haldujai

64 ms·

721.
by haldujai 4y ago
I greatly appreciate this response. We’ve come full circle. When seen by a competent physician who appropriately consents patients understand complications. Your issue is that your mother was misdiagnosed (at least by what was communicated
722.
by haldujai 4y ago
As much as you doubt that based on your anecdotal experience (addressed below), I’ve respectfully spent the past 9 years practicing medicine in 16 different hospitals across three countries and feel I am in a more appropriate position to co
723.
by haldujai 4y ago
You’re absolutely correct. I like to think I’m a good physician. At the very least I’m a highly trained subspecialty physician. I could never work in a small community hospital with poor standards because it drives me insane to work with ap
724.
by haldujai 4y ago
This isn’t necessarily covering his ass. Mesh infection is a known risk, by your description you were appropriately consented for this. It will be impossible to definitively identify the source of infection (I.e. was there an inadvertent en
725.
by haldujai 4y ago
I’m sorry but I’m not sure how this comment relates to mine which asks for clarification regarding the deleted poster’s treatment algorithm for anemia. I will however address the gaping flaw in your story. Depending on which doctor you see,
726.
by haldujai 4y ago
To be fair and in defense of OP, I’m not sure why you are putting quotes around hernia expert. I’m not sure what setting you practice in, I am personally in a ~1500 bed academic health sciences center. At my institution, we have 3 general s
727.
by haldujai 4y ago
Yes exactly, perhaps I was unclear. In my description, it is conceivable that due to chronicity the field was contaminated at the time of second OR and/or a lysis of adhesions resulted in a contaminated field. If the surgeon implanted
728.
by haldujai 4y ago
“Anemia” isn’t really a diagnosis. Your mother had a microcytic anemia (a broad class based on lab results), of which there are several types including iron deficiency anemia. Next, there are multiple causes of iron deficiency anemia of whi
729.
by haldujai 4y ago
I concur. I often work as a radiologist in the ED setting, while this is anecdotal I can’t imagine that anyone with history of recent hernia repair, purulent discharge, and chills would not get a CT scan at an academic centre in the US (OP
730.
by haldujai 4y ago
I think you’re hitting the nail in the coffin. As physicians were trained on the common and the deadly. We’re not that great at rare non-immediately life threatening conditions due to the nature of the discipline. We’re trained that when yo
731.
by haldujai 4y ago
Physician bias that women and people of colour are “tougher” is real. We are educated about it and are improving but as with bias against these classes of individuals everywhere else in life, we have come a long way but we are not perfect.
732.
by haldujai 4y ago
As a physician I am in complete agreement with danachow’s statements. A hemoglobin of 4 must be corrected irrespective of the underlying etiology. Furthermore, I am also in complete agreement that such a patient without obvious source for a
733.
by haldujai 4y ago
Disclaimer: I am a physician. Physician salaries represent a small fraction of overall healthcare costs. Nursing/allied health salaries make up the bulk of any hospital’s costs and are often bloated due to powerful unions physicians do
734.
by haldujai 5y ago
Sensitivity and specificity are interrelated. Increased sensitivity (I.e. in CTPA) often leads to over diagnosis and bad outcomes. We don’t routinely look at all three planes because most imaging and size criteria were developed and validat
735.
by haldujai 5y ago
AI in medical imaging has been very limited and ineffective thus far. My institution pays for an expensive lesion detection / mammography CAD software package but it generates so many false positives I don’t use it in my practice. Over
736.
by haldujai 5y ago
This isn't quite as big of a problem as they're portraying and there is a lot of misinformation in these comments. For context I'm a radiologist at one of the academic centres involved in the ongoing TMIST (3D mammography) tr
737.
by haldujai 5y ago
This wouldn’t work. I interpret musculoskeletal MRI studies in my practice. Small joint (what this would be used for) ligaments and tendons are incredibly difficult to see and assess even at ultra high res studies performs on 3T magnets. Wi
738.
by haldujai 5y ago
I am a radiologist. FDG PET/CT is not used to stage intracranial metastases due to background brain activity significantly reducing sensitivity. You’re likely only detecting lesions 1cm or greater in the brain, or ones which demonstrat
739.
by haldujai 5y ago
I mean isn’t the issue at hand a by product of how massive the internet is now and Google’s relative impartiality? In a truly inclusive and expansive index isn’t it a bit of cat and mouse with SEO? Presumably the only way to get rid of them
740.
by haldujai 7y ago
The mechanism of respiratory failure is different in COPD vs ARDS (in the case of COVID), hypercarbic vs hypoxemic. There is minimal human research in the use of NPV/iron lungs with ARDS. As far as I’m aware the technology does not eve
741.
by haldujai 7y ago
We have a lot more ECMO capacity than people think, CPB machines from heart surgery cases can be used to provide ECMO which are at least an order of magnitude more common than classic ECMO machines.
742.
by haldujai 7y ago
This is an extremely flawed idea. Not only does transfusion present a big risk, we quote ~20% risk of adverse events (minor to severe), but what you’re suggesting massive transfusion protocol (DIC, hemolysis, TRALI, TACO) AND ECMO which its
743.
by haldujai 7y ago
I don’t follow your logic. When COVID-2019 first became a thing the “standard of care” was to use airborne precautions and respirators, it did not “lag badly” as you so claim. Two months of research later there has been no evidence that thi
744.
by haldujai 7y ago
Not entirely true. Ultrasound actually has pretty good sensitivity for pneumonia (88%) and even higher if you look at the “difficult” cases requiring CT in the Cochrane review I link to below. While the fundamentals of what you say are corr
745.
by haldujai 7y ago
To keep it simple you have a device that increases pressure through a closed circuit to push air into the lungs, when its time to exhale it drops pressure (although is still positive pressure i.e PEEP) that is weaker than the natural recoil
746.
by haldujai 7y ago
Arguable. Needing ventilation (i.e developing ARF/ARDS) is not necessarily the cause of mortality rather suggestive of decompensated sepsis. From the limited literature available the causes of death are multi organ failure secondary to
747.
by haldujai 7y ago
Can you provide this link? I could only find: https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v... Which does not actually address whether there is airborne transmission of the virus but rather refers t
748.
by haldujai 7y ago
Most nations have follow the WHO advice and have all dropped the requirement for airborne precautions/isolation rooms and we now use droplet precautions as we do with every other influenza and Coronaviruses. It is my understanding that
749.
by haldujai 7y ago
As a radiologist in a tertiary care centre operating CT scanners from four different manufacturers of various generations and age (0-20 years) I can assure you that there is no current CT protocol that requires minutes of active scanning ti
750.
by haldujai 7y ago
Actually you just need to have them wear a mask and wipe down the equipment with standard hospital grade wipes. We know now that COVID-19 is not airborne and is spread by droplets only so this would be routine precautions, unlike TB which w

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