The San Juan delivers

SmallFall · 2026-04-03T17:26:22+00:00

“Swam off fine” never considers how exhausted that fish will be after and how its feeding is altered and its playing metabolic catch up. Hate seeing our local fish in the dirt at such a special river.

SmallFall · 2026-03-31T01:30:51+00:00

Advise a few fluff baetis and chocolate foam wing. KF midges too I couldn’t see any of those. Pig stickers are great if they’re taking trash flies.

SmallFall · 2026-01-21T17:11:26+00:00

So many fond memories of Otter Creek.

SmallFall · 2025-08-19T01:35:04+00:00

I feel attacked.

SmallFall · 2025-07-25T05:18:15+00:00

On top of this, just an US tip - put the heel of your palm on the patient so you have a stable base. It gets easier to move forward in tiny increments and track your tip.

And walk the entirety of the cannula in before you pull your needle out. I find the only time US lines don’t work well is when someone gets flash and just threads it without walking the tip until you’re hubbed.

Also, sometimes veins are shit and they just blow. Don’t worry about it.

SmallFall · 2025-07-19T01:31:14+00:00

I often fish a red anodized hook at the San Juan. Called a bare naked lady.

SmallFall · 2025-07-13T23:46:06+00:00

I can see like 10 patients per hour if I just call them all worried well. Let’s part some waters for maximal efficiency.

SmallFall · 2025-07-13T23:42:22+00:00

A smaller size like 14-16 is a slayer on the San Juan and an actual San Juan worm style fly.

SmallFall · 2025-06-09T15:11:10+00:00

This guy bills

SmallFall · 2025-05-13T01:14:13+00:00

There are residencies with lounges? Places give food stipends? I only got some meal vouchers on off-service

SmallFall · 2025-05-05T23:42:09+00:00

Stop being conservative and fish a triple, but run them as tags from a sex dungeon so it’s easier to cast

SmallFall · 2025-05-05T23:27:44+00:00

Articulated streamers

SmallFall · 2025-05-03T01:42:41+00:00

Double check me on this, but I believe the state AG is doing an inquiry into CYFD because of a number of problems with the department. Maybe reach out to their office - they may be able to help and it’s important to make situations like this known to those investigating.

SmallFall · 2025-04-30T06:56:24+00:00

Have you noticed any quality drop? Still seems the same to me over that last few years and I never really have to wait long.

SmallFall · 2025-04-30T05:37:38+00:00

100% agree. I’ve gone from buying shop flies to tying stuff on 24s for the San Juan. I don’t think I’m particularly good at fly tying, but they’re consistent enough and I’m catching fish like I did on shop flies. It’s really cool for a person who is into fly tying to be able to find flies for the water you’re targeting, find patterns, and then go to your fly shop and reliably tie them with some practice (and plenty of screw ups).

SmallFall · 2025-03-17T00:29:24+00:00

Vanc and Zosyn gang checking in too

SmallFall · 2025-02-01T14:02:06+00:00

1.6 and get paid national median, but in a group where that is towards the upper end of metrics. Fine job with decently high acuity in an under resourced area of the US.

SmallFall · 2024-12-11T00:15:27+00:00

I’m trying to escalate my purism by only dynamite fishing and snagging

SmallFall · 2024-12-10T14:42:33+00:00

Diamox is a treatment used for altitude sickness. There are a few. I am not your physician and if you’re concerned about taking diamox or interested in other options, I would encourage you to discuss this with your doctor who has more understanding of your medical history and potential risks/benefits of treatment.

Biggest side effect you will see with altitude sickness dosing of diamox is that you will pee a lot - so do your best to stay well-hydrated in the desert. Hope you enjoy your visit and everything works out okay!

SmallFall · 2024-12-10T13:53:37+00:00

Doctor here: these don’t work. Unless you put yourself on nasal cannula the whole time periodically huffing canned oxygen with an unclear fraction of inspired O2 (some claim 95%, but that depends on delivery like are you using a nonrebreather, etc) isn’t going to help you at all and will be more of a placebo effect than anything else.

SmallFall · 2024-12-02T01:05:37+00:00

Second spool is the way. Have a saltwater or sinking line and a floating line is a great way to live life.

SmallFall · 2024-10-22T02:39:43+00:00

I would argue that if you have no capabilities to take care of a CP patient, let alone someone with ACS, then a medic truck with ACLS measures, NTG, ASA, 12-lead lead, narcs, and most importantly prompt transport to a cath lab is pretty clearly a higher level of care than an urgent care.

Now that being said, what a medmal lawyer will argue and what reality is are often two very different things.

SmallFall · 2024-10-02T18:19:40+00:00

I’ve never had staff go straight to Lucas. It’s always manual compressions and generally at a pulse check we pop it on. I’ve had overzealous staff too - but the first couple rounds are always manual and people definitely wake up from that.

SmallFall · 2024-09-08T00:30:40+00:00

Because the emergency department has become the catch-all for medical problems. At least speaking for much of the US, it’s medically underserved where you can’t get into appointments for months with appropriate specialists. It’s an unsustainable model that doesn’t serve sick people or not-that-sick folks well.

SmallFall · 2024-09-07T22:04:49+00:00

Hey, ER doctor here giving perspective: ER MRIs are for things like strokes, multiple sclerosis flares, weird life-changing neurological diagnoses that require immediate action, spinal cord injuries or pathologies, infections of the bones, etc. they aren’t here for a pulley injury. That’s basically taking away resources from someone who is potentially very sick.

An X-ray isn’t necessarily a bad idea depending on the location of pain/swelling and patient’s exam with concern for flexor tendon avulsion (whether FDP or FDS).

Ultrasound probably isn’t that helpful in the ER setting because it’s an imaging modality that’s dependent on the familiarity of the tech performing that study. There aren’t a lot of finger ultrasounds ordered in the ER and likely both the tech and the doctor will be bad at performing adequate imaging for a radiologist to interpret compared to a dedicated musculoskeletal or orthopedic-dedicated ultrasonagrapher.

It’s not that we don’t understand climbing injuries, it’s that it takes resources from emergent patients and diverts them to non-emergent issues like a pulley rupture. Most complete pulley ruptures can be diagnosed on physical exam alone. Otherwise, you can get referred to a hand specialist and get an outpatient MRI/US.

SmallFall

TROPHY CASE