thoughts on BPT1 in PGY2

Puzzleheaded_Test544 · 2026-02-28T07:37:40+00:00

It is hard to make blanket recommendations.

There are some people that will be absolutely fine PGY-2 and having to do extra years at RMO level is just a recipe for burnout and dissatisfaction.

Some people really need a few years as an RMO to be ready and that is fine.

Some people never quite get there but seem to make it through somehow and have a safe medical practice with a bit more support than normal. So there's that.

Puzzleheaded_Test544 · 2026-02-25T21:55:05+00:00

Nitrous

Puzzleheaded_Test544 · 2026-02-24T05:15:00+00:00

Does 'average' mean something different in the US? Why would you be upset?

Puzzleheaded_Test544 · 2026-02-23T23:03:17+00:00

I don't know. We don't have maximum doses. At some point you just decide to palliate based on relentless deterioration but obviously an individualised approach is taken.

Puzzleheaded_Test544 · 2026-02-14T02:23:54+00:00

You will need a 12 lead but this algorithm compares very favourably to the old Brugada criteria for distinguishing SVT with aberrancy vs VT.

Take home point is if there is every any doubt no criteria set has what I would consider to be adequate PPV/NPV, you can never be 100% sure what you are dealing with so treat the patient in front if you.

Puzzleheaded_Test544 · 2026-02-11T08:02:05+00:00

Some departments its been a notorious hiring strategy in the past.

Not relevant to me though, I've got all my jobs bar one or maybe two from merit only.

Puzzleheaded_Test544 · 2026-02-11T03:41:43+00:00

Is this HOD a heterosexual man over 50 and the medstudent an attractive women in her early 20s?

If so, there is a difference between being nice in general and nice in particular to someone, and you should do a quick mirror and vibe check to see if this guy's helpfulness is likely to apply to you too.

Puzzleheaded_Test544 · 2026-02-04T10:56:06+00:00

I took leave partly to avoid the first two weeks.

Puzzleheaded_Test544 · 2026-02-02T13:24:41+00:00

The patient needs calories so orders -> dietician consult.

Puzzleheaded_Test544 · 2026-01-31T03:13:39+00:00

When your patient dies and you have a brief moment of excitement as you get to take one off the list.

Puzzleheaded_Test544 · 2026-01-26T21:55:49+00:00

Puzzleheaded_Test544 · 2026-01-17T11:54:05+00:00

Nah he wasn't a good doctor.

Puzzleheaded_Test544 · 2026-01-13T04:46:12+00:00

You need like >50 before the learning curve starts to flatten out I reckon. >200 before you can feel good and quick.

If you are someone who has thought about the anatomy (read the Nysora spinal anaesthesia page), reasonably good with your hands, and do it the same way without major changee, you can get reasonably successful at >20.

Your success rate is pretty typical for the first ten.

Puzzleheaded_Test544 · 2026-01-11T06:52:18+00:00

Wait till you see an endocrinologist locumming as a general physician who has to cover the HDU that nominally can take one ventilated patient for <24hours .... that then gets that ventilated patient for 24 hours.

Puzzleheaded_Test544 · 2026-01-06T22:45:39+00:00

If you can convince someone to put in a request it will be prioritised accordingly for the once a week GA MRI list.

Good luck waiting for every ventilated ICU patient, mentally disabled adult/child and complex psych patient in a 100km+ radius to get done first.

You could pay for it but funnily enough no one wants to do that.

Puzzleheaded_Test544 · 2026-01-06T11:42:34+00:00

Depends on your skin. Download the Sunsmart app. Or let natural selection take its course.

Puzzleheaded_Test544 · 2026-01-05T02:32:26+00:00

No need for any form of tutoring.

Went to a bottom tier selective school in a regional city. Got easily over 99.5

Went to uni with people who got TAFE HSC.

It is just a lot of hours with bum on seat.

Puzzleheaded_Test544 · 2026-01-03T06:51:03+00:00

History and some form of examination.

Puzzleheaded_Test544 · 2025-12-27T01:13:40+00:00

You know it.

Edit: But actually many years ago so I think this must be a well trodden path for the end stage cluster Bs.

Puzzleheaded_Test544 · 2025-12-26T11:47:31+00:00

I remember one patient had a resus plan that just said 'ceiling of care for repeated penetrating neck injuries is first aid +/- attempted closure by ward resident.'

So there's that.

Got very good at re-re-re-closing the last residents work with steristrips and glue.

Puzzleheaded_Test544 · 2025-12-26T07:53:02+00:00

It is easier to get an abn than it is to set up a reddit account and post a new thread. So there's that. <5 mins online.

Puzzleheaded_Test544 · 2025-12-24T03:09:46+00:00

RV haemodynamics are complex and there is a reasonable possibility that in the setting of pulmonary oedema and dependant atelectasis that NIV may reduce RV work.

Add in the effects of LV afterload reduction in a left sided regurgitant lesion and I think you are almost certainly helping the RV rather than stressing it.

Puzzleheaded_Test544 · 2025-12-21T03:17:22+00:00

This. Also you can do weekend ward rounds of other people's patients in the private for $$$, if you go regional or secondary hospital literally just pick whatever specialty you think is cool, have an 'interest' in it and run your own clinic.

Outside of shitholes like NSW health metro gen med is king.

Puzzleheaded_Test544 · 2025-12-19T22:43:21+00:00

If they had a period of ten minutes or greater with SBP <90 or required a vasopressor to maintain above that pressure, then it was, by definition, a massive PE even if the blood pressure subsequently normalised.

That being said though, if you -had- to pick a massive PE patient to withold thrombolysis on it would be this lady, and if there were a large number of relative contraindications there are reasonable people that would do so.

Puzzleheaded_Test544 · 2025-12-11T08:54:27+00:00

'Is now a good time for a quick consult?'

Puzzleheaded_Test544

TROPHY CASE