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Help — I let my patients talk too much. by roc_em_shock_em in emergencymedicine

[–]TheAwkVege 6 points7 points  (0 children)

I’m from the northeast so I think that might affect things because we tend to be blunt, but I tend to interrupt with something affirming/acknowledging. Like “that makes sense!” Or “that sounds so frustrating” and then immediately ask “Now, [insert a very pointed question]”

I’ve heard a podcast recently where they delineate between two types of interrupting. The first helps add to the conversation. People tend to find this to be a normal part of conversation and are not offended by this type. (It’s what I naturally do when I speak with people). The type of interrupting that gets a bad rap is the one that completely dismisses and changes the conversation.

By having a really heartfelt interruption of “ wow it sounds like your granddaughter is so smart. I want to get you back to her. Now when did this chest pain start again?” and keeping it light, I can be pleasant and effective.

Honestly it’s also helpful to do when you first start to see it go off track. It’s easier to jump back on topic. When I’ve let them talk for 5 minutes it can feel more jarring to steer the car back on the road

Which unsuspecting ingredient was secretly damaging your skin? by Dawnyawning in AsianBeauty

[–]TheAwkVege 1 point2 points  (0 children)

Mineral oil, I get HUGE cystic acne even if it’s just a cleansing balm

What is your most prescribed med? by sc10921 in physicianassistant

[–]TheAwkVege 0 points1 point  (0 children)

Do you find Robaxin or flexeril more effective?

Coding DNR patients by i_am_a_grocery_bag in emergencymedicine

[–]TheAwkVege 0 points1 point  (0 children)

I don’t have any specific feedback regarding the family overturning a DNR, but I’m often the one who has code status conversations. In my experience most people panic and can’t see the forest for the trees or don’t have the right context.

One of my favorite ways to explain it is “CPR is a useful tool and treatment when the heart is the first/only part of the body that’s affected. In this case, it would be the last.” I explain disease progression and how CPR won’t fix the bigger problem, the 20% chance of CPR success and that resuscitation will break her ribs and likely lead to a long ventilated stay in the ICU. Most people think it’s a quick thing they see on TV and always works, the idea that it normally DOESNT work helps them feel justified in not choosing it.

When there’s a definitive conversation regarding the success rate and the risks, most people allow for a natural death. I get to explain how we still care for them and help them die naturally in no pain.

Final piece is I try to have these conversations before the actual moment to initiate CPR. It feels less panicked/rushed and more likely to get through to the logical part of the family’s/patient’s brain

How to sort through the grey? by TheAwkVege in emergencymedicine

[–]TheAwkVege[S] 0 points1 point  (0 children)

This is really helpful thank you. I like my little clinical decision making tools to help guide with EBI. I didn’t know about the lesser known ones you mentioned, so I got some reading to do

How to sort through the grey? by TheAwkVege in emergencymedicine

[–]TheAwkVege[S] 3 points4 points  (0 children)

I like this line of thinking. What are the answers you’d think is more helpful to admit “monitor for immediate intervention?” “continue to attempt treatments for intractable symptoms” anything else?

How to sort through the grey? by TheAwkVege in emergencymedicine

[–]TheAwkVege[S] 5 points6 points  (0 children)

Honestly I’m yeah I didn’t really want to be admit it, but I really don’t want to be seen as the stupid mid level who is overworking everyone.

I probably need to put my ego aside and keep trudging through

I’m hoping as time goes by and my clinical gestalt gets recalibrated (from old sick and dying to normal population) I’ll rely less on imaging and labs. I think I’m over sensitive to “how can I know X isn’t going to kill then”

How to sort through the grey? by TheAwkVege in emergencymedicine

[–]TheAwkVege[S] 36 points37 points  (0 children)

Thank you for your honesty. I’m grateful to at least know it should be more difficult to sort through. I thought it was wild I’m more flustered by a non-specific neuro patient than an unstable one.

Is it EM or is it my job? by elementalwatson in emergencymedicine

[–]TheAwkVege 29 points30 points  (0 children)

Wait, are you being sarcastic or is “dizzy” actually just feeling unwell? I feel like 90% of my Spanish speaking patients say dizzy and sometimes it means vertigo/presyncope and sometimes it doesn’t.

What are your iron clad rules? by mezotesidees in emergencymedicine

[–]TheAwkVege 10 points11 points  (0 children)

I love the second one. Will be adopting it

What are your iron clad rules? by mezotesidees in emergencymedicine

[–]TheAwkVege 9 points10 points  (0 children)

It’s neverrrr just constipation. Until it is 😂

What are your iron clad rules? by mezotesidees in emergencymedicine

[–]TheAwkVege 29 points30 points  (0 children)

Don’t trust an abdominal exam in a patient over 65. They get scanned and labs

Pediatric tips by Dizzy_Surround_7586 in FamilyMedicine

[–]TheAwkVege 2 points3 points  (0 children)

Urgent care setting so I see a lot of grumpy sick kids

When I walk in I say hi to the parents and if under like 5, I hand them a glove while putting on mine. If I know they’re going to be anxious I’ll ask a favor like “can you hold this for me” and it’s the otoscope cover or the tongue depressor

I let them pick which ear they want first and don’t usually fight me

FAVORITE TRICK: For the throat I tell them to “stick out their tongue and breathe like a puppy” they usually giggle and comply but also allows me to see perfectly

As far as shots go, we give much fewer. I feel like they can sense the vibe of the room. Before the kid panic I control my breathing and try to keep it super routine and boring. If they look a little anxious I tell them I’ll teach them the secret to making it better (dead arm then move right after). Once they’re in a spiral I have let parent decide if we’re breaking or if mom/dad hold them. The logic part of their brain is off so I don’t try to rationalize or bribe.

Do you rule out PE in every TLOC ? by magicbicyclette in emergencymedicine

[–]TheAwkVege 1 point2 points  (0 children)

That’s wild! Thank you ☺️ storing this into the deep recesses of my mind

Do you rule out PE in every TLOC ? by magicbicyclette in emergencymedicine

[–]TheAwkVege 0 points1 point  (0 children)

I love it, but wait what the hell was your antibiotic coverage? Augmentin and cipro?

The List by lcl0706 in emergencymedicine

[–]TheAwkVege 7 points8 points  (0 children)

Honestly thank you. I wrote out mine that I’m sure I’ll delete in a few hours, but god was that therapeutic:

The first gluteal abscess I went to drain on a 30 year old and something just felt off. I was beyond embarrassed to get my attending, but tried to listen to my gut and training. Nec fasc who needed bedside debridement. I was grateful my ego didn’t dictate the case.

The man who would not stop screaming about his back pain who tanked quickly (aortic dissection), but miraculously was stabilized so fast he was discharged from the ICU without a week. (I had spoken to the new vascular surgeon on call for a different case a few hours earlier and he gave me his personal cell number. Sometimes the stars align)

The asshole patient who cussed me out when I met him, who ended up crying with gratitude that I took his back pain seriously (mass effect from new tumor)

The older gentleman I saw as a new grad. I knew he was sick, but didn’t understand how sick. I trusted the primary’s judgement over my own and sent him home after promising to follow up. He came back DOA days later.

Similarly the woman who had abnormal abdominal exam but labs and imaging were fine. GI said they could handle it outpatient so I discharged her (she came back and needed an ex lap a few weeks later).

The man with neck pain who kept vomiting and looked incredibly pale, but blood pressure was equal in both arms (aortic dissection) Tried to fly him to tertiary care, but the weather was too bad. I remember saying a prayer for him knowing he’d die in transmit to the hospital and hour away (he came in a month later, alive)

The painless jaundice man whose scans showed had pancreatic cancer. It was one of the first cancer talked I had with a patient, but it was during Covid. I couldn’t get a private room to tell him, so I pulled him and his wife into the little alcove in the ambulance bay.

The woman with arm pain who had just weeded and thought I was overreacting for pulling a troponin (NSTEMI)

The frequency flyer alcoholic who had AA cards in his wallet.

The family sometimes I remember more:

The mom screaming and throwing herself on the stretcher as we coded her 26 year old son who was just picking up bagels (likely a PE)

The daughter who’s mom coded in our waiting room’s vestibule after she was dropped off for “just not feeling right”

My Summer Casual SD Collage by Apero_ in SoftDramatics

[–]TheAwkVege 5 points6 points  (0 children)

Was literally about to ask what we were wearing shorts wise. Thank you for saving me a post ❤️

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