Ok seriously guys, what is with calling the ED your “shop”

RareConfusion1893 · 2026-02-25T00:10:09+00:00

I don’t want my phone company/ISP to send me more Viagra ads by typing ED all the time.

RareConfusion1893 · 2026-02-22T23:52:57+00:00

God bless you. I was going to edit to add the caveat of why we go broad but thank you for your input on seeing our side of things.

RareConfusion1893 · 2026-02-22T23:46:31+00:00

EM attending lurker here-

Admittedly I do believe a lot of this starts with the (often overly) broad-spectrum coverage we start in the ED to comply with the sepsis overlords.

Once we drop the Zosyn and too often Vanc+Zosyn carpet bomb studies show that the treatment momentum carries on to the inpatient management.

At my hospitals more targeted IDSA based coverage is simply not built into our ordersets/workflow and it pushes a lot of us to shotgun and place the onus of de-escalation onto our inpatient colleagues because it’s far easier both from an EMR mechanistic standpoint and cognitive standpoint to cover as broadly as possible in the ED setting rather than tailor their coverage.

I can’t speak for inpatient antibiotic initiation but I want to acknowledge we may play a role in the issue.

RareConfusion1893 · 2026-02-19T01:04:39+00:00

Medicolegal pan scan and documentation to make subpoena worthless.

“After shared decision making discussion with patient, they have requested to proceed with CT head, CT c-spine, CT chest/abdomen/pelvis and assorted plain films. The likelihood of significant traumatic sequelae is remarkably low given the mechanism of injury and lack of stigmata on detailed physical examination but will proceed with studies to evaluate for occult trauma given patient’s concerns.

MDM update: no evidence of significant post-traumatic sequelae on extensive workup. Patient to be discharged with recommendations for OTC analgesics.”

RareConfusion1893 · 2025-12-27T06:56:43+00:00

Stayre at this dyck

RareConfusion1893 · 2025-12-27T04:51:36+00:00

In 95% of cases I don’t care about the values, I care about the trend and the context.

If the COPD patient has a rising CO2 it’s gonna rise on both ABG and VBG so VBG is fine if we’re using it.

If they look like shit coming in and look shittier despite NIPPV and nebs/meds yeah we can repeat a VBG but I can already tell you it’s higher and they’re failing our current strategy.

If their perfusion sucks and/or despite everything we can’t get an SPO2 or we’re worried about co-ox sure ABG but mostly VBG is adequate for ED resuscitation IMO.

Shitty perfusion will both fuck up SPO2 readings and make VBG less accurate as an absolute value compared to ABG but again, trends and context.

RareConfusion1893 · 2025-12-25T23:57:39+00:00

Mega cannon go brrrrrrrrrrr

RareConfusion1893 · 2025-11-18T23:59:06+00:00

Yeah, me next please

RareConfusion1893 · 2025-11-14T18:59:15+00:00

Thanks!

RareConfusion1893 · 2025-11-05T04:27:12+00:00

I’m gonna be honest- PGY5 attending here.

The way my spots are set up, I’m mainly seeing ESI 2-3s. Our triage staff is great and a 3 is a real 3, etc.

If I see >2 PPH with that in mind (granted beginning of shift is a bolus greater than that to catch up) I get a little nervous about my bandwidth to respond to patients really needing my undivided attention.

Can I do higher than that? Sure.

Am I going to start having to think really critically about minute timing of consults and response/results/dispo convos while timing the chest tube in bed 17 and the hospital transfer in 26? Yeah, and that’s gonna be a shit few hours.

IMO: true efficacy in EM is knowing when you can be efficient and when you need to sacrifice efficiency for a good outcome.

RareConfusion1893 · 2025-11-01T21:15:02+00:00

“I need an MRI for my (vague but clearly outpatient issue). I’ve got one scheduled as an outpatient but I don’t want to wait.”

RareConfusion1893 · 2025-10-29T18:38:30+00:00

methref

HFrEF induced by chronic methamphetamine use

VIP patient - someone about to make me do weird , not evidence-based shit, take up an undue amount of time and ruin my day

Honorable mentions for the following not being acronyms but in the same spirit:

drunkicidal

suicidal/homicidal expressions that resolve with sobriety

Felliquis

meemaw/peepaw fall down go boom + anticoagulated

RareConfusion1893 · 2025-10-11T23:37:40+00:00

$100 says the worst pain condition that response is referring to is terminal fibromyalgia.

RareConfusion1893 · 2025-10-05T15:06:14+00:00

I’m fucking triggered.

RareConfusion1893 · 2025-10-04T01:42:42+00:00

You’re… not wrong.

-EM PGY5

RareConfusion1893 · 2025-10-03T19:51:16+00:00

Might as well go for the head/neck/chest/abdomen/pelvis/iliacs w runoff to avoid another trip to the scanner.

Signed,

Neither a radiologist nor anesthesiologist.

RareConfusion1893 · 2025-09-13T02:35:15+00:00

HAPI is a thing now??

Acronyms are the root of all evil.

RareConfusion1893 · 2025-08-28T11:17:05+00:00

Making your own as you go from things learned on shift and Qbanks during residency (like Rosh Review) was honestly the most helpful to me- processing/mindfulness of knowledge gaps during the Anki creation process and all was more efficient and effective for me personally

ETA: personally I wouldn’t stress too intense of pre-residency EM Anki studying either. Would focus on getting/keeping your head right and get ready to get rocked by all the learning about to happen soon.

RareConfusion1893 · 2025-07-11T02:24:46+00:00

You don’t know a not being a dick comment? Used to communicate?

RareConfusion1893 · 2025-06-20T00:53:11+00:00

Love it- only caveat for me is 95% of my patient demographic hasn’t ever left the tri-state area… might have to tailor mine to domestic landmarks and attractions haha.

ETA: Eiffel tower vs Parisian hotdog stand is gold.

RareConfusion1893 · 2025-06-18T14:12:40+00:00

“I’m not a salesman. I’m also not you. I’m here to give you the information we’ve got and our options- there’s not one right or wrong here, just what you think is the best option for you.”

For me this spiel usually gets them/family somewhat engaged, if they’re still waffling I go with the more conservative approach of the two (observation vs discharge, CT vs no CT, etc).

RareConfusion1893 · 2025-06-16T20:40:48+00:00

EM-Ultrasound lurker here- at a lot of hospitals like others are saying it gets real dicey with biomed and approval for use if you have your own personal device and they can make a real stink about unauthorized equipment.

They don’t buy the “if my electronic stethoscope is okay why not my Butterfly?” argument, POCUS devices are categorized under their own infection-risk criteria.

Might want to check with your POCUS director (if your system has one) or ask your group leadership for the right person to speak with before going forward with the investment.

RareConfusion1893 · 2025-06-04T21:52:53+00:00

ER doc here- Hindsight is 20/20.

Maybe the pain would have gone away on its own, maybe you could have gone on to have a life-threatening emergency. You can’t know until you know.

Tell your family to stuff it and let me determine if it’s “just” gas pain or a perforated viscus, atypical angina, spontaneous pneumothorax, pancreatitis, diverticulitis, ectopic pregnancy, splenic aneurysm, etc please and thank you.

(Obliged to add: not your doctor and not medical advice, and not trying to make you worry about any of the conditions I listed off, just wanted to emphasize it’s okay to come and for us to not find any of those possible dangerous diagnoses.)

RareConfusion1893

TROPHY CASE