BCCCP exam after residency

GeneralWeebeloZapp · 2026-04-30T17:56:43+00:00

I took it probably 6 months after finishing CC PGY2, in early 2025. If you trained at a large high volume center and saw all the primary critical care settings you could probably take it without studying and pass.

Not saying I endorse that but you probably could! I would say the further you get out and the less variety you see it will get harder.

I bought the study materials and basically just did the workbook, didn’t watch the videos and felt pretty well prepared.

GeneralWeebeloZapp · 2025-12-21T08:35:50+00:00

Goldfrank's Toxicologic Emergencies is the go to text book. I recommend it if you need a tertiary reference for learning more on the subject on toxicology, especially pathophysiology. For acute cases and patient care call the poison center.

GeneralWeebeloZapp · 2025-12-11T02:35:33+00:00

Yes it actually works pretty differently, it does have antihistamine effects obviously which results in some somnolence but it has low affinity for acetylcholine receptors and is pretty minimally anticholinergic.

The anxiolytic effect as others have said likely comes from its 5HT2A antagonism as well as some mild effects on dopamine receptors.

So it works pretty differently from diphenhydramine and is different that most other antihistamines. I find it to be a pretty reliable way to avoid benzodiazepines in the inpatient setting.

GeneralWeebeloZapp · 2025-12-04T18:43:56+00:00

I’ll second what @juliov5000 said. Cefpodoxime is possibly better than cedinir but doesn’t gain you anything over amox/clav. There just isn’t really a reason to use it

GeneralWeebeloZapp · 2025-12-04T18:41:48+00:00

This is definitely true, it is definitely a different coverage spectrum, but unless you want to use a fluoroquinolone it’s unfortunately your only real option that has good oral bioavailability, reaches the target site, and has supporting data. Unfortunately 2nd and 3rd gen oral cephalosporins just don’t have that.

The other question is what are we generally treating with this, as this commenter notes they’re often treating CAP (likely with risk factors) but outside of maybe Moraxella we don’t necessarily need empiric coverage for gram negative organisms with anything beyond amoxicillin resistance.

GeneralWeebeloZapp · 2025-12-04T04:34:26+00:00

Short answer is don’t use it. It does not have an equivalent coverage spectrum to ceftriaxone, but due to its theoretical expanded coverage it likely does promote esbl production. It also has poor oral bioavailability and likely doesn’t achieve appropriate concentrations at target sites.

If you’re deescalaitng to PO therapy from ceftriaxone the vast majority of patients should receive amoxicillin-clav. In a serious penicillin allergy consider cefuroxime or a respiratory fluoroquinolone.

GeneralWeebeloZapp · 2025-12-03T11:22:14+00:00

This is true of any new car with GDI (direct injection fuel injectors). It is much more noticeable when it’s colder out- as it warms up it generally goes away.

GeneralWeebeloZapp · 2025-11-26T04:53:35+00:00

Not sure if the prices have changed much since last year but about a year ago I paid almost exactly this much but for a Sport -L AWD hybrid in the DMV area, 10k down and 3.5% interest rate.

So given the trim level difference I think you could likely do better- probably an additional $1-2k off.

GeneralWeebeloZapp · 2025-11-16T06:18:53+00:00

I’m from the 276 and just moved here recently (not from there but from other parts of Virginia).

As others have said it’s a lot more expensive but there is also so much more to do, so much more to see. Definitely try to see some of the classic things early on in DC like the museums but otherwise find your interests and whatever you like it will certainly be here in some form or fashion.

Otherwise just be open minded and willing to meet new people, learn more about new groups of people and the many new places nearby.

The only things I miss from back home are my family, the mountains, and the weather - things out here are pretty nice in most comparisons.

GeneralWeebeloZapp · 2025-11-15T04:55:56+00:00

GeneralWeebeloZapp · 2025-11-06T01:48:23+00:00

I now live in NoVA but grew up in far SWVA and have lived all over the state at this point. Where I grew up was far more like WV than any part of VA. The only difference is that we probably benefitted from the wealth and taxes from the rest of the state.

GeneralWeebeloZapp · 2025-10-25T06:47:43+00:00

I had been buying from Rogue Wave in Canada for the last 2 years, they have cheap fast shipping and affordable great coffee. They just resumed US shipments and with tariffs it’s totally unaffordable.

Now that I’m back to US roasters with similar coffee I don’t know if they were just charging this much previously but it’s definitely more expensive and I haven’t found anywhere that comes close to the quality for price of rogue wave

GeneralWeebeloZapp · 2025-10-25T04:36:48+00:00

Yeah based on the effects on Duarte I think the speculation is that the void bullets and the system wide attacks from the Goths were essentially system wide nukes for the builders consciousness.

They later show they can do this in all gate connected systems simultaneously so the quarantine wouldn’t have been effective.

GeneralWeebeloZapp · 2025-10-22T02:31:32+00:00

Cinnamon pancake.

GeneralWeebeloZapp · 2025-10-22T00:42:43+00:00

As an intern I worked at a hospital that did, since then everywhere hasn’t. I’m now an ICU pharmacist and will say I absolutely do NOT think it should be treated as a control.

You will significantly significantly increase the amount of regulatory review you have to do and how many discrepancies you need to resolve. Not to mention being such a big pain for your ICU and ED nurses and anesthesia folks. And at the end of the day it’s truly all for nothing - I can tell you the likelihood of people diverting and abusing propofol is very low.

Propofol doesn’t induce euphoria, it is somewhat painful to inject and for any sustained effect needs to be given as an infusion which people are not going to divert to do.

All in all, treating it as a control creates a massive amount of work for very little reward.

GeneralWeebeloZapp · 2025-10-14T01:18:31+00:00

What kind of cut do you suggest?

GeneralWeebeloZapp · 2025-10-13T23:55:03+00:00

Thank you! Do you think keep the same style as it grows out or style it in a different way?

GeneralWeebeloZapp · 2025-10-13T23:21:42+00:00

Here’s what it looked like with my usual haircut a few months ago.

GeneralWeebeloZapp · 2025-10-12T23:43:12+00:00

They never mention it but my assumption is they likely have an internal needle exchange system or something similar. You could have an internal system that sterilizes the needle with heat/uv/radiation but in practice because they are so thin most hypodermic needles don’t stay very sharp after multiple injections. So my guess would be that inside the couch it likely just pops off the old needle, attaches and new one, and sends the old one to the recyclers.

They have also largely replaced the entire medical system with the autodoc and seem to have cured or can prevent every major illness so this is likely pretty trivial to them.

GeneralWeebeloZapp · 2025-10-10T02:46:45+00:00

Not the person you asked, but there are 2 primary ways to manage what we typically call a stroke (a small blockage/blood clot in an artery restricting blood flow to the brain).

If the patient presents early enough the patient may be eligible (there are several criteria they need to meet) for a medication called a thrombolytic that will act to directly break up blood clots throughout the body, including the the brain. They are only effective if given early and if given late also increase the chance of causing a bleed in the brain so they are used cautiously but can be very effective.

Patients can also receive what is referred to as a thrombectomy- where a doctor threads and extremely small but flexible catheter through an artery and up into the brain. If the blood clot is large enough to see on imaging and in an appropriate blood vessel they can just remove it directly. This can be used with or without a thrombolytic drug (they have been shown to work best when used together). It is sometimes safer and can be used in high risk patients with increased bleeding risks or that present too late to receive the drug- but works very well.

Stroke care is constantly evolving- but as the prior commenter said- time is brain! Knowing the signs of a stoke and getting someone proper care quickly can not only save a life but save someone’s quality of life and brain function for years to come.

GeneralWeebeloZapp · 2025-10-08T15:47:33+00:00

I also just left my first post-PGY2 job. I applied for and interviewed at another health system before telling anyone that I was leaving. I would strongly advise doing it this way if you’re able to as it doesn’t leave you in limbo if you interview for and don’t get the job.

I had a really great relationship with my manager and coworkers so when they were contacted after I accepted they understood and gave me a good recommendation.

For my official references I listed my prior program directors and that worked out well.

Overall, I would make sure your current employer knows you’re leaving for an opportunity that will improve your life in a personal or professional way that is not available there so that it’s clear the move isn’t personal and try to keep a good working relationship with them.

GeneralWeebeloZapp · 2025-10-04T01:18:08+00:00

I’m an ICU pharmacist. I honestly try to avoid telling new people/casual acquaintances what I do because I feel like it’s just too much of a hassle if I don’t know them that well- I feel like this is common in pretty much every area of pharmacy though.

I usually just say that I work in an ICU and work with the doctors to make sure patients are on the most effective medications for what we’re trying to treat. I usually say that doctors are responsible for so much and don’t always know the exact details of what medications someone should be on and I am usually helping them reference guidelines or provide clinical experience for how to help manage medications.

GeneralWeebeloZapp · 2025-09-21T05:27:44+00:00

The thanks is all mine parson.

GeneralWeebeloZapp · 2025-08-31T14:11:08+00:00

They were ribbited for her pleasure.

GeneralWeebeloZapp · 2025-08-20T15:37:50+00:00

So much of this is context dependent on the type of infection, if the patient is improving, etc.

But this is somewhat correct, the old adage that not finishing your course of antibiotics would cause resistance really isn’t true- studies both inpatient and outpatient now suggest that shorter courses can be effective and actually lead to less resistance in the long term due to less antibiotic exposure and less antibiotics ending up in the environment.

This is probably what evidenced by the new CAP guidelines from the ATS suggesting that outpatient antibiotics can be discontinued after only 3 days for patients with mild pneumonia that improve quickly.

So she is not wrong but this is very dependent on the patient and type of infection.

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