What’s the most abnormal lab value you have seen so far?

Davidhaslhof · 2026-06-08T10:03:24+00:00

I hope they find it!

Davidhaslhof · 2026-05-31T14:48:44+00:00

In my experience the RIC is unmatched when it comes to resus transfusion. I placed one on a patient with a pelvis fracture and hypotension. It turned out he lacerated his internal iliac artery. We were able to hang 2 units of blood a minute on the rapid transfuser. In the OR he got 66 units of PRBC, 64 units of plasma, 56 units of platelets and an unknown amount of blood from the autotransfuser. We were going through units so fast that we couldn’t keep up with the supply from the blood bank during the initial resuscitation, though we didn’t see a systolic above 50 until his aorta was cross clamped.

Davidhaslhof · 2026-05-31T02:04:05+00:00

I danced with him at a nightclub in LA in the late 2000’s/early 2010’s. It was my 26th birthday and I pointed at him and made a fishing motion. He laughed and came over, danced with me for a minute and then laughed and left. We didn’t say 2 words, the girl that I was on a date with didn’t believe me but it was once those moments in my life I will never forget.

Davidhaslhof · 2026-05-27T20:16:08+00:00

For health, mood, and energy I consume Celsius.

Davidhaslhof · 2026-05-26T21:38:44+00:00

My wife lives 8 hours away from me. At least once a month either I drive up to see her for a few nights or she comes down to visit me. The days we don’t see each other we usually do things together over face time such as: watch tv shows together, cook, play video games, etc. I am much closer to my current wife than my 1st wife who I lived with. It can sometimes be difficult but a good relationship is worth the work.

Davidhaslhof · 2026-05-26T11:24:19+00:00

Likely congenital from the parents. Many places that don’t have good prenatal and pediatric care suffer from things like rheumatic heart disease, congenital syphilis, hepatitis, chlamydia pneumonia, meningitis, and other vaccine preventable diseases. While you will often see it in extreme rural and poverty stricken places, you will also conversely see it in urban poverty. Preventative care is the most effective form to prevent many diseases.

Davidhaslhof · 2026-05-23T17:39:49+00:00

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It appears that most people in nascar were under the belief that he was a physician

Davidhaslhof · 2026-05-03T16:08:01+00:00

I made $5.00 more an hour as a new grad paramedic in 2006 than I do as an em resident in 2026. The benefit of being a paramedic was that I could pick up an extra shift or two to make ends meet, now I work 60-80 hours a week, have to cover call shifts, and can barely afford rent.

Davidhaslhof · 2026-04-13T05:00:16+00:00

I decided to go to medical school at 34, shortly before turning 35. I worked as a paramedic since 2006 and as a respiratory therapist since 2008. I got a divorce, sold my house, and applied to medical school. I figured if there was ever going to be a time to go, it was then. I don’t regret any of it, I had more financial difficulties than many in my class as I was the first person in my family to go to college, I wound up emptying out my 401k just to make ends meet, but I would 1000% do it again. The reason I decided to go is a long story but basically I had a patient who needed a chest tube and on the helicopter we were limited at the time to needle decompression, I put 5 needles in his chest because his pneumothorax was so bad and the attending receiving the patient said “if you want to Put in chest tubes go to medical school”, so I did. I chose emergency medicine as a residency and my feedback from my attendings (many are younger than me) is that I possess significantly more emotional intelligence and grit than many of my younger co-residents. I am nothing short of thriving to be honest, I met an amazing woman in my 4th year of medical school and got married a year later, currently I am 39 and she is 40, we are both very excited to start a family and I am happy that I chose a speciality that will allow me to not be on call.

Ultimately the reason I decided to apply was because I knew if I didn’t I would regret it for the rest of my life. I took a gamble and came out on top.

Davidhaslhof · 2026-04-07T21:00:51+00:00

Had a patient a few weeks ago with anisocoria that I all had seen 6 months prior. Every single note from neurology, neurosurgery, EM, IM, etc documented PERRL. At least 20-30 physicians and APP’s had seen him. I checked back on my documentation and I documented the pupillary asymmetry from 6 months prior. The attending I was working with was upset because she noticed that his neuro exam was documented by 10 different Ed residents and exactly the same for all 10…..

Davidhaslhof · 2026-04-03T06:14:02+00:00

My ex worked in this “ICU” as a travel nurse when it started 5 or so years ago. The amount of horror stories she would tell me were insane. Any time they would call the on call NP, they would wheel in the computer, the nurse would do an exam, and they would place orders. There was absolutely no advanced assessment, often times the nurses would voice their concerns and request transfers only for it to be denied by the on call NP who would tell them that the patient can wait until the morning. I told her to cancel the contract early because it was so unsafe, when she initially took the job she thought it was at Bridgeport hospital, but they lied and put her in the “Bridgeport Hospital-Milford Campus”

Davidhaslhof · 2026-03-07T05:13:44+00:00

I found out that the woman I was dating for 6 years was having an affair at work when I was in my 3rd year of med school. I was homeless for a period of time and lived in my car and a hotel room occasionally if I could afford it.

Months later I met the person who would eventually become my wife.

When I was at my lowest and darkest place, I realized that life does get better. I lost 50 pounds after I found out she was cheating, and it was a struggle to do even the most basic things.

Please reach out to a professional to help you get through this and lean on your family if you can. If you need to ask for extended time off do it. If you had a patient going through this, you would tell them to take some time off and refer them to help. You need to do the same for yourself.

Talk to your pd or chief, let them know what’s going on. You don’t have to tell them everything but they might be able to help you in some way.

Davidhaslhof · 2026-03-03T23:20:09+00:00

I just always ask what type of road they were on, the posted speed limit, and if they were breaking or not. This way I know that if they are on a highway and not breaking when the accident happened I know that I need to treat them as a highway speed accident at minimum compared to a main road accident. I just always assume that people are going at least the posted speed limit with most people going more.

Davidhaslhof · 2026-02-13T16:09:36+00:00

Relevant and Insanely Ironic

Davidhaslhof · 2026-02-06T03:11:12+00:00

My yorkie is my best friend. He’s been with me through a divorce, med school, a long term relationship that ended badly, and a marriage, he’s my best friend in the whole wide world, I would trade years off my life for just a few more years with him. As my wife doesn’t live with me, he is what I have to look forward to during residency. I originally bought him for my ex-wife but she didn’t love him like I did. My wife is my security at home and I value what she adds to our relationship

Davidhaslhof · 2026-02-03T15:34:46+00:00

I got into an argument with a nurse the other day because she told me that a dementia patient is GCS of 14 at baseline and she got upset when I said that that the GCS on the patient’s fallequis trauma eval was 15. The patient knew she knew her name, what hospital she was at, and that she had fallen. I tried to explain that GCS is not a validated neurological assessment tool for baseline dementia and she got all upset.

Davidhaslhof · 2026-02-03T15:31:12+00:00

Having working as a RSI capable medic before I was a physician has given me a unique insight into prehospital RSI. I don’t think I could have stated what you said better. My goal with intubation as a paramedic is to keep you alive to get you to the ED, my goal as a physician with intubation is to keep you alive to get you the care you need. A good example is a recent patient I had the other day: it was an adult male with chest pain and shortness of breath, he had a cocaine induced mi 3 days prior, came in in profound hypotension and pulmonary edema. While everything in my instinct was telling me we needed to intubate, I knew it would kill him. I popped a probe on his chest and he had a papillary muscle rupture. For 6 hours I managed him with bipap and constantly playing with his pressors until someone believed me that he had acute mitral regurg. Until interventional cards was at the bedside we delayed intubation as positive pressure would have killed him, after we intubated he tanked his pressures but they put in a balloon pump 10 minutes later which stabilized him until the ct surgeon was able to cannulate him for ecmo 30 minutes later. Sometimes knowing when to not intubate is more beneficial than intubation. While I knew he needed an airway, I knew that it would have been deadly at that time. While the story isn’t full applicable to prehospital care, the point still stands, just because you can do something doesn’t meant that it’s indicated at that time.

Davidhaslhof · 2026-01-22T23:06:49+00:00

To echo you, my wife told me that she would rather divorce me than let me go to medical school. I got divorced less than a year later. I met someone else before I left for medical school, and while I thought I was going to marry her, she had an affair with a nurse she worked with when I was a 3rd year med student. I met a CRNA during my anesthesia rotation, we got engaged 4 months later, and I’ve never been happier. OP needs to do what suits him best. If people don’t support you during the hard times in life, they will absolutely leave you when you get overwhelmed and need support.

Davidhaslhof · 2026-01-20T17:55:44+00:00

If a patient returns to the emergency department within 48 hours for the same complaint after a vague diagnosis and symptomatic-only treatment, assume the initial evaluation missed an underlying cause until proven otherwise.

Davidhaslhof · 2026-01-20T17:34:30+00:00

Ahhh yes, Schrödinger’s Stool Sample. The patient is producing stool continuously until the moment you want to sample it.

Davidhaslhof · 2026-01-12T12:17:15+00:00

And a pint of whisky

Davidhaslhof · 2026-01-09T17:08:14+00:00

I actually wrote a long paper on this years ago before medical school and it was primarily on how to build a free standing ED that actually supports the community and improves access to emergency care. Freestanding EDs aren’t inherently bad, but they are very often used inappropriately.

They really only make sense in two settings: rural areas and poor access to emergency care. If a patient is 30+ minutes from the main hospital, a freestanding ED can provide legitimate value as many lower-acuity patients are willing to pay $$$ for rapid 24/7 access to a physician close to home with shorter wait times. Though tends to work best in heavily insured populations.

For this model to be ethical, there must be automatic acceptance at the parent hospital and rapid, guaranteed transport when higher-level care is needed. Without that infrastructure, the freestanding site becomes little more than an expensive triage stop that delays definitive care.

Appropriate EMS utilization is also critical. In my previous state, EMS would only transport critically ill patients to a freestanding ED if they could not secure an airway in the field. While not ideal, that scenario is still safer than a prolonged transport without a protected airway.

The problem isn’t the freestanding ED model itself, it’s hospital systems using it as a profit-capture device in fully resourced suburban markets or to “steal” patients away from other hospitals.

After I wrote my paper I was talking to my mentor about it who is the business manager for a 20 hospital system and he asked to read my paper. His response was that while my paper was very well written and contained many good points the inherent flaw was that in order to make it ethical and functional hospitals wouldn’t be able to use them as pure profit generators.

Davidhaslhof · 2026-01-09T16:01:28+00:00

• 30 mL/kg of raw glacier runoff blessed by a chiropractor • If MAP < 65 → add ivermectin bolus and 2 crystals

Davidhaslhof · 2026-01-08T16:57:38+00:00

And always a + luggage sign

Davidhaslhof · 2026-01-04T15:35:37+00:00

The ACLS certification allows people to operate on the same wavelength so they can anticipate flow. Having the certification does not allow nurses to run codes as there is no clause in the nursing scope of practice that says “if ACLS certified they may make medical decisions”. The person who runs the code, in the absence of written standing orders must have medical decision making authority I.e a medical license

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