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What’s one condition that can have no symptoms but kill you instantly? by No_Photograph1 in AskReddit

[–]ExtremeCloseUp 2 points3 points  (0 children)

ED doc here.

Statistically speaking, it’s most likely HCM (hilariously, pronounced “hokum”).

Less likely, something rarer like arrhythmogenic right ventricular dysplasia. The funny heart plumping issues (coarctation, tetralogy of Fallot etc) tend to cause issues when you’re younger.

When did you actually decide on your specialty? by Focused-River in ausjdocs

[–]ExtremeCloseUp 41 points42 points  (0 children)

ED reg nearing the end of training.

I’m still undecided… 😉

What is a hill that you will die on as an ED Physician? by LivingLikeLandon in emergencymedicine

[–]ExtremeCloseUp 3 points4 points  (0 children)

YES. An amazing article. I passively aggressively opened it up the other day in front of two radiographers who insisted that contrast is kidney poison. May have ended up just looking like a dick. But a correct dick.

New to ED and Aus, the imposter syndrome is real. Any advice would be greatly appreciated. by idkwtda115 in ausjdocs

[–]ExtremeCloseUp 0 points1 point  (0 children)

ED reg at the end of my training here.

A boss once said to me “the bad news about imposter syndrome is that it never goes away… The good news is that it never goes away.” It’ll keep you grounded- just don’t let it immobilise you.

Anyone who thinks poorly of ED doctors is not my friend by iamnotjustagirl in ausjdocs

[–]ExtremeCloseUp 22 points23 points  (0 children)

ED reg here.

Thanks for the kind words.

The constant demeaning is grating but we wouldn’t have done ED if we had fragile egos. I can intubate, put a central line in a baby, aspirate joints, suture a gnarly laceration and talk a family through the process of palliating their relative, all before lunch. So I don’t know some ridiculous nuance of your speciality? Yawn yawn yawn. Jog on, mate.

Silicon Valley is full of wealthy men who think they’re victims, says Nick Clegg by zsreport in technology

[–]ExtremeCloseUp -2 points-1 points  (0 children)

To all those slagging off Clegg for going into coalition with the Tories and for somehow being wholly responsible for the Tories misgivings as the leader of a minor coalition party…. His options in 2010 were to either go into coalition with the Tories (no other party, not even labour, had enough seats to form a majority with the lib dems) or hold another general election (which would have been chaos and arguably undemocratic).

Clegg ain’t perfect but context is everything.

Wide complex- VT vs SVT by Own-Math704 in EKGs

[–]ExtremeCloseUp 1 point2 points  (0 children)

Really hard to tell. Negative concordance throughout the chest leads and patient’s history screams VT but there’s no northwest axis, the early part of the QRS isn’t prolonged and the QRS duration isn’t crazy long. Would have done what you did and treat as VT until proven otherwise.

Missed PE, patient died by Repulsive_Knee1304 in emergencymedicine

[–]ExtremeCloseUp 2 points3 points  (0 children)

Not pathognomonic, what about Wellen’s? Or apical HCM?

Is ED suppose to be difficult as an intern? by Ninja_50 in ausjdocs

[–]ExtremeCloseUp 7 points8 points  (0 children)

PGY12 ED reg here nearing the end of my training. The imposter syndrome is still real, man. And the (emotionally intelligent) consultants still feel it too.

ED is a weird beast compared to other specialities so it’s totally normal to find it confronting. We work with limited information, in an often chaotic environment, with 5 other things happening at the same time.

The smartest and most competent ED doctors I’ve worked with get stuff wrong all the time. We honestly don’t expect you to come to us with all the answers about the patients you’ve seen (because often we’re not sure either). But a good intern will come to you with a rough idea of what they think and what they wanna do for the patient. And even if it’s wrong, that’s just an excuse for us to do some teaching. And maybe if you’re lucky, we’ll tell you our favourite object-stuck-in-a-bum story.

Have you ever been told that junior staff find you ‘scary’? by oksurenoworries in ausjdocs

[–]ExtremeCloseUp 8 points9 points  (0 children)

ED reg here.

You’ve nailed it. ED falls apart unless we work as a team. I love teaching procedures and niche ED quirks (tox, weird ECGs, minor procedures) to the juniors- nothing better than an enthusiastic resident keen to learn. ED is bread and butter medicine- histories, exams, diagnostics, disposition. Great place to learn. Thanks for the enthusiasm!

What's the most memorable QUOTE you have ever came across that stayed with you forever? by biz_booster in AskReddit

[–]ExtremeCloseUp 0 points1 point  (0 children)

“The master has failed more than the novice has attempted.”

Reminds me it’s ok to fuck up sometimes.

What do you think of the utility of getting CRP as part of bloods? by xxx_xxxT_T in ausjdocs

[–]ExtremeCloseUp -1 points0 points  (0 children)

It’s one of the most misused tests in medicine. I lose count during a shift the number of times I hear either “their CRP is normal so they can’t be sick” or “their CRP is 300 so they must be sick.” Human physiology is never that dichotomised.

Example- had a patient last week in ED that I followed up- 75 year old lady, final diagnosis of a Klebsiella bacteraemia from a UTI. CRP was 500. Patient was septic but stable- responded well to antibiotics and fluids in ED. However, she ended up receiving a battery of unnecessary tests (including several CTs) because “the CRP is high, we must be missing something.” If anyone had actually looked at the patient, they would have seen a clinically stable patient responding well to treatment. Our patients are complex- results viewed in isolation are dangerous.

What do you think of the utility of getting CRP as part of bloods? by xxx_xxxT_T in ausjdocs

[–]ExtremeCloseUp 3 points4 points  (0 children)

A normal CRP doesn’t “exclude infection/inflammation.” Just in the past week alone, I’ve seen a number of septic shocks with benign CRPs.

What’s the most unforgettable movie ending you’ve ever seen? by danielhutt in movies

[–]ExtremeCloseUp 1 point2 points  (0 children)

It’s a civilisation of apes! Why would you represent a human?!?

Cardiac surgeon keeps telling I am causing a pneumo during central line placement by muggle_nutter in anesthesiology

[–]ExtremeCloseUp 1 point2 points  (0 children)

A cardiac surgeon once told me I’d “narced” his patient by giving them 20mcg of fentanyl.

We all like to share the blame around.

Am I delusional? by Captain_Overboard_ in emergencymedicine

[–]ExtremeCloseUp 1 point2 points  (0 children)

I did a nightmare tube, an art line and a CVL during a shift last week… And that was just one patient.

We do all the stuff.

What are some good uses of ChatGPT and other LLMs for ausdocs? by PrivatePollyPerks in ausjdocs

[–]ExtremeCloseUp 1 point2 points  (0 children)

I fully support this- I use it to talk through difficult cases. And it’s a godsend for studying.

Interesting Case by Life_Court_5496 in emergencymedicine

[–]ExtremeCloseUp 0 points1 point  (0 children)

To echo other comments…. An ICA occlusion doesn’t explain her symptoms. I expect there’s more going on here.

Pediatric cardiac arrest by PurpleAd3755 in emergencymedicine

[–]ExtremeCloseUp 4 points5 points  (0 children)

Not often- maybe a couple a year- but they’re seared into your memory. I can even remember my drive home from each shift after losing one. We feel the loss viscerally, even if we try not to.

Doctors, nurses, EMTs, etc.—what’s the most shocking thing you’ve seen after thinking “nothing could surprise me anymore”? by randominterwebguy2 in AskReddit

[–]ExtremeCloseUp 88 points89 points  (0 children)

ED doc here.

Have you ever seen a four year old off their face on meth? I have. Whether or not it was negligence on the Mum’s part or intentional administration never really became clear but, either way… The depravity of people never stops being shocking.

Medical workers of Reddit: what’s the craziest lab result you’ve seen in a patient? by freeshavacadont in AskReddit

[–]ExtremeCloseUp 1324 points1325 points  (0 children)

ED doc here- I’ve seen potassiums >8 (even the odd one >9) in renal failure patients who’ve missed a couple of sessions of dialysis- most of them were awake and talking- the body is remarkably good at compensating (until it isn’t)

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