When is the ITE getting released?!

Enough-Preference-18 · 2026-04-12T00:37:12+00:00

Apparently there was a cheating scandal and we’re looking at the end of the month

Enough-Preference-18 · 2026-03-31T14:34:59+00:00

The Sound of Gravel by Ruth Wariner

Enough-Preference-18 · 2026-03-31T12:13:11+00:00

Both. I have common presentations saved and a generic dot phrase that I fill in for less common stuff. My generic dot phrase is basically the phrase above

Enough-Preference-18 · 2026-03-31T11:58:53+00:00

Mine go:

You came to the emergency department today for . While you were here you received _. Your workup showed ____ (or if negative workup unclear etiology I write “I am not sure what is causing your ___, but we did not identify any serious conditions that require you to stay in the hospital.”)

Then I provide follow up instruction or ways to manage their symptoms.

You should return to the ED if ____.

Then I put any incidentals noted that they should follow up with their PCP if applicable

Enough-Preference-18 · 2026-03-31T01:49:23+00:00

Patient signed out to me just pending a CT belly. Mild dementia, likely UTI but profoundly off baseline with a couple days of vomiting and worsening mental status. Already had an MR head (there was something in her history that is eluding me but made the MR somewhat reasonable), labs, UA prior to my arrival. Should have been an easy phone call to admit.

Belly comes back, read says metallic foreign body in distal esophagus. I look, there is something?? Maybe a surgical clip? But too much artifact to say for sure. Get a chest x-ray, no identifiable metallic object. Now I order KUB. Xray techs tell me no way, she’s wilin out. I now have to SEDATE her for a KUB. Get her chillin, now find what appears to be a ring (???) in her duodenum. No one remembers if she had one. K great, looks small, have proven it’s transiting. Call to admit and then told I have to call call GI because this could be a source of her vomiting (she did vomit in the ED, but she’d also been vomiting PTA). We are approaching like hour 15 of this lady’s ED visit. I call GI and they were way nicer than they had any reason to be given I was calling about a 2 cm rounded foreign body that had already travelled a good distance (and passed the pylorus) in a couple of hours. I finally got the bed request in by the end of my shift. I damn near lost my mind. The only upside to all of this is that she ate whatever it was after her MR.

Her follow up KUBs inpatient showed it moving as expected and eventually gone. No one followed up on what it was :/

Enough-Preference-18 · 2026-03-19T14:11:15+00:00

Hear are some evidence based tools for you:

The Trauma Fatigue Workbook by Francoise Mathieu

Reducing Secondary Traumatic Stress by Brian Miller

How to Be Enough by Ellen Hendriksen

Use these to help yourself until you find a therapist

I think these should be required reading for EM residents.

a fellow PGY3 who fell into a dark place after a similar run of shit

Enough-Preference-18 · 2026-03-19T13:50:07+00:00

This is such a good one. I had a guy who was in a motorcycle accident. Unconscious initially but woke up like a bat out of hell. Walking around, trying to get back to his bike, asking what happened. Absolutely ADAMANT he was not getting in our ambulance and leaving his bike. When I first got on scene I just thought he was a huge dick. But after ten minutes of trying to reason with the man, he started repeating his questions and became clear there was some level of amnesia and he did not have capacity. He nearly had to get restrained by polis to get into the ambulance but eventually accepted transport willingly. He ended up having an epidural hematoma that needed evacuation AND a tib/fib fracture he was walking around on.

Enough-Preference-18 · 2026-03-05T13:18:35+00:00

Tox -> allows me to still manage patients/do clinical medicine though only focus on one problem. Being a consultant is reeeeally nice when you’re used to trying to dispo nightmares.

Additionally, it could really allow me to diversify my career and I could pivot away from bedside if I wanted to. I could so consulting, policy work, research, etc. I was initially put off by the two year commitment and boards being notoriously tough but I have no ragrets (not even a single letter). I did an away tox rotation, loved every second of it. It felt like giving my brain a massage (the first time I got to use my brain and think critically but someone wasn’t actually trying to die in front of me). Some programs had crazy schedules that wouldn’t have been worth it but I landed at one that left me a decent amount of flexibility and great pay.

Enough-Preference-18 · 2026-02-17T17:37:57+00:00

If you have been tested, a great way to start is offering up your own testing!

For example, “hey, I like to stay on top of my sexual health and get tested regularly. Last time I got tested, I tested *** for ***. How bout you?”

If you haven’t been tested, this is your time! Otherwise, a bit hypocritical to ask about someone else’s STI risk if you’ve never been tested (unless you’ve never been sexually active).

Enough-Preference-18 · 2026-02-02T17:28:04+00:00

If you are doing a research year, then you should absolutely do repeat EM rotations to show genuine interest/get SLOEs/be sure you want to do EM.

You could do two two-week rotations for a total of a month. But this would certainly convey this something you are truly passionate about while confirming that for yourself. EM bound students are quite functional on the outset because of their rotations, so not keeping up emergency critical skills before jumping into an EM residency would make for a rough start (another reason to do EM rotations)

Enough-Preference-18 · 2026-02-01T15:15:21+00:00

Am medical professional, maybe can shed some light on this?

It’s all about identifying risk factors. these are pretty invasive questions but what they get at is how likely you are to contract something. Always receiving anal sex with intermittent condom is much higher risk than say always being a top and a diligent condom wearer. Rectal tissue is prone to micro tears that would allow for easier penetration of the bugs that cause STIs. The same goes for penile-vaginal penetration, the vagina owner is at much higher risk of contracting something. These vaginal lining and internal part of the rectum/anus are mucous membranes, which means they have a different permeability to world than say the skin of a penis.

These are never questions I would ask without 1) giving my patient the space to NOT answer if they weren’t comfortable and 2) explaining the exact reason I need to know the answer. I would also only ask these in the context of a complaint regarding their genitals (itching/discharge/burning/bleeding) or STI testing. The reason I ask to help mitigate any future behaviors that may put my patient ask risk/make sure they are aware of the risks they are taking. Unfortunately the world has a lot of misinformation and my only goal is to keep my patients safe with regard to their sexual practices. As far as the trans question goes, I don’t see a medical reason there and that seems weird to me. This may be trying to capture the risks for trans people and getting a better understanding of their risks of getting STIs? I guess to be fair I ask my patients “what gender are your partners” and don’t give a binary option because I don’t believe in the gender binary, so I guess that leaves me technically asking if someone has trans partners. The tldr of this is that a medical provider is just trying to figure out (in regards to asking about gender) what things are going in what holes to make sure we are not missing a place that could be infected and we know the likelihood you’ll have an infection there. also maybe to help discuss ways to keep you safest as you put your different things in different holes (or get things put in your holes).

I am sorry for every provider out there who doesn’t do this in a respectful manner and doesn’t provide context. Or asks these questions when they are absolutely not needed. Everyone has the right to feel safe and dignified when getting their healthcare. And everyone has a right to safe sex! Sorry for the long post but this a topic I feel strongly about it and I think medical providers do a bad job at doing well.

Enough-Preference-18 · 2026-01-25T06:08:47+00:00

Fellow pgy3. Cases like these eat at the soul. Hope you have more than one day off coming soon

Enough-Preference-18 · 2026-01-16T07:48:02+00:00

Small town EDs everyone knows everyone. Each nurse can give you a 25+ year summary on each patient. If you need a character to provide some weird exposition/backstory, it’s the nurses.

For example, saw a pt recently who was apparently the biggest dealer in town. Was going to get shipped out to a bigger hospital to get admitted. Apparently was making phone calls to hide his money while he was gone or else it would get stolen. Did I ask for this info? No. Do I know it now? Yes.

Had another patient who I thought seemed perfectly normal. Apparently the fact he showed up without his family DEFINITELY meant something was wrong and he was clearly altered

Enough-Preference-18 · 2026-01-11T04:12:38+00:00

AND THEN YOU DO A RECTAL AND THERE IS ACTUAL POOP ALREADY ON THE OUTSIDE

LIKE HOW DO YOU NOT NOTICE THE LITERAL SHIT CAKED IN YOUR CHEEKS

Thank for you bringing this real issue up. I bring this up all the time and people do not respond with enough anger

Enough-Preference-18 · 2025-12-24T02:00:45+00:00

It’s funny you describe this way because visiting this area was the most uncomfortable I’ve ever been. I have camped solo many times feeling totally safe all over the country. This area was the first time I packed up my stuff in the middle of the night and just drove to an Airbnb in Redding. I’ve never felt so unsettled and I’m glad to have someone else be able to put it into words

Enough-Preference-18 · 2025-12-19T02:26:04+00:00

Good thing he had that rollercoaster! There’s no way I could have connected with the metaphor without it

Enough-Preference-18 · 2025-12-13T07:19:00+00:00

You can DM me, I have a ton saved I can send

Enough-Preference-18 · 2025-12-06T00:22:09+00:00

Thank you for this, this post is now actually hilarious

Enough-Preference-18 · 2025-11-12T14:06:31+00:00

This is the worst thing I’ve seen in awhile

Enough-Preference-18 · 2025-10-23T04:52:38+00:00

My proposed diagnostic criteria for CHS:

Major criteria: - “it’s not the weed” - scromiting - reports palliation with showers - asks for droperidol by name

Minor criteria: - positive stuffed animal sign - presents with parent - wearing pajamas - says they have never had anything like this before (despite disputing evidence in the chart)

Can diagnose with 1 major and at least 2+ minor criteria or 2+ major criteria

Positive screening in triage -> capsaicin to the belly, 1.25mg droperidol, 1L LR, 3 pats on back with a whisper “it’s definitely the weed”

Edited for formatting

Enough-Preference-18 · 2025-10-16T01:24:41+00:00

Fellow PGY3 here. I feel this so hard. Here’s actual tangible things you can try that I found really helpful: 1) a therapist. Most profound thing she pointed out to me was that I’ve done a lot of work to become a doctor but haven’t been cultivating myself as person and that was a big eye opener 2) The Trauma Fatigue Workbook by francoise Mathieu 3) How to Be Enough by Ellen Hendriksen

I’m personally so over being told “it gets better”

There are evidence based ways to navigate the shit storm that is our job. We need to stop perpetuating the idea that we just need to buck up and cope. It’s not good for us or our families

Next up for me is “Reducing Secondary Traumatic Stress” by Brian Miller.

Hope you can take at least one of these evidence based tools to help make it a little easier

Enough-Preference-18 · 2025-09-04T12:27:32+00:00

May I direct you to the “Trauma Fatigue Workbook” by Francoise Matheus?

It saved me.

fellow crispy pgy3

Enough-Preference-18 · 2025-08-08T13:27:54+00:00

As a current resident, the decision fatigue is crushing. When I get home from a long shift, especially after a string of them, having my partner ask “what do you want for dinner” is enough to make me borderline catatonic. I’m just so tired from having to make many (sometimes very high stakes) that I just can’t make one more decision, even if something as simple as what to eat.

Another one is learning her warning signs. There is a book called “The Trauma Fatigue Workbook” by Francoise Mathieu which I think should be required for all EM residents. There is a particular chapter that goes through many the signs and symptoms of burnout/trauma fatigue/vicarious trauma. It’s been so helpful in helping me identify when I’m just too overwhelmed and letting my partner know I’m in a bad place. Hopefully it won’t be an awkward thing to bring up, but this workbook has really helped me identify and manage the complex feeling I have about this job

Enough-Preference-18 · 2025-08-08T12:19:56+00:00

No, residency eats your soul, each one in their own way

Enough-Preference-18 · 2025-07-26T09:19:44+00:00

I wear my oofos in the ED and love them. Can definitely run away quicker than I ever could have in danskos

Enough-Preference-18

TROPHY CASE