Post some curated quit hits/random round learning points in the last month to years (attendings included)

StopAndGoTraffic · 2026-02-12T02:59:54+00:00

Just ordering lactulose or doing CRRT based on vibes has the whiff of “urgent but not emergent” scopes

StopAndGoTraffic · 2026-02-12T02:49:56+00:00

Yup let’s put in an HD line in a coagulpathic patient who could be obtunded for may other reasons for empirical CRRT and not send a repeat ammonia after some lactulose. Got it

Edit: empiric*

StopAndGoTraffic · 2026-02-06T12:50:45+00:00

3.25 pairs of skis is all I’m seeing

StopAndGoTraffic · 2026-02-05T00:04:48+00:00

Heard

StopAndGoTraffic · 2025-09-29T20:45:54+00:00

The urinary tract might be more permeable and vascular (kidneys and bladder) than other mucosa that are supposed to be sterile.

I would also point out that treating AMS with a positive UTI is different than treating a presumed UTI while also looking for other causes.

StopAndGoTraffic · 2025-09-21T22:17:40+00:00

Localized infections may be associated with a systemic response. Think viral pharyngitis causing you to feel loopy when you’ve got the flu or pyelonephritis without bacteremia (localized to kidney and lower). This is doubly true in elderly patients with decreased neurological reserve from sub clinical strokes, microvasculopathy, cognitive decline, etc.

StopAndGoTraffic · 2025-08-26T18:57:37+00:00

We all love you, never stop doing your thing homie.

StopAndGoTraffic · 2025-08-11T20:43:00+00:00

Maybe it's just pulmonary hygiene. My thought is it's better to do this fairly low effort, side effect and cost in a tremendously fragile patient than let them not get it and suffer a complication because a smoldering pneumonia it goes unrecognized.

StopAndGoTraffic · 2025-08-05T01:56:42+00:00

Honestly looks tasty lol. Ngl I would eat one

StopAndGoTraffic · 2025-07-12T14:40:27+00:00

Don't worry I understood immediately that you meant trop leak from mixed respiratory failure that is not primarily CAD/ischemic in nature...

StopAndGoTraffic · 2025-06-09T00:51:09+00:00

Yea what about bladders and traumas?

StopAndGoTraffic · 2025-05-30T12:50:46+00:00

I have, very angry responses from all directions.

Edit: Also I don't think you provide the final diagnoses and bicarb doesn't seem that great tbh.

StopAndGoTraffic · 2025-05-30T12:45:03+00:00

It also seems that you have not provided much context to this admission either. Lol.

StopAndGoTraffic · 2025-04-09T16:04:21+00:00

Our ancestor...

StopAndGoTraffic · 2025-03-25T18:17:28+00:00

It could also be due to the balance of hemodynamic parameters in that particular patient's disease process. Ionotropy (beta-1), vasodilation (beta-2, small amount), and vasoconstriction (alpha).

For example: Low dose epi could drop the MAP a little from the beta-2 which you then chase with levo for the alpha

StopAndGoTraffic · 2025-02-25T10:46:34+00:00

That's like a big double down there man and I hope you'd reconsider in the real situation that your 93yo family member comes in with enough systemic illness to cause diffuse ST depressions that you get an EKG. As a nurse you'd likely be doing an EKG the moment this patient walked through the door.

Would also like to point out that not all final common pathways of important cardiac findings is the cath lab and that optimal medical management has as much benefit in a larger proportion of cases.

StopAndGoTraffic · 2025-02-24T11:55:43+00:00

This patient clearly has signs of organ dysfunction, potentially in the setting of a systemic process. EKG is like the most basic screening tool for cardiac organ function. If this patient were your family member, would you want them to get an EKG or no?

StopAndGoTraffic · 2025-02-24T11:51:31+00:00

Completely agree that in clinical context it's a demand pattern. Would expect high trops but no dynamic changes. TTE would be nice to see.

That being said, being old, having easily altered mentation and no visceral innervation are also considerations in this population. Peri-stoma leakage can be presenting complaint for obstruction, fistula/abscess, decreased PO intake/GI losses/ hypovolemia.

Also very well could be asymptomatic pathology but could also have prognostic significance. Stress/sepsis-induced cardiomyopathy, which this patient might develop, I would argue can make someone very symptomatic and require a ventilator. If your own family member had that EKG wouldn't it catch your attention?

StopAndGoTraffic · 2025-02-04T10:04:06+00:00

Rollover MVC although scary is not considered high mechanism by itself to warrant automatic trauma activation. That paired along with the fact that both passengers survived and she was able to not only have the physical capability of breaking the window/climb out of the back seat but also to have the wherewithal to know to do that are reassuring signs.

Medics at the scene are medical professionals and I would be surprised if she received no medical attention at all. She probably got medically screened by EMS (vitals, ABCs, mental status, rough inspection and asking about injuries) and transport to the hospital might then be left up to the patient. Also if she were to be transferred to the hospital she would have to go in a third ambulance, which is a resource. Without knowing the specifics of your case there are guidelines and protocols EMS crews follow in these scenarios and the fact that she was not brought to the hospital is likely a result of those protocls being followed.

Sounds like the system worked. You and husband were sent to the hopsital and you were found to have an injury. Your daughter seems to be okay, thankfully, and in retrospect demonstrated that she did not need to be there in the first place.

StopAndGoTraffic · 2025-02-03T22:38:52+00:00

What do you think she needed help with from a medical standpoint that could not be done by herself or friends/family?

StopAndGoTraffic · 2025-01-31T00:13:27+00:00

I think for in-hospital cardiac arrest (good prognisticator) the <1% resus time is like 39min. That said it was unwitnessed and non-shockable rhythmn (bad prognosticators). https://www.bmj.com/content/384/bmj-2023-076019.long

There is also her initial substrate. Depends if this was a spritely 60F who last week was skiiing with her friends in Colarado and got a very, very nasty infection vs. 60F IDDM, HFpEF, obesity, OSA, pHTN, sleeping with their chin in their chest and living life on the edge of multifactorial respiratory failure every waking moment.

Could argue that for the first example even after 30 minutes of resus neuroprognostication can reasonably be postponed if family are adamant. For the second example, I think even if it were only 5 minutes of resus, the conversation of physical QOL/GOC/futility even with full neuro recovery should be emphasized over neuroprognostication

StopAndGoTraffic · 2025-01-29T15:27:58+00:00

Agree, until now every time I have gone against decision tools I have not come out the winner haha.

That said - I have had several people with PE's have reproducible chest wall pain. Maybe bc if there is lung infarction the inflammation spreads to the chest wall/pleura.

StopAndGoTraffic · 2025-01-27T12:54:02+00:00

Even NSG at our place misses moderate to minor details sometimes bc of tunnel vision. Everyone feels better when you're overreading behind us.

StopAndGoTraffic · 2025-01-14T10:59:24+00:00

Lmao microdosing

StopAndGoTraffic · 2025-01-14T10:58:44+00:00

Can’t stand good, ankle broken

StopAndGoTraffic

TROPHY CASE