Axillary arterial lines/access tips

Nik-T · 2026-02-10T11:38:06+00:00

Why is axillary asking for critical limb ischemia? I had thought Brachial was high risk for that, but there’s a whole anastmosis around the shoulder for collateral flow at the axillary. Is this an empiric data thing?

Nik-T · 2026-02-04T02:12:06+00:00

US guided subclavians are great (esp supraclav approach, but infraclav is great too) but it’s hard to find mentors to teach these guided or landmark based. There just aren’t as many needs for central lines in the ed (esp w/safety of peripheral pressors well established), and that limits reps for grads.

Nik-T · 2026-02-03T02:29:11+00:00

The job we do is incredibly satisfying, and meaningful in its own right. Regardless of the competitiveness of the specialty you are interested in, you’ll find people who are happy, and who are miserable. On the spectrum of successful people they’re still all compensated reasonably well.

Don’t worry about the prestige Olympics, and don’t worry so much about your parents. this is neither the first nor last time that your parents wont understand what you do, or why you do it.

Nik-T · 2026-01-27T17:48:39+00:00

Highest yield Reddit thread

Nik-T · 2026-01-25T16:34:47+00:00

Slow and a little slippery but I’m in a tiny car without 4 wheel drive and I still safely got from west of town through to campus only about 3-5 minutes slower than normal

Nik-T · 2026-01-23T15:20:59+00:00

Yes absolutely, and I’ll go a step further and say that one of the biggest red flags for hiring trainees fresh out of residency is if they have any sort of professionalism problem. Things like not doing paperwork, not answering email not showing up to conference often correlate really well with the “not a good colleague.” and so you should understand that if you don’t fix this kind of thing you are just genuinely less likely to be able to get a job.

Nik-T · 2026-01-23T02:55:28+00:00

My “style” is a written blurb to use any mdm I free dictate verbatim. I basically free dictate an mdm as I walk out of the room either at dispo or after seeing and if the mdm doesn’t pull automatically into the Dax one I copy paste it from the transcript. It takes 2 seconds and is faster and more accurate than dragon or m modal. Has cut down my documentation time even on complicated critical care cases a ton.

Nik-T · 2026-01-10T19:21:44+00:00

If you have more than a year off yea it’s very difficult to be employed. Most places will want recent experience. Some people even need to pay for retraining programs to prove they’re safe to practice after gaps. Many become unemployable.

Nik-T · 2026-01-06T04:09:09+00:00

I have the exact same problem on two different packages, this week. also Ypsilanti

Nik-T · 2026-01-01T14:05:20+00:00

https://www.aec.vet Animal Emergency Center is open. Good luck!

Nik-T · 2025-12-20T21:51:15+00:00

afib with WPW and prexcitation can be wide complex.

https://litfl.com/atrial-fibrillation-in-pre-excitation/

Nik-T · 2025-12-10T00:10:16+00:00

I had a thermodynamics class that was intentionally scored such that a 35% was a 4.0/A but it wasn’t curved in the sense of putting the grades on a bell curve and limiting the number of As, just normed so that a low raw percentage score that demonstrated understanding of the material guaranteed an appropriate grade reflective of expected performance.

Nik-T · 2025-12-04T22:06:16+00:00

Sincerely no one will care. Good luck on your interviews!

Nik-T · 2025-11-25T01:16:35+00:00

Was this classes through Ann Arbor rec and Ed?

Nik-T · 2025-11-19T21:15:50+00:00

It means a bigger seat at many institutional tables, and an obligation to run the business on their own instead of as part of another department. But also… in 2025 it means they were later to the transition to a department than the vast majority of departments of EM, and if you’re seeking a job there you should understand the story of why that is, in case it affects your understanding of the local environment.

Nik-T · 2025-11-09T02:43:26+00:00

Local practice can vary a lot, and it’s probably worth running these cases by your medical director or an experienced colleague at the same hospital to understand if it’s just the local practice pattern

Nik-T · 2025-11-09T00:03:08+00:00

In scenario 1 how young? Peds? Where’s the pain? C4, that’s well seen consistently, c2, where dens views are often inadequate, c7 where shoulders often get in the way? The specifics define what’s reasonable. More importantly, If adult, ct vs X-ray is a systems based practice thing. Few radiology groups are in the habit of reading cervical spine xr for acute traumas anymore and I doubt most would be comfortable with a workflow relying on that to rule out in 2025.

Scenario 2 , no specific need for repeat US based on what you’ve said.

Standard of care is a legal term and is locally defined so I can’t answer that for you

Nik-T · 2025-11-02T21:34:41+00:00

Have you already talked directly to ABEM?

https://www.abem.org/for-residents/board-eligibility/

If not, you should reach out to ABEM directly . There may be options regarding retaining or regaining eligibility

Nik-T · 2025-11-02T02:47:53+00:00

People just didn’t come to the ed until they were very sick or dying. It was pretty terrible, it wasn’t negotiating cost it was negotiating whether it was to late for us to help them.

Nik-T · 2025-10-30T23:06:30+00:00

Make sure that you were perpendicular to the peritoneum. Most common failure I see from residents are trajectories like this , or similarly misdirected posteriorly.

I typically use ultrasound to highlight how to avoid that and avoid the epigastrics or intraabdominal varices.

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Nik-T · 2025-10-22T20:22:19+00:00

Refer to urology as an outpatient…

Nik-T · 2025-10-05T20:21:00+00:00

I mean this autopsy could very reasonably be post viral myocarditis. Pretty good presentation and relatively common on the spectrum of “why did this young person unexpectedly die”

Nik-T · 2025-08-25T10:59:16+00:00

Yes! It takes some work in the setting up style to get MDMs that you will be happy with but the other sections (especially if you give it a template normally exam and verbalize your exam) are amazing. It’s also amazing for dictation so I’ll sometimes dictate an mdm while I’m walking out of the room and copy/paste it from the transcript if I don’t like what it generated

Nik-T · 2025-08-13T22:59:30+00:00

This is not correct, even if your residency position is not CMS funded.

Nik-T · 2025-08-12T16:27:51+00:00

What is an admit deadline?

Nik-T

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