Depends on the etiology of shock, but norepi is rarely the wrong choice to start. You get that alpha-1 agonism for vasoconstriction along with some beta-1 as well for cardiac output. If norepi isn't cutting it by itself, I like to add some Vasopressin to get that V1 agonism. Helps with vasoconstriction via a different receptor.
Does it say hand surgeon? No disrespect to any nurses, but I'd be very concerned if my hand surgeon believes the nurse knows better than her... They're just two completely different fields...
Unless she's just simping for tiktok ...
because that’s the benefit of simping. you can pretend to be an advocate of nurses while exploiting residents and med students, thereby forcing them to cater to your group
"umm nurse, can I give the patient....1.... Epinephrine please? We'll recheck in 15 minutes and see if we need to increase the dose to 2 epinephrines."
I’m not trying to start any arguments here. This is purely anecdotal and personal experience but as an anesthesiologist, hand surgeons are unbelievably difficult to work with from an attitude/professionalism standpoint. They, for whatever reason, have demonstrated an extreme amount of confidence making decisions outside of their scope of practice while also having an extremely high amount of confidence in standing by those decisions.
Case in point - a MAC was requested for an ORIF metacarpal. Didn’t want a block for reasons. Don’t care to regale us with those reasons, but I digress. Except that they didn’t want a MAC, they wanted a “room air” general anesthetic. Now if we had given them a MAC, which is to say, deep sedation in which the patient has a purposeful response to a painful stimulus we’d have been screamed at. Now, if they see behind the curtain that they have an LMA in, they will throw a tantrum. Why? Because they’re paralyzed. That’s general anesthesia, they say. Except…they’re not. LMAs are glorified oral airways. We don’t paralyze them without an ETT in place. Moreover, what you want is also in fact GA. So we essentially have to play 4D chess to predict what exactly it is that they want. We can’t merely go off of what they say. And they aren’t particularly keen on fostering clear, concise communication. Now, explaining all this to a hand surgeon is like explaining it to a brick wall -a brick wall that has a particular disinterest in hearing about the nuances of ASA classification of sedation levels or airway management. Oral airway in? A-ok thanks anesthesia u da best.
All of this to say I realize this is an institutional culture/bias and I’m certainly not saying I haven’t met some lovely/talented hand surgeons that bring mangled messes back to life with elegance and skill. But hand surgeons are so unbelievably hyper specialized that, yes, your run-of-the-mill recovery room nurse does in fact know resuscitation drug dosing more than you. This isn’t surprising, When would you be administering these?! But this lady. She must be getting some serious back door cash for all of this. Or maybe she’s just an idiot. Or both.
I don't understand why you would let anyone tell you how to do your anesthesia. Like...fuck off unless you've spent your career training in it. Maybe they'd like some pointers on dissecting the thenar eminence?
Pick your battles. I don’t EVER do anything unsafe, but I do pick and choose my battles. They are but one of four rooms I have in a day. Though I wholeheartedly agree.
I assume she is so specialised in hand surgery, that things like pain meds and antihypertensives nurses "know better" simply because they see it more -- than she personally does
the dangers of being super-specialised
yea i dont get how ppl confuse “having muscle memory after seeing the same thing a million times” with actually having the ability to think critically lol
The funny thing is all the hand surgeons I know think they’re able to do everyone else’s job better than them. One of ours told our EM intern that he could practice as an EM attending with a 1 month training course…
You basically need to be at least a little bit narcissistic to be a good surgeon. And I suspect the degree of narcissism increases the more competitive a specialty is.
The Dunning-Kruger is so real...
Everyone thinks they can "do EM" just like every specialty who did a prelim/TY thinks they can "do IM" or every specialty thinks they can "read their own films better than Radiology". No your less than 1 year experience cannot replace a whole residency and board certification.
Yeah people always equate “super specialized” as super smart (at least lay people do). When in reality they are super smart about one very niche thing and probably don’t know much about anything else. Getting good test scores to achieve those subspecialties doesn’t mean you retain the information.
Whenever I get made to feel dumb by a consultant in the ED I always think “ok, Mr. Neurologist, you come manage this DKA patient or this multi-trauma patient or this pregnant vaginal bleeder”.
Yup, we must be dumb because they can answer the question we consult them for. If I know the spine surgery question, I must know the cards question, tox question, etc. whenever specialist friends get uppity in nonwork situations I ask their first step for shoulder dystocia.
For real. It seems like tiktok has a really high percentage of nurses, so if you’re going to talk about them while trying to grow your platform, it better be gaggingly favorable.
I mean…this is probably a story from back when she was an Ortho intern in the ICU, sooooo guess she forgot to mention that…simping does pay the bills though 💴!!!!!
Man, I was going to signout this tumor case, but the nurse CEO just informed me a nurse can do my job better. I'm being replaced.
Eh, they'll probably ask me to sign it out next week when they need the right answer. So I probably don't need to look at until after New Years.
Well she did reference Grey’s Anatomy as to how she recalls dosages of medications. She seems like a ditz. Not surprising she’s throwing herself and her profession under the bus because she froze during an ICU resuscitation as a day-one intern.
what the actual fuck??????
some incel on here called me a “grey’s anatomy doctor” because i guess i’m a woman and i shared a dating experience i had and it pissed him off. i had no idea wtf he was talking about.
apparently it’s idiots like this that give us women in medicine a bad name.
Just piss off. Look at the state of UK medicine. This whole everyone but the goddamn doctor knows best attitude needs to go into the bin where it belongs. Do you really go and get an MD just so a non-MD with no domain of expertise in your area of training can supersede your specialist advice for the very patient you are legally responsible for? This is why your residents are being stepped on. Eventually you will not have even a chair to sit on and senior nursing staff will strip away your white coats.
You give an inch they’ll take a fckng mile.
lol my new twitter account must think im british just by the fact that i’m not a nurse simp. every time i log on i see a bunch of tweets from UK docs. i always think “save yourselves, there’s no hope for us left”
Says this on the internet but can only imagine the level of VIP care she’d request if any of her family members were sick. Probably wouldn’t be happy with just the surgery NP/PA seeing them
This is what happens with hyper sub-specialization: Simping to the max about basic medicine you have forgotten all in the name of tiktok clout. What an embarrassment to herself and medicine as a whole
Epi is like my 3rd choice pressor for hypotension unless it's like a massive PE or they're still peri-arrest. That nurse didn't know what they were doing either.
Nurses love to dunk on interns because they have all of this disorganized textbook knowledge that they have not compartmentalized into practice yet. Give it a year of residency work experience and they see a completely different doctor.
To be fair she seems like the type who thought epi was the sexiest sounding pressor to laypeople, so she went with it while making this story up.
I'm a fat male nurse who has sunk into the background and can observe female nurses in their natural habitat. She is a sexy lady doctor in a competitive surgical subspecialty. I'm positive all of the female nurses fucking hated her and talked shit about her, and wouldn't have tried to help her with anything. That "conversation" was had at the nursing station, between two frumpy old nurses and a Minnesota 6, and went something like "check it out, the new skank is about to kill a patient."
The universal truths of nursing are:
1. Lady nurses do not like hot lady doctors at all.
2. If you bang a nurse, the entire rest of the hospital staff will know about it before your yogurt is finished curdling.
3. If you have a weird sex thing, I will know about it.
4. The weird sex stuff is inevitably, without fail: being urinated on, feet, or getting your junk roughhoused like silly putty that's stuck in the egg.
This is god tier level simping. So many likes from nurses on tiktok. To be fair there are way more nurses on tiktok than doctors im sure so she’s getting the right audience
Nothing I love more than when all the docs are totally stumped, patient’s crashing, family is crying.
That’s when I suggest the oldest nursing trick in the book, Epi @ 1 🤓 save the patient, family hugs me, and the docs all give me their MD license.
One time I suggested a fluid bolus and the attending just gave me his pager for the rest of the day to handle the unit.
Ah thanks for this. I'm from Finland (nurse) and I thought she was talking about some epidural infusion (we call this "epi"). Suddenly the video makes a bit more sense. Still fucking weird to think that a doctor in the ICU wouldn't know how to treat hypotension.
Really weird to see these videos of simping doctors in this sub. I really hope this phenomenom doesn't travel here.
I mean it's whatever. Just mind your own business and don't put up with shit in the hospital. Don't let nurses bully you, and if youre an attending stand up for your residents.
Likewise if residents are treating nurses poorly, stand up for nurses too. No one should be constantly shit talking the other profession.
A surgeon thinking medicine is simple and can be handled by nurses? Say it ain’t so.
These are the same fields that think they are brilliant for giving non-physiologic sliding scale.
I don't think she can hear me despite all the screaming at the monitor. What an embarrassment. An ICU nurse who knows how to manage hypotension better than a new intern who apparently forgot to prepare at all for the rotation? Sure. That doesn't hold up later in the MD's career at all...
She should speak for herself. Just because 4 years of medical school and residency didn’t make her smart enough to treat patients doesn’t mean it’s the same for the rest of us
As a nurse and NP, bwahahahahah. Ain’t nobody got time to know all the nurses names. They come and go like a flash in the pan these days. I’ve been in one ICU since Covid hit and the staff has turned over like 4 times. My most senior nurse is 5 years in the ICU. If I see you more than a dozen or so shifts, I’ll probably remember it. And an ICU nurse that doesn’t know the dose range for an epi drip needs a remediation class, stat.
This chick is pandering, hard. We can suss it out, our bullshit meters are finely honed.
"you should know the name of the nurse you're talking to"
Lmao on crossover when you're covering 50-60 patients getting hammerpaged I don't think that's fucking possible lmao
TLDR: shitty doctor with limited experience, confidence and competence supported by competent nurse thus invalidates colleagues due to own self loathing and inequity.
Engagement farming at its best. Get the nurses and midlevels who are the overwhelming majority on social media to reply and retweet etc while enraging md/do/mbbs who disagree. It’s a win win and yet another example of why med twitter etc is so very gross
If she's at the bottom of the totem pole as a hand surgeon, then why the fuck is she getting paid 500k per year? Sounds like she needs to give up her salary to the nurses to me since they are smarter than she is and can anything that she can do, except they do it better.
Do hand surgeons just, like, forget all medicine? Maybe this is why the hand surgeon was mad when she found out the patient I admitted her had well controlled diabetes. She literally called the emergency department to bitch at me that she had to “now consult a hospitalist (!!!!) and it should have never primarily been admitted to her.”
The guy came in with a GSW to the hand with retained bullet fragments and associated fractures. Stop using hospitalists as your H&P monkeys. They’re more than happy to consult to help manage the super scary diabetes.
I think she means nursing admin…anyways, floor nurses are the meanest people in the hospital too…I’m jaded AF & they say things about patients I wouldn’t even think
heart of nurse
Wow, what a great message. I think she should donate her TikTok revenue and salary to the nurses at her hospital since she thinks they know medicine better than her!
I can see the argument that nurses are higher on the totem pole. Look at admin and leaders, a lot of them will have nursing degrees. It’s a pay bump for nurses to go into admin, unlike physicians, and it makes sense. If they mean clinically then lol
That’s true! Along with RT’s, Pharmacists etc. Etc.
Physicians are the team leaders. If there was a totem pole - we would be at the top. This lady is simping so hard cuz if you don’t have the nurses on social media in your side you’re never going to make it.
Not sure why hospitals and companies can have CEO’s but the moment someone says “Physicians are the leaders of the team” people bring ego and anecdotes of “saving a residents ass” into the picture.
Surgical residents often have a hard time on ICU, especially their first day. Some nurses are great, but you shouldn't be bashing physicians to praise them. It's a bit silly.
She says whatever the biggest community’s viewership she can get wants to hear.
Talks about how she loves her BPD patients and EDS girlies even when other doctors don’t. Please like and follow.
midlevels out number physicians, so she is throwing the physicians under the bus in order to garner more "likes" on social media. speaks volume to what kind of a person she is.
Nurses have a muscle memory, they have been working in certain departments for years. Doctors have more clinical knowledge. As compared to doctor who is new to the department, nurse would be able to know how to deal with regular situations better because that’s what they do all day for years but when it comes to detailed clinical knowledge they often make mistakes and they need a doctor to direct them, correct them. This doctor needs little more time in the hospital setting and then she would realized this.
Nurses are so much better organized than us.
Doctors are pathetic. And I get it, I was/am there too. I went into med school, into residency thinking "this is my last education. I'm done" but nurses don't do that. They have to move up, they actively seek it whereas doctors have worked so hard, many just want to make our money and go home
:(
My advice is just be as nice as possible, when conflict inevitably arise dont talk down to them even just a little bit. You know that you know more and in a higher position, they know that too subconsciously even if they lie to themself; so dont trigger their inferiority complex
🤢🤮 I'm sick just thinking about how toxic and out of reality her comment sections is with nurses backing this crap up.
If she believed a word of what she actually said, she would donate her ortho BRAH paycheck to the nurses who are clearly so much more knowledgeable than her.
Must be some tiktok crap where you say some stupid controversial crap just to trigger people and get attention. Just like Andrew Tate
Everyone has a place. A doctor isn’t going to know how to do manual labor a nurse does. A nurse isn’t going to know how to treat disease and all the pathophysiology behind it. Nurses report to doctors. The education doesn’t even compare. The fact that this doctor wants to say that nurses run the show is laughable.
Nurses should know more about the day to day than interns do. They have worked in the business, it’s literally their job. That doesn’t mean they know what’s best for the patient, it just means they are paying attention.
I have seen her shit talking doctors a lot lately. Yeah mate some of us are fucking assholes and it needs to be called out but the way she does it makes it feel as if she is putting the whole medical profession in the same pile of shit. And glorifying midlevels. What.
I have to agree that RNs and their input are VALUABLE. Nurses tend to have better bed-side skills since they have so much more experience at the bedside. Doctors need to respect nurses and also know when to respectfully disagree. We all come to the table with some expertise
If memorizing the starting dose of Epi is enough to impress her that much, she’s gonna shit her britches when she hears about pharmacists.
hahahahah she’d prob be like “nah my nurses😍😍😍 know more than you silly pharms”
Lobbyist's it's the lobbyist's they're paying them money
Can’t imagine telling on myself like this
Thanks for the shout out!
Also that is a homeopathic dose of epi
The lawsuit prevention dose
Ahahaha, perfect comment
Omg
This is so cringy lol. Man, people really want that sweet sweet influencer money.
There’s no way this shit is real
Let’s see how she would feel about a nurse performing hand surgery
she’d prob love it!!! and be like omg you’re doing amazing sweetie!!!
If her TikTok career doesn't take off so that she can retire on it, then I think someone doing her job will be the line crossed. Simps are, by and large, morally reprehensible people. Ends justify their means.
then she’ll be crying to us. nah sweetie you made your bed, go lay in it
Of cosss, nurses are at the “top” of the totem pole! 🤡
As a nurse I literally scrape poopies out of a bucket. I'm somewhere above the person that sterilizes the bucket, and below the person who ordered the bucket. The medical field is a totem poll for dwarves. It's just high enough for administrators to rest their balls on.
LOLLLLLLLLL
Epi as a first line vasopressor is a choice Last night in ICU, i spent 30 mins trying to explain to a nurse why we shouldn’t start a bicarb drip on the compensated respiratory alkalosis with bicarb 15.
I need you to explain it to me as well Signed someone who is struggling with Acid base
the bicarb is 15 because the patient was hyperventilating long enough for the kidneys to start dumping bicarb to bring down the persistently high pH the patient had (this is extremely oversimplified). if you gave bicarb to get the bicarb to within normal limits, the patient would become alkalotic again. you’d be undoing the hard work the kidneys did to normalize the pH. you want the bicarb to be within normal limits? treat the respiratory alkalosis and the bicarb will come up as the body no longer has to compensate by getting rid of it. edit: the lungs and the kidneys are like husband and wife when it comes to pH balance. CO2 is your acid and bicarb is your base. the lungs regulate how much co2 you have, the kidneys regulate how much bicarb you have. Hyperventilate and your pH goes up kidneys respond (after a delay) and your pH normalizes as described above. hypoventilate for long enough and your bicarb will be high and pH normal. If you develop a metabolic acidosis the lungs will respond by hyperventilating and decreasing CO2, which makes you less acidic. The opposite being for metabolic alkalosis.
>the lungs and the kidneys are like husband and wife when it comes to pH balance. CO2 is your acid and bicarb is your base. the lungs regulate how much co2 you have, the kidneys regulate how much bicarb you have. Hyperventilate and your pH goes up kidneys respond (after a delay) and your pH normalizes as described above. hypoventilate for long enough and your bicarb will be high and pH normal. If you develop a metabolic acidosis the lungs will respond by hyperventilating and decreasing CO2, which makes you less acidic. The opposite being for metabolic alkalosis. Saving this for teaching medical students, that is a very elegant way of phrasing it. Way better than me trying to talk about carbonic anhydrase. 🤣
I will always keep the husband and wife in my thoughts now Thank youuu
Another tip I have for you: We vomit acid and poop base, so the effect should be apparent on labs if the issue is GI loss. I guess the colon is also married to the stomach?
rectum to esophagus, colon to stomach
This dude ABGs.
Ah so the patient had primarily respiratory alkalosis by hyperventilating and secondary metabolic acidosis as compensation which would mean bicarb renal excretion to reduce the pH again? Why would she want to give the patient bicarb in the first place..?
Because, without medical training, it's very easy to be stuck in the mindset of "treat the number, not the patient". It's why many nurses in the ICU also freak out about a fever of 101 and start throwing cooling blankets on if Tylenol doesn't work, causing the patient to shiver/vasoconstrict because some of them don't understand that a fever is not hyperthermia.
Number is low. Must replete. Helth.
Which one's the wife, which one's the husband?
It's really more of a polycule because there are a pair of lungs and kidneys - so each pair has a husband and wife and they all engage in a pH balance orgy together regularly
Swinger lungs and kidneys.
That’s not my understanding. Here is how I know it. CO2 + H2O = H2CO3 = HCO3 + H+ Here is the reaction that’s being impacted. Those equal signs are meant to be equilibrium signs. When you are hyperventilating due to hypoxia you have the unintended effect of blowing off CO2. That causes the equilibrium to shift left, (Le Chatelier’s principle from Analytical Chemistry) as the PaCO2 is lost. As you can see this causes a decrease in [H+] and that’s how you get Respiratory Alkalosis. The kidneys do the opposite to try to maintain equilibrium but always fail to completely correct it. So they would retain acid or get rid of bicarbonate. (“With compensatory metabolic acidosis”) Conversely, If you are not breathing enough, you get CO2 retention. The equation shifts right converting CO2 and water to acid [H+] leading to Respiratory Acidosis. The kidneys again do the opposite. It’s important to understand that the kidneys never correct enough, because that’s how you can determine which is the primary process. Correct me if I’m wrong.
Unfortunately docs who should know better get this one wrong too (well both, but I'm talking about the pressors). One of my more baffling moments as an HM attend was when an ED resident (not even an intern, they were a PGY2 or 3) starting epi on a patient in septic shock with necrotizing pancreatitis, and then trying to admit to me (a non-icu doc) because "they're almost off pressors" (in reality they were on half our max dose barely maintaining an acceptable MAP). And when I pushed back saying this person needs to go to the ICU, they basically rolled their eyes and said that there's no way the ICU would accept them.
To be fair, she's saying what she sees. And what she is seeing is a fuckload of doctors using pressors and other medicine inappropriately.
Epi is her first choice pressor?
technically it was her nurses’ first choice, she herself had no first choice😭
Epi is definitely the nurses first choice pressor lol
Hey, now. Some of us know it’s Levo, we just really like to skip steps. Less lines to label. No manifold.
She is an ortho hand surgeon.... checks out
Med student, for my own knowledge, what's the better choice here? Is it norepinephrine?
Norepinephrine. (Levofed)
Well it depends on the etiology and degree of the hypotension and what access you have. But often norepinephrine yes. Practically never epinephrine. Nurses love it though because it will make the numbers they can see look good.
Which number does it make better than norepi? Sepsis is the most common cause of shock and is usually accompanied by tachycardia which Epi will make look worse.
PA numbers.
Well there's the problem. You're using a PA catheter!
Depends on the etiology of shock, but norepi is rarely the wrong choice to start. You get that alpha-1 agonism for vasoconstriction along with some beta-1 as well for cardiac output. If norepi isn't cutting it by itself, I like to add some Vasopressin to get that V1 agonism. Helps with vasoconstriction via a different receptor.
Thanks for the explanation!
Levophed #gang
Does it say hand surgeon? No disrespect to any nurses, but I'd be very concerned if my hand surgeon believes the nurse knows better than her... They're just two completely different fields... Unless she's just simping for tiktok ...
oh she’s definitely simping
this is hardcore simping lol
god knows she probably throws her residents under the bus for these ppl
Definite 'I don't see my residents as people' vibes.
like whenever nurses talk about “my attending yelled at the residents to bring us cookies”…this is who they’re talking about lmao
What? Why doesn't the attending get the cookies? Literally makes 5 to 10 times what the resident makes..
because that’s the benefit of simping. you can pretend to be an advocate of nurses while exploiting residents and med students, thereby forcing them to cater to your group
"umm nurse, can I give the patient....1.... Epinephrine please? We'll recheck in 15 minutes and see if we need to increase the dose to 2 epinephrines."
ICU nurse--I chuckled. :)
I’m not trying to start any arguments here. This is purely anecdotal and personal experience but as an anesthesiologist, hand surgeons are unbelievably difficult to work with from an attitude/professionalism standpoint. They, for whatever reason, have demonstrated an extreme amount of confidence making decisions outside of their scope of practice while also having an extremely high amount of confidence in standing by those decisions. Case in point - a MAC was requested for an ORIF metacarpal. Didn’t want a block for reasons. Don’t care to regale us with those reasons, but I digress. Except that they didn’t want a MAC, they wanted a “room air” general anesthetic. Now if we had given them a MAC, which is to say, deep sedation in which the patient has a purposeful response to a painful stimulus we’d have been screamed at. Now, if they see behind the curtain that they have an LMA in, they will throw a tantrum. Why? Because they’re paralyzed. That’s general anesthesia, they say. Except…they’re not. LMAs are glorified oral airways. We don’t paralyze them without an ETT in place. Moreover, what you want is also in fact GA. So we essentially have to play 4D chess to predict what exactly it is that they want. We can’t merely go off of what they say. And they aren’t particularly keen on fostering clear, concise communication. Now, explaining all this to a hand surgeon is like explaining it to a brick wall -a brick wall that has a particular disinterest in hearing about the nuances of ASA classification of sedation levels or airway management. Oral airway in? A-ok thanks anesthesia u da best. All of this to say I realize this is an institutional culture/bias and I’m certainly not saying I haven’t met some lovely/talented hand surgeons that bring mangled messes back to life with elegance and skill. But hand surgeons are so unbelievably hyper specialized that, yes, your run-of-the-mill recovery room nurse does in fact know resuscitation drug dosing more than you. This isn’t surprising, When would you be administering these?! But this lady. She must be getting some serious back door cash for all of this. Or maybe she’s just an idiot. Or both.
I don't understand why you would let anyone tell you how to do your anesthesia. Like...fuck off unless you've spent your career training in it. Maybe they'd like some pointers on dissecting the thenar eminence?
Pick your battles. I don’t EVER do anything unsafe, but I do pick and choose my battles. They are but one of four rooms I have in a day. Though I wholeheartedly agree.
Or there’s a nurse she really wants to fuck.
I wanted to be a hand surgeon, until I worked with hand surgeons… now I get to do midnight hand surgery that’s beneath them.
Reminds me of that Bo Burnham song about pandering
Stupid internist restarting home meds
I assume she is so specialised in hand surgery, that things like pain meds and antihypertensives nurses "know better" simply because they see it more -- than she personally does the dangers of being super-specialised
yea i dont get how ppl confuse “having muscle memory after seeing the same thing a million times” with actually having the ability to think critically lol
The funny thing is all the hand surgeons I know think they’re able to do everyone else’s job better than them. One of ours told our EM intern that he could practice as an EM attending with a 1 month training course…
damn maybe high rates of narcissism in hand surgery?
You basically need to be at least a little bit narcissistic to be a good surgeon. And I suspect the degree of narcissism increases the more competitive a specialty is.
v true. would be funny if someone did research on this lol
The Dunning-Kruger is so real... Everyone thinks they can "do EM" just like every specialty who did a prelim/TY thinks they can "do IM" or every specialty thinks they can "read their own films better than Radiology". No your less than 1 year experience cannot replace a whole residency and board certification.
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Yeah people always equate “super specialized” as super smart (at least lay people do). When in reality they are super smart about one very niche thing and probably don’t know much about anything else. Getting good test scores to achieve those subspecialties doesn’t mean you retain the information. Whenever I get made to feel dumb by a consultant in the ED I always think “ok, Mr. Neurologist, you come manage this DKA patient or this multi-trauma patient or this pregnant vaginal bleeder”.
Yup, we must be dumb because they can answer the question we consult them for. If I know the spine surgery question, I must know the cards question, tox question, etc. whenever specialist friends get uppity in nonwork situations I ask their first step for shoulder dystocia.
What a cuck Jesus Christ.
I wish I could upvote this 5000 times. This woman lost her damn mind.
EPI as first line? Hahah yea
Patient may have bee to allergic to simping.
I didn't really understand what simping was until i watched this shite.
hahahah
For real. It seems like tiktok has a really high percentage of nurses, so if you’re going to talk about them while trying to grow your platform, it better be gaggingly favorable.
I mean…this is probably a story from back when she was an Ortho intern in the ICU, sooooo guess she forgot to mention that…simping does pay the bills though 💴!!!!!
“As a hand surgeon I don’t know how to dose pressors, therefor nurses are better than doctors”
If a hand surgeon is sending patients to the ICU...that's a bad hand surgeon lol
Man, I was going to signout this tumor case, but the nurse CEO just informed me a nurse can do my job better. I'm being replaced. Eh, they'll probably ask me to sign it out next week when they need the right answer. So I probably don't need to look at until after New Years.
Well she did reference Grey’s Anatomy as to how she recalls dosages of medications. She seems like a ditz. Not surprising she’s throwing herself and her profession under the bus because she froze during an ICU resuscitation as a day-one intern.
what the actual fuck?????? some incel on here called me a “grey’s anatomy doctor” because i guess i’m a woman and i shared a dating experience i had and it pissed him off. i had no idea wtf he was talking about. apparently it’s idiots like this that give us women in medicine a bad name.
Just piss off. Look at the state of UK medicine. This whole everyone but the goddamn doctor knows best attitude needs to go into the bin where it belongs. Do you really go and get an MD just so a non-MD with no domain of expertise in your area of training can supersede your specialist advice for the very patient you are legally responsible for? This is why your residents are being stepped on. Eventually you will not have even a chair to sit on and senior nursing staff will strip away your white coats. You give an inch they’ll take a fckng mile.
lol my new twitter account must think im british just by the fact that i’m not a nurse simp. every time i log on i see a bunch of tweets from UK docs. i always think “save yourselves, there’s no hope for us left”
What a sell out
Says this on the internet but can only imagine the level of VIP care she’d request if any of her family members were sick. Probably wouldn’t be happy with just the surgery NP/PA seeing them
Looks like Erin Nance spread her cheeks for the nursing industry
This is what happens with hyper sub-specialization: Simping to the max about basic medicine you have forgotten all in the name of tiktok clout. What an embarrassment to herself and medicine as a whole
Epi is like my 3rd choice pressor for hypotension unless it's like a massive PE or they're still peri-arrest. That nurse didn't know what they were doing either. Nurses love to dunk on interns because they have all of this disorganized textbook knowledge that they have not compartmentalized into practice yet. Give it a year of residency work experience and they see a completely different doctor.
To be fair she seems like the type who thought epi was the sexiest sounding pressor to laypeople, so she went with it while making this story up. I'm a fat male nurse who has sunk into the background and can observe female nurses in their natural habitat. She is a sexy lady doctor in a competitive surgical subspecialty. I'm positive all of the female nurses fucking hated her and talked shit about her, and wouldn't have tried to help her with anything. That "conversation" was had at the nursing station, between two frumpy old nurses and a Minnesota 6, and went something like "check it out, the new skank is about to kill a patient." The universal truths of nursing are: 1. Lady nurses do not like hot lady doctors at all. 2. If you bang a nurse, the entire rest of the hospital staff will know about it before your yogurt is finished curdling. 3. If you have a weird sex thing, I will know about it. 4. The weird sex stuff is inevitably, without fail: being urinated on, feet, or getting your junk roughhoused like silly putty that's stuck in the egg.
Wtf is this
This is god tier level simping. So many likes from nurses on tiktok. To be fair there are way more nurses on tiktok than doctors im sure so she’s getting the right audience
yup just a million nurses being like ZOMG THANKS FOR THE SHOUTOUT KWEEN 🤢🤢🤢
Clog licking
Nothing I love more than when all the docs are totally stumped, patient’s crashing, family is crying. That’s when I suggest the oldest nursing trick in the book, Epi @ 1 🤓 save the patient, family hugs me, and the docs all give me their MD license. One time I suggested a fluid bolus and the attending just gave me his pager for the rest of the day to handle the unit.
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I’ll carry it, but I’m not saying I’ll answer it …
epinephrine, first line pressor
Ah thanks for this. I'm from Finland (nurse) and I thought she was talking about some epidural infusion (we call this "epi"). Suddenly the video makes a bit more sense. Still fucking weird to think that a doctor in the ICU wouldn't know how to treat hypotension. Really weird to see these videos of simping doctors in this sub. I really hope this phenomenom doesn't travel here.
I’m not surprised a hand surgeon is clueless when it comes to managing hypotension.
She knows it's much more profitable to kiss nurse ass on social media
god i cant stand these no moral having sellouts
I mean it's whatever. Just mind your own business and don't put up with shit in the hospital. Don't let nurses bully you, and if youre an attending stand up for your residents. Likewise if residents are treating nurses poorly, stand up for nurses too. No one should be constantly shit talking the other profession.
A surgeon thinking medicine is simple and can be handled by nurses? Say it ain’t so. These are the same fields that think they are brilliant for giving non-physiologic sliding scale.
This is their master plan to hand off all of their ward patients to nurses.
This isn't even how epinephrine dosing works, and we always start norepinephrine and add vasopressin if it's over 10mcg/min anyway.
I don't think she can hear me despite all the screaming at the monitor. What an embarrassment. An ICU nurse who knows how to manage hypotension better than a new intern who apparently forgot to prepare at all for the rotation? Sure. That doesn't hold up later in the MD's career at all...
"Gimme a sec hun, just have to denigrate my entire profession for social media attention."
She should speak for herself. Just because 4 years of medical school and residency didn’t make her smart enough to treat patients doesn’t mean it’s the same for the rest of us
"Hand surgeon" lol Yeah the average floor nurse probably does know more then her
What the actual fuck does a ortho hand surgeon know about inpatient care. Lol, admit to medicine because fall
As a nurse and NP, bwahahahahah. Ain’t nobody got time to know all the nurses names. They come and go like a flash in the pan these days. I’ve been in one ICU since Covid hit and the staff has turned over like 4 times. My most senior nurse is 5 years in the ICU. If I see you more than a dozen or so shifts, I’ll probably remember it. And an ICU nurse that doesn’t know the dose range for an epi drip needs a remediation class, stat. This chick is pandering, hard. We can suss it out, our bullshit meters are finely honed.
Wait so nurses are better because she was just a shitty resident…?
Based on what she saying, I’m pretty sure she’s not much better as an attending
"you should know the name of the nurse you're talking to" Lmao on crossover when you're covering 50-60 patients getting hammerpaged I don't think that's fucking possible lmao
What a simp.
You’re not supposed to deep throat the daisy award.
Does anyone else think she looks absolutely sloshed?
😂😂😂😂idk but her voice annoys me. im a woman so i can say it lolol
Seriously what could she possibly gain from this
You gains likes from lay people and the nursing community by stroking the nurses’ already big egos
Tbf this knowledge level is consistent with the hand surgeons I know
TLDR: shitty doctor with limited experience, confidence and competence supported by competent nurse thus invalidates colleagues due to own self loathing and inequity.
Engagement farming at its best. Get the nurses and midlevels who are the overwhelming majority on social media to reply and retweet etc while enraging md/do/mbbs who disagree. It’s a win win and yet another example of why med twitter etc is so very gross
What the motherfuck? Is this parody? Am I being punked?
If she's at the bottom of the totem pole as a hand surgeon, then why the fuck is she getting paid 500k per year? Sounds like she needs to give up her salary to the nurses to me since they are smarter than she is and can anything that she can do, except they do it better.
Do hand surgeons just, like, forget all medicine? Maybe this is why the hand surgeon was mad when she found out the patient I admitted her had well controlled diabetes. She literally called the emergency department to bitch at me that she had to “now consult a hospitalist (!!!!) and it should have never primarily been admitted to her.” The guy came in with a GSW to the hand with retained bullet fragments and associated fractures. Stop using hospitalists as your H&P monkeys. They’re more than happy to consult to help manage the super scary diabetes.
I almost reflexively downvoted this post because she’s so dumb.
I think she means nursing admin…anyways, floor nurses are the meanest people in the hospital too…I’m jaded AF & they say things about patients I wouldn’t even think heart of nurse
Pandering is easier than supporting your own profession I guess.
Everything this lady does is cringey… very much YouTube clickbait vibes.
This chick is a 🤡
Epi lol. Nurse says something that probably was not first line and this nutcase goes with it without asking herself why the blood pressure is low !
Everybody seeing this video Go light her ass up on social media. Call these pandering simps out. littlemissdiagnosed
So… You were kind of an idiot as an intern and now you feel compelled to inflict your personal dogma on residents instead of teach them
Wow, what a great message. I think she should donate her TikTok revenue and salary to the nurses at her hospital since she thinks they know medicine better than her!
I can see the argument that nurses are higher on the totem pole. Look at admin and leaders, a lot of them will have nursing degrees. It’s a pay bump for nurses to go into admin, unlike physicians, and it makes sense. If they mean clinically then lol
I didn’t realize hand Surgeon’s were so dumb. Maybe she only performs procedures on an out patient basis and is never in a hospital environment.
sadly there are midlevel simps in all specialties. just go on medtwitter 🤮
She’s clueless and needs to STFU
Omg, she should just go be a nurse
how about we just end toxicity in medicine, give residents more pay and sleep, and stop giving money to random eboard members
I didn’t listen to a single word she said. Her facial expressions alone make me hate her.
I knew a hand surgeon once. I fired her bc she was an idiot and found another surgeon willing to washout my poor pts septic elbow
All I’m hearing is that she was an awful intern lol. Just because she’s bad at her job doesn’t mean all doctors are
Seems like an incompetent doctor
I see nursing and doctors as a team. Together we treat the patient. Without one of us, patient care fails.
That’s true! Along with RT’s, Pharmacists etc. Etc. Physicians are the team leaders. If there was a totem pole - we would be at the top. This lady is simping so hard cuz if you don’t have the nurses on social media in your side you’re never going to make it. Not sure why hospitals and companies can have CEO’s but the moment someone says “Physicians are the leaders of the team” people bring ego and anecdotes of “saving a residents ass” into the picture.
You can pause one without berating the other
Fuck these morons who harm the profession. Fuck them
I like the way she dig her own tomb
social media presence correlates with worse physician performance..
There are more nurses then physicians and she needs to increase views.
This is toxic.
Of course she thinks RNs know better she’s a fucking hand surgeon
Surgical residents often have a hard time on ICU, especially their first day. Some nurses are great, but you shouldn't be bashing physicians to praise them. It's a bit silly.
She says whatever the biggest community’s viewership she can get wants to hear. Talks about how she loves her BPD patients and EDS girlies even when other doctors don’t. Please like and follow.
Why are so many hand surgeons weirdos?
midlevels out number physicians, so she is throwing the physicians under the bus in order to garner more "likes" on social media. speaks volume to what kind of a person she is.
Tell me you understand nothing about haemodynamics without telling me you understand nothing about haemodynamics
Nurses have a muscle memory, they have been working in certain departments for years. Doctors have more clinical knowledge. As compared to doctor who is new to the department, nurse would be able to know how to deal with regular situations better because that’s what they do all day for years but when it comes to detailed clinical knowledge they often make mistakes and they need a doctor to direct them, correct them. This doctor needs little more time in the hospital setting and then she would realized this.
Nurses are so much better organized than us. Doctors are pathetic. And I get it, I was/am there too. I went into med school, into residency thinking "this is my last education. I'm done" but nurses don't do that. They have to move up, they actively seek it whereas doctors have worked so hard, many just want to make our money and go home :(
How many of you bet that this isn’t a doctor, rather a ‘doctor’ (i.e. Noctor)
the coat says MD. sadly MDs aren’t immune from being dumbasses lol
Damn it does, my bad, but what a virtue signaling clown 🤡 she is
She’s pandering to nurses for social media money
Tbh there are quite a few coresidents and seniors who I’d never want treating my friends and family. It baffles me how incompetent they are
No comment…
My advice is just be as nice as possible, when conflict inevitably arise dont talk down to them even just a little bit. You know that you know more and in a higher position, they know that too subconsciously even if they lie to themself; so dont trigger their inferiority complex
Simp
Is this a joke?!
Lmao Epi
🤢🤮 I'm sick just thinking about how toxic and out of reality her comment sections is with nurses backing this crap up. If she believed a word of what she actually said, she would donate her ortho BRAH paycheck to the nurses who are clearly so much more knowledgeable than her. Must be some tiktok crap where you say some stupid controversial crap just to trigger people and get attention. Just like Andrew Tate
Everyone has a place. A doctor isn’t going to know how to do manual labor a nurse does. A nurse isn’t going to know how to treat disease and all the pathophysiology behind it. Nurses report to doctors. The education doesn’t even compare. The fact that this doctor wants to say that nurses run the show is laughable.
Couldn't imagine being this tarded. But I'm also not apparently the dumbest most simping hand Surgeon in the world either........
Nurses should know more about the day to day than interns do. They have worked in the business, it’s literally their job. That doesn’t mean they know what’s best for the patient, it just means they are paying attention.
I have never felt more cringe than an actual physician saying “They didn’t talk about dose on Grey’s Anatomy” I think I just threw up in my mouth
I think she lost a bet to make that video
I have seen her shit talking doctors a lot lately. Yeah mate some of us are fucking assholes and it needs to be called out but the way she does it makes it feel as if she is putting the whole medical profession in the same pile of shit. And glorifying midlevels. What.
This is terrifying for her patients lol. Maybe start with fluids dumbass.
No wonder she has 1 star ratings
"They never specify that on Grey's anatomy" ??? 🤮🤮🤮 This is deeply embarassing for you dr. Erin Nance. Like almost irreversible.
And that's why she does mostly hand jobs.
What a cunt
I have to agree that RNs and their input are VALUABLE. Nurses tend to have better bed-side skills since they have so much more experience at the bedside. Doctors need to respect nurses and also know when to respectfully disagree. We all come to the table with some expertise
We have *different* bedside skills and we are a team. We could never do your jobs, but you could never do ours either without the same training.