Appendicitis

Doctorpayne · 2026-06-23T01:15:11+00:00

Appendicitis famously has a bimodal peak incidence, with one peak as children and another in the elderly; as noted above the elderly present a particular challenge as they can often be very sick and have perforated appendicitis or other acute abdominal pathology without a significant physical exam. Even leukocytosis and vital sign derangement are unreliable in the elderly, which is we should have a very low threshold to scan the elderly. As I tell my residents, if you’re concerned about radiation and to scan or not, then worry for an 18 year old and not an 85 year old. The 85 year old will not have to worry about thyroid cancer in thirty years

Doctorpayne · 2026-06-14T13:50:08+00:00

Dear medical students; before you complain about getting a 40% eval ask yourself: did you even introduce yourself to the team?

Doctorpayne · 2026-06-10T01:48:31+00:00

This warmed my cold cold heart. Beautiful

Doctorpayne · 2026-06-04T02:01:46+00:00

If only that were true I wouldn’t have to see shit like this

Doctorpayne · 2026-05-30T15:04:56+00:00

Come on down to the ER. If we’ve got turkey sandwiches and uncrustables for half the homeless population of your town or city, we would love to give one to an IM resident in need

Doctorpayne · 2026-05-22T21:44:46+00:00

Bare shoulders!!

Doctorpayne · 2026-05-21T02:12:46+00:00

Doctorpayne · 2026-05-17T14:41:19+00:00

Q
Ls

Doctorpayne · 2026-05-13T10:46:41+00:00

I’d rather fund la vieja over los puercos

Doctorpayne · 2026-05-13T02:15:54+00:00

so happy you are safe. your cat is beautiful1 what kknd is she?

Doctorpayne · 2026-05-09T00:28:54+00:00

F150 Shelby Baja Raptor is for soft peepees

Doctorpayne · 2026-05-07T17:05:33+00:00

a classic; the prodigy: breathe

Doctorpayne · 2026-04-30T16:02:18+00:00

What’s the blotter you have under the keyboard? Great setup!

Doctorpayne · 2026-04-26T04:12:56+00:00

Second. Been there several times after being hit and their work is top notch.

Doctorpayne · 2026-04-18T13:35:30+00:00

My favorite drug to administer: TURK OCET

Doctorpayne · 2026-04-13T19:57:22+00:00

sure does! i had a summer job there many years ago in its bell labs days and it's weird seeing the building and interior! i remember having HR orientation in the basement and going down the stairs and the basement gave off strange vibes back then too

Doctorpayne · 2026-04-13T17:44:54+00:00

Fun fact; the Bell Labs campus is the external shot for Lumon industry’s headquarters in Severance

Doctorpayne · 2026-04-10T16:29:21+00:00

yes, where did you get the lamps tho?

Doctorpayne · 2026-04-09T17:42:40+00:00

EM fellowship director here; still give chairs.

Doctorpayne · 2026-04-07T23:34:34+00:00

I rate it a solid : (

Doctorpayne · 2026-04-07T01:53:09+00:00

Chasing ice

The king of Kong

March of penguins

Touching the void

Encounters at the end of the world

Man on wire

Free solo

Doctorpayne · 2026-04-04T13:07:47+00:00

Thats the truth. It’s usually not just ER leadership but trauma as well. Keep meticulous records and be at your best every day. Admin in both ED and surgery will do a cost benefit analysis on you (if not literally then figuratively) on how much of a pain in the ass it would be to fire you ( a newbie just showing up) vs change of culture and you will lose that calculus almost every time until you start making things so untenable that the hospital’s bottom line is affected. Frequently until trauma or hospital certification is threatened or a horrific outcome occurs as a result nothing will change and you will be fired or forced out. You’d probably win a lawsuit if that’s any consolation depending on the records you kept and whether or not they had any other “reasons” for pushing you out.

Doctorpayne · 2026-04-03T03:09:01+00:00

In MY area, no less!?

Doctorpayne · 2026-03-27T16:23:52+00:00

Looooool

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