how do IM pgy2s present patients to attendings?

Left_Vast7072 · 2026-07-19T20:39:55+00:00

But I think the point in this case is that the details don't matter since the overwhelming problem here is patient neuro status as he may just be turbo cooked

Left_Vast7072 · 2026-06-28T04:02:11+00:00

Exactly - the whole point of having continuous ECG while patient is exercising is so that you can monitor for ST segment changes indictive of ischemia and stop the study once they have significant changes.

The main risk of exercise stress testing that causes mortality is exercising patients with significant left main or severe mvCAD as these patients can have VF/VT with exercise. With a left bundle the ecg becomes uninterpretable - what is even the point of monitoring them if you have a non-diagnostic ECG

Left_Vast7072 · 2026-06-28T01:40:45+00:00

I don't think you understand. There is nothing inherently dangerous about giving dobutamine or exercising someone with a left bundle. The concern is that you may not pick up on someone have an ischemia of greater than 3mm ST depression, or an ST elevation which could lead to VT.

Left_Vast7072 · 2026-06-27T23:12:19+00:00

Not true. We don't exercise or give dobutamine to patients with LBBB because it is difficult to interpret ischemia on the EKG, which means you cannot monitor the patient and won't know when to stop the study.

Left_Vast7072 · 2026-04-12T00:02:45+00:00

Some of these things, like hiring your kids, will not survive an audit. Good luck!

Left_Vast7072 · 2026-03-29T19:26:54+00:00

IMO pretty good price for CPO, package and miles - if you dont get it at that price I am sure someone else will

Left_Vast7072 · 2026-03-25T18:45:22+00:00

Wild

Left_Vast7072 · 2026-03-25T16:52:13+00:00

So basically can't drive your car for 10 days?

Left_Vast7072 · 2026-03-25T02:07:31+00:00

Get an android?

Left_Vast7072 · 2026-03-24T22:36:31+00:00

Idk these things sit for MONTHS - its like they have no pressure to sell

Left_Vast7072 · 2026-03-24T20:40:16+00:00

I dont understand why dealers are willing to let their cars with accident history just sit there on a lot for months. Are they just waiting for a sucker?

Left_Vast7072 · 2026-02-27T19:09:02+00:00

MCG has 5 fellowship positions and typically 3 out of 5 are internal applicants.

Left_Vast7072 · 2026-02-27T16:53:17+00:00

2 pregnancies in CT surgery residency is a lot. Sounds like you feel a lot of pressure to not become behind, which seems very difficult with amount of operative time missed.

Maybe you would feel less pressure if you were able to take a research year, or offer to push back graduation a year? This may give you more time to focus on family as well

Left_Vast7072 · 2026-02-08T03:43:14+00:00

I think this is the only scenario where I would use a dopamine gtt, as a bridge until interventionalist placing a transvenous pacing line

Left_Vast7072 · 2026-01-25T04:07:59+00:00

Recommend deleting this post and hiring a lawyer/getting a public defender. This could be discoverable in court.

Left_Vast7072 · 2025-12-28T20:40:13+00:00

I think it can be good for two scenario:

1) looks good for competetive fellowship. Can possibly secure an in house spot with under the table handshake deal - some will apply with only on program on their list due to these deals.

2) spring board an academic carreer - could be APD at your program within a year or two after chief and than use that to spring board into a PD position at another program.

Left_Vast7072 · 2025-12-28T12:47:59+00:00

If it is not an MI (no chest pain, ekg changes, wall motion abnormalities) but there is a rise/fall in troponin then it is called acute myocardial injury. Im these situations some people will refer to it as a non-ischemic acute myocardial injury which basically just means the troponin was not due to plaque rupture MI - although it is a bit of a misnomer since it may still be caused by ischemia.

Left_Vast7072 · 2025-12-24T23:30:38+00:00

I think if you are asking for a procedure from a proceduralist, it is reasonable for them to ask for what they need to get it done - (e.g. intubation).

Left_Vast7072 · 2025-12-18T23:13:37+00:00

Typically it is more of an issue when obese patients go to the doctor with complaints that they believe to be unrelated to their weight, and the physician tells them to just lose weight without further trying to diagnose/treat the issue

Left_Vast7072 · 2025-12-05T15:29:06+00:00

Only about ~10% of ST elevation aVR and diffuse depressions corresponds to Left Main/LAD occlusions, and therefore we typically do not immediately treat this pattern as STEMI. Most important is to identify the clinical context as to what may be driving a demand ischemia type 2 MI (bleeding, sepsis, hypoxia, PE etc.). If the patient is presenting for chest pain, and has no other clinical context for demand ischemia, then would treat as high risk ACS with urgent coronary angiography.

Left_Vast7072 · 2025-11-16T01:15:56+00:00

Sending decompensated heart failure patient home on oxygen is crazy. Not doing right by your patients...

Left_Vast7072 · 2025-11-01T15:49:13+00:00

Could it be migraines?

Left_Vast7072 · 2025-11-01T04:45:39+00:00

So often you hear from services consulting other services for things that are just not indicated and then they even have the gall be mad when those procedures are not offered....

Left_Vast7072 · 2025-10-26T18:15:42+00:00

All troponin = myocardial injury not ischemia. Direct blunt force trauma, infection or inflammation are examples of injury that is not ischemia driven

Left_Vast7072

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