Bored of making alot of money?

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vistaril said:
5mg IM Haldol and 2mg ativan....the term is more commonly used in the ER by nurses and ER docs probably when agitated and potentially violent patients come in.
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They like to add Benadryl in to the mix these days.

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nancysinatra said:
I agree about C/A not being terribly prestigious, but it's the longest fellowship we have and the only one I could think to compare to CT surgery. Pain and sleep, and maybe forensic are definitely harder to get into.
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well yeah but it's still just 5 years of training....someone who does geriatrics or whatever still has as much total training time.
 
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BS81 said:
They like to add Benadryl in to the mix these days.

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perhaps....but that is *not* part of what the B52 is.....which is what the original question asked.
 
vistaril said:
perhaps....but that is *not* part of what the B52 is.....which is what the original question asked.
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For a lot of people 50 mg Benadryl IM is part of the B52 definition.

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vistaril said:
this is true for certain things...I think it would probably be difficult to be a 2 day a week CT surgeon for example(although Im sure one exists somewhere). But that's a silly example anyways I just picked because nobody debates between being a CT surgeon and a psychiatrist. But in all of medicine there are plenty of other ways one can work from 1 to 3 days a week if they want to....pediatrics, radiology, dermatology, and bunches of other fields. Certainly EM. And it's not just health care....one can do lots of professions 1-3 days a week.

There are IM moonlighting in house/overnight jobs where you can work 1-3 days or nights a week.
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This is why we have a doctor shortage in this country.
 
BS81 said:
For a lot of people 50 mg Benadryl IM is part of the B52 definition.

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complete nonsense....what do you think the 5 and 2 stands for? 5 clearly represents haldol. 2 clearly represents ativan. There is no 50 in it at all.....

similarly, a lot of the time when a B52 is ordered a sitter or some type of restraints are also ordered. It would be just as silly to state that because they are often ordered with the b5(haldol)2(ativan) that they are part of a B52.

regardless of what percentage of the time benadryl is given with a B52(I would guess this varies a lot from place to place and person to person....this obviously isn't very complicated or sophisticated stuff here), benadryl is not part of the b52.
 
vistaril said:
complete nonsense....what do you think the 5 and 2 stands for? 5 clearly represents haldol. 2 clearly represents ativan. There is no 50 in it at all.....

similarly, a lot of the time when a B52 is ordered a sitter or some type of restraints are also ordered. It would be just as silly to state that because they are often ordered with the b5(haldol)2(ativan) that they are part of a B52.

regardless of what percentage of the time benadryl is given with a B52(I would guess this varies a lot from place to place and person to person....this obviously isn't very complicated or sophisticated stuff here), benadryl is not part of the b52.
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Complete nonsense. The B-52 obviously refers to the Boeing Stratofortress subsonic jet.
 
vistaril said:
complete nonsense....what do you think the 5 and 2 stands for? 5 clearly represents haldol. 2 clearly represents ativan. There is no 50 in it at all.....

similarly, a lot of the time when a B52 is ordered a sitter or some type of restraints are also ordered. It would be just as silly to state that because they are often ordered with the b5(haldol)2(ativan) that they are part of a B52.

regardless of what percentage of the time benadryl is given with a B52(I would guess this varies a lot from place to place and person to person....this obviously isn't very complicated or sophisticated stuff here), benadryl is not part of the b52.
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Really? B for benadryl doesn't ring a bell? :rolleyes:

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I think forensic psychiatrist has a bit of an impressive ring to laymen. But no, it's not ______ surgeon. However if you're picking your career based on plane conversation impact factor, you're gonna have a bad time.
 
BS81 said:
Really? B for benadryl doesn't ring a bell? :rolleyes:

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Aug 19, '08 by traumaRUs
We called it a B52: Haldol 5mg and ativan 2mg - given IM seemed to calm most folks - lol.
- See more at: http://allnurses.com/psychiatric-nursing/haldol-ativan-cocktail-326862.html#sthash.C0BNb8WO.dpuf

On the other hand:

Medically, a 'B52' in ER parlance is 50mg Benedryl (IV), 5mg Haldol (IV) and 2mg Ativan (IV).
It's given to put down psychotic/psych patients when they get agitated. http://answers.yahoo.com/question/index?qid=20101117095129AAUZaQR


It is discussed in this 2006 SDN thread http://forums.studentdoctor.net/archive/index.php/t-279888.html



So B52 refers to Haldol 5/Ativan2/and sometimes Benadryl 50
 
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The B has always stood for benadryl. Giving cogentin instead of benadryl is the same thing as using herbsaint instead of absinthe in a sazerac.

Come on, complete nonsense? I thought vistaril was the only guy in the mid-South prone to such hyperbole.

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Out California way, we refer to a "5150" (the name for our 72 hour hold) which is 5 mg Haldol, 1 mg Ativan, and 50 mg Benadryl. The problem with this is that its so catchy it get overingrained in folks and every now and then you get requests to give a sundowning 80 year old a "5150," which obviously makes you shudder.

The ERs like to "HAC" people (Haldol, Ativan, Cogentin). I think they mainly prefer this expression because it make for a nice verb and emergency docs tend to be verb people.
 
For folks not on high dose neuroleptics, I often go for 2.5/2. The acute tranquillizing effects actually ceiling out at pretty low doses, though that's less true for the benzo. If I need to take a dude down without massive worries of respiratory suppression, he's getting 5/4.

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BS81 said:
Really? B for benadryl doesn't ring a bell? :rolleyes:

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Click to expand...

the B in B52 represents the force of the drug combo....named of course after the jet.

It's just a B52 for that reason, and not because benadryl may or may not be given with it. I'm sure some institutions and people use cogentin when they 'give a B52'. I'm sure some use nothing else. That's important for this discussion because you *never* see another IM benzo or another IM antipsychotic substituted....not that that would be innapropriate clinical care, but rather because it would then be called something other than a B52.
 
billypilgrim37 said:
The B has always stood for benadryl. Giving cogentin instead of benadryl is the same thing as using herbsaint instead of absinthe in a sazerac.

Come on, complete nonsense? I thought vistaril was the only guy in the mid-South prone to such hyperbole.

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Click to expand...

that's not the same thing because absinthe isn't IN THE NAME of the drink.

it's called a B52 for two reasons: 1) the power and speed of the famous fighter jet 2) to represent the doses of the two drugs in it, 5mg and 2mg

If benadryl were never invented and some other drug was always used in combination with haldol and ativan, it would *still* be called a B52.
 
vistaril said:
it's called a B52 for two reasons: 1) the power and speed of the famous fighter jet 2) to represent the doses of the two drugs in it, 5mg and 2mg
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A B-52 is not a fighter, it's a bomber. And being subsonic, it's not what most folks would consider speedy.

So given that most folks give Haldol and Ativan with Benadryl (or Cogentin), logic seems to say that the B52 was probably chosen for the fact that all the pieces fit.
 
notdeadyet said:
A B-52 is not a fighter, it's a bomber. And being subsonic, it's not what most folks would consider speedy.

So given that most folks give Haldol and Ativan with Benadryl (or Cogentin), logic seems to say that the B52 was probably chosen for the fact that all the pieces fit.
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I'll defer to your knowledge of aviation...the point was that a b52 packs a punch. Just like 5mg of haldol and 2mg of ativan do.

And no, not all the pieces fit because you just put (or cogentin) part in your post above. I would also add there is a third common practice when giving a b52, which is not to give anything with the haldol and ativan in some patients.

You might have some point if another someone said 'give them a b52' and another antipsychotic or benzo was ever substituted. Or one left out. But that's never the case. When a b52 is ordered 5mg of haldol is always given. 2mg of ativan is always given. That's not the case with benadryl.
 
vistaril said:
well yeah but it's still just 5 years of training....someone who does geriatrics or whatever still has as much total training time.
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Ok so what's more impressive then:

A) C/A psychiatrist

B) Geriatrician

Or are both equally unimpressive?
 
nancysinatra said:
Ok so what's more impressive then:

A) C/A psychiatrist

B) Geriatrician

Or are both equally unimpressive?
Click to expand...

like a geriatric psychiatrist? I'd be more impressed with a child psychiatrist than a geriatric psychiatrist *if* the child psychiatrist was a good child psychiatrist and was as good at general adult psychiatry as the geri psychiatrist.

If it's a geriatric internist, I'd be more impressed with them...depending on their knowledge base and skill set of course.

We have to keep in mind that psychiatry is psychiatry....whether we mainly work in forensics, addiction, geri, whatever....it's still just one specialty. It's not like the subspecialties of internal medicine for example which are much more distinct entities where intense structured fellowships(and not just work experience in many cases) is actually needed to practice in that area. except for child, one doesn't need one of the 1 year fellowships to start working in any of the other areas.....
 
We don't even call it this in my neck of the woods. It's a "5-2-1" around these parts.
 
digitlnoize said:
We don't even call it this in my neck of the woods. It's a "5-2-1" around these parts.
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this is very common as well. I suspect that B52 is more of an ER thing, where 5-2-1 is a psych ward thing.
 
notdeadyet said:
the ERs like to "HAC" people (Haldol, Ativan, Cogentin). I think they mainly prefer this expression because it make for a nice verb and emergency docs tend to be verb people.
Click to expand...

hack (plural hacks)
(obsolete) An ordinary saddle horse, especially one which has been let out for hire and is old and tired. [from the 14th c.]
A person, often a journalist, hired to do routine work. (newspaper hack) [from the 17th c.]  [quotations ▼]
(pejorative) Someone who is available for hire; hireling, mercenary.
(slang) A taxicab (hackney cab) driver.
(pejorative) An untalented writer.  [quotations ▼]
(pejorative) One who is professionally successful despite producing mediocre work. (Usually applied to persons in a creative field.)
(pejorative) A talented writer-for-hire, paid to put others' thoughts into felicitous language.
(politics) A political agitator. (slightly derogatory)
 
vistaril said:
this is very common as well. I suspect that B52 is more of an ER thing, where 5-2-1 is a psych ward thing.
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Even our ER guys call it a 5-2-1.

I like the 5150 though. Great Van Halen record as well, and the 5150 guitar amps freaking rock.
 
digitlnoize said:
the 5150 guitar amps freaking rock.
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:thumbup: But way too loud for me... it'd wake up my entire apartment building. Kind of the opposite of what you're trying to do with haldol/ativan/benadryl...
 
vistaril said:
like a geriatric psychiatrist? I'd be more impressed with a child psychiatrist than a geriatric psychiatrist *if* the child psychiatrist was a good child psychiatrist and was as good at general adult psychiatry as the geri psychiatrist.

If it's a geriatric internist, I'd be more impressed with them...depending on their knowledge base and skill set of course.

We have to keep in mind that psychiatry is psychiatry....whether we mainly work in forensics, addiction, geri, whatever....it's still just one specialty. It's not like the subspecialties of internal medicine for example which are much more distinct entities where intense structured fellowships(and not just work experience in many cases) is actually needed to practice in that area. except for child, one doesn't need one of the 1 year fellowships to start working in any of the other areas.....
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A "geriatrician" is a geriatrician. If I meant "geriatric psychiatrist" I would have said "geriatric psychiatrist." If anyone is referring to their local geri-psychiatrist as a "geriatrician" then they are totally off their rocker and need to given a MOCA right now.

I do wonder why we don't have "real" fellowships. And why do we have no official sub-sub-specialties?

(Of course, I spend a fair amount of time wondering things like whether it is possible to have a pseudo-pseudoseizure. And whether conversion d/o could present with the "neurological complaint" being "conversion disorder." And why we don't have sub-sub-specialties.)
 
nancysinatra said:
(Of course, I spend a fair amount of time wondering things like whether it is possible to have a pseudo-pseudoseizure. And whether conversion d/o could present with the "neurological complaint" being "conversion disorder." And why we don't have sub-sub-specialties.)
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Sometimes frontal lobe seizures are called "pseudo-pseudoseizures" because they can present as bizarre behavior that can be mistaken for a pseudoseizures.

As far as your 2nd question, I once had a patient who was diagnosed by neuro as conversion d/o who ended up having status epilepticus as the cause of his "conversion" symptoms

As far as your 3rd question, sleep could be considered a subspecialty of neurophysiology, and therefore a sub-sub-specialty of psychiatry (and neurology).

I bet you didn't think you were going to have all 3 of your questions answered so fast (though I am not sure if my answer for #2 is what you were looking for)
 
michaelrack said:
Sometimes frontal lobe seizures are called "pseudo-pseudoseizures" because they can present as bizarre behavior that can be mistaken for a pseudoseizures.

As far as your 2nd question, I once had a patient who was diagnosed by neuro as conversion d/o who ended up having status epilepticus as the cause of his "conversion" symptoms

As far as your 3rd question, sleep could be considered a subspecialty of neurophysiology, and therefore a sub-sub-specialty of psychiatry (and neurology).

I bet you didn't think you were going to have all 3 of your questions answered so fast (though I am not sure if my answer for #2 is what you were looking for)
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You answered all my questions!! :)

I especially like #2--because there you have a case of status epilepticus presenting as conversion disorder, so in other words you have a real neuro condition presenting as a fake neuro condition, which is the perfect reversal of normal conversion disorder. So the neurologist was a little out to lunch in making the call, no big deal.

As for #3--while that's definitely an advance in our classification system, the only problem is that sleep would be a sub-sub-specialty of both psych and neuro (isn't it also a sub-sub-specialty of medicine, via pulmonology?). The IDEAL subsubspecialty is one that does not merge fields but rather is so arcane that only one road leads there. Cardiac electrophysiology would be an example. But sleep's not bad!

My real dream is to invent a pseudospecialty. Oh wait, that's C/L. ;-)
 
Getting ready to sign a contract for 110k to work 20 hours a week (2 ten hour days), all outpatient, and no call! I'm feeling pretty good, like I am about to get my prize for finishing medical school and residency. There are some other random gigs I could take on to push my hours to 60 hours/ week like an average physician and pull in around 330k (I have discovered that it pays to work at multiple settings in psych)... but I don't feel like I need the extra 220k. As residency ends I am getting back into more serious exercise, I haven't felt better (that I can remember) in the last 8 years. After 12 years of books and tests getting in the way of my physical health, I plan on getting into the best shape of my life.
 
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F0nzie said:
Getting ready to sign a contract for 110k to work 20 hours a week (2 ten hour days), all outpatient, and no call! I'm feeling pretty good, like I am about to get my prize for finishing medical school and residency. There are some other random gigs I could take on to push my hours to 60 hours/ week like an average physician and pull in around 330k (I have discovered that it pays to work at multiple settings in psych)... but I don't feel like I need the extra 220k. As residency ends I am getting back into more serious exercise, I haven't felt better (that I can remember) in the last 8 years. After 12 years of books and tests getting in the way of my physical health, I plan on getting into the best shape of my life.
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:thumbup:
 
F0nzie said:
Getting ready to sign a contract for 110k to work 20 hours a week (2 ten hour days), all outpatient, and no call! I'm feeling pretty good, like I am about to get my prize for finishing medical school and residency. There are some other random gigs I could take on to push my hours to 60 hours/ week like an average physician and pull in around 330k .
Click to expand...

You must not be married or have any children
 
F0nzie said:
Getting ready to sign a contract for 110k to work 20 hours a week (2 ten hour days), all outpatient, and no call! I'm feeling pretty good, like I am about to get my prize for finishing medical school and residency. There are some other random gigs I could take on to push my hours to 60 hours/ week like an average physician and pull in around 330k (I have discovered that it pays to work at multiple settings in psych)... but I don't feel like I need the extra 220k. As residency ends I am getting back into more serious exercise, I haven't felt better (that I can remember) in the last 8 years. After 12 years of books and tests getting in the way of my physical health, I plan on getting into the best shape of my life.
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How can you pull this off? Did you find some other way to pay off your student loans?
 
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Oh yea. Forgot to mention I'll get another 15k per year over 4 years in loan-repayment because the site qualifies as underserved. That should also help chip away at the loan.
 
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PistolPete said:
Can you elaborate what you mean by this? Are you basically saying that there is a law of diminishing returns at one location, so it pays to split your time in two places, for example?
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A lot of psychiatrists will work 20 hrs/wk at a place with good benefits (health insurance) and the rest of the time at a job/position with a higher hourly salary/income but without benefits.
 
PistolPete said:
Can you elaborate what you mean by this? Are you basically saying that there is a law of diminishing returns at one location, so it pays to split your time in two places, for example?
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Yes full-time employers will try to entice you with a fancy 175-230k fulltime salary job and the fantasy of "stability". They will also slip in a bunch of call and expect random coverage. IMO some of those jobs are really worth over 300k if you're willing to shop around.

Look for organizations that require a psychiatrist on site for their operations to be viable. Next, negotiate like a pawn star. Do this at several sites. You will get paid a lot more per hour.
 
michaelrack said:
A lot of psychiatrists will work 20 hrs/wk at a place with good benefits (health insurance) and the rest of the time at a job/position with a higher hourly salary/income but without benefits.
Click to expand...

How is something like this structured? 3 days at one place, two at another?
 
Cool thread.. worth reviving to see how the posters from 3 years ago feel now?
 
What seemed to be a lot of money 3 years ago is no longer a lot of money


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F0nzie said:
Yes full-time employers will try to entice you with a fancy 175-230k fulltime salary job and the fantasy of "stability". They will also slip in a bunch of call and expect random coverage. IMO some of those jobs are really worth over 300k if you're willing to shop around.

Look for organizations that require a psychiatrist on site for their operations to be viable. Next, negotiate like a pawn star. Do this at several sites. You will get paid a lot more per hour.
Click to expand...

If only this worked in coastal california. Too much competition.

BTW B52 has benadryl AKA 5150 or 5250.
 
I cant believe someone can work 20hrs a week and get paid 110k thats great. I wonder if psychiatrists can make millions and how that would happen.
 
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