studentforlife

I was thinking more for the "rest" and "load management" games than true injury games. The suggestion was to try to improve regular season shittiness and maybe should have been a spin-off thread?

obviously C&S 3PA and dunks should be taken when available, but they usually aren't in the playoffs.

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BI's attempts at the rim have also gone down each of the past 4 years.

22-23: 13.7% of his shots
21-22: 14%
20-21: 14.4%
19-20: 24.8 %

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Don't know where to get the catch and shoot 3PA. For reference some other guys with established midrange game rim attempts:

Kevin Durant's attempts at the rim each of the past 4 years:
22-23:12.3%
21-22: 10.9%
20-21: 14.9%
19-20: DNP

Devin Booker's attempts at the rim each of the past 4 years:
22-23:15.1%
21-22: 11.0%
20-21: 17.9%
19-20: 22.8%

Paul George attempts at the rim each of the past 4 years:
22-23: 13.9%
21-22: 14.6%
20-21: 18.5%
19-20: 15.0%

Kawhi Leonard's attempts at the rim each of the past 4 years:
22-23: 15.5%
21-22: 18.6%
20-21: 16.7%
19-20: 24.9%

Khris Middleton's attempts at the rim each of the past 4 years:
22-23: 12.7%
21-22: 10.4%
20-21: 15.0%
19-20: 12.7%

If only BI had good coaching, he would just dunk every possession.

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Thats exactly what he said

!) extremely rare- Yes
2) a diagnosis of exclusion - Yes
3) have to rule out via testing, everything else first - Yes

Thats exactly what "least likely" means. - NOPE
Every other condition gets ruled out before we even consider it to be at commitio cordis Yes

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a diagnosis of exclusion does not mean something has to be the least likely diagnosis. It just means there is no good test for it and the things that could be intervened upon/are dangerous need to be ruled out before settling on the diagnosis.

To give an every day example - first trimester vaginal bleeding occurs in approximately 25% of pregnancies and is most commonly benign (implantation bleeding or threatened spontaneous abortion). However these are diagnoses of exclusion, so the standard of care is to rule out less common, more dangerous causes such as ectopic pregnancy, heterotopic pregnancy, molar pregnancy, incomplete spontaneous abortion, cervical malignancy, etc. Once these are ruled out, the diagnosis of exclusion -threatened spontaneous abortion (which is also the most likely diagnosis when they walk in the door) is given.

In this case, I am confident they
- rapidly ruled out acute coronary syndrome (most common cause of cardiac arrest) and pericarditis via EKG and likely serial troponins.

- ruled out HOCM via echo.

- ruled out preexisting conditions long QT, brugada, WPW, and ARVD with EKGs

-ruled out severe metabolic derangements such as hyper/hypokalemia and hypomagnesemia (would be unlikely in a young healthy patient) with labs

- profound hypo/hyperthermia was ruled out by taking his temperature (even though it was very unlikely)

- As I had pointed out before acute R sided heart failure secondary to PE does not at all fit his presentation but was also ruled out with an echo and ct chest that they were doing anyway.

- based on presentation (and subsequent workup), traumatic aortic dissection, pericardial effusion leading to tamponade, hemorrhagic shock, and tension hemo/pneumothorax were ruled out

- ruled out intracranial pathology (traumatic intracranial hemorrhage, ruptured aneurysm, or malignancy via head CT (and likely follow up MRI)

-ruled out lightening strike or shock by a high voltage line via video review

- likely performed a urine drug screen to rule out accidental opioid overdose (very common in general population but highly unlikely in this case)

And so we are left with Commotio Cordis as the most likely diagnosis, now that other things that could be tested for have been ruled out.

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The hit likely caused a pulmonary embolism from dislodging a clot.

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This inaccurate statement stems from a complete lack of understanding of the pathophysiology in a variety of ways.

Where do you think the clot was "lodged" in his chest? You think he had a giant clot in in right atria or Superior vena cava and was completely asympmtomatic?

When PEs cause people to die, it is from acute right heart failure and/or profound hypoxia. These clots are very big. These patients are VERY difficult to regain pulses in because the acidosis that rapidly develops when you lose pulses makes RV function even worse. He responded to a single round of CPR and defibrillation (had a shockable rhythm (Vtach or Vfib)- which is very rare as the presenting rhythm for PE).

Where do you think this clot magically went after 1 round of CPR?

Once they got him back, he was intubated and remained hemodynamically stable (despite the increase in intrathoracic pressure than comes form invasive ventilation, which would put additional strain on the right ventricle if he had a large PE) in the back of the EMS truck while they waited for his mom. IF you can regain pulses in patients with massive PE without lysing (use of a clot busting agent like tPA)(which they didn't), they are hypotensive and usually require inotropic agents to bridge them to intervention. If he had a massive PE he would have been profoundly unstable until they removed the clot (done via embolectomy in most large institutions and catheter directed lysis in some other places I've worked).

It could be argued that he had an underlying condition (long QT, WPW, HOCM, Brugada, ARVD) or acute pericarditis (unlikely given he was asymptomatic before the hit)that put him at risk for Vtach/Vfib and the hit just so happened to take place just before it happened (this is not a good argument, but is at least pathophysiologically plausible). Him having no findings on EKG reported thus far for any of these conditions effectively rules it out but it was at least possible based on the sequence of events (loss of pulses, CPR, defibrillation, ROSC, hemodynamic stability without further intervention).

Based on the sequence of events, there is no chance this was caused by a pulmonary embolism.

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It doesn’t make any sense for any of them to be black. Dwarves it really doesn’t make sense given they live underground.

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Just so we are clear on your argument, which of these is so obvious?

1) their creator Aule was omniscient (I don't think this is the case but I am no expert) and knew they would eventually settle in a mountain underground when he created them, so therefore gave them skin genes that could help them synthesize vitamin D in a low UV radiation environment (instead of say giving them the ability to break down lactose and get what they need from milk)

or

2)In the 2000 years (dwarf lifespan is 250yrs) since the awakening of the dwarves, at the time of the RoP, the natural selection pressure within the mountain was so strong that darker skinned dwarves were unable to pass along their genes before dying of vitamin D deficiency, leading to 100% of dwarves being white

Seems to be written by someone who has no idea there is a difference between droplet precautions and airborne precautions LINK. While COVID was initially thought to be spread primarily through droplets, this is really a spectrum, and COVID-19 seems to fall a lot closer to airborne than other droplet transmissible diseases such as influenza LINK. Using this as a "gotcha" is likely based on ignorance.

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Once again you are wrong. So educated but so dumb!!!! I posted the AMA above 259 percentages and you chose to dispute the numbers. Now I realize why you didn't get into med school at 22 like most US Doctors. You Loser!!!!!

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You posted numbers but clearly have no idea what they mean. I did not dispute any numbers from the AAMC, (though you had multiple errors attempting to copy from the page), you just don't know how to read and interpret a chart or data in general. I tried to explain it you but you continue to just throw around insults instead making yourself look foolish. Last chance, I'll try to explain it to you like a 4th grader, just so maybe you can be slightly more educated if you decide to actually look at the data. From the site(AAMC, not AMA) you attempted to quote but did so incorrectly, of the 7058 students who matched into internal medicine, 215 of them (3%) scored above 259 on both Step 1 and 2. Of the 460 applicants who applied to dermatology, 54 (11.7% of them, not 3% as you incorrectly typed) had step scores above 259 on both step 1 and 2.

215 is a bigger number than 54 (you can ask the nearest elementary school educated person if you need verification of this), so more applicants who had the highest scores sortable by any reports available, went into internal medicine than dermatology (or any other specialty). I'm quite confident an average 4th grader would understand this so I'm done dumbing it down any more.

Also, you are right, I didn't get into med school at 22. I was only 21 when I got into med school, though I had turned 22 before the first day of class. Not really sure how that makes me a loser, but given how bad you have proven yourself to be with numbers and simple concepts maybe you just think 22 is better than 21 because it is larger? I'll just have to take LSUA 75's advice and give up on trying to explain things to you going forward as you clearly have no desire to learn.

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EM had 2212 matches
Dermatology had 480 matches
Pediatrics had 2661 matches

How can you compare the three?

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Once again, we are discussing what specialty the highest ranked applicants choose. You seem to think how many other people match into that specialty is relevant, but it is not. THE HIGHEST RANKED APPLICANTS GO INTO EVERY SPECIALTY.

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You are still wrong, geez I sure hope I never end up in an ED with you or "Your ED" if you can't understand statics aren't on your side. How can other subspecialties have a higher average if lower ranked applicants are being accepted? How about you dumb it down alittle more for us ignorant and stupid folks!!

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Sure, I'll dumb it down some more now that you have edited out at least some of your over night insults. I am not sure how my knowledge of statics will help, but I am happy to provide some simple statistics as I feel those are more likely to help you understand. Like I said before, if you are willing to learn, I'll help you out. The top applicants in each class can go into whatever specialty they like, and go into every specialty. I posted numbers above demonstrating this but maybe the raw numbers are making it difficult for you to interpret. I'll try percentages instead as that may make it easier for you to digest. Below are the percentage of applicants with scores greater than 250 (highest sortable score from my link above) who matched into each specialty for the past 5 years

Anesthesia 5.1%
Child Neuro 0.4%
Derm 5.5%
Radiology 6.1%
Emergency Med 7.0%
Family Med 2.3%
General Surgery 6.0%
Internal Medicine 28.5%
IM/PEDs 1.7%
IR 1.5%
Neuro Surgery 2.4%
Neurology 2.8%
OBGYN 3.4%
Ortho 8.9%
ENT 3.9%
Pathology 1.5%
PEDs 5.9%
PMnR 0.5%
Plastics 2.1%
Psych 2.4%
Ras Onc 1.7%
Vasc Surgery 0.4%

If you were to perform a similar exercise for the lowest scores set, you would find very few of them go into the more competitive specialties, which results in the average scores of those specialties being higher.

Simple summary:
Having higher scores enables applicants to go into whichever field they prefer, and the top 3 most common are internal medicine (by a wide margin), ortho, and emergency medicine. Not Dermatology. These applicants also tend to get their preferred institution come match day.

Having lower scores limits applicants ability to go into more competitive fields (though it does happen sometimes) and subsequently drives up average scores of these specialties.

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Let me know where your ignorant arse practices, I would never want to go there. Statically the highest ranked Med students don't go into EM. You can debate it all you want.

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It's ok to be stupid as long as you are willing to learn. Instead of a "debate" with your made up numbers based on your feelings, here are the number of applicants who matched into each specialty with scores greater than 250 (highest sortable score) for the past 5 years. Source: LINK As is clear from the data, people at the top of their class go into every specialty, with the bulk of them going into internal medicine.

Anesthesia 880
Child Neuro 72
Derm 946
Radiology 1051
Emergency Med 1200
Family Med 397
General Surg. 1036
Internal Med 4894
IM/PEDs 285
IR 256
Neuro Surgery 420
Neurology 488
OBGYN 581
Ortho 1536
ENT 672
Pathology 254
PEDs 1011
PMnR 92
Plastics 353
Psych 419
Ras Onc 287
Vasc Surgery 61

I accept your apology and if you show up in my ED I will take great care of you.