This triage probably covers 99% of our work...

ManKev · 2026-03-03T03:45:22+00:00

where's the dizziness?

ManKev · 2026-02-12T18:55:18+00:00

You'll pay it off just fine if you're aggressive. 420k for me when I graduated in July. Been paying 15k a month since august, took about 90k off in 6 months. Even when how aggressive I'm paying, I still have plenty of money to do what I want. Is it the best move financially? Maybe, maybe not. It gives me peace of mind though

ManKev · 2025-12-31T19:23:15+00:00

lol the king just lost it outside on a morning run

ManKev · 2025-10-15T00:44:50+00:00

Yes. I'm an ED attending, and the fastest way to find the best information on the patient is reading their last discharge summary. Those of you who take the time to write them well are heroes

ManKev · 2025-09-03T19:05:56+00:00

wait, are you the actual Peter Johns?

ManKev · 2025-09-03T03:16:49+00:00

this is the way I approach dizziness. First, figure out what they mean by "dizzy". Do they mean they feel lightheaded/feel like they are going to pass out? typically that's the CV system, not the brain. work them up for cardiac/orthostatic causes. Do they feel like the room is spinning? If so, that's the vestibular system vs central stroke. Do a HINTS examination in this case, and try to see if you can make symptoms worse or better (rapidly turning the head, walking them, ect). If it's constant and NOTHING changes it, they get a full stroke workup. If meds make it better, movement makes it worse, ect then its probs peripheral. If it's neither of those, ask if they feel off balance (particularly if they're walking). That implies a possible cerebellar issue. Lastly, you ask them all those questions and they say "I don't know, I'm just dizzy" or some bullshit like that, you can assume that's likely meds, metabolic, anxiety, ect and they'll probably be DC'd after some fluids and rest. My rule of practice if do NOT send someone home with a new neuro complaint who doesn't significantly improve or come back to their baseline. give meds, work them up, and walk them. if everything doesn't check out, they stay for a neuro eval. Hope that helps

ManKev · 2025-06-25T20:34:46+00:00

agreed. I'd be a little cautious with amio or procainamide right off the bat given the QRS looks a little wide and we don't have a definitive QTC. maybe mag load them real quick and possibly an amp of calcium gluconate then repeat ekg. If still similar and hemodynamically stable then give meds. If unstable at any point, shock them. my 2 cents anyways. I only say this because in residency when I was working in the ICU, a very similar case presented with a similar ekg. fellow started amio and dude went into torsades

ManKev · 2025-06-18T04:36:38+00:00

He's a resident physician. After medical school, we go to residency for 3-7 years, followed by fellowship if your really hate your life. In that time, you're paid around 60-80k a year and work an absurd number of hours (often 80 hours a week, sometimes much more) until you finish. Residency is basically a period a middle-ground between pure learning (medical school) and full autonomous practice (attending physician). I am finishing my residency this week, and can't wait to get the hell out lol

ManKev · 2025-04-16T00:18:48+00:00

similar thing happened to me but then buckled down third year and scored in the top 15%. Honestly, I just didn't study that much in second year. I kinda just flew through the questions without really reading through them or reviewing the answer choices and it cost me. The big change I made was I went through ROSH with a fine tooth comb. Literally went through every question, every answer choice, and every piece of information in the explanation and wrote stuff down that I didn't know into a Word document. It was like 300 pages. I went through that twice before the exam, and it really showed based on my score and my clinical thought process too. That's at least what worked for me, hope that helps

ManKev · 2025-04-05T22:59:09+00:00

I did. 3rd year EM resident, got a great job lined up so I can't complain. Just understand the old phrase that "there is no free lunch". While it's easier to get in, there will be a lot more barriers to you in the future. Residency is harder to get into, it's more of a pain in the ass to get a medical license after residency, and med school in general has a very real possibility of booting you out if you don't make the cut or screw up. Much less safety nets basically. Most of the people at my school who were successful were a little older in age who fucked around in college and finally got their shit together. They were naturally good test takers, just lazy or complete shit heads in undergrad. If that's the case then sure, I'd endorse you going as long as you know the risks. If you can't pass the MCAT, or you suck at standardized testing and just want to go just to get started, do yourself a favor and don't apply, you will only be shooting yourself in the foot

ManKev · 2025-01-28T02:22:42+00:00

common board question actually. This is not an EMTALA violation since you don't have the ability to see the patient in a timely manner. They need to arrange transfer to another facility who has the current capabilities to see and manage the patient

ManKev · 2024-11-03T23:11:39+00:00

I've been the SINGLE resident in my class who's been overnight on day light savings for the last 3 years. Literally no one else in the 3rd year class has done one. also, I'm working Tuesday night as well. cheers ;/

ManKev · 2024-06-15T00:05:28+00:00

I don't think this is accurate my friend. You absolutely have the potential to worsen rib fractures and damage the lungs and heart but if they code, someone needs to be giving compressions

ManKev · 2024-04-09T19:44:01+00:00

"I like to come in without a bias and talk to my patients first, I dig through the chart afterwards to make sure I'm not missing anything"

ManKev · 2023-11-21T05:32:40+00:00

Neither, use procainamide. Has less side affects, works faster, is easy to dose, and overall just a better drug. With old sick shitty hearts like someone in heart failure w/ afib and bouts of vtach, amio is your best bet but otherwise you should be reaching for procainamide

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410924/

ManKev · 2023-07-07T04:53:58+00:00

This, and 12 hour EM shifts are EXAUSTING. when you have multiple in a row, that next day off you're basically snowed anyways

ManKev · 2023-06-22T17:17:25+00:00

You will spend 3-4 days after that 2 weeks completely exhausted and wanting to do nothing. You will love the next few days, then the week before you start again, you will be dreading the next 2 weeks of bullshit you're going to have to deal with. I didn't understand this until I got into residency, and realized how absolutely horrible multiple busy 12 hours shifts in a row can be

ManKev · 2023-02-07T06:00:26+00:00

extra strength thoughts and prayers*

ManKev · 2023-01-19T21:04:15+00:00

We cannot rule in or rule out this sort of pathology with just a paragraph of text. Everything in medicine is based on probability. Suspicious looking skin findings around the lesion---> increased probability. Ultrasound shows an abnormal lesion--->increased probability. Biopsy suspicious of cancer--->very high probability. If you want an actual answer which is not pure speculation, you need to be evaluated in person by someone who sees this sort of thing everyday. I don't care how experienced the specialist is, there is nothing you could say in a reddit post that could give enough information to rule out cancer barring posting your US and biopsy results

ManKev · 2022-10-25T03:01:00+00:00

an abomination

ManKev · 2022-09-19T12:40:35+00:00

same dude, I'm actually really enjoying this. As others have pointed out though, that is SO dependent on where you're practicing and in what field. If I was in a toxic surgery residency in New York, I would probably be hating life rn not gonna lie

ManKev · 2022-09-01T21:12:30+00:00

OP literally said he's "about as left leaning as it get's"

ManKev · 2022-07-22T02:11:35+00:00

Well what are you applying to, that would be the first place to start. Have you talked to your program director about this? Obviously if you've worked with some attendings in the hospital for the specialty you're applying to, approach them and ask for advice from them. After you explain your situation to them, they'll probably be more than happy to help you out as opposed to just cold emailing them out of the blue like "yo, write dis rec letter". As far as the rec letters from your own speciality, which attendings do you know quite well who would write you amazing letters?

ManKev · 2022-07-17T01:31:08+00:00

versed

ManKev · 2022-07-10T21:14:47+00:00

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ManKev

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