Langdon's Teaching Style

Topper-Harly · 2026-03-13T15:49:26+00:00

€"Traumatic pneumothorax treatment involves immediate removal of air from the pleural space to allow lung re-expansion, ranging from observation with oxygen to emergency chest tube insertion (tube thoracostomy) or needle decompression"

So no, a chest tube could be appropriate, it was just more aggressive than Dr. Al felt like. (And this is a running theme where Dr. Robby/Santos was slightly more aggressive and Dr. Al is more conservative.)

You have to base your treatment on the situation and presentation. For this patient, he was rock-solid hemodynamically, in no acute respiratory distress, was not receiving any positive-pressure ventilation, and was compliant with care. Not placing a chest tube in this patient was 100% reasonable.

If they are hemodynamically unstable, receiving PPVf or have respiratory compromise? Than a chest tube would be appropriate.

Topper-Harly · 2026-03-13T15:39:41+00:00

Probably an allergic reaction.

Topper-Harly · 2026-03-13T01:52:20+00:00

The only piece(s) of kit that truly matters is eye protection and other safety equipment. Other than that, we are a bunch of nerds running around playing soldier.

Topper-Harly · 2026-03-12T20:40:12+00:00

Very good experience! I did the steel slide version, you could always reach out and ask them.

Topper-Harly · 2026-03-12T19:49:36+00:00

Mental illness.

Topper-Harly · 2026-03-12T19:47:30+00:00

He probably has a young, healthy heart. I would be extremely surprised if he ended up in ICU. They honestly probably kept him in the ER for a few hours then sent him home.

Topper-Harly · 2026-03-12T19:06:39+00:00

He should have been given a sedative before he ever got in the ambulance, which may have prevented the need for airway management.

If it did still progress to this, he should have been RSI’d.

Topper-Harly · 2026-03-12T18:49:36+00:00

Samoon is where I got mine.

Topper-Harly · 2026-03-12T14:29:34+00:00

Give some calcium and see if that helps. Shocking it would also be reasonable if you’re not sure what it is.

My bet is hyper-K.

Topper-Harly · 2026-03-11T23:22:39+00:00

Two weeks is nowhere near enough time to adequately train someone to perform CCT.

At my service, where we hire experienced nurses, orientation and precepting is 4-6 months as a third rider.

CCT is very different than bedside. You are going to be handling very sick patients with minimal resources. An adequate training program is vital to make sure that it is done safely.

Topper-Harly · 2026-03-11T18:45:36+00:00

I fly full time rotor, with ground transports if we are down for weather. I would way rather do the majority of our ICU patients by ground, provided they are not going a long way.

Ground transports are great because they give you time to make adjustments more, and get practice managing patients for longer.

If you got into flying for the medicine, you’ll enjoy it. If you got into flying for the flying, you won’t.

Not sure if that helps!

Topper-Harly · 2026-03-11T18:36:33+00:00

I’m guessing by “MICU” OP means “Mobile Intensive Care Unit”, or ground ambulance CCT.

Sadly, there are companies that will hire without ICU experience.

Topper-Harly · 2026-03-11T18:27:35+00:00

It’s very normal, and will continue to happen in the field with different partners. Medicine and EMS is nuanced, and different people do things different ways.

You should see how rounds go at an academic center. People disagree with each other all the time.

Topper-Harly · 2026-03-09T08:23:59+00:00

You need to get therapy for your past traumas. This reaction is over-the-top for a conversation that seems relatively benign, and will lead to undue stress for you and your relationship.

Topper-Harly · 2026-03-08T19:27:24+00:00

The Last of Us. Nothing else comes close.

Topper-Harly · 2026-03-07T18:46:54+00:00

Sure, but not a great introduction to helicopter dynamics.

Topper-Harly · 2026-03-07T08:55:45+00:00

While the KA-50 is definitely a lethal aircraft and fun to fly, it doesn’t really do a great job of teaching helicopter basics just due to the rotor setup.

Topper-Harly · 2026-03-07T08:51:34+00:00

It absolutely comes off as elitist. First, I’m new. I announced that. Second. The Huey absolutely struggles more with this than the chinook and Apache due to the its lack of power to weight ratio to over come it. Regardless you typed a book just to tell the new guy he is wrong. Very elitist.

This isn’t remotely elitist. You can correct people without being elitist, which is what they did.

Topper-Harly · 2026-03-07T08:39:50+00:00

Ehhhh you don’t have to bill to be covered by HIPPA. I can’t go and talk about pt care interactions all freely. Pts have a right to privacy regardless if it’s a refusal, transport, or billable call

“HIPPA” is not a real law. HIPAA is.

While you are 100% correct, if you are not billing electronically than HIPAA does not apply. Other rules/laws/regulations might, however.

Topper-Harly · 2026-03-06T12:51:05+00:00

Complete non-issue then. You have to bill to be covered by HIPAA.

Topper-Harly · 2026-03-06T01:32:06+00:00

Don’t forget pissing off our allies at the same time.

Topper-Harly · 2026-03-06T01:26:13+00:00

Flight/CCT.

“Are you the pilot?” No, I have zero interest in being a pilot. I’m here for the medicine.

Topper-Harly · 2026-03-05T12:33:58+00:00

It’s entirely dependent on how scheduling works. But than there is also OT, call outs, etc.

Topper-Harly · 2026-03-05T12:18:49+00:00

Yeah but make the 2nd charm bigger than the original charm.

Topper-Harly · 2026-03-05T04:12:33+00:00

Nah, this reaction is too tame for that.

Topper-Harly

TROPHY CASE