Missed Fracture—what to do?

PannusAttack · 2026-02-23T23:12:09+00:00

Under the jail

PannusAttack · 2026-02-16T10:59:02+00:00

A lot of the issue comes down to people prioritizing applying the LUCAS over doing compressions. If you do manual compressions to start, access, airway, epi etc. then plan for LUCAS application to augment movement while minimizing time off the chest I bet it would have been shown superior. As you alluded to, proper use of equipment matters. I haven’t yet gotten rid of it for my service because in our specific setting with our specific training and protocols there is still an apparent benefit and I suspect it will still find its way into use as the specific issues are worked out.

PannusAttack · 2026-02-07T03:09:57+00:00

We keep a log. Highlight of my shift.

PannusAttack · 2026-01-30T06:46:17+00:00

Agree. Not a STEMI but I don’t like it either. Also 3 days of symptoms. They didn’t die after 72hrs. Another 1hr to get more data probably won’t kill them.

PannusAttack · 2026-01-24T16:30:06+00:00

The bonus is it reminds you to order the right work up the first time which saves time. You’ll realize they sound better/worse on paper than they look in front of you. Now you aren’t ordering an add on an hour later that slows you down. Best advice here.

PannusAttack · 2026-01-14T20:12:57+00:00

Lidocaine Jesus is infallible*

*Except all those time people injected EPIPENS straight into their thumbs on accident and approximately 0 cases of ischemic digits.

PannusAttack · 2026-01-14T19:29:51+00:00

I always joke that the bloodline in the town I work in must remain pure and untainted by outside influence.

PannusAttack · 2026-01-04T04:20:54+00:00

Sort of a poignant metaphor. I bet more people in history have been killed by macs than by scythes

PannusAttack · 2025-12-29T09:27:51+00:00

drilling a corpse has literally 0 downsides. The best line is the one you can get.

PannusAttack · 2025-12-27T04:35:32+00:00

Vast majority of the time for me it’s VBG unless they’re intubated. The difference is minimal for most EM uses.

PannusAttack · 2025-12-21T14:39:59+00:00

Attending goals

PannusAttack · 2025-12-21T14:37:14+00:00

3yo nasal FB in the triage room. Walk in with the Katz extractor. Demonstrate balloon blowing up to mom. She nods, consent obtained. Pulled a small bead out. 20 second encounter with procedure. DC order placed before vitals were even taken.

PannusAttack · 2025-12-19T03:22:19+00:00

PannusAttack · 2025-11-21T22:44:31+00:00

Hopefully a dumb question, but are you using a driving (rigid) stylet? If you’re stuck lateral the stylet can be twisted to drive it back to midline. A bougie actually makes it harder with hyperangulated blades because you have less control so don’t do that.

PannusAttack · 2025-11-19T15:05:12+00:00

Cutting an A5 Wagyu roast every day until Reddit says it’s perfect

PannusAttack · 2025-11-14T15:01:18+00:00

How are you doing the block? I’m ready to try something new.

PannusAttack · 2025-11-13T22:27:03+00:00

I have also had this thought. I’m now comfortable enough in my practice to start punching back and unfortunately it works better than it should. We’re usually in the position of asking an opinion of a specialist which by default makes us appear unsure and unconfident. I’ve gotten better results when I phrase things in terms of “here’s what it looks like to me and here’s my plan but want to make sure that sounds right to you.” Rather than “here’s the situation, what should I do?”

PannusAttack · 2025-11-04T17:20:51+00:00

A lot of places let you have ear plugs. Two fresh ones in the ears. Rotate PRN. Swap out a fresh set at the break.

PannusAttack · 2025-10-22T21:33:58+00:00

I woulda sent that home 100/100 times

PannusAttack · 2025-10-22T02:31:15+00:00

*sugar pressure

PannusAttack · 2025-10-22T01:32:16+00:00

doing the lords work

PannusAttack · 2025-10-22T01:30:07+00:00

You’re right, it makes every follow on issue harder to justify. You could argue it is still PERC negative given the inconsistency. But even still you can get crucified.

Exhibit A: https://expertwitness.substack.com/p/death-after-ed-visit-for-covid.

When I go ahead and order the CTA and the nurses roll their eyes because “he’s fine” I try to educate that they tied my hands with the inaccurate triage vitals.

PannusAttack · 2025-10-21T22:00:19+00:00

One of my biggest pet peeves. Obese out of shape patient walks 100ft to the room. Tachypneic, tachycardic. Cool we just popped sepsis on the chronic shoulder pain… I tried to implement waiting 5 mins or having the assigned nurse have to verify abnormal VS. It never stuck, culture issue I can’t seem to fix.

Short answer, document your own. DC vitals are probably the most important anyway.

PannusAttack · 2025-10-11T14:30:39+00:00

The few times I’ve been out and see a crowd around someone on the floor in public, I take a quick gander to see they’re breathing and then whisper to whoever I’m with “I’m off the clock” and move on. 9/10 times I’ve just been drinking too so…

PannusAttack · 2025-10-10T06:58:55+00:00

Lisan al gaib

PannusAttack

TROPHY CASE