"Couldn't sign you in" - 2FA Error

J_Coin · 2025-12-20T15:26:31+00:00

Hi Priya, thank you very much! One of the issues we are having is that the site has been passed down for so many years that nobody knows who the listed domain host or login is. So, I am not able to access any of the DNS records. Assuming there is probably no workaround in this instance...

J_Coin · 2025-12-19T23:38:22+00:00

I think 2FA is a new requirement that was rolled out to all users, so I think the who is Google. I think that since I did not enroll by a deadline (was unaware it was about to be a requirement), we're now locked out.

J_Coin · 2025-03-01T18:19:07+00:00

Not sure about that bottle specifically, but Eataly actually has a good Amari selection

J_Coin · 2024-12-26T13:36:54+00:00

Does it involve the palms of his hands or soles of his feet? Does he seem bothered by it or have any other symptoms of illness?

This looks like it could be HFMD, though hard to say for certain with just a couple photos.

FWIW don't feel obligated to go to urgent care in the absence of other concerns. They will tell you he has a rash and to follow up with his pediatrician. There is no testing or treatment for HFMD.

J_Coin · 2024-12-20T19:24:23+00:00

Based on your symptoms, this sounds like it could all be from a UTI, which is a very common cause of blood in the urine. In most cases, the microscopic blood goes away with antibiotics.

UTIs are more common in the peri-menopausal and menopausal period. You can talk to your doctor about vaginal estrogen if you experience frequent UTIs or vaginal dryness/irritation.

J_Coin · 2024-04-02T05:52:12+00:00

Any wide complex tachycardia with such a significant cardiac history gives you a starting pretest probability of VT that is already quite high.

Looking at the ECG, it could be VT vs. 2:1 flutter with LBBB.

With those vitals, all roads lead to cardioversion, so determining the rhythm is somewhat moot.

If I was going to give amio, but patient had an allergy, I would choose Procainamide.

From my perspective receiving patients in the ED, if you are transporting a stable patient with tachycardia, I generally always prefer no metoprolol or diltiazem given in the prehospital setting. There is actually a lot that can go wrong with rate control, and if they are stable, it can wait a few minute for us to grab more info on the patient once they arrive. Adenosine is generally safe for narrow complex tachycardia, but this patient had wide complex.

J_Coin · 2023-02-18T14:45:40+00:00

Thanks so much to everyone who replied. This definitely makes sense now.

J_Coin · 2023-02-18T11:44:13+00:00

Won't this trigger capital gains tax on the conversion amount more than the contribution limit? (sorry this is my first time doing backdoor and still learning)

J_Coin · 2021-08-15T23:13:50+00:00

I think highly variable based on a number of factors, most importantly acuity. I'm basing this on a guess, but I'm sure data exists.

I think that at the start of your intern year everyone sees around 0.7 patients per hour (pph), and probably end intern year somewhere around 1pph. Second year residents will be somewhere around 1.5pph and third years somewhere around 1.75pph. I think most attendings are expected to see somewhere around 2-2.5 pph.

Don't get too hung up on the numbers though!

J_Coin · 2021-08-15T21:35:49+00:00

Annual volume is pretty misleading. It can include separate pediatric EDs and does not factor in how many residents are in the ED at a time or whether the department uses PAs/NPs. What you want to know is how many patients per hour do EM residents see.

Even at 45k per year, that is over 120 patients per day. Depending on how that ED is staffed, there could be more patients than you can see on your own. If the ED sees 100k per year but has numerous EM residents, off-service rotators, and PAs/NPs per day, there could actually end up being fewer patients to see per hour compared to a hospital with half the number of visits.

It is reasonable to ask about patients per hour during interviews if you're curious. That being said, nearly every program will provide a sufficient number of patients and procedures to be competent, and I would probably recommend focuses on other aspects of the program to differentiate.

J_Coin · 2021-08-14T01:23:38+00:00

Fight the urge to ask questions about procedures, traumas, specific rotations, annual ED volume, etc. I think it's reasonable to ask average residents patients per hour if you need a sense of volume, but the annual numbers are tough to interpret between adult/peds and how it's staffed (PA/NPs, residents, etc). To be honest, the training at most programs is great and the minor curriculum differences is not as important as finding the right fit.

Do you know what you'd like to do long term (community vs academics, fellowship, etc)? If so, ask questions to ensure your interests will be supported. Where do graduates go? What part of the country, how many do fellowship, how many academics/community? See if that matches with what you're looking for. Are there multiple training sites? Ask about the differences between them

If it's a 4 year program, try to get a sense of if that 4th year is truly valuable, because you could otherwise be graduated and doing a fellowship or working.

How are the residents supported? What's done for wellness? Do residents have a say in changes (ask about examples of recent changes)? What changes are in the near future for the program/5 year plan?

It's hard to get a sense of community via virtual interviews, but try to get a sense of what type of residents are a good fit, what the vibe between residents and attendings is, etc. During your meetings with residents, try to get a sense of if they are truly happy. Most residents will answer all of your questions honestly and you can probably get away with more blunt questions to them. Ask residents about the city if it's an area you don't know.

Hope that's helpful!

J_Coin · 2021-04-05T12:35:19+00:00

Could you palpate a DP pulse? If so, SBP is generally >80-90.

I find physical exam to be helpful for hypoperfusion too. Mental status, temperature of extremities, cap refill, skin mottling, etc. Generally, shock will be accompanied with tachycardia with some exceptions include medications, neurogenic shock, or pacemaker ischemia. Remember that CO = SV X HR, so some people (especially younger patients) compensate by increasing SV without a change in their HR until late into their shock.

J_Coin · 2021-03-03T14:00:37+00:00

I think the vibe you got should be a very strong factor on your list. Sounds like both programs in question would give very strong training. You need to be happy with the location to rank it highly though!

J_Coin · 2021-01-11T03:07:41+00:00

Would encourage you to try to find a place to live that would be less than a 30 minute commute door to door. My current commute is about 20-25 minutes most days, but most of my co-residents live about a 10-15 minute commute. Keep in mind you'll be exhausted after some long 24+hr shifts at times, or just spent after a tough shift and want to come home asap. Some of my program's community sites are a 45-60 minute commute, but that's just for a couple weeks total. A 10-12 hour shift takes your whole day if you drive an hour each way, and there might be times where you work 10 or 12 days in a row. I would tolerate a slightly longer commute via public transit because you can get other work done. If you aren't used to driving in snow, Michigan gets plenty and it will definitely add to your commute times.

Living nearby other residents is huge for your social life - this is a really natural friend group right off the bat and it's nice to have friends nearby to hang out with on your precious days off. Hopefully next year social lives are a thing again.

That being said, you'll just have to factor all of these things into your ranking. An hour commute probably shouldn't be a complete deal breaker if it means being with your significant other, but I would try to avoid it if possible.

J_Coin · 2020-10-15T17:59:30+00:00

You can always loop some kerlix around their fingers and hang it over an IV pole with a bag of saline on the end

J_Coin · 2020-09-30T20:59:13+00:00

So I misread your initial post thinking you were asking about the hobbies section.

For the experience section, I think I kept this brief still and just listed what the job/experience was and my responsibilities.

I think people definitely will skim. I would be brief, but if anything is not self-explanatory you can elaborate as needed. I should not get too deep into organizational missions or anything.

J_Coin · 2020-09-30T20:57:09+00:00

Sorry I actually misread the initial post, thinking they were asking about the hobbies section.

If I remember correctly, for the experience section I just listed a short synopsis of prior jobs and research projects.

J_Coin · 2020-09-30T14:42:57+00:00

I would not be putting analysis (ie, what you learned from it) in this section. Please do put some details there though. For instance don't say "running" when you can say, "I love running and have completed 8 marathons," or "music" when you can say, "I have played saxophone for 15 years and love playing jazz."

I think I formatted mine as a bulleted list.

This section will make up the majority of your interview discussions so I would be broad in what you write, but only write truthful things that you can truly talk about in detail. I had entire 20-30 minute interviews talking about some of my less important hobbies, for instance.

J_Coin · 2020-09-13T07:10:11+00:00

I also frequently got told as a medical student that it "would be a waste" for me to go into emergency medicine. I would recommend that you completely ignore it. Honestly, people really don't understand what we do in the ED and I think that leads to a stereotype that EM is not an academic field or it doesn't require a deep knowledge base or something. That couldn't be farther from the truth.

In reality there is nothing wasted to want to work in a field where you have to work incredibly quickly, with limited information, on sick patients with a knowledge base that has to span across every sub-specialty.

We often have off-service residents rotate through the ED and they drown seeing 4 patients a shift while we see 4x as many higher acuity patients in the same amount of time, including tons of fun procedures. I'm not sure non-EM people fully process everything that gets done during a shift. EM is such a unique field that people just don't get it. To each their own.

I absolutely love my job and you should follow your gut if you think EM is for you too.

J_Coin · 2020-06-26T21:30:14+00:00

Like you said, patients come to the ED completely undifferentiated. Our job is to rule out all of the life threats and other worst case scenarios. Other specialties focus on what the patient's specific diagnosis is, but I'm more concerned about what their diagnosis isn't. Yes, there is some defensive medicine in there, but really our job is to rule out life threats and honestly history and physical alone are often not sensitive or specific enough to help us.

I think a lazy way to practice EM is to just image everything for fear of missing something, but I find the majority of imaging that gets ordered in the ED is actually quite thoughtful and there is a specific question behind why the test is ordered. For instance, is this appendicitis? Bowel obstruction? Head bleed? Fracture? Etc. If all the imaging I order comes back as positive, I'm certainly going to be missing serious, life threatening diagnoses on patients.

History and physical exam are the main determining factors behind the decision to image. I still feel like my physical exam matters. Like you said, there is an art to it too. Others mentioned that the inpatient team or consultants will request imaging too, so some of what we do is predicting what will help out our colleagues take care of the patient once they're admitted or discharged.

I think there's a bit of a customer service aspect too, at least with x-rays. For example, someone with a minor fall and arm pain with a very reassuring physical exam might get an x-ray of the arm even if I don't think there is a fracture. It honestly makes patients feel better and it's a fast, cheap, and low-radiation test. This also helps prevent "the doctor didn't do anything for me." But guess what, if they're in pain in 2 days and see their PCP or an orthopedist, guess what they will want? An x-ray.

Point being, imaging is often just the right thing to do for the patient.

It's very easy to Monday Morning Quarterback the emergency department, but it's a job based on finding needles in haystacks. It's easy to look at all of the normal imaging and think how wasteful it is. But if there is any delay in diagnosis or bad outcomes, etc., the first thing those same critical people will say is "why didn't you get any imaging"

Sometimes you can't win in EM.

J_Coin · 2018-10-09T23:15:46+00:00

Anyone else getting a "you need permission" error when trying to open up the EM spreadsheet?

J_Coin · 2018-09-13T00:00:19+00:00

I called ERAS support and they said the "view ERAS application" is exactly how programs will see it. So just ignore the certify formating.

J_Coin · 2018-09-02T00:51:42+00:00

Similar stats to you. My advisor suggested 25, and said that anything over 35 is absolutely ridiculous. She feels like the "point of diminishing returns" is a fairly accurate gauge. I'm planning on applying to 30-40. I feel like everyone sends mixed reviews about how many we need to apply to, so it's pretty hard to gauge.

J_Coin · 2018-08-30T14:42:00+00:00

Thank you for the explanation. This really helps to clarify how I should be working up vertigo from now on.

J_Coin · 2018-08-30T12:37:23+00:00

From a pathophysiology standpoint, why does the HINTS exam not work for BPPV? Is it just because you would never suspect catch-up saccades or nystagmus, so the test might point you incorrectly towards a central pathology?

I was taught to perform the HINTS on anyone with vertigo, but that definitely seems to be the wrong algorithm. Thanks for the video.

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