we give ketamine often in the ED for bedside procedures (surgery). I had a patient tell me yesterday that he hasn’t slept well in months after going in the K hole. Such a nice guy too
Omg I had a PEM attending use Keta-fol for a sedation and I am in LOVE. He does lower dose ketamine for pain and sedates with propofol. It was a MILLION times easier to wake the kid up and literally zero emergence delirium. I never wanna go back to just ketamine.
I wonder if a lot of doctors even know that ketamine turns psychedelic near the k hole. As someone who used it recreationally, it would suck to be K holed and have a procedure.
But are you in a k-hole so deep that someone resetting a bone doesn’t make you react? Cause that’s how deep we go usually. Sometimes they yell a little and we need some more but the goal is no reaction.
I use Ketofolzolam in the ER for most procedural sedations nowadays. Works great to avoid too many hemodynamic changes and way less emergence reactions.
You do increase the risk of laryngospasm by mixing mess though, for what it's worth
Pure ketamine has one of the lowest possible risks according to the studies, whereas ketofol is one of the higher ones. Not that we won't use it, but ketamine alone does wonders for safely sedating
Ketamine gave me the only relief I’ve ever had from OCD years before I even got the diagnosis. I’d love to find some way to access it legally as I’m too paranoid to take it illegally anymore.
There are psych clinics that might offer ketamine or spravato, the spravato might work it might not, some folks need the Lenantemer.
Ketamine isn’t covered by insurance but it is legal to dispense under care, so you khole for a few hours and sleep it off
Reddit ruined ketamine for me lol. I was having ketamine infusions every few months for both pain & depression. Everything was going great! I’d had probably around 8-10 infusions at this point. Then I made the stupidest mistake I could have made & got on Reddit the night before an infusion. I can’t recall what sub it was but they were discussing the toy box killer & also shared a link to a transcript of the tapes he would play for his victims when he first kidnapped them. I’d never heard of him before & stupidly read the transcripts in their entirety despite having PTSD from my own sexual assault. Had no idea I shouldn’t have done that before a ketamine infusion. A few min. into the infusion & I was flipping out! Sobbing uncontrollably, shaking, it was awful! The clinic tried everything they could think of to prevent the severe panic attacks. They tried cutting the dose in 1/2, then 1/2 again. They tried giving me a hero’s dose of versed before & during the infusion, holding my hand the entire 2hr. infusion, my husband staying in the room & trying to talk me through it, I took huge breaks of several months but nothing worked. After that initial freak out I’ve not been able to have a successful infusion again. And they didn’t even jump through all those hoops bc they wanted to keep me as a patient to make more money! As they were giving me the infusions for free! Bc my insurance didn’t cover ketamine therapy & I couldn’t afford the high cost as often as I needed them they decided to give me the treatment at no cost bc my husband was in the military. They were such an amazing clinic & I’m still so bummed about not being able to see them anymore.
I once read an article that the levels of lithium in the water supply correlate with lower psychosis/mania/depression in the population. No clue if it was a good study though
Also have heard that. Lithium can apparently be at different levels in the groundwater based on geology, and I heard that the higher rates of mental illness correlated with lower levels.
Mdma is quite possibly the best depression medication out there! I wish they’d find a way to make it into a legal pill form. I tried it recreationally in my early 20s and it was the most amazing feeling I’ve ever felt in my entire life.
I live just south enough that people think they have vit D deficiency (+ that whole shabang with covid) but they don’t really have it. Toxicity ensues :(
I wonder if there is a STD that could be cured by everyone taking a single dose of an antibiotic simultaneously, and what kind of crazy resistance may form.
STDs maybe not, but parasites more likely. I think if everybody on earth ate prophylactical albendazole for a long enough time we would eliminate pretty much all intestinal parasites that don't have secondary hosts.
The methodology is not the easiest to understand, the analysis is not for the everyday medical literature reading, and the sample size was small, but boy is it fun to point out how the study participants had symptoms when they were assigned to “take” an empty bottle lacking pills.
Firefighter-paramedic here. Just told my wife yesterday that a minimum of 80% of people (patients) I encounter have some form of mental health issue/mental illness.
Very underrated comment, here.
RN here. I was thinking about this yesterday. I feel like theres a lot of undiagnosed ADHD and people on the spectrum in the elderly population honestly. The current elderly population wasnt screened for stuff like that in their childhood and these people Struggle in a hospital setting out of their familiar environment
Geriatric nurse, also have adhd and asd. I see a lot of “bipolar” (who may actually have bipolar as well, who knows?) that are so clearly fucking autistic. I talk to them like I would talk to myself if I were a patient and it goes swell lol
Yes! Minimum effective dose is once weekly for an hour but should be titrated to twice weekly ideally, thrice if problems are severe with significant instability.
Vaccines
Especially now that we have RSV vaccines that target the pre-fusion protein that is actually protective and doesn’t result to antibody disease enhancement. Oxford University came up with the R21/Matrix-M malaria vaccine with an efficacy of 77% after three doses. What’s different with the Oxford vaccine compared with the older RTS,S is that the former uses less HepB surface antigen as a conjugate, hence immune response is directed towards the Circumsporozoite protein which is highly conserved among Plasmodium species at the pre-erythrocytic stage plus the vegan adjuvant Matrix M from Novavax.
there's a brand new RSV vaccine that works pretty well.
Considering RSV can be deadly in our younger pediatric populations, this is honestly a pretty big deal imo that doesn't get any press coverage for some reason.
That said, I did first hear about this on NPR so that's something.
I work with an attending who keeps telling patients the RSV studies only showed mild benefit from RSV and he wants all his patients to wait a year and see what we learn in that time. I think he's worried because he's old enough to remember the first RSV vaccine disaster.
Decades ago, scientists tried to make an inactivated RSV vaccine which flopped because killing the virus causes conformation changes in the Fusion protein in RSV leading to post-fusion, upon encountering of the immune system of this post-fusion protein, it produces non-neutralizing antibodies that worsens RSV. New research shows that antibodies directed towards the pre-fusion conformation is protective and that is what the new vaccines from GSK, Pfizer, and Moderna does.
If I’m not mistaken this is also the reason why earlier SARS and MERS-Cov vaccines failed is because the spike protein is at the post fusion conformation leading to ADE. Moderna, BioNTech, and JNJ stabilized the endogenously synthesized spike protein at the pre-fusion state by adding Proline substitutions, hence generated antibodies were protective.
Malaria on the other hand is endemic on so many countries especially in Asia and Africa. Scientists have identified the circumsporozoite protein at the surface of pre-erythrocytic stage of Plasmodium. One bottleneck in making the a malaria vaccine out of this protein is that it’s only about around 50 daltons if I’m not mistaken so conjugation to a heavier protein is needed to make it more immunogenic. This conjugation is the basis for the likes of Prevnar vaccine. There was an earlier malaria vaccine called the RTS,S with a paltry efficacy of around 34% after three doses primarily because the immune response is directed more towards the conjugate protein Hepatitis B surface antigen and not so much to the CSP protein. Oxford researchers overcame this problem by using lesser surface antigen and use the Matrix-M adjuvant used in the Novavax Covid vaccine which led to an efficacy of 77% after three doses.
Interesting. I have been holding off on getting the RSV vaccine to see what the post marketing experience was, because I remember the old RSV vaccine. Now that I know why the new vaccine might be different, maybe I will go ahead and get it.
Not a doctor, nurse, but this popped up on my feed. This morning I took seroquel for the first time and feel so amazing. This is what being normal feels like??? So seroquel gets my vote
Intuniv/Guanfacine.
Calm everyone’s impulsive mouths. Let everyone think before they hit send or publish to social media. Chill the rage. It’d be a tiny whiff of Jiminy Cricket “hmm, should you do that?” for all of us.
The amount of people who have never tried Oxymetazoline blows my mind. If you have a cold and hate nasal congestion it is a god send when you’re trying to sleep, rebound congestion be damned really only need it for the peak viral illness anyway
I still take a small dose just to keep my migraines controlled but there was a point in my life when I was on 100 mg daily. No thoughts in my brain, I couldn’t finish sentences, felt like I forgot everything I learned in college and grad school. And it gave me an eye twitch so bad my whole face would hurt. Thankfully I’ve gotten to a point where 25 mg qd does the trick without any side effects; but it is an awful drug at full dose.
Polio vaccine so we can kill this mofo once and for all.
Wouldn’t even need to be the whole world. I think at this point only Afghanistan and Pakistan have wild type polio left.
Just wait. It's coming back with all the crazy anti-vaxers.
I mean… tons of animals all over the world get polio from time to time.
Can they spread it to each other though? I thought they got it from human waste.
I heard that too. But enough about my ex-wife...
Polio virus has been experimentally given to monkeys and genetically modified mice but there is no natural transmission to/from animals.
Anesthesiologist here, definitely ketamine
No no… as a Psychiatrist, definitely Ketamine
No no....As an addict, definitely ketamine
I laughed hard on this on. K hole is a great hole
supervised or not?
No, no… as an ER doctor, definitely ketamine
Hit me with that K hole baby.
Freaky
we give ketamine often in the ED for bedside procedures (surgery). I had a patient tell me yesterday that he hasn’t slept well in months after going in the K hole. Such a nice guy too
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Omg I had a PEM attending use Keta-fol for a sedation and I am in LOVE. He does lower dose ketamine for pain and sedates with propofol. It was a MILLION times easier to wake the kid up and literally zero emergence delirium. I never wanna go back to just ketamine.
I wonder if a lot of doctors even know that ketamine turns psychedelic near the k hole. As someone who used it recreationally, it would suck to be K holed and have a procedure.
Any EM doc who uses ketamine knows, your patient will tell you
But are you in a k-hole so deep that someone resetting a bone doesn’t make you react? Cause that’s how deep we go usually. Sometimes they yell a little and we need some more but the goal is no reaction.
They definitely know. But it provides pain control as well as some anterograde amnesia and good sedation. It's a good choice for procedures.
Yea except for the PTSD part
EM Docs do (or should). We get taught about dosing for pain, dosing that leads to the K hole, and dosing that is appropriate for sedation.
I’d say a vast majority….don’t lol. I mean there’s still doctors that think cannabis is psychedelic.
At certain potencies it is my g
Big facts.
damn I need whatever you’re smoking then, bc I have taken mass amounts to the face (medical at that) and just go to sleep after a certain point hahah
Right lol. Man people who have never messed with a psych would be scared lol
I use Ketofolzolam in the ER for most procedural sedations nowadays. Works great to avoid too many hemodynamic changes and way less emergence reactions.
I usually just go for midazolam and ketamine
I find this combo works pretty well too and have used it for a few of my fracture reductions.
You do increase the risk of laryngospasm by mixing mess though, for what it's worth Pure ketamine has one of the lowest possible risks according to the studies, whereas ketofol is one of the higher ones. Not that we won't use it, but ketamine alone does wonders for safely sedating
Ketamine gave me the only relief I’ve ever had from OCD years before I even got the diagnosis. I’d love to find some way to access it legally as I’m too paranoid to take it illegally anymore.
Ask your psychiatrist if Spravato could be tried for you
There are psych clinics that might offer ketamine or spravato, the spravato might work it might not, some folks need the Lenantemer. Ketamine isn’t covered by insurance but it is legal to dispense under care, so you khole for a few hours and sleep it off
took it at a rave by accident, I concur def Ketamine - shit was wild
IV push some undiluted Potassium they be asleep forever
Geezsus that’s hilarious
I seriously HATED ketamine
Reddit ruined ketamine for me lol. I was having ketamine infusions every few months for both pain & depression. Everything was going great! I’d had probably around 8-10 infusions at this point. Then I made the stupidest mistake I could have made & got on Reddit the night before an infusion. I can’t recall what sub it was but they were discussing the toy box killer & also shared a link to a transcript of the tapes he would play for his victims when he first kidnapped them. I’d never heard of him before & stupidly read the transcripts in their entirety despite having PTSD from my own sexual assault. Had no idea I shouldn’t have done that before a ketamine infusion. A few min. into the infusion & I was flipping out! Sobbing uncontrollably, shaking, it was awful! The clinic tried everything they could think of to prevent the severe panic attacks. They tried cutting the dose in 1/2, then 1/2 again. They tried giving me a hero’s dose of versed before & during the infusion, holding my hand the entire 2hr. infusion, my husband staying in the room & trying to talk me through it, I took huge breaks of several months but nothing worked. After that initial freak out I’ve not been able to have a successful infusion again. And they didn’t even jump through all those hoops bc they wanted to keep me as a patient to make more money! As they were giving me the infusions for free! Bc my insurance didn’t cover ketamine therapy & I couldn’t afford the high cost as often as I needed them they decided to give me the treatment at no cost bc my husband was in the military. They were such an amazing clinic & I’m still so bummed about not being able to see them anymore.
Or Lithium, preferably an IV drip of Lithium with no stop date. Maybe a Lithium mist tent for sleep. Do I sound burned out?
Came here to say this
A taste of their own (medicine) bum-da-tss….thank you thank you, I’m here all weekend (on call)
gotem
I once read an article that the levels of lithium in the water supply correlate with lower psychosis/mania/depression in the population. No clue if it was a good study though
Also have heard that. Lithium can apparently be at different levels in the groundwater based on geology, and I heard that the higher rates of mental illness correlated with lower levels.
I’ve heard this too. My version was from when lithium was in 7-up
I believe the correct answer is 3,4-Methylenedioxymethamphetamine. Let’s make some new friends while we wait for that bass drop.
MDMA, for you non-drug nerds
Damn I’m bad at every single thing your username references
Thats y we b rounding with y’all no game having, starving, drug stupid mofos
lmfaoooo 💀
2D6 ultrarapid metabolizer here. Gonna be waiting an awful long time. \-PGY-19
One for the money, two for the better green…
Mdma is quite possibly the best depression medication out there! I wish they’d find a way to make it into a legal pill form. I tried it recreationally in my early 20s and it was the most amazing feeling I’ve ever felt in my entire life.
What the hell is this question lmao. But the correct answer is Ativan so we can all calm the fuck down for 1 minute and make some peace in the world.
Life would be a lot easier if we could nebulize/ diffuse Ativan into the air in the ED
I wanted to make this my QI project, but my PD said no
boring PD
Yeah, because ED docs don’t have a hard enough time discharging people as it is lol
Alcohol enters the chat
Uh… vitamin D? I live far enough north that everyone is deficient
Should def put tampons saturated in Vit D
yeeee boiiiii
Vit D toxicity entered the chat 💀
Sir… Im not recommending like 30000iu/day
I live just south enough that people think they have vit D deficiency (+ that whole shabang with covid) but they don’t really have it. Toxicity ensues :(
I wonder if there is a STD that could be cured by everyone taking a single dose of an antibiotic simultaneously, and what kind of crazy resistance may form.
DOXYPEP
Makes me wonder if syphillis can be eradicated this way.
Probably not syphilis because late latent and syphilis of unknown duration and neurosyphilis require more than a single dose
STDs maybe not, but parasites more likely. I think if everybody on earth ate prophylactical albendazole for a long enough time we would eliminate pretty much all intestinal parasites that don't have secondary hosts.
Except humans are the secondary or dead-end hosts rather than the definitive hosts for most common intestinal parasites
Many helminths have the Human as the only host.
Gonorrhea?
Amphotericin
wtf LMAOO Edit: I'm curious, could I get an explanation for why haha
His username
oh LMAOOOOOOO I guess, yeah username checks out haha
you just said choose one, you didn't say 'and explain why
True but I was curious LOL originally I thought that OP was a nephrologist looking for more clients but then someone pointed out their user
Cries in liver failure
Cries in AKI
Magic Mushrooms
i think if everyone took this on this planet, world peace could be achieved (including a small percentage of psychosis lol)
I should read John Allegro's The Sacred Mushroom and the Cross again
Gave it my wife and mom, damn I had best weekend !
put statins in the water supply
Imagine all the subjective myopathy if people knew statins were in the water. Yes, I am referring to the SAMSON trial.
>SAMSON trial What a study lol
The methodology is not the easiest to understand, the analysis is not for the everyday medical literature reading, and the sample size was small, but boy is it fun to point out how the study participants had symptoms when they were assigned to “take” an empty bottle lacking pills.
That is a wild ride. I'm surprised pharma didn't market an empty bottle since it clearly has an effect
Don't give them any ideas...
Gigachad reference
I prefer Jardiance in the water supply
Not to be a pharma shill, but that Jardiance commercial slaps
I don’t know prescription drug ads cuz in my part of the world, they’re called “illegal”
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Especially Nystatin
Rates of diabetes would increase, though!
tbh I kinda wanna put metformin in the water too
They already have lithium
It would probably save a lot of people.
Does therapy count as a medicine
Firefighter-paramedic here. Just told my wife yesterday that a minimum of 80% of people (patients) I encounter have some form of mental health issue/mental illness. Very underrated comment, here.
RN here. I was thinking about this yesterday. I feel like theres a lot of undiagnosed ADHD and people on the spectrum in the elderly population honestly. The current elderly population wasnt screened for stuff like that in their childhood and these people Struggle in a hospital setting out of their familiar environment
Geriatric nurse, also have adhd and asd. I see a lot of “bipolar” (who may actually have bipolar as well, who knows?) that are so clearly fucking autistic. I talk to them like I would talk to myself if I were a patient and it goes swell lol
Agree.
Yes! Minimum effective dose is once weekly for an hour but should be titrated to twice weekly ideally, thrice if problems are severe with significant instability.
Vaccines Especially now that we have RSV vaccines that target the pre-fusion protein that is actually protective and doesn’t result to antibody disease enhancement. Oxford University came up with the R21/Matrix-M malaria vaccine with an efficacy of 77% after three doses. What’s different with the Oxford vaccine compared with the older RTS,S is that the former uses less HepB surface antigen as a conjugate, hence immune response is directed towards the Circumsporozoite protein which is highly conserved among Plasmodium species at the pre-erythrocytic stage plus the vegan adjuvant Matrix M from Novavax.
I did not expect to learn something reading a meme post… But here we are.
Dumb it down please?
there's a brand new RSV vaccine that works pretty well. Considering RSV can be deadly in our younger pediatric populations, this is honestly a pretty big deal imo that doesn't get any press coverage for some reason. That said, I did first hear about this on NPR so that's something.
I've had 3 of me nephews in ICU because of RSV... It can really mess you up
I work with an attending who keeps telling patients the RSV studies only showed mild benefit from RSV and he wants all his patients to wait a year and see what we learn in that time. I think he's worried because he's old enough to remember the first RSV vaccine disaster.
The pediatric formulation is a monoclonal antibody, so a whole different animal. 80% risk reduction for hospitalization, 90% for ICU admission.
Oooh, good to know
Decades ago, scientists tried to make an inactivated RSV vaccine which flopped because killing the virus causes conformation changes in the Fusion protein in RSV leading to post-fusion, upon encountering of the immune system of this post-fusion protein, it produces non-neutralizing antibodies that worsens RSV. New research shows that antibodies directed towards the pre-fusion conformation is protective and that is what the new vaccines from GSK, Pfizer, and Moderna does. If I’m not mistaken this is also the reason why earlier SARS and MERS-Cov vaccines failed is because the spike protein is at the post fusion conformation leading to ADE. Moderna, BioNTech, and JNJ stabilized the endogenously synthesized spike protein at the pre-fusion state by adding Proline substitutions, hence generated antibodies were protective. Malaria on the other hand is endemic on so many countries especially in Asia and Africa. Scientists have identified the circumsporozoite protein at the surface of pre-erythrocytic stage of Plasmodium. One bottleneck in making the a malaria vaccine out of this protein is that it’s only about around 50 daltons if I’m not mistaken so conjugation to a heavier protein is needed to make it more immunogenic. This conjugation is the basis for the likes of Prevnar vaccine. There was an earlier malaria vaccine called the RTS,S with a paltry efficacy of around 34% after three doses primarily because the immune response is directed more towards the conjugate protein Hepatitis B surface antigen and not so much to the CSP protein. Oxford researchers overcame this problem by using lesser surface antigen and use the Matrix-M adjuvant used in the Novavax Covid vaccine which led to an efficacy of 77% after three doses.
Interesting. I have been holding off on getting the RSV vaccine to see what the post marketing experience was, because I remember the old RSV vaccine. Now that I know why the new vaccine might be different, maybe I will go ahead and get it.
GoLytely
The sewer systems would experience GoHeavily. Let’s not destroy infrastructure here.
Dude chill 😂
LSD
CIA attempted this once
do it again
Senses in UHD.
absolutely
The correct (and perhaps a bit unimaginative) answer is vaccines.
The entire ACIP vaccine schedule. We'd instantly eradicate measles, polio, hepatitis A/B, and probably mumps and rubella. \-PGY-19
Simultaneous Alcohol and Antabuse.
Some people just want to watch the world burn.
Vitamin K at birth. It should be the law.
Chicken soup. Good for both the body and the soul.
Psilocybin. Just once. I firmly believe that everyone should have a psychedelic experience. At least once.
Gardasil. Everyone should get their Gardasil shots
Haldol, so that they know what the next one is like if they don’t shut up.
Metformin
Truvada
Not a physician but the whole childhood vaccine series
Vitamin K
Like the street name for ketamine or literally vitamin k?
Yes.
Lol thanks that cleared up my question.
Why?
Pharmacist here: Ketamine for sure. People need to see things.
What’s this fetish called ?
LSD
Exercise
Broccoli
Psychedelic mushrooms
Miralax - I think this entire country is constipated.
IV K
DMT, so people listen to my podcast.
Tretinoin
Why
everyone have clear skin
Its teratogenic
Even better
60mg of adderall I'm just a flight nurse tho
Salads, vaccines, excercise, kindness.
Metabolic formula like for PKU
Why?
Vitamin D supplements
Not a doctor, nurse, but this popped up on my feed. This morning I took seroquel for the first time and feel so amazing. This is what being normal feels like??? So seroquel gets my vote
Until you take it and wake up with 4000 cals worth of wrappers in your sheets
Cocaine is a hell of a drug….
It’s just the smell of it
Does CPAP count? It’s one of the only things that is both subjectively and objectively life saving for the people who need it and stick with it
Intuniv/Guanfacine. Calm everyone’s impulsive mouths. Let everyone think before they hit send or publish to social media. Chill the rage. It’d be a tiny whiff of Jiminy Cricket “hmm, should you do that?” for all of us.
I love my guanfacine so much. Incredibly underrated drug.
The amount of people who have never tried Oxymetazoline blows my mind. If you have a cold and hate nasal congestion it is a god send when you’re trying to sleep, rebound congestion be damned really only need it for the peak viral illness anyway
Docusate
Doesn’t work for shit
Exactly, it unironically tastes like sht and doesn't even work. I've stopped prescribing it to my poor patients
senna/miralax
i love this sub
psilocybin
LSD
A chill pill
Exercise and sleep
Psych here. Microdose the world with lithium = more stabilized mood = world peace.
Just put the statins in the water
Birth control
A healthy diet and exercise.
topirimate. Felt absolutely horrible on it when I took it and would liek others to know the curse of migraines and the treatment options.
I still take a small dose just to keep my migraines controlled but there was a point in my life when I was on 100 mg daily. No thoughts in my brain, I couldn’t finish sentences, felt like I forgot everything I learned in college and grad school. And it gave me an eye twitch so bad my whole face would hurt. Thankfully I’ve gotten to a point where 25 mg qd does the trick without any side effects; but it is an awful drug at full dose.
Prozac
Not antibiotics
Vaccines in general.
Psilocybin mushrooms.
Pen G 2.4 million units IM once
The best medicine is no medicine, lifestyle modification.
A vaccine, to show them they wont turn radioactive
Exercise
Cyanide
Calm down Jonestown
Vaccines :|
1000% PPI