u/princetonwu

Incoming a patient with massive lower GIB. Hypotensive. HH dropped several units. GI won't do a colo since pt is unprepped. CT angio positive for active bleed. I call IR:

IR: We need the patient to be stable before we do a visceral angiogram/embolization

< Patient gets rapidly transfused blood, is stabilized; good BP. I call IR back >

IR: The patient looks stable now. In that case go ahead and prep for colo; they no longer meet criteria for urgent angiogram

I'm not criticizing IR here but just wanted to see if I'm missing something? Patient met criteria for an angiogram because they're too unstable to undergo prep. I stabilize the patient per IR request but now they're too stable to meet criteria?

I was reading a case -- Medina v. Hochberg, 987 N.E.2d 1206 (Mass. 2013) -- that held that a medical professional other than a mental health professional owes no duty to third persons to warn her patient of the risks of dangerous driving associated with an underlying medical condition.

A google search resulted that forty-four U.S. states do not have laws that mandate physicians to report or warn state motor vehicle authorities about patients with epilepsy.

I thought that most states would mandate reporting (since physicians have a duty to warn others of their patients' contagious diseases) but I'm surprised by the findings.

If I didn't, would I be civilly liable for negligence based on the theory that I failed to provide affirmative duty to rescue?

This is from another sub, but I'm wondering, can the family sue for breach of contract for accidentally cremating someone that they weren't supposed to?

Up to recently, our standard for alcohol withdrawal is the CIWA with benzo prn. Lately, we've been using more phenobarbital, but more as a adjunct for refractory or severe withdrawal despite benzos. On Uptodate, phenobarb is only mentioned in the section for refratory DTs. However, i've been seeing our ER use one time phenobarb weight-based therapy even though the withdrawal isn't that severe. I thought that was new, but I found one article saying the following

>A single weight-based loading dose can provide rapid and sustained symptom control, in contrast to sequential, reactive dosing often used with short-acting benzodiazepines in US hospitals.

Wolpaw BJ, Oren H, Quinnan-Hostein L, et al. Hospital-Wide Implementation, Clinical Outcomes, and Safety of Phenobarbital for Alcohol Withdrawal. JAMA Netw Open. 2025;8(8):e2528694. doi:10.1001/jamanetworkopen.2025.28694

What are your experiences?

1 Corinthians 14:34-35

>Women should be silent in the churches. For they are not permitted to speak but should be subordinate, as the law also says. 35 If there is something they want to learn, let them ask their husbands at home. For it is shameful for a woman to speak in church.

Romans 16:1, 3

>I commend to you our sister Phoebe, a deacon of the church at Cenchreae. ... Greet Prisca and Aquila, my coworkers in Christ Jesus

Galatians 3:28

>There is no longer Jew or Greek; there is no longer slave or free; there is no longer male and female, for all of you are one in Christ Jesus.

Based on the Rom and Gal passages, Paul seems to suggest that women should have an active role in the church and that they are worthy of equality. 1 Cor seems to suggest the opposite. It's possible the role Paul is talking about doesn't rise to the level of a preachers but a lesser role, but nonetheless a role. It's not clear if that's what he means here or that's somehting we're putting into Paul's mouth?

I didn't cite 1 Tim 2:11-12 since it's the scholarly concensus that Paul didn't actually write this.

Original sin was a concept flourished by Augustine, who believed literally that there was a couple called Adam and Eve.

However, many Christians today do not believe the literalness of Adam and Eve. If that's the case, then the concept of original sin no longer exists, and the value of Jesus' redemption falls apart.

My learning throughout the years is that in HFrEF, we avoid diltiazem due to its negative inotropic effect. So in such patients with AF RVR, I never give IV dilt and has been giving IV beta blockers (or digoxin or amio). Now, the uptodate article says

>For patients with HFrEF, we use intravenous (IV) amiodarone, IV digoxin, (and rarely IV diltiazem) 

>We generally avoid augmenting beta blocker therapy in patients with AF and acute decompensated HF. In such patients, the negative inotropic properties of a beta blocker may worsen the clinical condition. 

It seems like what I learned is now flipped. What if the patient has AF RVR and HFrEF but not in acute decompensation? Does the above still apply?

https://www.uptodate.com/contents/atrial-fibrillation-and-heart-failure-management

I just finished reading Acts. Im onto Romans

In Acts, the author describes the Damascus experience and the numerous acts of miracles/healings performed by Paul

Paul in Romans (and through a cursory google search) and his other letters do not describe this conversion experience nor any miracles he performed. (There might some subtle allusions in 1 Cor or Galatians perhaps). Since Paul's letters were written much earlier than Acts, does it lend support to an argument that the author of Acts embellished or added many details such as Damascus and the miracles?

Background: in the book The God Delusion, Dawkins writes:

>On 21 February 2006 the United States Supreme Court ruled, in accordance with the Constitution, that a church in New Mexico should be exempt from the law, which everybody else has to obey, against the taking of hallucinogenic drugs. Faithful members of the Centro Espirita Beneficiente Uniao do Vegetal believe that they can understand God only by drinking hoasca tea, which contains the illegal hallucinogenic drug dimethyltryptamine. Note that it is sufficient that they belive that the drug enhances their understanding. They do not have to produce evidence.

https://www.oyez.org/cases/2005/04-1084

Hypothetical: Can person A kill person B, with the genuine belief that by killing B will send them to heaven (in according with A's religious belief), and claim that doing so was invoking the freedom to practice their religion?

Of note, I think in Catholicism, people do believe that on Divine Mercy Sunday, they can go straight to heaven if they were to die, provided they confessed all their sins on that day and did not commit further ones.

Im reading Ehrman's book on forgery. He mentions that 2 Thes is a forgery because it doesnt sound like what Paul's authentic letter, 1 thes. Same goes for Ephesians.

(I havent read past this yet)

Im not disagreeing with anything, but im just curious: if two letters are different, how do scholars conclude which one is authentic?

Ie, why do scholars not argue the other way around? That 1 Thes is forgery bc it's different from 2 Thes? The only way to determine which letters are forged is to first establish the authentic corpus. Then the forged letters can be compared. I'm wondering how is it determined that the Pauline corpus is undisputedly authentic in the first place?

Acts 16

>6 They went through the region of Phrygia and Galatia, having been forbidden by the Holy Spirit to speak the word in Asia. 7 When they had come opposite Mysia, they attempted to go into Bithynia, but the Spirit of Jesus did not allow them; 8 so, passing by Mysia, they went down to Troas. 9 During the night Paul had a vision: there stood a man of Macedonia pleading with him and saying, “Come over to Macedonia and help us.” 10 When he had seen the vision, we immediately tried to cross over to Macedonia, being convinced that God had called us to proclaim the good news to them.

Everything in Acts 1-15 were in the third person with nothing to indicate a first person perspective; and yet he immediately to we in the middle of the sentence in verse 10, and thereafter. What's going on here?

I'm reading through Acts.

If God could have instantaneously converted Paul, then he could have instantaneously converted anyone. He didn't need to resort to this roundabout way whereby Paul and the disciples had to work so hard to preach and evangelize the gentiles and spread the word to the end of the world.

This applies to modern times; if God can give everyone a Damascus experience, then everyone would convert instantly, instead of relying us to trying to find him.

Christians might argue "God didn't want to force anyone to believe him." Well, he forced Paul.

I realize that if im in a lane that's moving relatively fast, and FSD is trying to merge into a lane that's very congested (ie an exit lane), it will have a very hard time doing so. It tends to want a comfortable cushion before it merges (understandably), but in a congested lane that might never happen. Several times I wanted to see what it will do and it missed the exit because it couldn't find a spot to merge into. Now, I usually have to take over and do a human-merge.

Whats your experience?

>17 Then the high priest took action; he and all who were with him (that is, the sect of the Sadducees), being filled with jealousy, 18 arrested the apostles and put them in the public prison. 19 But during the night an angel of the Lord opened the prison doors, brought them out,

If we are to believe in this passage, then it's rather conclusive that God has the omnipotence to undo human suffering, that he is capable of interfering in human lives by releasing the apostles from prison. Therefore, if worldly suffering persists, then it must be that he allows it.

This applies more so with patient asking for opiates for chronic pain (frequent flyer for recurrent abdominal pain usually). I usually can get past the first hurdle:

Patient: i want dilaudid

Me no, your condition does not warrant opiates and in fact can get worse with opiates. You can try XYZ instead

A few hrs later nursing will call me saying pt tried XYZ and still in 10/10 pain and asking for dilaudid. Sometimes patients will even say "I'm allergic or have a bad reaction to XYZ so I can't take the other meds." They sometimes make the RN put those non-opiates in the allergy list just so it wont even be offered.

What do I do when this happens? Pain is subjective so it's not like I have an objective measure if they're indeed at 10/10. I've heard that some pts can have 10/10 pain even if they aren't actively writhing or grimacing. At this point I usually just cave and give something although I'm pretty sure I'm just getting played.

tips?

Christians often argue that God did not create robots, and that we have the free and voluntary choice to either accept or reject him. If that's the case, it does not make sense for Christians to have historically needed to forcibly convert non-believers. In addition, unless you are living in a 3rd world country with no internet access, everyone has the free ability to learn about Christianity. If Christians argue that we are not forced to believe in God, then it wouldn't make sense for modern Christians to aggressively proselytize non-believers.

What does this sub think of this blogger's interpretation of this verse in its original Greek? Is it accurate, inaccurate? Misleading?

>Conclusion

>It’s about the desire to posses (covet) another man’s wife that Jesus warns about here. It’s perfectly normal and natural to find women attractive; just don’t cross the line and covet another man’s wife.