Xarelto On Discharge for Pulmonary Embolism Decision Tree

Is Xarelto the right medication for you after a life threatening pulmonary embolism?  This medicine is a great option, but how do you know if it is the right medicine for you?  The Happy Hospitalist has provided a detailed flow chart decision tree for you to decide if Xarelto will work for your clotting disorder.  Years of dedicated clinical experience can be summed up in this one simple graph.  So, if you've got a big clot in your lungs and you want to know if you should take Xarelto, look no further.  You have found the answer you've been searching for.





LASIK vs Lasix. What's the Difference? Ophthalmologists Know and They are Cashing In On the Difference.


Bel-Aire, CA.  Every year, hundreds of thousands of patients study the pros and cons of getting eye surgery to finally get rid of their glasses or contacts forever.  They consider the costs and benefits before paying thousands of dollars to experience the freedom of Lasix.  And that is exactly what some ophthalmologists are giving them.  Lasix.

Lasix is a diuretic used to make you pee.  LASIK--Laser-Assisted In Situ Keratomileusis-- is an FDA approved eye surgery that permanently changes the shape of your cornea to try and say goodbye to contacts and glasses forever.

Lasix costs several pennies per treatment dose.  LASIK costs several thousand dollars.  Smart ophthalmologists finally realized they could optimize their revenue stream by taking advantage of cash paying customers and giving them exactly what they asked for.

Lasix did this!
It started in 2007 when Opportunologist Dr. Johnny Redman got tired of constantly explaining to his patients the difference between Lasix and LASIK.  So he decided to give them exactly what they asked for.  For only $2,000, Dr Redman offered his patented Minimally Invasive Vision Lasix therapy, and advertised it as so minimal that patients would never feel anything, except an overwhelming urge to pee out all the eye toxins causing the blurry vision.

"I can't believe I can see so well.  After just one Lasix treatment I was able to throw away my contacts forever.   Thank you Dr Redman for giving me back my eyes," said Nancy Getterman, a stay-at-home mother of three and leading essential oils Facebook poster among all her friends.

Dr Redman has made no apologies about his business model.  "I have a patient satisfaction rate of over 98% and a complication rate of 0% after 9 years of my proprietary Lasix method," said Dr Redman.  "Patients are lining up around the block to experience the joys of my Lasix therapy."



Nurse Creates The Mother Lode of All Advance Directives.

Albany, NY -- Adrian Fleming knew all about the horrors that went on at her hospital everyday.  As a seasoned floor nurse at SunnyView Hospital for over 20 years, she had a front seat view of the face palms that threatened patient safety everyday. She also knew someday she would be a patient in her own hospital and with that fear in mind, set out to create the mother lode of all advance directives.

An advance directive is a written statement of a person's wishes regarding medical treatment created to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

Her advance directive began as a collection of wishes and prayers and fears written on the back of sticky notes and used napkins, the communication method of choice between doctors and nurses.  After her first year on the job, Adrian had a large collection of random demands, each meticulously notarized by the hospital chaplain for authenticity.

Over the years, her collection of requests grew into a 17 page hardback nonfiction book titled Nobody Is Ever In a Fu*king Vegetative State:  What You Should Really Include In Your Advance Directive, an Amazon Times best seller.

An advance directive nobody will ever miss.
Then tragedy struck.  After twenty years of caring for patients, Adrian found herself hospitalized in the ICU,  seriously injured after hitting a light pole trying to avoid a barely gowned patient that just left AMA to buy cigarettes at a gas station across the street from her hospital.

Luckily, Adrian had her advance directive with her at all times; a barcode tattoo on her wrist, where she knew all the nurses would place her numerous armbands.

Unresponsive and intubated, but not in a vegetative state, Adrian's new grad nurse working in the ICU for the first time because seven nurses quit the week before after being accepted into nurse anesthetist school, scanned her wrist before placing the first of her seven  Joint Commission mandated arm bands. And what she found was a treasure of information on how to care for Adrian in the hospital.

Up on her computer popped a message that started, "Think of this as my birth plan for my ICU stay. I can hear everything you're saying.  As your guiding force, if you're thinking 'I would never let that happen to me, then don't let it happen to me either.'"

Then page after page of medical directives started flowing from the computer, as if a damn had broken upstream and a river of knowledge was released on the newby.  All in all, 496 legally binding demands were laid out for all the medical staff to adhere to.  Here are the top 10.

TOP 10 ADVANCE DIRECTIVE REQUESTS


1)  Don't let these surgeons operate on me Dr. XXXX, Dr. YYYY,  Dr. ZZZZ, Dr. XOXO, Dr XXY.   I don't care if they are the only ones on-call.  Transfer me AMA to another hospital if you have to (Names protected for publication).

2)  Don't even think about putting a Foley in me just because you don't wan't to clean me.  And that means no rectal tube either.  This is nonnegotiable.

3)  I don't want a CT scan to rule out shit that you and I both know I don't have if you just take the time to examine me.

4)  Don't put me on antibiotics because you can't tell if its CHF vs PE vs PNA vs COPD.  The xray is probably abnormal because of poor technique.

5)  If the radiologist says clinical correlation recommended, I don't want any other images read by that radiologist.    They are fired.

6)  Don't even think about consulting dermatology for any reason.   Instead, if it's wet make it dry and if it's dry make it wet.

7)  If you don't put me on VTE prevention dosing prophylaxis, I'm going to sue every...last...one...of...you, when I get a DVT.

8)  If I get c diff, it's because you didn't wash your f**cking hands.  I'm not a carrier, I can assure you.  That means I'm going to sue every...last...one...of...you.  Don't give me c diff.

9)  If I'm in isolation, I expect you to follow all the precautions, every time.  Not just the first 30 minutes of your shift.

10)  I am not hospice material.  Don't let the hospitalist tell you otherwise.


"You get a Foley. And you get a Foley. Everyone gets a Foley!"

You get a Foley.  And you get a Foley.  Everyone gets a Foley!



Top 10 Causes of DKA Hospitalization (ICD-10 Codes)

Most internists are taught the three most common causes of hospitalization for diabetic ketoacidosis (DKA) are infection, infection, infection.  In clinical reality, the three most likely causes of hospitalization for DKA are didn't take insulin, didn't take insulin and didn't take insulin.  With ICD-9, E15.1 could be used to code DKA Hospitalization Due to Noncompliance.  With ICD-10 coding rules, didn't take insulin is not specific enough to code the cause of DKA hospitalization.  The new ICD-10 codes provide a much more detailed look at the causes of DKA leading to hospitalization and will hopefully allow healthcare agencies an enormous amount of your personal data to improve public health.


TOP 10 CAUSES OF DKA HOSPITALIZATION (ICD-10 CODES)


1)  I forgot to take my insulin because I was Playing Pokemon GO. (E15.1)

2)  I forgot to take my insulin because I was twerking  and puking all night. (E15.2)

3)  I didn't to take my insulin because I was was nauseated and had abdominal pain and I was light headed and I wasn't eating and I didn't know what my sugar was.  (E15.3)

4)  I didn't take my insulin because I didn't f**king feel like it. (E15.4)

5)  I ran out of my insulin and couldn't even afford to buy a pack of cigarettes and I didn't have a friend to bum a bottle of insulin off of. (E15.5)

6)  I told everyone at the hospital I took my insulin just like I was supposed to but I actually haven't taken it for a week because I didn't f**king feel like it. (E15.4.6)

7)  Whether I took my insulin or not is none of your business and can I have some Dilaudid and a bag of Cheetos for my abdominal pain? (E15.7)

8)  I didn't take my insulin because the doctor who told me seven years ago I had diabetes didn't know what they were talking about. (E15.8)

9)  I didn't take my insulin because this sh*tty hospital wouldn't give me free insulin to take home when I was hospitalized last week. (E15.9)

10)  DKA hospitalization unknown because the childlike adolescent in their upper 20's who lives with their enabling parents refused to talk, gave nasty faces and slept with their boyfriend/girlfriend every night and then left AMA after eating a hearty breakfast.  (E15.10)

With ICD-10 exposing the top 10 causes of DKA hospitalization, make sure to provide insight for other readers with your experiences as well.  In the interest of public safety, please leave your experience with the causes of DKA hospitalization in the comments below so other healthcare professionals can gain a greater understanding of what to be on the lookout for when frequent flyer DKA patients come to the ER for hospitalization.

"So you have another DKA hospitalization this month.  Tell me again how you took all your insulin and have no idea why this happened, again."

So you have another DKA hospitalization this month.  Tell me again how you took all your insulin and have no idea why this happened, again.



Top 10 Reasons Patients Skip Dialysis

The National Association of Noncompliant Dialysis Patients (NANDP), the largest noncompliant patient association in America, has released their 2016 Top 10 Reasons For Skipping Dialysis survey. Debuting in the top ten for the first time  in this annual survey  were Shopping on Amazon Prime Day and Playing Pokemon GO.

 "Amazon, Pokemon and Netflix are driving our chronic dialysis patients to an early grave,"  said Dr Stanley Cornsmith, M.D., Director of AMA Patient Satisfaction.  "I don't even want to think of what will happen once virtual reality goes mainstream.  We'll have hundreds of thousands of patients hospitalized because they thought they actually got dialyzed.

 Falling out of the top ten reasons for missing dialysis were I Was Eating and I Couldn't Get a Ride, which had been perennial powerhouses on the survey's top 10 list.

TOP 10 REASONS PATIENTS SKIP DIALYSIS

1. I just had dialysis two days ago.

2. I was shopping on  Amazon Prime Day.

3.  I had shit to do.

4.  My chiropractor does manipulation instead.

5.  They wouldn't let me smoke.

6.  I was too busy playing Pokemon Go.

7.  What is dialysis?

8.  I drink Plexus instead.

9.  I was Netflix Binging

10.  I was too short of breath to go.

(11).  Obamacare.

(12).  They wouldn't let me bring my therapy dog for emotional distress.

(13).  Changes mind on hospice hourly.


"The number of noncompliant dialysis patients is too damn high."

The number of noncompliant dialysis patients is too damn high.