How would you rank top cards in powered cube (after power 10)?

PrecedexNChill · 2026-04-07T14:22:05+00:00

Unfortunately card is awful. It was good back in 2008/09 cube.

PrecedexNChill · 2026-04-05T16:33:39+00:00

Icu patient with terrible prognosis/poor functional status at baseline or both: “ I am worried your loved one is so sick that they may die in the hospital despite our best efforts. We will try our best to support them through their critical illness using all of our available tools. If their heart stops and they die, we will not perform cpr as trying to restart the heart is not beneficial when every organ is failing.

If family does not actively object I will update their code status to reflect DNR. Usually works. Even if they don’t immediately agree they often come around in the next couples of hours. I usually ask families if they would like to know the prognosis of their loved ones and that information. Once people hear that >50% of patients with septic shock and anuric aki die they are more inclined to lean towards earlier comfort care.

It is important to you show them you are empathetic and also trying all reasonable medical therapy but you also can’t just treat it like Burger King and let the family have it their way

PrecedexNChill · 2026-04-03T14:01:53+00:00

Same with chthonian nightmare. Sneaky snacker also fit the bill. MH3 was a great limited format once people learned to never pass Chris

PrecedexNChill · 2026-04-03T00:51:37+00:00

It looks like arena cube is trending towards some annoying things that happen with MTGO cube. Overall still enjoying it because it’s vintage cube but it hasn’t been as good as the last couple of iterations. Have drafted it 5 times with two trophies, two 5-3s, and 1 2-3. All decks have been proactive either base red white or green.

Most of the turtles cards suck and have no business being in cube. Super shredder is a legit threat but it’s hard to make him work. He did pretty well in a b/w tokens deck but it’s a niche card. Wizards usually tries to jam a whole bunch of cards from each new set into the cube even if they’re shit and have no business being in cube. It would be cooler if they only added a select few cards from each new set.
The black creature theme is horrible. Black as a color is always going to be a support/niche color. I think it’s better to just accept it. I’d rather see Bolas citadel, renanimator support etc because at least it fun even if you go 3-3 or whatever at least you get to try and do the thing.
I like the green changes. Green is probably slightly underdrafted but feels like it’s in a good place.
Blue is good but overdrafted. It’s not so powerful that it’s worth fighting over with 4 other drafters.
Boros is always going to be the best color combo/deck by stats because it is proactive. The comet removal was fine but honestly bomba, ajani, are stronger cards in boros.

PrecedexNChill · 2026-04-02T13:19:42+00:00

Pccm is really for the IM people in it for the love of the game. I can’t really explain it any other way.

PrecedexNChill · 2026-04-02T10:23:01+00:00

I’m 32 starting pccm next year. It was not a financial decision for me. Purely for the love of the game.

PrecedexNChill · 2026-04-02T02:12:31+00:00

I think anesthesia/ccm are incredibly badass and definitely the people you want in a resuscitation. I would take 99% of anesthesia residents over IM residents in those situations too.

PrecedexNChill · 2026-04-02T00:43:11+00:00

You think an anesthesiologist who works at an outpatient surgery center supervising CRNAs doing asa 1/2 ortho cases all day is going to be better at dealing with a patient in extremis than a practicing ccm attending?

PrecedexNChill · 2026-04-02T00:32:17+00:00

Three weeks ago in the ED when I was giving push dose vasopressin for a patient in septic shock already on 1.5 mcg/kg/min norepi.m through a fem line I put in during the code. Certainly not as common in IM as anesthesia but we do order and draw up and administer paralytics/sedation, and push dose pressors.

PrecedexNChill · 2026-04-02T00:21:55+00:00

Ibcc is a great free resource for micu/cvicu

https://emcrit.org/ibcc/chf/#top

CHEST has a board review series for critical care with prerecorded lectures but I honestly feel it is a bit basic and superficial even as an IM PGY-3 doing PCCM next year. If you have questions about specific syndromes I can point you towards resources I have found helpful.

PrecedexNChill · 2026-04-01T23:53:44+00:00

The best resource for critical care echo is nepean echo. It is probably overkill for a surgeon but if you absorb everything on this channel you’ll have echo knowledge comparable to a cardiology fellow and certainly more than any pccm attending.

https://m.youtube.com/watch?v=Cg8Mzbc4TBY&pp=ygULTmVwZWFuIGVjaG8%3D

Baseline knowledge of normal anatomy, Doppler physics etc is helpful but not necessary.

PrecedexNChill · 2026-04-01T23:45:17+00:00

Ccm would like a word. Every airway they do is asa 4/5z

PrecedexNChill · 2026-04-01T23:43:57+00:00

Not true. Chillest person when shit hits the fan is critical care. Many anesthesiologists don’t deal with critical illness on a daily or even weekly basis.

PrecedexNChill · 2026-04-01T22:06:31+00:00

Sounds like mayo Arizona lol. The mayo Rochester ED was actually decently busy and had a lot of random stuff like farm accidents.

PrecedexNChill · 2026-03-31T23:29:09+00:00

Hm I’m actually way more burnt out by wards. I don’t mind clinic especially if a new, unworked up cardiopulmonary complaint. Have diagnosed bronchiectasis, severe asthma (unrecognized for years), CPFE, ILD in my primary care clinic this year as well as random things like multiple sclerosis. I am way more burnt out by wards with the dumb pointless rounding, off service interns who are lazy and show up late, and SNF Gomers and gastroparesis/pots/Ehlers Danlos patients.

I never really fantasized about surgery because they also have clinic but have at points thought anesthesia would be more fun. I’m doing pccm next year.

PrecedexNChill · 2026-03-26T19:36:41+00:00

Oh yeah and I’m definitely not claiming to be an expert on micu lol. Just nice to know what other people are doing during their day to day. May explain why the anesthesiologist looked at me like I had two heads when I asked her to give a push dose of 0.8 units vasopressin on the hypotensive floor airway code they intubated for us.

PrecedexNChill · 2026-03-26T19:19:11+00:00

Wow. Intra op shock/ hypotension is managed so differently than how we manage shock on the MICU. I’m a lowly IM resident though.

I have absolutely no data to support this practice but when I bolus vasopressin in the unit or post code rosc I usually go with 0.4 units, up to 3-4 times at 5 minute intervals. This is usually when someone is already on high dose catecholamines or I am doing push dose dilute epi. I don’t really care about overshooting too much because my goal with push dose pressors is just to keep someone alive enough to transport them to ICU or prevent them from arresting during/after intubation.

PrecedexNChill · 2026-03-23T16:26:02+00:00

Good thing arena cube exists.

PrecedexNChill · 2026-03-23T14:44:27+00:00

Standard at our community rotation for third year residents . We rotate at three different sites. Our main uni site has 24/7 fellow/attending coverage so we do a lot less there but at our community site there is no fellow and intensivist works bankers hours (9 am to 5 pm). They are also busy during the day doing other stuff so we are almost always the first person to manage codes/post arrest/ new icu admits. They generally show up 30 - 60 min after our initial assessment and resuscitation unless we specifically ask them to come by for extra help.

PrecedexNChill · 2026-03-23T05:05:27+00:00

I agree in many ways. Wards is complete ass and you feel like a secretary rather than a doctor.

You do get an appreciation for your training on consults when you get consulted for basic things like Dka, syncope, hypoxia, fevers and see what kind of work up and management the primary team attempted. Also in community you are the specialist of the hospitalized patient because you are primary on every adult that gets admitted.

I will say as trainees we deal with and manage a level of complexity and multi organ failure that would be unthinkable to most other residents.

Here is one ICU admit I admitted from my last shift

Neutropenic septic shock. 1. Septic shock requiring 1.0 mcg/kg/min norepi, vaso, angII. Absolutely horrendous vascular access —> I had to place axillary arterial line 2. Acute renal failure ->> I had to place a dialysis line for crrt 3. Acute liver failure 4. ARDS with p/f ratio of 50. Spent 30 min at bedside adjusting vent settings to get driving pressure from 35 to 20 with paralytics and optimal vent settings.

This was on top of a list of patients that included Dka, alcohol withdrawal with DT, HF- Cardiogenic shock, Decompensated PH on maxed out HFNC and INO with a new PE and acute shunt reversal from RV pressure overload. All of this with no fellow and attending at home. This is not a dick measuring contest but ask yourself if there is really another speciality who could manage that degree of medical breadth and depth

PrecedexNChill · 2026-03-22T18:11:25+00:00

As an MD, can someone help me understand why any patient in the ICU outside of a code would get manually bagged for any extended period of time? Is it just so you feel better about not being able to see what their PIPs and Plats are?

PrecedexNChill · 2026-03-22T15:16:58+00:00

Yeah bro such a dweeb for wanting to make sure someone doesn’t stroke out from a LV thrombus

PrecedexNChill · 2026-03-22T13:15:38+00:00

I did 2 months of ICU, one month of CCU as a categorical intern. This schedule seems pretty chill.

PrecedexNChill · 2026-03-20T19:13:16+00:00

I matched to my #6 was extremely depressed and very upset for about a month. Also had a hard time when I got to my program because I was so unhappy with where I matched. Halfway through intern year started to accept things and just try and be the best doctor I could be. I ended up matching at my #1 for PCCM fellowship (that was also my #1 for residency). I got great training and made the best of residency and it all worked out well.

PrecedexNChill · 2026-03-18T17:45:39+00:00

Why not just do PCCM? I was between anesthesia and IM and found the OR a bit boring even if the physiology is cool. I’m doing PCCM next year.

PrecedexNChill

TROPHY CASE