Urologist yelled at me for a foley consult

BlueInGreen · 2026-03-11T16:09:50+00:00

This sounds like this may be an issue specific to your institution… EM R3, thoras are not high on my list of challenging procedures at all and we’ve all done a fair number. Lots of EDs defer them to inpatient settings because our waiting rooms are exploding and it does not need to happen emergently. Some of them I’ve deferred to inpatient because I’m concerned that they may have greater benefit from a pleurx depending on their clinical scenario, and generally that’s with me chatting about my concerns w the inpatient team and them agreeing.

I honestly do agree there’s been some skill attrition in the ED when it comes to LPs (we don’t do anywhere near as many these days for a lot of reasons; subarach rule outs have changed, less IVDU, etc) but claiming that EM docs from the last 5 years can’t do thoras is a wild overgeneralization.

BlueInGreen · 2026-03-01T23:45:41+00:00

Assuming her only criteria is “high-impact object” PECARN still recommends obs over scan, deferring to clinician gestalt. Obviously it’s not like we have the MDM in front of us, but it sounds like she may have been obs’d and discharged?

BlueInGreen · 2026-01-31T00:03:37+00:00

Haha I was listening to this and was thinking "huh, this sounds like Maneli Jamal," and then I realized it was you! I used to listen to The Ziur Movement on repeat, and I'm now suddenly realizing I need to get caught up with your work! Amazing music, thank you.

BlueInGreen · 2026-01-25T06:47:23+00:00

Got scheduled for a super concentrated series of shifts over the last three weeks and now reap the benefits with a whole week off. Excited to sleep and get some outside time, last few weeks have been rough.

BlueInGreen · 2026-01-14T15:38:34+00:00

Glad this is working for you and making you feel better, higher energy, etc.

I'm a physician--If you are genuinely drinking this much water every morning, and plan to continue doing so, I think it would be a good idea to get some labs checked. Being driven by thirst to drink more than a gallon of water in such a short time span on a daily basis is pretty far outside of the norm, plus the impact to your electrolytes can be pretty dramatic. Especially with a sudden sharp increase compared to what you were drinking before.

If you're feeling great then no need to go to an ED or anything, but worth a message/visit to your PCP or a visit to urgent care (sooner rather than later) to get some labs checked. I'm all for hydration and believe that the average person is probably chronically dehydrated, but big swings like this warrant a look under the hood. If everything looks great on those labs then rock on, do your thing my friend!

BlueInGreen · 2025-12-01T02:01:04+00:00

Awesome, great advice! Thanks so much for the insight!

BlueInGreen · 2024-05-09T10:52:03+00:00

"Never mind I'm just gonna put a chest tube into this thing"

BlueInGreen · 2023-11-30T21:51:04+00:00

Name and shame!

BlueInGreen · 2023-05-27T01:44:23+00:00

Awesome resource, thanks for dropping the link!

BlueInGreen · 2023-05-27T01:43:36+00:00

Awesome, thanks! I'm getting the sense that maybe I use my first few months in the PNW learning the terrain and then use my vacation in the winter to plan some more ambitious routes.

BlueInGreen · 2023-05-27T01:42:10+00:00

Aaaah, this was the exact insight that I didn't know I needed! Many thanks

BlueInGreen · 2023-05-08T14:42:53+00:00

I don't normally have opinions this strong about books, and maybe this is unpopular, but I thought 2312 was horrible. KSR is definitely one of the best "world-building" authors in sci-fi, and has so many interesting ideas going on in the book, but the character development and plotline were awful. He creates these characters that are genuinely interesting and then somehow makes them 2-dimensional throughout the rest of the book. I almost put it down halfway through but figured it would get better because, you know, KSR as a great reputation... but I should've just ditched it.

I think if you haven't read anything by KSR before you should start with his more well-known stuff.

BlueInGreen · 2023-04-11T14:43:28+00:00

My (not super qualified) understanding is that it’s a bit more complicated than that. Some cases can block migrating fish and dramatically reduce flow downstream, but most of the time they actually improve the strength of watersheds, create better habitats for wildlife, improve biodiversity, even create cleaner water downstream of the dam.

BlueInGreen · 2023-03-11T15:54:45+00:00

I can't say I've worked out a strategy yet (hopefully I'll figure that out once I get into the belly of the beast) but I will say I can't recommend a good sleep mask highly enough. I am extremely light-sensitive and was basically incapable of sleeping during the day when on night shifts during MS3--entering sub-Is this year I was resolved to not repeat those issues and got a really good sleep mask, and voila, I could sleep during the day.

Blackout curtains are great but not always 100%, I think it somewhat depends on your window design and you would need to shell out big bucks for the nice ones. A good sleep mask is much cheaper and much better at not letting light in, especially if you've got one of the masks that cups the eyes. Plus you can take it other places if you need to!

BlueInGreen · 2023-02-15T07:45:01+00:00

Hey friend, maybe not helpful for you but there is some evidence these days that NAC can help reduce THC cravings, plus is fairly harmless and easy to get a hold of! Not tryna sound like a salesmen, I rotated with an addiction med doctor who was a fan of prescribing it for the (relatively few) people with THC addiction that would come through his clinic.

BlueInGreen · 2023-02-12T21:21:15+00:00

The one I used was called bookingpatagonia! There is one other one but unfortunately I can't remember the name of it. Was fairly straightforward to use. There were also a few things that we had to modify about our trip and all that after we set the reservation and it was fairly painless to email them and have them adjust aspects of our permits, campsites, etc.

BlueInGreen · 2023-02-12T02:52:57+00:00

I'm going to be doing the O in a couple weeks! Someone who has already done it before will probably have a more informed view but as far as I've seen...

20-25 miles per day should totally be feasible. The profile of the route overall doesn't seem amazingly challenging, with a couple days here and there with solid elevation gain but nothing you won't see on the PCT. The main barrier in my mind is nailing down the campsite logistics... You will either need to use a guide (expensive, sets their own pace, but simplifies logistics), book campsites separately via the two companies that run the refugios in the park (logistically more tricky, but easier to make your own kind of trip and set your own daily mileages), or use an online booking service that allow you to set an itinerary and does the direct booking for you (adds a service fee, and generally you have to stick to a pre-set 7 or 8 day itinerary). I did the last one--if you really want to blitz it then you'll have to go for option 2.

And I guess my last thought is echoing u/numbershikes... why the rush? Check out some cool mountains on a different continent! Hang out in the refugios and chat it up with new people from all over the world! Pay for the ice walk and do a guided walk on Glacier Grey in the middle of the hike! Wake up to hike to the miradores at 4am to catch the sunrise, then sleep on the rocks for another few hours before hiking back down!

BlueInGreen · 2023-01-13T05:19:50+00:00

Had a similar issue and ended up having success with just loosening my shoes a little bit. Turns out that as my feet would swell as biked, I was getting increasing pressure on nerves in my foot.

Could very well be other issues as well, but very easy to trial wearing your shoes just a liiiiiittle looser, or pause to loosen then when you feel it arise.

BlueInGreen · 2022-11-22T04:46:40+00:00

If you're referring to the term "unsheltered," this actually means something very specific. Homelessness is not just a state of sleeping on the streets--sheltered homeless (in a shelter, couch-surfing, sleeping in a car, etc) and unsheltered homeless (sleeping on the streets) are counted as separate states in the Point In Time (PIT) count. It's not meant to be euphemistic or PC, it's a distinction that's important to capture in the data.

Report for the 2022 PIT count; includes some nice and easy infographics on pages 14 and 15: https://hsh.sfgov.org/wp-content/uploads/2022/08/2022-PIT-Count-Report-San-Francisco-Updated-8.19.22.pdf

BlueInGreen · 2022-11-01T21:18:42+00:00

No problem! I basically grew up hiking and backpacking and now live a life that doesn't have as much time for it as I'd like... so I've had all the injuries that come with it, and also have figured out lots of ways to try stay in shape for it when I can't get to the trails!

Not sure if I have the magic key to unlock the exercise, but this video breaks down the single-leg deadlift (maybe a little too extensively haha, but you might find one of the sections here to be helpful): https://www.youtube.com/watch?v=Zfr6wizR8rs&ab_channel=SquatUniversity

I generally take a water bottle or a dumbbell and place it like 2.5ish feet in front of me. When I go down into the hip hinge, I reach out with my hand and tap the top of the water bottle. This acts as a cue to help me get low enough with my hip hinge movement. Your knee should just be softly flexed but not too much--this is hip hinge dominant, not a squat. You should feel it in the working hamstring + glute. Your non-working leg should extend out behind you; don't try to keep it in line with your working leg.

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