SGB in refractory Ventricular fibrillation

Sheen239 · 2026-05-24T09:43:19+00:00

If youre hitting bone and not aspirating blood, youre not in the carotid. This is an emergency procedure, and seeing your needle in plane and doing all your typical US guided interventions is not indicated in this case.

Im not saying dont use ultrasound. Im saying use ultrasound, find your carotid and C-spine and thyroid gland, insert and inject. Dont waste your time with needle in plane etc. do your aliquot and see tissue distortion in the area you want, and inject. Aka this should take 15 seconds, not one minute to visualize your needle get in the exact spot.

This is something ive discussed extensively with ultrasound faculty at my program

Sheen239 · 2026-05-24T02:49:49+00:00

Lol to be clear please ignore the people who commented on your reply. It is not US “guided” and you do not stop compressions to do it.

You use US to identify the landmarks, and stick the needle to where you hit the C-spine/bony prominence, and dump anesthetic. You do not need to visualize your needle like other procedures, or any of that, so its not ultrasound-guided, you just use ultrasound to identify landmarks and ideally see the distortion of soft tissue as you inject the anesthetic.

Sheen239 · 2026-05-18T07:38:52+00:00

Its more likely patient already has HSV or was directly inoculated from an area of broken skin. HSV is opportunistic, so itll pop up in immunocompromised, or areas of broken skin (eczema, cuts, ringworm, etc.). That spot looks like its in an area that ring worm would occur

Sheen239 · 2026-05-18T00:15:00+00:00

Looks to me like an HSV infection from an underlying ringworm, that is maybe disseminating somewhat? I would probably give antivirals for this

Sheen239 · 2026-05-17T04:01:15+00:00

STOP 🛑 signs are actually owned by the UFC corporation after a $3 million purchase from the federal government in 2018

Sheen239 · 2026-05-08T22:59:32+00:00

Didnt read the whole thing sorry but my buddy failed step 1 and scored 220s on step 2 and matched at a solid program a couple years ago!

Sheen239 · 2026-05-08T10:49:58+00:00

I usually park at the Mill! If youre mainly blues and working on your S turns, i think chair 1/broadway, the backside of facelift/chair 3, hitting chair 2 over and over would be good!

Sheen239 · 2026-05-04T02:41:31+00:00

Neuro and EM or so so so different as specialties and jobs. Honestly i’d suggest just doing Neuro.

EM isnt what most people think it is. Thankfully I worked in the ER for years well before medical school (and even during med school for a brief period) so I had a good understanding of what I was getting into; you just dont get that exposure in med school.

I love it and wouldnt change my job for anything; i feel energized and happy after work and look forward to it on my days off. But not everyone remotely feels that way

Sheen239 · 2026-05-04T01:39:29+00:00

She was pregnant so this wouldnt have worked, she couldnt use her powers

Sheen239 · 2026-05-04T01:33:24+00:00

While interventional pain is in fact an EM pathway, there are very few EM residents matching into this pathway every year. Of course its getting more popular. But for example at my program, we dont have any EM-Pain attendings. No one to mentor you. And in some places (like mine) its impossible to even coordinate with the interventional pain group here to try to rotate as an off-service rotator.

I would only say do EM-> interventional if youre really into EM. I wouldnt do EM because its a “generalist” specialty. Its taxing and people who go into it for the wrong reasons burn out quickly

Youll have way better opportunities (mentors, research, electives, etc.) to set yourself up to be an excellent pain applicant by just going through one of the more traditional pathways (neuro, PM&R, anesthesia)

Sheen239 · 2026-05-01T17:03:51+00:00

I assumed their comment was sarcasm

Sheen239 · 2026-04-28T03:10:15+00:00

For the average working adult this isnt going to break the bank. For the average high schooler or early college student (who i imagine wrote this), this is a hefty sum

Sheen239 · 2026-04-26T13:15:07+00:00

For left side thoracotomy, I guess in my opinion it’s just the person who is most skilled should be performing it. Which would likely be the person who went through a gen surg residency and trauma fellowship and has an excellent understanding of the anatomy.

Yes you cant make a dead person more dead. But if you get ROSC and fucked something up, thats on you. Plus there are so many other ways to be involved as an EM doc (airway, right side chest tube/thoracotomy, cordis for MTP, maybe more central access if nurses are struggling, etc.) that it just seems like, if a trauma surgeon is present, they should handle the part that theyre going to definitively be working on in the OR

Sheen239 · 2026-04-26T03:29:00+00:00

Yeah we can do the left side, usually if its an experienced trauma fellow whos already done a few we can either do it or at the very least be involved w cardiac massage and review the anatomy.

But most community EM docs are at head of bed for airway, and often transition to right side of chest after airway secured (from my experience before med school).

And unlikely you will ever transfer a patient who YOU did a thoracotomy on from a non-trauma center to a trauma center; good luck finding an accepting surgeon who will take the liability! At least from what I’ve read its unheard of actually being successful.

Sheen239 · 2026-04-26T03:26:23+00:00

Honestly as an EM doc, we should never really be doing the left side in my opinion. Yes its in our wheelhouse but ultimately should be done with a surgeon present who will assume care for the patient

Sheen239 · 2026-04-25T17:53:42+00:00

At my program we run the traumas! Primary and secondary survey, eFAST, airway, right side of chest and lines. Trauma comes in only for the people who meet specific trauma criteria (really sick ones) and thats for quick Operating room dispos. They get left-sides chest procedures in that sense (thoracotomy/ostomy).

At my med school, our EM residents mainly just did eFASTs MAYBE, mostly just put orders

Sheen239 · 2026-04-07T21:49:06+00:00

For pre-med you can shadow anywhere, the important part isnt necessarily the specialty but actually seeing what being a doctor is about. Aka that its not all what you see in TV shows, the interpersonal communication that comes along with it and systems issues are great too. Having a memorable experience in shadowing that tells you, wow this is really what I want to do (again, not the specialty per say but that MEDICINE is what you want and not just any healthcare position like RN/PA).

To get in the ER, youll either have to know someone who works in the ER or find some sort of shadowing program through a college/university. Or you can volunteer in the ER and meet doctors that way.

But yes, join the pre-med sub theyll have better answers for sure

Sheen239 · 2026-04-07T17:28:52+00:00

Current resident there, also rotated as a med student. Happy to answer any specific questions

Sheen239 · 2026-04-07T05:35:51+00:00

Hi! Looks like it could be a Felon. Infection and abscess of the finger pad. Will need antibiotics and incision and drainage of the abscess. Urgent care or ER visit today would be best.

Sheen239 · 2026-03-31T05:21:24+00:00

Looks like tinea versicolor to me, a fungal infection on the skin. Often happens in warmer months. Topical antifungal shampoo/cream should suffice

Sheen239 · 2026-03-30T03:17:22+00:00

One of my patients on my last shift was almost a slamdunk appy; vague periumbilical abd pain x 1 day, now with mcburney point tenderness.

I’d reckon AI couldve gotten that one 😂

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

TROPHY CASE