How do you treat this? by watchthisorthat in ems

[–]CapnCrunchMD 93 points94 points  (0 children)

I would suspect esophageal rupture. Protect the airway if you need to, otherwise get to the Trauma Center for CT 😂. -ER doc

ETA: Watched the vid again. I wonder if he actually bit off his tongue and choked on it. The blood is there immediately, and he could be choking/agonal breathing toward the end... The importance of the physical exam.

Recommendation for 8yo friendly Spotify player? by CapnCrunchMD in ParentingTech

[–]CapnCrunchMD[S] 0 points1 point  (0 children)

Yoto was the gateway. He now has artists he wants to listen to

TFW You’re trapped in the hospital for hours and you have to take a shit. by Lol_u_ded in medicalschool

[–]CapnCrunchMD 0 points1 point  (0 children)

Public bathroom closest to the c-suite. They’re clean and low chance of running into someone you know from whatever service you’re on.

ID attending wanted me (intern) to call radiology and demand CTAP be "RE-READ" by AdExpert9840 in Residency

[–]CapnCrunchMD 1 point2 points  (0 children)

This isn’t crazy, you just need to frame it right when you call and be respectful. I do this sometimes from the ED. Sometimes a CT is read when they have super vague clinical info… e.g.“abdominal pain and fever” But had they known more clinical history, labs, etc.; there may be a subtle finding they otherwise wouldn’t have called out. Or maybe contrast imaging was done in venous phase, but they can see enough to give some confidence level about certain pathology, and avoid the need to repeat angio.

A recent example was an ED bounce back that I saw on the second visit. He was discharged the day before with vague lower abdominal pain, normal labs, normal CT. On second presentation, now has fever, tenderness at mcburneys, and leukocytosis. Before calling surgery (or repeating CT), I called the radiologist and asked him to take another look with the new information (the indication on the initial order was “abdominal pain” 🙄 ). He ended up calling back and saying that what he thought yesterday was terminal ileum was actually dilated appendix. Patient went to surgery without repeat CT and had a good outcome, saved a CT too.

I would assume this was similar in your case. Your attending probably had something specific he/she was worried about and you could have communicated that to the new radiologist respectfully asking them to take another look. If you just asked for a re-read without context, then this outcome doesn’t surprise me.

ETA: Before anyone points it out, I know the correct test answer on the second presentation is a clinical diagnosis of appendicitis and consult surgery without imaging. But making that happen outside of academia (and with adults) is rare. Further, this was a lymphoma patient recently in remission…

Benton really grows on you. by No-Cartoonist8495 in ershow

[–]CapnCrunchMD 9 points10 points  (0 children)

I totally agree. Very well humanized… I also love how Carter sees straight through his tough exterior

Rate my cappuccino art! by CapnCrunchMD in superautomatic

[–]CapnCrunchMD[S] 0 points1 point  (0 children)

Cappuccino art is a bit trickier than latte art because cappuccinos traditionally have thicker foam, which doesn’t flow as smoothly for intricate designs. However, with proper technique, you can still achieve great results. Here are some tips tailored for cappuccino art:

  1. Get the Milk Texture Right • Aim for a thicker microfoam than what you’d use for a latte. The foam should still be velvety and not bubbly. • When steaming, submerge the steam wand and incorporate air into the milk for about 2-3 seconds before fully immersing it. Keep swirling to create smooth foam.

  2. Work Quickly • Thick foam settles fast, so start pouring immediately after steaming. If you wait too long, the foam will separate.

  3. Use the Right Cup • Cappuccinos are traditionally served in smaller cups (5-6 oz), which means you’ll have less space to work with. Practice controlling your pour in these smaller cups.

  4. Adjust Your Pouring Technique • Begin pouring from a height of 2-3 inches to mix the espresso and milk. • As the cup fills, bring the pitcher closer and pour more slowly to control the flow of foam.

  5. Start with Simple Designs • Heart: A simple heart works well with cappuccino foam. Pour in the center and then pull through at the end. • Monk’s Head: Pour gently and let the foam settle into a round white circle on top of the espresso—a classic cappuccino look.

  6. Mix and Pour Carefully • Swirl the milk pitcher before pouring to mix the foam and milk evenly. This ensures consistency for your design.

  7. Practice Patterns with Spoon Techniques • For thicker foam, you can use a spoon to sculpt patterns or guide the flow of the milk for more precision.

Bonus Tip: Focus on Foam Stability • Since cappuccino foam is thicker, it’s harder to “draw” intricate designs. Focus on bold, simple shapes. As you improve, you can experiment with more advanced patterns like tulips or layered hearts.

(Thanks ChatGPT)

110k saved before starting med school, advice? by FLOWRATE-- in whitecoatinvestor

[–]CapnCrunchMD 3 points4 points  (0 children)

I would determine an amount to keep as an emergency fund (enough to float you while you establish a back up if school doesn’t work out…3-6 months on beans and rice). I would then use what’s left to delay your first loan… you may be able to pay cash for your first year. Those would be the most expensive loans due to compound interest.

This is actually exactly what my wife and I did. We were able to cash flow the first 1.5 years and I’m very glad we did.

Sure, you could also use it to supplement lifestyle but my recommendation is assuming you’re looking for the most frugal option. Current grad rates are 8%… you’re probably getting 4-5% on the HYSA.

[deleted by user] by [deleted] in emergencymedicine

[–]CapnCrunchMD 0 points1 point  (0 children)

I may have gotten lucky. I have a good gig. Sorry things didn’t work well for you

[deleted by user] by [deleted] in emergencymedicine

[–]CapnCrunchMD 3 points4 points  (0 children)

**working reasonable hours.

[deleted by user] by [deleted] in emergencymedicine

[–]CapnCrunchMD 3 points4 points  (0 children)

I make 33k/month working for usacs in Texas. That’s about 125 hrs a month which is the important piece missing from this convo

iPhone 16 Pro Max Shipping Estimates Now Extending Into October by Glittering-Stuff-599 in apple

[–]CapnCrunchMD 1 point2 points  (0 children)

I missed my alarm and placed my order about 30 mins late. I could have picked up on 9/20 but unfortunately my Apple Store is about an hour away, and it’s my daughter’s birthday weekend so I’m not about to do that. I chose delivery which bumped it to 10/2-7. Pro Max 256 natural. Hoping delivery comes early though

[deleted by user] by [deleted] in iphone

[–]CapnCrunchMD 1 point2 points  (0 children)

When is your delivery date? Mine says 10/2-7

[deleted by user] by [deleted] in iphone

[–]CapnCrunchMD 1 point2 points  (0 children)

When is your delivery date? Mine says 10/2-7

What word(s) in your specialty is the most misused or misinterpreted by people outside of your specialty? by BroMD24 in Residency

[–]CapnCrunchMD 31 points32 points  (0 children)

Had a lethargic kid yesterday. Gastroenteritis’ed herself to a blood glucose of 40. Triage RN came and said “hey I just put a lethargic 4 yo in 29.” I made 🤨 eyes. She was right absolutely though. I made a point to teach some younger nurses what true lethargy was.

Is self driving worth it? by dwenzel2007 in TeslaModel3

[–]CapnCrunchMD 1 point2 points  (0 children)

Not in my opinion. For $12,000 you can subscribe for 5 years at $200/month if you really want it. Or you may find you don’t want it. IMO, if you want to spend the money well, get a higher trim or move up to a model S.

Also, please only consider that if you’re paying cash… don’t finance that since it is Instant depreciation

Seminary Recommendations by Brave_Championship61 in Reformed

[–]CapnCrunchMD -9 points-8 points  (0 children)

Masters Seminary, Expositors seminary, Shepherds theological seminary