Divemedic

2026

With this first post of the year, I want to wish a Happy New Years to all of you. I worked last night and got home late in the evening. It was an exhausting shift, and that means I was in bed asleep before the turn of the new year.

This past year was a huge one for both me and the blog: I posted 527 times, and the blog saw more than 2.4 million post views, which is more than 4600 views per post.

Personally, I did pretty well. I earned 3 board certifications and finished my MBA. I am doing that because I realized what a disaster of a dumpster fire my place of employment has become, so I decided to do something about it. That’s what all of us should do: If you don’t like your job, get a better job. If you can’t get a better job as is, then do something to make a better job more likely.

Let’s see if we can make this year a good one. I’m going to start the year by spending my day applying for new jobs. I already applied to three of them this morning. One thing I have discovered during this job search is this:

Employers are using AI driven ATS(Applicant Tracking Systems) to screen applicants. These systems look for very specific things, and automatically reject applicants before the application is even seen by human eyes. The key to getting your resume to a decision maker’s human eyes is to tailor your resume and application to that ATS. So the I have begun using my own AI system, pasting my resume and the job requirements into the system, and letting the AI rewrite my resume to match what the ATS is looking for.

Let’s see how that works.

By Divemedic, ago

ED Nursing Case

This is for my medical readers, a little pearl from critical care in the ED. This was a case I recently had in my care. Look at what decision making goes into critical care:

A patient presents with acute severe dyspnea consistent with hypertensive acute decompensated heart failure (flash pulmonary edema).

Initial Assessment:

Respiratory:RR 40/min with sternal retractions. Severe air hunger despite NIV. EtCO₂ 31 mmHg (hyperventilation, not ventilatory failure). SpO₂ 100% on NIV. Cardiovascular:HR 120 bpm BP 218/184 mmHg (marked sympathetic surge / afterload crisis)

Clinical interpretation:The patient was not hypoxic and not retaining CO₂, but was in extreme sympathetic overdrive with excessive work of breathing and anxiety worsening pulmonary congestion.

Intervention

Continued noninvasive ventilation (NIV). Morphine 2 mg IV administered as a targeted adjunct for refractory air hunger and anxiety. Reassessment (15 minutes post-administration)

HR: 95 bpm RR: 18/min BP: 142/72 mmHg SpO₂: 96% (clinically acceptable). Work of breathing markedly improved; patient calmer and tolerating NIV.

Teaching Points

Air hunger in acute heart failure is often driven by pulmonary congestion and sympathetic activation, not hypoxia alone. EtCO₂ of 31 mmHg confirms hyperventilation and preserved ventilatory reserve, reducing concern for opioid-induced CO₂ retention. Low-dose morphine (2 mg IV) in this setting blunts excessive catecholamine response, reduces central perception of dyspnea and panic. It produces mild venodilation, which lowers preload/afterload, and improves tolerance of NIV without suppressing respiratory drive.

Why this was appropriate: Although the use of morphine in heart failure is an old therapy that has been largely discredited in modern studies, it was appropriate in this case. NIV was already in place (airway support maintained), continuous monitoring, including EtCO₂, was available. The dose was anxiolytic, not sedating, and the primary threat was sympathetic storm, not respiratory failure.

Key Teaching Pearl

Morphine does not treat heart failure and can actually be harmful in many cases, but in rare, carefully selected patients, low-dose morphine can interrupt a life-threatening sympathetic–dyspnea feedback loop when NIV alone is insufficient.

Practice Implications

Morphine should not be routine in acute heart failure, consider only when:

  • Severe air hunger persists despite NIVEtCO₂, which indicates hyperventilation (not CO₂ retention)
  • Blood pressure and monitoring allow safe administration
  • Always pair with definitive therapy (NIV, BP control, diuresis)

My charge nurse disagreed, saying all HF should be treated with nitroglycerine and loop diuretics. That’s simply blind protocol adherence. The doctor and I disagreed with that, to the patient’s benefit.

Bottom Line

This case illustrates that physiology-guided, low-dose morphine when used judiciously and with monitoring can be a safe and effective adjunct for refractory air hunger in hypertensive acute heart failure, reinforcing the importance of individualized clinical judgment over reflexive protocol avoidance.

By Divemedic, ago

Social Media Lawyers

Why am I seeing so much of the “Where is your warrant?” bullshit on social media. Cops don’t need to show a warrant while arresting someone, especially not to anyone who demands to see it.

By Divemedic, ago

Computer Upgrade

I spent the day upgrading the computer I play games on. I put an RTX 5080 16 gb in today. Now this is a serious gaming system.

  • Ryzen 7 7800X3D 4.2 ghz CPU
  • 64 gb ddr5 RAM
  • 1tb NvMe SSD
  • 2 tb NvMe SSD
  • ASUS GeForce RTX 5080 OC GP
  • TrackIR system
  • Winwing Orion2 Warthog HOTAS

yeah, my wife was surprised that Im a gaming nerd, too. That may be the last upgrade for awhile. Chips are getting pricey.

By Divemedic, ago

Gold/Silver Ratio

There is something called the gold/silver ratio. For those who don’t know, that ratio is the price of one ounce of gold compared to one ounce of silver. That is, how many ounces of silver would be a trade for one once of gold at any given point in time.

A higher ratio means that either gold is overpriced, or that silver is underpriced. That can dictate which of the metals is the better deal. Historically, the ratio is usually between 60 and 80. In April of this year, the ratio was 100.8, meaning that one ounce of gold was worth about 100 ounces of silver.

Some investors are talking about the 80/50 rule. That is, if the ratio is higher than 80, stop buying gold and buy silver instead. If the ratio is less than 50, then silver is higher priced relative to gold, and it’s time to buy gold.

Thanks to the skyrocketing price of silver earlier in the week, the ratio is currently (as of this writing) 57. The gold/silver ratio was last below 50 in April 2011, when it reached a low of approximately 35:1. In April 1968, the ratio hit a century-long low of 16.75:1.

So why is this important to us? If you want to increase your holdings, you would sell some silver and use the cash to buy gold. Once the ratio returns to its historical mean, you would then reap a profit. Let’s say that the ratio hits 40. At that point, 40 ounces of silver (worth $1160 a year ago) could be sold and traded for a single ounce of gold. Once the ratio returns to its historical range, that would require that silver loses value or gold increases in value. Either way, your ounce of gold would be worth 60 to 80 ounces of silver, but you only paid for it with 40 ounces.

Just food for thought.

By Divemedic, ago

“Teens”

A 13 year old girl was shot and killed in Orlando on Christmas eve. The shooter was reportedly a “teen,” his victim being named Emoyn Nicole Jackson (her name is actually Ebony- MSM strikes again). Since no mention was made of the races involved and the shooting happened in Pine Hills, well, you all know the missing, unreported parts of the story.

A second Christmas eve shooting happened in the Americana area of town, another famous high crime area. The “teen” victim in this case was a 17 year old named Jamar Jerome. More teens without races being mentioned.

The story never mentions where the “teens” got the guns from, nor do they mention the races. We all know the answer, but everyone pretends not to know. More than 52 percent of all homicides in the US are carried out by the demographic that makes up less than 7% of the US population.

It’s not the guns. It’s, well, you know…

By Divemedic, ago

Cashing Out

We sold our last rental property today and used the money to pay off our current house. We bought that rental in 2019, paying a hefty down payment of more than half of the asking price. We plowed every dollar we made from renting the place into expenses and paying off the mortgage. Once that was done (it took six years) we cleaned the place up and put it on the market.

In case you are interested, we paid $150,000 down on a house that cost us $250,000. All of the rent collected went to paying off the loan. Sale price was $310,000. We had to put on a new roof and some other repairs, paid real estate commissions and closing costs that totaled $35,000.

Cost of $250,000, sale proceeds of $275,000, meaning that we made $25,000 in profit after holding the house for 6 years. When you consider that the only money out of our pockets was the initial $150,000 down payment, we actually wound up making $125,000 return in 6 years on our initial investment. That gives us a rate of return of 10.66%.

Now the house I live in is paid off, and we no longer have a mortgage payment. I am also out of the landlord business. It also means that I no longer NEED a job. Now I have options. I am considering dropping down to PRN (as needed) basis- meaning I can work 1 day a week, full time, or anything in between. My choice.

That gives me options with my shitty, shady employer. This is what my wife and I refer to as “fuck you money.”

By Divemedic, ago