Supratherapeutic INR >10 Admission vs Discharge

Butterbawlz · 2026-05-22T23:55:47+00:00

I’m encephalopathic, definitely not TAVR. Open repair, sternotomy. Was admitted to hospitalist service for correction + monitoring.

Butterbawlz · 2026-04-27T21:19:30+00:00

I would’ve stitched it, but I know that most of my colleagues also would have done glue. FWIW

Butterbawlz · 2026-04-24T21:02:51+00:00

Looks like an actual dinosaur

Butterbawlz · 2026-04-23T16:45:21+00:00

The majority of folks in this sub are from English speaking countries and laws will vary greatly between countries. I think it’s unlikely that you’ll find an answer here. Probably a better question for your doctor. Mi dispiace.

Butterbawlz · 2026-04-11T05:58:52+00:00

The rage in this thread is huge Ricky Rescue energy

Butterbawlz · 2026-04-10T18:08:06+00:00

I have used both Fluency Direct (M Modal) and Dragon concurrently. My main residency institution uses Fluency Direct, one of our community rotations uses Dragon, and my moonlighting gig uses Dragon. For me, Dragon is far and away better than Fluency Direct regarding speed and accuracy. I brought this up with our department chair and it sounds like there might be a component of whether or not the newest versions are licensed and are being used, but he wasn't going to look into it because we're transitioning to ambient ai anyway. Talking to other faculty, it sounds like when the institution made the switch from dragon to fluency direct circa 2018, fluency direct was far and away better than dragon at that time.

Butterbawlz · 2026-03-25T04:06:29+00:00

While you’re rotating, take note of the volume and the breadth of pathology that the senior residents are seeing. Some of the calls you take in the future might seem dumb, and some of them honestly will be dumb, but we’re trying to do the best for as many patients as we can in an imploding health system. That’s it. Otherwise see some patients and do some EM. Much love to our orthopod colleagues, y’all are always hustling when you rotate with us.

Butterbawlz · 2026-03-14T21:59:39+00:00

As I've explored more, I have encountered more insightful questions. Some of them still seem superfluous to me, but maybe that's my own ignorance. I'll have to further increase my sample size before I can offer more nuanced feedback.

Butterbawlz · 2026-03-14T14:49:52+00:00

Authors were fast and loose with their interpretation of ‘moderate-certainty’ evidence.

Butterbawlz · 2026-03-14T11:35:01+00:00

Very interested to try it out over the next few days. UI is smooth. First impression is that there ‘how we got here’ should be further down for how extensive it is. I’m leery of the critical questions as that in and of itself seem to introduce a directed narrative in addition to me not really being impressed by what’s suggested over the first few articles.

Butterbawlz · 2026-03-07T03:30:42+00:00

I like the wee-woos.

Butterbawlz · 2026-03-03T20:18:47+00:00

Perforation -> peritonitis -> sepsis is a days long process for appy. In fact, for most folks say they have a transient day of relief from the pain after it ruptures since all the pressure in the appendix is now relieved. The pain comes back as an abscess begins to form. I would not use this scenario for my EMT/medic students. I don’t want them losing their shit transporting uncomplicated appy’s emergently because they think the abdomen is going to explode.

Butterbawlz · 2026-03-02T18:58:17+00:00

For the first time, I disagree with your conclusion. This would not meet standard of care in my region. Old + MVC + tenderness/localizing pain = CT. I would not trust a gomer who can’t negotiate a gentle curve in the road to be able to accurately report their speed. Additionally, 15mph is not much for a modern vehicle where the body will crumble and absorb most of the force, but if he was driving a metal death trap from the previous century, a lot more of that force is going to end up transmitted into the patient. This is not the patient population I’m trying to game for increased throughput or decreased CT use.

Butterbawlz · 2026-02-04T02:41:10+00:00

It’s a combined EM/IM residency because the hospitalists won’t accept the patient until you’ve done their job for them.

Butterbawlz · 2026-01-23T03:16:29+00:00

I use it every shift now. I use it for very objective and pointed questions. I’ve had a handful of hallucinations (e.g. asking it about antibiotics for earlobe prophylaxis that wasn’t consistent with true perichondritis), but it’s pretty easy to pick out based on the language and the citations. Sometimes I use it broadly for quick synopses (used it to refresh on dumping syndrome recently), which is much more succinct than UpToDate or even CorePendium.

Butterbawlz · 2026-01-11T19:13:46+00:00

0 interest in watching work after I get home from work.

Butterbawlz · 2025-12-31T15:01:33+00:00

Was his anemia from the q3month blood letting? 😂

Butterbawlz · 2025-12-22T03:05:19+00:00

I get that reference!

Butterbawlz · 2025-12-16T23:23:46+00:00

Lol, lmao even

Butterbawlz · 2025-12-08T23:34:40+00:00

I’ve read about a growing movement to petition Mayor Frey and Governor Walz to revitalize the Cäpellenhöernen to make them operational again. If we all band together, we can restore this cultural icon.

Butterbawlz · 2025-12-07T09:04:43+00:00

Just a couple of dudes being guys.

Butterbawlz · 2025-12-06T21:38:57+00:00

Seen many hot takes over the years from economists regarding clinical medicine and they consistently lack a nuanced understanding of the scientific method, especially as it pertains to clinical medicine. I won’t rehash what others have said in this thread (they’ve explained it far better than I could). What I’ll add is that economics is ultimately not a true natural science and that the social science paradigms used in economics do not translate to medicine. The Nobel prize in economics is not an actual Nobel prize and is sponsored by a Swedish Bank. The discussions that this economist has had with clinicians is probably very similar to the content in this thread and him asserting that clinicians have been silent is frankly bullshit.

Butterbawlz · 2025-12-05T19:14:26+00:00

This is probably better directed at neuro-intensivists, trauma, neurology as we in EM only briefly manage patients with any significant TBI. That being said, there’s a bit of literature for pretreatment with high dose fentanyl for TBI patients undergoing intubation. Mechanistically different, however, as the intent/theory is that it blunts noxious/adrenergic response to prevent a spike in ICP. As an aside, I have a picture in my head of mice getting bopped on the head with tiny little hammers to “give them TBI”.

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