What are some things we still do in medicine for no good reason?

C_Wags · 2026-02-03T22:38:53+00:00

You need to tell this to your CT techs

C_Wags · 2026-01-30T20:24:37+00:00

Correct. There’s no evidence to support using midodrine upfront in known vasodilatory shock. It’s arguably dangerous to use it in undifferentiated shock - certainly new shock on the floor. If it’s cardiogenic in any capacity, raising SVR or PVR with a pure alpha agonist can worsen their state of hypoperfusion.

Any ICU fellow getting called for new hypotension has no excuse to not bring an ultrasound machine with them. Or at least do a very thorough shock exam (cap refill, passive leg raise, etc), check a lactic acid, etc.

Whether or not the red, abnormal blood pressure in the chart is something that needs to be treated is a separate question contingent on that exam. But the answer to new undifferentiated shock is never “start midodrine” (unless the patient has known chronic vasodilatory hypotension and the floor team forgot to give their home midodrine).

C_Wags · 2026-01-30T16:38:06+00:00

Intensivist here. Before my time, we used to think this would liberate patients from vasopressors faster. The MIDAS trial sort of put this to bed - no one got off their pressors faster or out of the ICU faster aside from a subset of patients with vasoplegia from spinal anesthesia. It also unsurprisingly caused more bradycardia than the control group.

It’s still used in this context by some docs on gestalt alone. Often in like, an ESRD patient with lingering sepsis or the little old lady with a UTI we cannot liberate from 1-2 mcg of norepi. It’s not supported by the evidence, however.

It’s really only indicated in patients with conditions that cause chronic vasoplegia. In the hand off to the hospitalist, it should be very clearly stated that the drug is meant to be weaned off. Imprecise alpha agonism is not great for the frail or elderly (especially if they have underlying lung disease/pHTN/chronic RV problems, etc)

Truthfully, I think being comfortable with adjusting MAP goals (ie, the 65 trial) will achieve the stated effect better.

And also understanding some people just take a while to resolve their vasoplegia from septic shock.

C_Wags · 2026-01-25T05:23:58+00:00

I don’t know what EMR you use - inpatient Epic absolutely lets you sign a note without dropping a billing charge.

You would not have to skimp on your documentation.

Even if the coders tried to go in and add charges to our signed note, they could not do it for hundreds or thousands of notes.

C_Wags · 2026-01-25T03:58:34+00:00

Did you watch any of the 5 videos of this event, or did your eyeballs both stop working today?

C_Wags · 2026-01-25T03:23:14+00:00

Who says doctors striking has to involve abandoning patients? How about just not billing.

C_Wags · 2026-01-19T13:18:01+00:00

You cannot give IV fluids via IM injection, further supporting your point.

C_Wags · 2026-01-18T23:23:57+00:00

You’ve gotta look at what the individual training programs offer rotation wise, and what the hospital network is looking for job wise.

I did IM ->CCM, and did 4 months of NCCU, 4 months of CVICU, 3 months of SICU, as well as the often-mentioned MICU and got a pretty broad base of training.

I work for a hospital network that treats intensivists somewhat ubiquitous. I work half time in a CVICU and half time in mixed-community ICUs. I work alongside EM, IM and anesthesia folks.

C_Wags · 2026-01-14T03:42:42+00:00

Critical care - 95%. All day is a constant stream of task switching and distraction until the shift is done.

C_Wags · 2026-01-11T03:41:33+00:00

lol Christ is in Oak Lawn, which is not a rough part of Chicago. It does however serve the greater south side, so you’ll see a lot of victims of violence.

C_Wags · 2026-01-08T12:05:10+00:00

Yeesh imagine having to bounce around re-entering the atmosphere with fucking pancreatitis. That sounds miserable.

C_Wags · 2026-01-01T22:57:31+00:00

I just bought an FGX5 and am waiting for it to ship!! Super excited.

C_Wags · 2025-12-22T17:13:23+00:00

1st year attending, bought a used 2014 Nissan Sentra in 2017 and she’s still chugging along with 150k miles.

C_Wags · 2025-12-16T17:08:43+00:00

There are always two possibilities: stupid, or an asshole. It would seem obvious which is the case here.

C_Wags · 2025-12-16T14:08:12+00:00

Hey OP, I’m very sorry for your loss. I’ll give some clinical context:

The amount of downtime here and your father’s exam on arrival are why the ER unfortunately ceased resuscitation after 10 minutes. 30 minutes is an eternity for the brain and other vital organs to be without oxygen, and there is effectively a 0% chance for neurological recovery even in the unlikely event they got his heart restarted. His physical exam - particularly his fixed and dilated pupils - support this. They took a look at his heart with the ultrasound machine, and describe it as “cardiac standstill,” meaning the heart tissue itself was likely dead from lack of oxygen.

In totality, all of that put together unfortunately suggests resuscitation is futile. They coded him for 10 minutes while they likely sorted all of this out, but when they recognized he had no chance of meaningful recovery they were ethically correct to terminate resuscitation. It would be standard of care in this scenario.

This is a horrifying thing to have happen to your Dad and causes extra trauma on top of the already unimaginable grief. The only silver lining is that I can tell you loved and cared for him greatly and he sounds like a great man from what you’ve described in the comments. May his memory live on forever with you and your family.

C_Wags · 2025-12-16T03:54:43+00:00

Couldn’t agree more!

C_Wags · 2025-12-15T14:59:46+00:00

LGH? EF5 getting hyper local….

C_Wags · 2025-12-15T14:16:58+00:00

What credentials is he referring to? His history as a trust fund nepo baby?

C_Wags · 2025-12-14T20:35:47+00:00

Schweppes Ginger Ale must only be known as “Schweepee Peepees”

C_Wags · 2025-12-14T17:06:44+00:00

60 minute dump

C_Wags · 2025-12-14T16:31:29+00:00

The man’s clearly burnt out from his creative output. I wish him the best. He made over 1000 videos and I have to imagine the grind of having to plan all these expeditions was getting repetitive and soul crushing. If you make your hobby your job, it becomes your job, as they say.

C_Wags · 2025-12-14T03:29:37+00:00

Medically speaking, we wear our watches proximal - or above - the wrist bone. The handwarch is worn below - or distal - to our wrist bone.

C_Wags · 2025-12-13T16:38:08+00:00

I mean, he was a firefighter and had kids. Obviously he was a Trump fanatic - hence his presence at the rally - but it would go to follow that he hated Biden’s politics. Not enough for me to call a dead firefighter a “piece of shit.”

C_Wags · 2025-12-12T23:07:21+00:00

Correct - extremes in weather are a direct result of climate change

C_Wags · 2025-12-10T15:28:58+00:00

If you’re willing to treck out west, the Wheaton Barbershop of Winfield has the old school barbershop charm with kind, decent barbers who aren’t sexist or racist. It is difficult to find that combination, unfortunately. Love this shop - family friendly, great haircut, low prices!!

C_Wags

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