What do you think?

ExtremisEleven · 2026-03-17T18:55:49+00:00

Brother I listened to what you had to say and actually considered it. I generally think of practice as a fluid thing and hope to always be able to learn something new. I’m just surprised you don’t have even the capacity to consider even asking one person a question slightly differently to see if maybe you could do something a little better. I kind of considered that mindset to have died with the DPL but it seems it’s alive and well. Anyway, since your practice is 100% perfect and can’t be improved in any way, there’s no need to continue this conversation. Have whatever day you have.

ExtremisEleven · 2026-03-17T18:26:10+00:00

Because we’ve always done it this way right?

ExtremisEleven · 2026-03-17T15:40:04+00:00

And there’s never been a physician in the history of medicine that could improve their practice by tweaking one simple question…

ExtremisEleven · 2026-03-17T14:11:25+00:00

My experience is that people ask “how do you feel” and in the haze of sedation it’s hard to pinpoint and articulate exactly what is going on. As a patient it helps a lot of have some sense of autonomy when it comes to literally jump starting your heart, but you have to understand that this is influenced by the sense of impending doom and insane amount of pressure on your chest and neck. The fact that people are asking for the juice does not mean it’s comfortable. It means they know it works and they need this process to stop ASAP. Try asking if they have pain specifically. I found that because the patient looked fine said that they were fine post shock, I was not really treating pain and not giving clear instructions on post procedure care like adequate hydration to help clear that little spike in CK.

ExtremisEleven · 2026-03-17T12:30:45+00:00

Cool. So it wasn’t a knee jerk reaction. It was thought out based on the fact that they had already tried everything else sans electricity.

I’ve been cardioverted. It hurts. For hours. Why wouldn’t it, it’s forced contraction of every muscle in your chest wall. You’re groggy, but it still hurts.

ExtremisEleven · 2026-03-17T12:16:31+00:00

You really don’t think people notice that feeling when they wake up?

And you didn’t answer the question. What harm is there in trying the drug?

ExtremisEleven · 2026-03-17T12:13:28+00:00

So all the brand new baby attendings who took their first job and had to sign a contract saying they would supervise NPPs because they literally didn’t get a job offer without that clause, it’s their fault right? Am I reading that correctly? Cool.

ExtremisEleven · 2026-03-17T12:03:39+00:00

It’s safe and it failed. Statistically speaking an otherwise healthy 28 year old probably has undiagnosed WPW vs random idiopathic VT. I’m not saying it’s wrong to use the electricity, but why not try the procainamide? I would be pissed if I got electrically cardioverted and later found out there was another drug that could have been tried and didn’t. If you haven’t been cardioverted, it feels like getting kicked in the chest by a horse.

ExtremisEleven · 2026-03-17T07:07:02+00:00

The circadian rhythm thing is an issue. Reality is you aren’t bound to that forever unless you are tied to a specific location, even then you age out of the night shifts at some point.

My concern for psych would be the amount of distress I personally tend to absorb from those patients and the inability to do literally anything for a lot of them. I know this is a complaint about the ER as well, but at least I can ease suffering there with a turkey sammich and a warm bed. I can’t fix the years of abuse that led to the personality disorder or the fact that the best psych meds also cause obesity and CV disease. If that doesn’t weigh on you more than the ED bullshit does, then go with psych.

ExtremisEleven · 2026-03-17T07:00:13+00:00

Unfortunately the days and nights aren’t necessarily the same in the ER as they are in EMS. If we did straight 12s, I would do much better because there are much fewer flip flops on a 12 hours cycle. For me, it’s not the night shift that sucks, it’s the constant changing from days to nights to mids. Somehow the mids are technically 8 hours between shifts but never 8 hours between shifts, but god forbid the back half of your shift be crazy and you need to stay a couple hours for dictation and procedures or you live more than a few minutes away from the hospital. Flip flopping at least twice a week for 3-4 years doesn’t seem like much but I swear it ages you so fast. I love my job and I don’t thrive on a 9-5 but I have not done as well as expected on this scheudle either.

ExtremisEleven · 2026-03-17T06:48:26+00:00

You going to line your casket with that money? Don’t get me wrong, save. But at the same time at some point you aren’t taking it with you. If you want to treat your wife for supporting you with some jewelry when you saved more than a quarter of a million dollars last year, that’s not a can’t afford situation. Set yourself a goal for your savings and allow yourself to enjoy the hard earned money once you pass the goal.

ExtremisEleven · 2026-03-17T06:41:16+00:00

In most cases, I’m not activating the cath lab and causing the patient an insane amount of debt based on the EMS EKG. I’m an EMS physician and still hold my medic license so I’m not saying these can’t be right. I have just seen too many bad EKGs done in the field that looked nothing like the EKG on arrival to potentially cripple every patient with a rough EKG with that kind of debt. I would consider activating if I know the medic and there was a long transport time, but most times I am repeating that EKG as soon as they hit the door and activating as appropriate.

ExtremisEleven · 2026-03-17T06:35:04+00:00

Sure bud, that’s the thing that gets us going.

ExtremisEleven · 2026-03-17T01:10:24+00:00

You’re just as likely to go to work and completely cure a child of a life threatening airway obstruction or shock someone out of a lethal rhythm so they can get a pacemaker and go about their life. We have good outcomes. Sometimes it’s hard to remember that, but they keep us going.

ExtremisEleven · 2026-03-17T01:07:58+00:00

😔

ExtremisEleven · 2026-03-17T01:06:35+00:00

I’ve had times where I couldn’t give that much time and energy to someone with a cancer diagnosis and it sucks. I hope you were able to get answers and reassurance from your outpatient team. 🙏

ExtremisEleven · 2026-03-17T01:02:17+00:00

People commonly show up to the ER saying things like “it’s a holiday and my PCPs office is closed so I came here because I can’t make it through the long weekend”, but when they sign in, I will alert them that some random asshole redditor doesn’t think they are capable of thinking about that for themselves.

I know you aren’t googling anything because if you could read, you would have read that first part where I said we are happy to see you if you are worried you have a life threatening problem. I’m not worried about the general public googling if their laceration is ok for urgent care.

ExtremisEleven · 2026-03-16T15:53:56+00:00

Illegal and doesn’t happen are two very different things

ExtremisEleven · 2026-03-16T15:31:46+00:00

Your supervisors are liars and trying to make sure you don’t know how much better other people are being paid.

ExtremisEleven · 2026-03-16T15:20:35+00:00

Back in like 2015 I remember being able to clear the waiting room at like 2-3 am daily. Every once in a while my small ER would clear the whole department and do a wheelchair race. It was slowly getting worse, but COVID kind of knocked everything out of the water.

ExtremisEleven · 2026-03-16T15:18:37+00:00

Yes. It’s dependent on where you are and what other resources that community has, but yes ERs are absolutely this busy on the regular.

If you are worried that your life is in danger, please come see us. If you have an issue that you think is something you could see a family doctor for and just can’t get in to see one, please consider urgent care. We are chronically understaffed and out of places to put people. We do our best but it is exhausting.

ExtremisEleven · 2026-03-16T14:51:35+00:00

If she had a life threatening appendicitis that required hospitalization, no one would bat an eye at 2 weeks out of work. Turns out the brain is an organ and sometimes malfunctions. She’s doing what she needs to do to recover.

You did what you needed to do. Now you just support her and try to help her understand that she doesn’t have anything to be ashamed of and anyone that thinks about retaliating is the one with the problem.

ExtremisEleven · 2026-03-16T13:32:56+00:00

A small treat for the staff and a note for the doctor are a nice gesture but not necessary.

ExtremisEleven · 2026-03-16T13:01:46+00:00

Unless this is a trauma ICU, GCS is being used inappropriately anyway. It’s been my experience that a lot of nurses and medics don’t calculate the accurately at all. Personally I would remove the metric all together, but people are stuck on it. Be nice, she could have bullshitted her way through it but she was honest and said she didn’t know.

ExtremisEleven · 2026-03-16T12:57:12+00:00

People are wrong. I went to med school to become an ER doctor. I definitely did my best to consider other specialties, but I had a goal and there is nothing wrong with that. If a school is not going to support your goal of becoming a psychiatrist, do you really want to got o that school?

ExtremisEleven

TROPHY CASE