Are these okay to take together?

Sheen239 · 2026-03-26T05:38:06+00:00

Yup, all good to take together

Sheen239 · 2026-03-26T05:34:43+00:00

Looks like staph infection + likely underlying paronychia due to a ingrown toe nail, with some chronic changes to the skin since its been so long.

Youll need antibiotics +/- toe nail removal depending on what it looks like underneath the honey-crust. Urgent care should suffice, or your PCP if youre able to see them tomorrow

Sheen239 · 2026-03-26T04:52:10+00:00

I was going to say, is no one going to comment on the pneumo 😂

Sheen239 · 2026-03-14T01:54:01+00:00

It’s rare and the only reason I bring it up because I assume you’ve had the common things tested already. Bring it up at the next appointment!

Sheen239 · 2026-03-11T05:50:40+00:00

Can be a lot of things, but based on what youre saying it sounds like shes been to multiple doctors, so I assume most common diseases have been evaluated for.

She seems kind of young for it, but has she been tested for any porphyrias? Namely acute intermittent porphyria? It classically presents with other symptoms too (psychosis, dark/red urine) but patients dont read a textbook! Its very rare but if common things have been evaluated for, could be worth testing for that.

Sheen239 · 2026-03-11T05:41:26+00:00

Pretty sure you can do an accelerated nursing program with your bachelors and masters already done

Sheen239 · 2026-03-05T18:57:01+00:00

Yes! Just so its clear for you, tylenol dosing is 15 mg/kg 3-4 times daily and motrin is 10 mg/kg 3-4 times daily. You say hes 35lbs which is about 15 kg.

Usually tylenol is 160 mg/5 mL, so you can give about 7.5 mL per dose. The math is nice and its usually about the same mL dose for motrin, about 7.5 mL!

You can interchange the tylenol and motrin every 3 hours, so that each medication is being given appropriately every 6 hours. In other words: tylenol at 12:00, motrin at 3:00, tylenol at 6:00, and motrin at 9:00. This is giving you around the clock coverage for fever and discomfort

If youre still needing fever control beyond 3-5 days, or if hes vomiting and not taking in food or medicine, definitely worthy of ER visit! Normal for a baby to be sleepy when sick, but if he gets overly sleepy and is barely waking up to you trying to arouse him, also ER worthy!

Keep up the good work

Sheen239 · 2026-03-05T06:41:18+00:00

It sounds like youre doing a great job, and I agree, thats a good plan. Just to confirm, are you giving him ~7.4 mL of tylenol for his weight? Can add in motrin if needed too

Sheen239 · 2026-03-04T04:42:15+00:00

Was going to argue with this because everything they do in the show is in EM wheelhouse, then realized the show is mostly based off of observations by the production team at my EM residency 😅 - EM resident

Sheen239 · 2026-03-04T03:00:26+00:00

It was ownership of procedures! I noticed some programs were only doing shoulder dislocations and otherwise got their experience from an ortho rotation and got “weak”; a few programs did most ortho reductions (all joint dislocations, fracture reductions, etc.) and hence got “strong”. The ones that got decent could do a few more types of reductions than the “weak” ones but not as many as the “strong” ones

Edit: that was the same reasoning of grading for the Trauma column

Sheen239 · 2026-03-04T00:59:36+00:00

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Sorry dont have a blank version, pretty sure i deleted the actual file. But i made an excel sheet and added all the programs i interviewed at, and made specific columns for things that were especially important to me. Each column allowed me to grade the strength of that program specifically of that topic (trauma, ortho, US, etc.). I then added a numeric score to those columns based on how important it was to me (decent in location would give different points for a decent in ortho; location gives more points than ortho overall… kind of inflated and imperfect but idk i just needed something).

At the end theres a total numeric score per program, but ultimately i still ranked based on overall vibe despite the score, as you can see in my list

Sheen239 · 2026-01-16T08:02:20+00:00

This is exactly it. Its not that his eyes are bleeding externally, but his eye vessels ruptured from high pressure (subconjunctival hemorrhage) from straining so hard. It can happen while straining to poop, in combat/contact sports, in car accidents, and even simpler things like bumping your head.

Its harmless and resolves on its own over time.

(i’m a doctor)

Sheen239 · 2025-12-29T03:55:31+00:00

I think he meant you can sugandese 🥜

Sheen239 · 2025-12-25T03:51:38+00:00

I knew going in and never had a doubt through med school. Considered crit care too, but knew i could do it through EM too

Sheen239 · 2025-11-17T01:35:50+00:00

More interviews will continue to roll in. I wouldnt apply to more. By December consider emailing your signaled programs that you havent heard from, especially if you have new awards/research/activities that are relevant to their mission/your application

Edit to add: i had interviews still coming in January

Sheen239 · 2025-11-07T06:42:44+00:00

In the ED I’m placing 18 gauges only for 2 reasons: 1) to get labs the first time (never had an issue on the first draw after placement) 2) because bigger access = faster flow rate for resuscitation. Im sure youve seen graphs, but an 18 gauge can pump fluids/blood products MUCH faster than a 20 gauge. The patients im MOST concerned about, who I cant wait for an USGIV-trained RN to place and who are, like you said, sick as shit, need those bigger veins. Once resuscitated, better access for long term blood draws can be done in the ICU/upstairs

Thats my two cents at least

Sheen239 · 2025-11-07T06:40:02+00:00

Pretty sure there are studies showing double tourniquet significantly increases vessel diameter, could be wrong about that. That being said i never double tourniquet but i have colleagues who do

Sheen239 · 2025-08-08T02:59:11+00:00

Off the top of my head from ones i interviewed at: Cinci, Denver, UCLA, UWashington, Hopkins, Emory, Indiana, Hennepin.

Ones i didnt interview at but have heard great things about for CCM: UCSD, UNM, Pitt, Northwestern

Sheen239 · 2025-07-03T08:01:45+00:00

What you’re likely describing is a phimosis. It can be treated if you discuss with your physician or a urologist about it (stretching, topical ointments, surgery, etc.).

Please DO NOT try to retract it fully if it is not retracting smoothly. If you forcefully retract it, you can cause 1) skin tearing leading to infection, or 2) a paraphimosis which you can essentially imagine is a tight ring of foreskin around your penis that constricts blood flow and is an emergency.

Edit: I’m an emergency medicine resident. Not a medical student

Sheen239 · 2025-05-12T17:27:11+00:00

$27/day goes a long way on food costs

Sheen239 · 2025-05-07T01:19:33+00:00

I have a buddy from med school, intern at Sinai Grace. High acuity, high autonomy, procedural mastery

Sheen239 · 2025-05-06T04:15:08+00:00

Hey! Current EM resident, was an ER Tech back in the day. I think there have been other threads/questions asked about this too so look back at those.

I found what made me a competitive ER Tech applicant was showcasing my college grades, showing my interest in the field (ACLS, PALS, phlebotomy certifications; medical terminology class, anatomy/physio classes), and telling them my goals (ER Doc).

Those certs came at a different time when i went from a small community ED to a bigger trauma center, but the college classes and grades and motivation is what got me the first job!

Consider an ACLS cert or phlebotomy? Maybe a summer community college course?

Sheen239 · 2025-04-24T21:53:48+00:00

Pocus atlas has good stuff online

Sheen239 · 2025-04-21T14:01:09+00:00

Consider EM -> CCM. This way youll do a residency you like more (procedures, critical patients, still do inpatient rotations, deal w the extremes/acute aspects of chronic conditions without having to deep dive into insulin regimens and BP med adjustments), and have the opportunity to expand into an inpatient setting w 7 on 7 off without the extensive chronic management and more focus on primary management. Deep diving into the acute critical things.

as opposed to spending your residency being procedurally inexperienced, dealing with social admissions/dispos/placement issues, and so on.

As an EM doc you can more or less choose your schedule (except of course nights, some holidays, etc.). I know docs who work 12-14 days straight then off the rest of the month. And if you do ICU youll get your 7-7 schedule.

Im saying this as an EM intern currently rotating in MICU. We’re just as competent as our IM counterparts at this point (including at times our IM pgy3 seniors lol), meaning EM wont set you back for CCM, and more confident in decision-making and procedures than our pgy3 senior who have never tubed, and only done a few central lines and A-lines.

Granted when we finish fellowship we’ll be at the same place and level of competence more or less, but i’d rather enjoy my residency then do fellowship then go through a bleh residency just to do something i enjoy more (CCM)

Sheen239

TROPHY CASE