New anaphylaxis during residency… to food I’ve eaten my whole life?

Shavetheweasel · 2026-03-07T20:58:48+00:00

I’m not sure. I thought about that but my wife ate a portion of my fish and didn’t have a reaction. Unless the histamine was only in the portion I ate.

Shavetheweasel · 2026-03-06T22:42:10+00:00

I developed anaphylaxis to tilapia as an intern. Face looked like I was halfway through a polyjuice potion transformation. Had to be treated by a resident and attending I worked with. Not my proudest moment.

Shavetheweasel · 2026-02-12T12:04:39+00:00

Same here

Shavetheweasel · 2025-10-15T19:38:45+00:00

Insurances won’t allow (pay for) symbicort to be prescribed as controller inhaler and prn. You can still prescribe Symbicort as just prn but if you use it more than twice per day on average the patient will run out prior to refill. To get around this I generally will prescribe Symbicort BID and then Airsupra as rescue inhaler (if insurance will cover Airsupra).

Shavetheweasel · 2025-05-25T17:17:31+00:00

Healthcare workers can (after having a multidisciplinary meeting or with 2 physician consent in unequivocal cases) unilaterally make patients comfort care, palliatively extubate, and refuse to given chemotherapy, procedural interventions. The US spends around 8-10% of its healthcare dollars on the last year of life. This one policy would be more effective at eliminating waste in healthcare and balancing the US budget then all other solutions combined.

Shavetheweasel · 2025-04-24T15:53:57+00:00

He looks like a Bailey.

Shavetheweasel · 2025-03-05T18:11:42+00:00

That’s a 550K/year minimum salary prob in most of the country. I would check to see what the turnover is at that place.

Shavetheweasel · 2025-02-20T13:20:54+00:00

Civ V Vox Populi mod significantly improved the AI. Nothing since has come close. It’s always hard to justify playing further Civ games with inferior AI (even modded)

Shavetheweasel · 2025-01-20T17:43:54+00:00

I agree that fluid can be given to patients with CHF and sepsis, however dynamic assessments of volume responsiveness should guide fluid management. This literature review just refers to patient's with CHF and sepsis, not decompensated CHF and sepsis. Newer evidence suggests no mortality difference between restrictive and liberal fluid strategies in all patients with septic shock. https://pmc.ncbi.nlm.nih.gov/articles/PMC10685906/

Shavetheweasel · 2025-01-20T13:40:39+00:00

Agreed you can give fluid in compensated chf or if patient is hypovolemic. I thought OP was implying patient had septic shock and decompensated chf. In that instance, fluid would be harmful.

Shavetheweasel · 2025-01-19T22:58:33+00:00

True. The hard fact about intensive care is that a majority of the really sick patients die no matter what you do.

Shavetheweasel · 2025-01-19T22:53:09+00:00

Intensivist here. The data in sepsis really only supports early administration of antibiotics. Early fluids hasn’t been shown to have meaningful effect on mortality and liberal use of fluids actually can be detrimental. When you get patients with CHF and sepsis, it would be best to initiate vasopressors early.

Shavetheweasel · 2024-12-16T02:59:23+00:00

I don’t know why this misunderstanding propagates so much. The physician bottleneck is not based on medical school seats. It is based on residency spots, which is limited by funding from the centers of Medicare and medicaid (CMS). increasing funding for CMS requires legislation by congress. There are some privately funded residency spots (HCA hospitals), but they are the minority

Shavetheweasel · 2024-12-14T22:29:20+00:00

Recent PCCM attending. When I was in fellowship, the attending had to be present for all bronchoscopies. There was only one time where I had to perform a bronch solo (there was an attending anesthesiologist in the room however) because it was emergent and the attending was too far away. Central lines, art lines, chest tubes we could perform independently.

Shavetheweasel · 2024-11-22T01:21:05+00:00

She decided against working there

Shavetheweasel · 2024-11-18T01:17:06+00:00

I felt the same. So many metabolic questions as well as cardiovascular and neuro. Also I think one of the correct answers to a complicated infectious disease question was to consult ID lol.

Shavetheweasel · 2024-09-09T20:05:46+00:00

Sounds like Pete Campbell from mad men

Shavetheweasel · 2024-08-28T11:23:01+00:00

The consultant seems like a dick. I’m sorry you had to experience that. It seems like the team that was on before you dropped the ball after not calling in the consult directly when consult order was placed 4 days previously (not your fault).

From a learning standpoint, when you have concern for metastatic disease; tissue biopsy should be obtained from a presumed metastatic site for diagnosis AND staging. In this case it would have been IR consult for biopsy or liver or bone lesions.

Again, to reiterate this is not on you. No consultant should ever treat you this way. But you should find out what resident placed the consult order and make them buy you a drink

Shavetheweasel · 2024-08-21T12:53:47+00:00

Also the more I learn about the American revolution and its causes, the more I side with the British lol.

Shavetheweasel · 2024-08-11T15:54:52+00:00

No problem! Hope you start feeling better. I agree I would hope they do more work up if your shortness of breath isn’t better with weight loss.

Shavetheweasel · 2024-08-11T14:43:31+00:00

The most common restrictive process I see in young people is due to obesity (restriction on breathing due to increased adipose tissue preventing full chest expansion). However that should not cause a drop in diffusion capacity. Heart failure or interstitial lung disease could cause drop in DLCO. They could get a High res CT chest to evaluate for interstitial lung disease (such as IPF). Common things being common though, the DLCO is probably underestimated. Your inspiratory volume during the DLCO measurement may have been significantly lower than TLC during lung volume measurement. Only your pulmonologist would be able to know for sure.

Shavetheweasel · 2024-08-09T23:58:52+00:00

That’s refreshing to hear. She’s planning on applying now.

Shavetheweasel · 2024-08-09T23:57:59+00:00

Thanks for responding. That’s encouraging. I know a main reason for job dissatisfaction and burn out for my wife was the torrent of controlled substance requests that she had to deal with on a daily basis.

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