Rad Tech here, this is true. I can’t see correctly in a well lit room.

I thought Radiology was simply bored with Nephrology's aggro. Thanks for the explanation 😀

It makes sense. Lights go out, they have to perform. When they leave the reading room, it’s because they either have a break or are finally leaving (no, I’m not counting going out to take ultrasounds, going to the CT scanner, etc)

Our circadian rhythms are regulated purely based on differences within the thin spectrum that exists in the blue light emitted by Barco monitors and cell phones.

Night owl lab tech - I can’t wait for the daywalkers to leave so I can turn off all the fluorescents and bask in the soothing glow of computer screens.

Or an angry Cardiologist, asserting his claim to a dialysis order from overnight chest pain, rattling his stethoscope in response to Nephrology's territorial challenge.

0:53 - The stereotypical Cowboy movie song that I can only describe as "Wa wa waaaa.....'trilling wistle that kind of sounds like locusts in background'......" that plays at High Noon when two Cowboys are approaching each other for a Stand Off, waiting for a shootout while the townsfolk hide in the nearby shops. The spurs on their boots ring with each step as the approach the center of the town and "talk" to each other. Your rattlesnake description would be a perfect aound effect for the scene described in the first paragraph.

​@iyaayas7703 So true 😂... The movie you're describing is The Good The Bad and The Ugly. It's a really good one I reccommend it

@@harnutvlad7662 THANKS! I remember scenes from it from somewhere but couldn't remember the source of those scenes!

unclear which is scarier

Laugh...its so true

Same here! Lol

They've already seen it because I used the word salt in the comments #inception

Do you want to get condescended by the nephrologist for showing something that is clearly not worth their time?

​@@doithimaceabhard7457Game, set, match

​@@AznJsn82091They probably know their nephrologist well enough to know they'll appreciate it (and it's nephrology, not neurology). Also, you sound super fun at parties.

Thanks for the context, salt-bro.

X-ray students are taught that iodinated contrast is contraindicated when patients BUN and creatinine are abnormal, or there’s a history of kidney disease. So even techs will question an order with contrast.

Ahh internal medicine has entered the chat 😉👍

@@wziqian Technically you're correct. But I'm primarily a nephrologist.

And that's just the CT contrast, wait till we get into MRI territory and fun stuff like nephrogenic systemic fibrosis. Although I believe most of the contrast solutions associated with that are no longer used anyway.

Having to learn about medical software and systems for QA and PI was a headache. Depending on the vendor/company and on top of their "vanilla" version, there may be the option of having custom changes or modules added on top, or the HIM dept can customize it based on their needs. Said HIM professionals may either be of the in-house dept or outsourced to the seller's. There's a ton of other details and headaches that can end up getting piled on, which just makes the entire thing a big ol' mess. Fun!

Some messages are definitely built in or come by default. Unfortunately making changes to an EHR like Epic is about as pleasant as walking on broken glass, and probably more expensive too! That's part of the reason why it's so hard to get rid of these things after the system goes live.

The red ones I look at, the yellow warnings I don’t.

I had a board practice question about this

Like in those absolutely garbage criminal charges against a doctor and pharmacist for giving methotrexate daily instead of weekly. "But they clicked through warnings" it feels like it's rare that an order doesn't have warnings we have to ignore. And it should have malpractice and grounds for disciplinary actions / censure, but not criminal charges. The people creating alert fatigue should bear appropriate liability for their decisions, too.

Photosensitivity is no joke! It's why I have prescription sunglasses. - photosensitive gremlin autist

I had a computer programming job at a place where they turned off the overhead lights in our area. It really does reduce stress.

Rad tech here - a lot of the things we do require lower lights to more easily see screens and/or use light to position properly, so radiology is traditionally lower light pretty much across the board. I walk out into the bright part of the hospital and it hurts! Lol. I call us in radiology mole people.

@@WelcomeApathyaha im a radiographer too and I’m fond of calling us the little radiation mushrooms 😊 i will say though in terms of the lower lights it drives me bonkers when people turn off the lights near the monitors because the brightness on the monitors is so high and all the programs bar one are white and it physically hurts to do anything at the computer which is a lot of my job. Its like having a torch beamed directly into my eyeballs but i also have to complete tasks while doing so

@@katierasburn9571 I've slowly been turning down the brightness of all the monitors in my department (not the ones for viewing images, obviously) 🧠 sweet relief.

As a layman, my silly brain is going to keep thinking Grand Funk Railroad.

🤣🤣🤣🤣

Did you say the patient was dipped into iodine?

@@Problemsolver434 I mean they used a lot of contrast while in angiography and embolisation.

It honestly depends on the case. If we're looking for a dissection/aneurysm or PE, sure. But a lot of times they order contrast for things that can be seen just fine without. Why run that extra risk if you don't have to?

OMG YES!!!!!

I've been trying to get a feature put in to let people specify communication preferences if they don't speak (say, picture board, particular AAC software, etc.). It's a nightmare.

@ReneeMontoya12 Similar to KZfaq, they'll add stuff NOBODY asked for or uses.

The word “epic” can scare any medical professional, guaranteed 😂

Ok BUT that means you’re getting to the point where it’s so broken it’s not functional which forces an actually useful update, that all the doctors will hate because all the other ones ruin it, or it’s learning a new setup. It’s the circle of incompetence

And they've already updated it at least 6 times in that timeframe, so you'll just have to start from scratch anyway.

100000%

I have a particular talent for finding Epic bugs it seems. Hours after a required functional/cognitive assessment went live I managed to find a way to get it completely stuck. If you are an Epic user in Oregon it’s because of me you have to type 777 or 999 if a patient answers yes but doesn’t list age of onset. Sorry/you’re welcome!

This is the most accurate thing I’ve ever read

May your recovery be uncomplicated, speedy, and complete!

And then he flipped the switch and pulled out Sudoku lol

You know billing is why EMRs exist. If it weren’t for billing we would all have paper- no née to actually ever read anyone else’s notes. If you’ve ever read them they are basically CYA

Oh EPIC is totally a cash register…

Not to mention all the very probable microatheroemboli from your illicit intraarterial instrumentation getting dislodged and shot down into the kidneys.

Ahhh radiology. No matter what, it is ALWAYS our fault

I've drawn worse 😂

the patient you insert your coils into must be dead cus that coil is abstractly spherical.

​@@biolumatenah that depends IR got like 10 or more type of coils with different length and everything. Those sphere type usually used for berry aneurysm.

@@Greatbylook ah that's because the aneurysm is shaped spherically. most of the time the coil is elongated because of bloodflow.

@@biolumate yup that's right. Sometimes they also have some kind of feather that help blood to clot faster.

@@biolumate 1st coil of a cerebral aneurysm procedure is usually a spherical shape. Subsequent soft platinum coils will conform to whatever shape they are placed into.

Sounds easy to me.

Yes must require clicks elsewhere or else those providers will be thinking they can get away without us techie types

He knows that radiologists are the most-sued physicians, so he is not going to hand the lawyers an easy one.

​​@@MyFiddlePlayeris that actually true? I know they really have to be careful, but I have one radiologist who I mainly work with in the breast imaging center who can be verrryyy particular about things. (Not necessarily a bad thing but it's more of a his way or the highway type deal). I've gone in to show him ultrasounds on cases and he'll say stuff like "so if **I** get sued and this is on here then...blah blah" Funnily enough he kind of swings the other way with different exam types and won't say much about findings I'd consider to be more significant for lack of a better word. He's just the boob-pro I guess lol

​@@taliag09probably because it's the branch og medicine that literally has all the records before during and after care. So yeah, there's that .

Radiology turned off the lights though, game over for nephrology

Fourteen bags of 3%?

😂😂

I mean you really arent far off at all. If you think about how many scans are completed per day it does stack up, especially if the radiologist is managing multiple imaging modalities plus they have to report on imaging taken out of hours on their list and is also being constantly called by doctors wanting reports or advice. There obviously isnt just the one but they have a long long list to get through and theres a priority order too just like in ED, kids are always first on the list for example.

Hahaha! Salt flying everywhere!

@@katierasburn9571 The worst part is that if you get behind, physicians (or their minions) start calling you to let you know that you are behind (oops, I mean, to ask you for their patient's results), making you more behind.

That’s because young nurses have never nursed with paper. Want to cause nightmares? Have Epic burp during the day light

Haha! I could hear that!

Jonathan told him what you were thinking about.

@@tscimb That's OK then, in Jonathan we trust.

Probably because some think contrast is always better so let's order it on every study and on every patient, we see this alot in MRI.

Wait did you have other exams on nephrology? We had two entire exams on the kidneys and an anatomy exam back in my med school.

@@thepapschmearmd we've had one exam where kidneys anatomy and physiology were included and one of pathology of the kidneys before the above mentioned exam. In my school we don't have exams on just one subject but rather a mix of several, for example in the exam mentioned above were also endocrinology, GI and urology included. So each field doesn't get that many questions in each exam though.

Brings me back to the horrors of medschool exams .. why do they do that! Out of the whole curriculum they choose a 0,1% part and still find every possible question to ask about it and ignore all the rest. I think it's done on purpose. Cause it doesn't even serve as a good way to test the students.. whatever.

Wish I could like this 1,000X!

I keep on having to remind myself that me saying I sent an "Epic message" just makes me sound like an overconfident 15-year-old boy if nobody else knows the context.

Hahahahaha, so true, especially for foreign viewers like me 😅

Bicarb drips for me. Pukeomyst is just... ugg,

@@gkd1982 I seem to remember us doing this too if they were really bad. It was a rare enough occurrence though that everyone always had to look it up

And I feel bad doing a NS gtt at 60ml/hr to gently hydrate someone with an iodine allergy AND ckd 😅

@@natalietremblay4373 Worked with a terror of a cardiologist that did it a lot. That and "renal dose" dopamine.

I gave mucomyst to patients before it was a pill. I tried it, tasted like my moms burned out vacuum cleaner belt. Nasty.

Radiology's wave has completely altered my perception of the Radiology character.

@@Joy21090 Also the little smile he did when he waved!

@@Joy21090 - Radiology is working on his social skills!

​@@aml7481He's been watching the "Charisma on Command" channel, and just read his very first self help book, too!

kzfaq.info/get/bejne/gsWfkrJo25fJp6c.html

Epic is electronic medical records program that their hospital used i supposed. Usually there are tons of program like these and most of them are annoying and not efficient.

⁠Thank you Hillary Clinton and President Obama.

@@25dcbEpic was alive and well and making a ton of money before either of those bozos showed up

@@Jen39x True enough, but they were the ones that essentially put the requirement in for EMRs and provided money for conversion to EMRs. Judy Faulkner was a very large contributor to President Obama.

"In radiology, when the lights go down, things get serious." I'm imagining cheesy sexy jazz music as the soundtrack for that.

@@jayschafer1760 When the lights go down, the radiologist undos his trouser's to women's Xrays.

Bill runs everything.

Possibly more that we are now seeing the folks Bill used to be - eventually he'll seem like a genius!

No one likes getting the same baseless consult over and over again. I am happy to take obgyn consults from my colleagues but every time I get a vaginal bleeder and then on exam she’s bleeding from her rectum, a part of me gets just a little saltier.

@@thepapschmearmdi wish it was harder for me to believe that this happens

​@@thepapschmearmdAre people just like "Oh, she's bleeding from between her legs, and she's a woman... must be vaginal!" Like, is it that hard to determine the source of the bleeding without your help?!

I know, right?! I used to think the radiologist was serious and unfriendly. Now I know he's a friendly dude who just works in the dark.

Let patients add&edit their own meds list! For your sanity, I hope no one else starts offering suggestions, but OMG it is nearly impossible to get a meds list anywhere near accurate if you see multiple doctors - especially when they aren't on the same systems. 🤐🤐🤐

You should be commended for your bravery to admit a thing like that publicly in front of medical professionals. May God have mercy on your soul.

@@tscimb Agreed. Constantly having to correct Epic's renderings of my meds list.

What kind of hospital doesn't even have PT?

Current Epic employee! Nice to see someone made it through and survived 😂

Can validate this as an Epic analyst. It's a choice to have these "BPAs" enabled or not.

Yeah, a lot of people in the comments here are attributing to Epic what their hospital decided to configure. It's not perfect software by any means, but most of their frustration is coming from their own organization's managment and IT

And there we go ! Congrats 🍾

Studying for boards currently and they just say to load the patients up with IV fluids and they’ll be fine 🤷🏽‍♀️

The real question that no one asks themselves is: do they even need the scan at all?

They're crucial to the distinction between nephrotic and nephritic Sx!

All cells deserve love. 😅

I had the "hold the metformin" lecture in nursing school!

I think it's his baby rattle. Even as a baby, he preferred the salt shaker...

Why is that?

No one seems to want to talk to a patient about CKD until dialysis is required (that is, very late in the game). Why is that?

Don't worry, dialysis patients can get contrast CTs if needed. We usually just schedule a dialysis session after the CT scan.

Radiologist and scientist here - this comment is inaccurate on many levels. The nephrology and radiology literature are now largely in agreement that the incidence and severity of "CIN" from intravenous iodinated contrast exposure has been hugely overstated in older uncontrolled studies and textbooks. In fact, the genesis of "CIN" was nothing more than two case reports in the 1950s - there has never been "proof" CIN existed, at least not from properly designed controlled studies. The observation they made (as you have) is that people got sicker after they underwent a contrast enhanced CT - one of the major confounders is that we image people when they need medical care, often at an inflection point in their disease. In these circumstances, they were getting sicker anyway and they renal function declines because their kidneys are shutting down - contrast is blamed in these cases when it is just a case of misattribution of the causality of renal failure. There is no lab test/biomarker for contrast induced AKI (CI-AKI) or any good means to extricate Contrast Associated-AKI (CA-AKI) from CI-AK( (e.g. CIN) on individual patients. Recent studies over the last 10 years suggest either CI-AKI does not exist at all or is an uncommon occurrence among patients with eGFR < 30. Even among these latter studies, there are no good data from controlled, propensity score adjusted, retrospective data (because there are no prospective RCTs and there may never be) of an excess risk of the more serious complications (death, emergent dialysis). A single study exists that may suggest a very modest decline in renal function after CI-AKI but there are many more that fail to observe this... In emergencies and cases of critically ill patients, withholding contrast when diagnostically useful is associated with FAR greater risks than the greatly overstated risks of CI-AKI/CIN. In fact the delay in diagnosis of patients with PEs, malignancies, other inflammatory/infectious processes (by withholding contrast) can contribute to premature mortality... If you have evidence to support your claims to the contrary, I am all ears. My interest in this topic goes beyond casual observer and I've participated in a lot of the research, publication, education, and regulatory/professional society policy changes over the past 10-15 years. Normally I lurk when I see this sort of stuff online and do not comment but the viewpoint posted above does not reflect current standard of practice for any nephrologist or radiologist, promotes misinformation, and spreads fear.

@je299 The people who sell treatements may not mind if this causes sickness 10-15 years later.. They stand to profit. First do no harm. Edit: my comment in refrence to gadolinium based ct agents.

​@@raddocwfmc Real life experiences, data and work at several emergency and ICU units do not need sponsored research conclusions which are largely based on a medical system thriving on unnecessary profits and lab tests. If you're truly following up cases of real people getting these scans, a lot of them suffer form their adverse effects soon after , within weeks and even after months. not just 2 people in a million. We dont treat treat patients like lab animals unless, ofcourse you're an atheist or a zionist who doesn't mind sacrificing people for 'pseudo science', pleasure or evil world domination plans which pays to enhance your riches as other people suffer and die in silence. (By your I mean anyone as a figure of speech).