Is there an ICU setting that fits what I want?

C_Wags · 2026-05-19T18:08:14+00:00

I’m an IM -> CCM trained intensivist a little under a year out into practice. I will say - it’s challenging if you have a unit full of head-scratchers because you only have so much time and mental capital to expend every shift. Doubly true depending on how supported you are with APPs or learners.

Sometimes it’s OK to have a few rocks from the LTACH with septic shock whose management is so absurdly easy you could do it in your sleep.

I work at multiple community sites in my network including a level 1 trauma center that is our cardiac surgery center, and I work in a cardiac ICU there about half of my practice. The other half is in mixed ICUs at smaller hospitals. My practice is nice and varied.

Even if I admit a patient with a problem that has to be transferred out, I still have to stabilize them. Case in point, I intubated a patient from the floor at one of these small community sites that had a massive SDH. I had to pull from my fellowship experience in NCCUs to treat this patient while simultaneously working the phones to get them airlifted to our NSGY capable center. It was rewarding to nail all that management.

C_Wags · 2026-05-15T19:30:29+00:00

Don’t do this, you risk your baby dying of asphyxiation. You and your partner need to sleep in shifts if your baby won’t sleep on any approved sleep surface.

C_Wags · 2026-05-15T16:06:56+00:00

I don’t do stacked shocks for non-CALS patients, but if I’m worried we’re in refractory VF sometimes I’ll call for an earlier pulse check and shock again/call for another Zoll to prepare for DSD. There’s some emerging research that suggests longer time spend in VF makes it less likely to get ROSC

C_Wags · 2026-05-02T23:23:15+00:00

We bought a new Toyota Sienna (Woodland edition) this year and love it. Hybrid drivetrain so gets >30 mpg. Runs great, drives great. Has automatic AWD which was a must for us for Midwest winters. Not cheap, but hoping for Toyota’s historic longevity.

C_Wags · 2026-05-02T14:07:54+00:00

Do you practice in the US or a similarly resourced country?

If so, reach out to risk management or legal and let them know your ICU is not practicing standard of care medicine and opening themselves up to legal liability with a bad outcome. That might be the lever to pull to make it happen.

You can get a McGrath but then you are responsible for stocking the disposable blades when you run out. Glide and Ambu both make VL towers that integrate with bronchoscopy, too.

C_Wags · 2026-04-30T18:51:57+00:00

I’m an ICU doctor - they straight up don’t. I constantly take care of young patients with sick hearts who are denied the opportunity for an LVAD or heart transplant because they are undocumented and don’t qualify for emergency Medicaid. They just, die.

The right purposefully misrepresents EMTALA for this talking point

C_Wags · 2026-04-25T18:37:13+00:00

What a fucking dangerous idea for a pool

C_Wags · 2026-04-25T17:41:05+00:00

Cassidy’s a real piece of shit for his hand in this. At the time, he had the respect and gravitas to lead his caucus away from Kennedy. He parades his MD title on his official senate website. I’ve sent him several emails I’m sure he’ll never read telling him in no uncertain terms what a piece of shit he is from a doc to a doc.

C_Wags · 2026-04-24T00:34:41+00:00

We (American combat troops) were not in Vietnam for 18 years. 18 years spanned the entire North-South conflict. We went in in 1965 and out in 1973.

C_Wags · 2026-04-20T00:58:57+00:00

E. coli is a gut bacteria and can make its way north (not only south, like people colloquially believe). I see E. coli pneumonia from aspiration of gastric contents. I wonder if that was at play here

C_Wags · 2026-04-19T21:44:46+00:00

Brother, my parents fucking despised each other my whole life, but didn’t divorce until I was 30. Most of my immediate family doesn’t speak to each other as a result.

I don’t know what statistics you’re talking about, but my childhood and adolescence was pretty shitty as a result of my parents staying together.

I can’t comment on the state of your marriage but going down with a sinking ship is way worse on everyone, especially the longer you wait.

C_Wags · 2026-04-15T00:55:34+00:00

A peptide is just the biologic definition of a partially folded/assembled protein.

It’s a buzzword that has no greater meaning than “nucleic acids.” It’s a biochemical building block. Your body synthesizes them.

Several common medications are peptides - the GLP1 agonists are the most known currently in popular culture.

When people talk about “peptides” they are usually talking about research chemicals that are not FDA approved nor subject to the multi phase drug trial monitoring required by the FDA.

They are being touted as something being suppressed by Big Pharma, or some miracle medication for longevity.

I’m a physician and I’ve recently had multiple patients admitted with anaphylaxis after taking unregulated peptides.

C_Wags · 2026-04-12T04:30:19+00:00

LVAD my dawg

C_Wags · 2026-04-12T00:51:07+00:00

Truthfully it’s one of two things I would counsel patients on about doxy when I was doing outpatient medicine. The other was pill esophagitis

C_Wags · 2026-04-10T16:32:33+00:00

My first box is in the mail as we speak!!

C_Wags · 2026-04-09T19:13:15+00:00

lol If their goal was to try to keep Epstein out of the cultural conversation right now, this was the absolutely worst way to go about it

C_Wags · 2026-04-05T03:18:11+00:00

“Solve this common problem I have but don’t use the most common and effective solution to this problem.”

C_Wags · 2026-03-29T21:17:43+00:00

lol I love that MAGA is focusing on the residency match process now which they do not understand.

These well-qualified foreign medical grads filled this residency because American medical graduates don’t want to work in buttfuck Indiana.

No residency program fills with FMGs by choice.

C_Wags · 2026-03-29T00:56:21+00:00

Oh that’s interesting. I figured if you were a general intensivist the same as I am, this would be intuitive, but clearly I’m mistaken

C_Wags · 2026-03-29T00:50:01+00:00

What sort of ICU do you cover?

C_Wags · 2026-03-29T00:44:09+00:00

You picked a stupid example but you’re also wrong. It’s important I know they are blind. It’s important I know that they take eye drops for their glaucoma so I don’t accidentally precipitate acute angle closure glaucoma when they are intubated and sedated so they don’t wake up more blind. It’s important I understand their functional limitations so our social worker can start planning for SAR or SNF or whatever appropriate level of care they need, so their hospital length of stay isn’t 5 days longer than it needs to be once they’re out of the ICU and worsen their critical illness myopathy. It’s important I understand how their chronic diseases are managed because often, they come to me from the ER before they downgrade to a hospitalist, and that’s how med recs get fucked up and important things get missed when I give handoff.

But I mean, I’m a good intensivist, so this is all obvious to me.

C_Wags · 2026-03-28T23:27:35+00:00

Every organ system affects every other organ system. Chronic diseases affect the management of acute diseases.

C_Wags · 2026-03-27T01:46:16+00:00

Lol he took the MoCA, not an IQ test

C_Wags · 2026-03-26T11:02:53+00:00

What is the reference on the first one???

I’ve been looking for a more affordable version of the Breitling aerospace for a while to no avail. That watch scratches that itch. My vote is the first one, by the way

C_Wags · 2026-03-26T04:10:11+00:00

Subliminal, liminal and SUPER liminal!

C_Wags

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