I could only visulize my needle tip 2/5 a lines that I did.
I ended up mixing up sliding the probe with fanning and got lost couple of tines.
What is the recommended approch specially for shallow vessels within 0.5 cm depth.
​
Do you make the poke and slide your probe to see the tip or fan towards you ?
I wanted to ask this here because I’m not looking for medical advice. I’m more interested in hearing from other healthcare professionals who may have experienced something similar.
For some background, I’m an ICU nurse (previously a paramedic and firefighter), and over the years I’ve taken care of just about everything—from healthy young people who suddenly became critically ill, to patients my own age who ended up intubated, on ECMO, or who didn’t survive despite everyone doing everything right.
When I first got into healthcare, those cases were rare enough that I could separate them from my own life. Lately, though, it feels like I’m seeing more and more younger patients with serious chronic illnesses, strokes, massive PEs, advanced cancers, unexplained cardiac events, liver failure, sepsis, and other diagnoses that I used to associate with much older patients. Whether that’s actually happening or whether it’s simply because I now work in the ICU and that’s all I see, I honestly don’t know.
A few weeks ago I came back from a trip to Europe, and shortly afterward I started noticing my heart beating harder than usual. Since then, it’s almost like something in my brain flipped. Even after being evaluated and having reassuring testing, I keep finding myself catastrophizing every symptom and every mildly abnormal lab value.
Objectively, I know what cognitive distortions look like. I know how statistics work. I know that rare diseases are, by definition, rare.
But emotionally, I keep thinking, “Someone has to be the rare case.”
I’ve noticed myself checking lab trends from years ago, worrying about things like slightly low neutrophils that have actually been stable for years, and convincing myself that I’m missing some hidden disease. Intellectually I can recognize the pattern, but emotionally it’s much harder to turn off.
The thing that’s surprised me most is that this didn’t happen when I was younger. It developed after years of taking care of critically ill patients.
So I wanted to ask other physicians, nurses, paramedics, RTs, PAs, NPs, and anyone else in healthcare:
- Have you found yourself becoming more anxious about your own health after years in medicine?
- Do you think we’re actually seeing more younger patients with serious illness, or is it simply a form of selection bias because of where we work?
- How do you keep yourself from assuming the worst every time you notice a new symptom?
- Has anyone successfully worked through health anxiety after developing it later in their career?
I know this isn’t a substitute for professional help, and I’m not looking for anyone to diagnose me over Reddit.
I’m genuinely interested in the perspective of people who spend their careers seeing the worst-case scenarios every day.
Sometimes I wonder if developing health anxiety after years of watching people suffer means I’ve become mentally weaker than I used to be.
Or maybe it’s just an occupational hazard that more of us experience than we talk about.
I’d really appreciate hearing your experiences.
I thought maybe this would be appreciated in this sub. For the record, no drugs ended up on the floor!
I'm sat in a safety meeting currently reviewing Ambubag provision. In my nursing career (30 years) I'm used to having an Ambubag in each patient room. Other nursing directors are reporting the same thing. Our supply director is proposing keeping 1 Ambubag on a code cart for the entire floor. Are you guys used to keeping an Ambubag for each patient? Edit... Units are ICU and ICU stepdown.
Thanks
You're admitting (sorry) a patient from OR. Tubed, prop, levo, vaso, random bags of fluids Y sited into no where specific, SWAN and a-line, all tied together in a clusterfu-- bowl of spaghetti. Nothing is labeled. You have to unhook them from everything OR so they can take their monitor and tram back and hook them up to your stuff. The usual. Where do you start on your spaghetti? What are your methods/priorities? Infusions or monitoring? You are allowed to set up all of your new lines before they arrive.
It takes me like an hour where it takes my coworkers 5-10 minutes to get everything where I want it so I'm asking for advice on how to do it more efficiently.
organ donation leaves a sour taste in my mouth (sometimes)
that’s it that’s the tweet
Futurism: https://futurism.com/artificial-intelligence/woman-death-hospital-brazil-ai-icu-beds
The original article in Portugese: https://g1.globo.com/mg/zona-da-mata/noticia/2026/06/11/psicologa-morre-apos-5-dias-de-espera-por-leito-em-mg-familia-contesta-novo-sistema-de-regulacao.ghtml
Summary (based on the English translation as reported by Futurism)
32 year old woman in Brazil was hospitalized for gallstones, spends 5 days awaiting transfer to a larger hospital's ICU unit before dying. Family accuses the algorithm — Brazil’s State Regulation Operations Center (Core-MG) — of underestimating the patient's acuity and thus alleged to have played the deciding role on delaying transfer to an ICU bed.
English translation of the family's statement:
>"What we saw was that doctors lost the autonomy to decide if a patient is very seriously ill. The one who has to accept whether a patient is seriously ill is no longer the doctor who is there experiencing that reality with the patient, it’s the Core. She would have been a 10, and the system only accepted her as a 6.8. So she couldn’t progress properly in the system because a patient at 8, a patient at 6.9 would jump ahead of her. And the system wouldn’t accept increasing her severity level within the system because of the tests that were constantly feeding it data. My sister, other people, are not just numbers, they are not just protocols, they are not just a CPF [Brazilian tax ID number] thrown into the system. They have families, they had dreams, they had a whole life ahead of them."
Official statement by the Deputy Secretary of Health (English translation)
>"Core provides a bed map that is updated three times a day. With this, it will be possible to have much more control over the process and generate better data on the clinical condition and needs of each person waiting for a bed."
Comments
I wish I'm able to read the original Portugese article (and I'm not going to use any translation software so as to avoid mistranslating the reporter's meaning). To my knowledge, this is the first time a patient's family is accusing an artifical intelligence system in contributing to a patient's death. Although the type of AI used in Brazil's hospital system is not an LLM (actually more akin to an EHR algorithm based from RegulaRN), it very well may be an LLM. Apparently the algorithm failed to get updated with lab values. The model used by Brazil appears to be proprietary and thus a black box for many of us. And algorithms are not going to have the right answer for the individual person as they cannot physically examine and assess the patient at the bedside.
Hello I thought I would start here as this is one of the more NP friendly communities. I will be starting this September as a new grad pulm NP. I am very excited and even more nervous. I have been an ICU nurse for the past 9 years, I feel comfortable with patients who are definitely dying and not those who are tetering in the outpatient setting. I have subscribed to CHEST and plan on doing their pulmonary board review but are there any other resources anyone has found worth their weight or use daily?
Our hospital is getting aerogen installed in every room on every floor - basically everywhere. Aerogen sales rep - along with our department manager who has some questionable ties to the company - insist aerogen is not a risk to spreading Covid or influenza, or any resp illness even if the patients aren't in isolation, aren't in a pressure negative room, & /or aren't even in their own room, which is unfortunately common in our overflowing ER.
I'm not so sure - but I can't find literature saying one way or the other. Does anyone know definitively?
Reposting something I've been meaning to write up after a few months doing critical care air transport alongside ground ICU work.
Most intensivists know the theory. Fewer have felt it in practice at 28,000 feet with a deteriorating patient and a ventilator that's not the one from your unit.
The oxygenation problem is real and underestimated.
Commercial aircraft cabins are pressurised to approximately 6,000–8,000 feet equivalent altitude. Charter aircraft used for medical transport are similar. At that pressure, FiO2 from your 100% oxygen source still delivers 100% - but the partial pressure of inspired oxygen (PiO2) drops by roughly 20–25% compared to sea level.
For a patient with healthy lungs, inconsequential. For a patient with:
...that drop is not trivial. I've seen patients who looked stable at ground level show SpO2 dips within 20 minutes of reaching cruise altitude, requiring FiO2 escalation we hadn't budgeted for in our oxygen reserve calculations.
The ventilator switch problem nobody talks about.
Patients arrive from ICUs on specific ventilators — often Draeger, Hamilton, Maquet. Transport ventilators are a different beast. Volume-pressure relationships behave differently. Trigger sensitivity varies. If your patient has been on a specific mode and PEEP for 48 hours and you switch devices 10 minutes before loading onto an aircraft, you will spend the first 30 minutes of the flight chasing settings.
Best practice I've landed on: if at all possible, do the ventilator transition at the referring ICU while the team is still present and you have backup. Don't do it on the tarmac.
The moments that actually scare me - and it's not the flight.
In order of actual clinical risk in my experience:
The flight itself, if the patient is appropriately stabilised, is usually the most controlled phase. The transitions are where things go wrong.