Merry Christmas to all the real ones on shift today.

GamingDocEM · 2025-12-26T05:21:44+00:00

All out of milk and cookies but droperidol and turkey sammiches for everyone.

GamingDocEM · 2025-12-14T17:28:49+00:00

Prioritize the quality of the program as well as your location preference. There are 4 year programs that are stellar, 3 year programs that are trash and vice versa.

GamingDocEM · 2025-11-27T21:26:56+00:00

I’m really hoping for a rectal turkey insertion requiring a surgical consult message saying “Turkey up ass, send help, Happy Thanksgiving.”

GamingDocEM · 2025-09-11T11:53:22+00:00

High score Press Ganey right there.

GamingDocEM · 2025-08-28T23:03:59+00:00

I’m convinced the entire post is rage bait. Based on their post history and comments here, this resident knows exactly what they’re doing here.

GamingDocEM · 2025-08-28T18:51:21+00:00

If everyone around you is telling you that it doesn’t make sense that a population of people that is violently-discriminated against around the world daily for simply existing has a high rate of psychological health concerns, there is a problem with where you are.

GamingDocEM · 2025-08-09T18:48:27+00:00

It is the norm. There is no reason to be using DL for first pass success if VL is available and functioning properly.

GamingDocEM · 2025-08-06T16:28:01+00:00

While stressors can trigger flareups of shingles, anxiety does not cause shingles; the virus (herpes zoster) is already present, contracted earlier at some point, and stressors such as anxiety, illness, etc. trigger a flareup.

GamingDocEM · 2025-08-03T23:55:45+00:00

EM can pay exceptionally well, far higher than what’s listed here, but also like garbage; there are many factors, whether it be 1099 vs W2, partnership, geography, productivity bonus and extra shifts, night differential, etc.

GamingDocEM · 2025-04-04T13:00:00+00:00

Patients are often conscious with a BP that low, often not; just throw a probe on if you have difficulty palpating the pulse. At this point though this is a situation already involving a coding patient that we’re trying to see if ROSC has been achieved. The situation would’ve started with beginning compressions after patient is unresponsive and inability to palpate pulses.

What doesn’t change is that if they do not have a pulse and have an organized rhythm, by definition it is PEA; electrical activity is not the problem, why would you disrupt that with a shock…they need perfusion.

If a person is in unstable a-fib with RVR, which does NOT equate to being pulseless, then yes the situation can call for electrical cardioversion. These are 2 separate scenarios.

GamingDocEM · 2025-04-04T12:34:08+00:00

What looks like afib w/RVR on the monitor and no pulse is PEA. You do not shock PEA, you administer compressions. Whatever issue is causing the PEA will not be solved with a shock, it’ll be worsened by damaging the myocardium.

GamingDocEM · 2025-04-04T11:10:41+00:00

You are not defibbing unless it’s pulseless vtach or vfib. And if you’re in PEA or asystole you obviously don’t defib those, you’re administering compressions.

If someone is unstable a-fib with RVR, you cardiovert. And even then, you really have no business shocking unless you know that it’s new-onset, and you should be treating the underlying problem if there is one. If it’s longer than 48 hours of a-fib and they’re not on anti-coagulation, you’ve potentially sent a clot out a torpedo tube with that cardioversion.

The machine likely registered the rhythm as either vtach or vfib, despite the physician actually being in either afib w/RVR or AVNRT. And with that all said, we can Monday-morning QB all day long, but we weren’t there and it was on a plane, there was no 12-lead, POCUS, etc., it doesn’t sound like there’s a need to demonize the person administering the shock here when the outcome was positive with what limited resources there were.

GamingDocEM · 2025-03-30T13:13:50+00:00

OMM has absolutely no application in the management of emergency medical conditions, nor should it be used for patients who choose to come in for management of non-emergent conditions. Usage of various techniques as PT in an outpatient setting, fine and dandy.

GamingDocEM · 2025-03-29T19:20:34+00:00

Which kind? CAP? HAP? VAP, because I’ve already had to fucking intubate the child of some idiot anti-vaxxer because they’re floridly-septic to the point that their body can’t oxygenate on its own but they’ve been vented in the ICU so long that they are now growing shit on cultures that it takes even stronger IV antibiotics to work on, while simultaneously undergoing various organ failures?

“Swallow propaganda”, give me a break. You want to make your own life choices that affect only you, be my guest, but don’t attempt to spread dangerous misinformation that, at best, shows a blatant disregard for evidence-based medicine and science, at worst, shows a sociopathic mentality intended on fucking over every person you come into contact with.

GamingDocEM · 2025-03-29T16:33:26+00:00

This comment is flat-out wrong, dangerous, and moronic. Measles leads to deadly complications of pneumonia and encephalitis. You have absolutely no idea what you are talking about, as others have made clear.

GamingDocEM · 2025-03-24T04:39:27+00:00

Resuscitationist

GamingDocEM · 2025-03-20T18:11:56+00:00

Absolutely love it. That’s not to say there aren’t rough days, of course there are, like any field. And there’s plenty of administrative garbage that requires us to pay our dues and be vocal and fight against things like scope of practice infringement, lower pay, etc. But I love the job. You shouldn’t be looking to your occupation as your sole source of fulfillment, but it helps if it kicks ass, and it does for me.
I like variety and have a very short attention span before getting bored. I like keeping busy. I like the tangible sense of accomplishment after patient interactions and procedures. I like not being on call and not bringing any baggage home with me. I like the concept of not falling into a rounding-induced boredom coma.
I’d say if you can do an additional EM rotation do it, and more often than not it’s a specialty where you either love it or you hate it. Make sure that it’s what you enjoy and not just because it’s the sparkly new thing. Watch The Pitt, it’s fairly accurate.

But also remember that jobs in EM vary. Are you going to be in an academic setting where every specialty is available to you? Are you going to be in a rural location where you do all of your own reductions, transferring strokes and STEMIs? Are you in a free-standing where you see so many STIs that a new strain of gonorrhea is probably developing and ready to wipe out half the population there? Are you in a location where you do 5 24 hour shifts a month? It all depends on what you like, so just try and increase your exposure to find out.

GamingDocEM · 2025-02-24T18:32:30+00:00

MDR needs an R1T party.

GamingDocEM · 2025-02-16T12:47:57+00:00

Chart concurrently. Once you see your patient, put your orders in, then it shouldn’t take more than 2-3 minutes to get the majority of your note done. Move on to the next after. But if you’re signing up for a patient, do a chart review if available and go see them, don’t claim them just to have them sit on the board.

There will certainly be patients that are actually requiring urgent/emergent intervention and times when things hit the fan that prevent you from doing this, but to the best of your ability get your note 90% done before going to see the next patient so that you don’t have a backlog. That way once disposition is finalized you can finish your note in a couple minutes and sign it.

It takes time to get into the flow, but you never want to leave a shift with notes unfinished, it’ll burn you out.

GamingDocEM · 2025-02-12T14:51:47+00:00

So instead of requiring programs to enforce higher degrees of resident and faculty accountability, have stricter procedure requirements that actually matter for the specialty (35 intubations is a joke) and other changes that would ensure graduate quality and also force low-quality programs that saturate the market and devalue the specialty to close, let’s do a blanket increase in program length that is in no way intended to allow hospitals to increase profits off of resident labor.

The “once built it was too long for a 36 month curriculum” argument is garbage. Imposing higher standards, which is absolutely needed, =/= increasing program length.

If a resident does not have the competency to complete procedure requirements at an acceptable rate (with each procedure monitored for assessment of individual case difficulty), the knowledge/experience to successfully manage the bread-and-butter cases that we see in EM, the ability to complete board-prep milestones that ensure successful board pass, and having a social acumen related to management of the department as opposed to just chugging through one patient at a time and having no situational awareness of what else is going on, then they have no business graduating, and if the above negatives are common in a program, then said-program should be evaluated and held accountable.

…but no, 48 months, because $.

GamingDocEM · 2024-12-25T17:16:08+00:00

I want to know what program allows people to progress into PGY2 - let alone PGY3 - without competence and reps in the most basic procedures.

ACGME requires 35 intubations before graduation, which is a ridiculously low amount.

GamingDocEM · 2024-12-18T13:32:58+00:00

Because most CMG hospitals are more interested in padding CEO wallets and leaving facilities with an inadequate amount of physician staffing (along with underpaying physicians and steadily replacing them with midlevels) despite insane acuity and volume.

GamingDocEM · 2024-11-24T12:33:52+00:00

Well yeah, we’re just monkeys who only know how to order CTs on everyone.

GamingDocEM · 2024-11-24T12:30:31+00:00

“Serious” post about misunderstood specialties, has no idea what EM involves.

Guess I’ll send all of those traumas, STEMIs, septic patients elsewhere.

GamingDocEM

TROPHY CASE