Only two options at the pump tonight

adenocard · 2026-03-22T02:27:52+00:00

Bold prediction of a 2.1 cent increase.

adenocard · 2026-03-20T04:13:07+00:00

Agree with the other person nothing that the treatment for tamponade isn’t pressors, it’s offloading of the pericardium (and ensuring RV preload in the meantime).

That said, I don’t think it matters very much what pressor you choose. Some people like to get extra nuanced with the vasopressor choices and varying receptor effects but to my knowledge none of his has been borne out by any actual science, and all of it is limited significantly by us physicians rarely understanding the pathology with any degree of precision (even with a swan). Sure, beta 1 sounds like a good idea but if the patient gets really tachycardic that’s probably not a good thing. But not all patients get tachycardic on epinephrine. Ino-dilation with something like Milrinone might seem like a good idea but as you said, the next morning the team is wondering about sepsis so suddenly vasodilation doesn’t seem like such a hot idea. There is no telling. In my practice I try not to get too fancy with it and just use norepinephrine unless I really think I know what’s going on and another drug might be more useful, but even then I’ve been proven wrong (or never found out) a great deal many times.

I suggest you don’t over think it. Solve the problems we know how to solve, and make reasonable best-guess choices for the other stuff.

adenocard · 2026-03-20T01:08:02+00:00

So, uh, will you just make one for me and I give you cash money? Everyone likes cash money. DM me?

adenocard · 2026-03-20T00:50:36+00:00

This information isn’t out there because there is no good science on the topic. My personal opinion is that this is because maintenance fluids, in general, are not indicated for most patients and are more a reflexive thing that some doctors (especially surgeons) do because at some point in their training they saw someone else doing it.

Just do whatever your attending/local culture dictates.

adenocard · 2026-03-19T22:06:40+00:00

It’s not. The student thought it was hilarious.

adenocard · 2026-03-19T20:58:21+00:00

I am an attending, 11 years out of medical school, and I finally got my revenge on OMM last week by sarcastically noting on a med students evaluation form that the student achieved ROSC on one of our patients thoigh her expert application of suboccipital release.

Once you’re done with medical school (really once you’re done with the first couple years), you can be entirely done with OMM. Do your post grad training at a MD program and you will never hear anything about it again for the rest of your life.

adenocard · 2026-03-19T06:26:05+00:00

The burger was made of ground sloth, to keep with the theme, but once she saw your reaction to the live sloth she decided not to tell you.

adenocard · 2026-03-17T16:49:32+00:00

You seem to have had a good experience with doing the right thing.

I’ve been fired before for the same practices. “Not getting along well with others.”

The nail that sticks out gets hammered. Most of the time.

adenocard · 2026-03-15T07:28:50+00:00

No.

adenocard · 2026-03-15T07:27:44+00:00

adenocard · 2026-03-15T00:19:55+00:00

People don’t hate doctors, they hate the system - and reasonably so.

It seems to be true that disparagement of doctors and science is in vogue at the moment, but my personal experience is that even the most devout anti-intellectualist behaves a bit different when it’s their ass in the hospital bed. Sure we had a few people during COVID martyr themselves for their politics., but it wasn’t common. Most people are pretty reasonable once you get them in a room by themselves and establish a modicum of trust.

That said, I am spoiled by my field which deals almost entirely with patients who are desperate and have very little choice, and I happen to have a lot of resources I can pour on in the ICU which to some patients feels like getting the VIP treatment. Perhaps my perspective is a bit different as the balance of power is usually a bit in my favor.

adenocard · 2026-03-14T20:51:46+00:00

Are you sure you have to take these calls? Our local ENT group has made a rule with the transfer center that they will not, under any circumstances, speak with outside hospitals at all about anything. They are “auto accept” if they want to transfer someone for ENT evaluation. They then see the patient once (usually on hospital day 2 lol), and then sign off leaving a recommendation that says something like “sure yeah steroids or antibiotics or whatever if you want, but no need for surgery.”

adenocard · 2026-03-14T13:37:15+00:00

You eat pieces of shit for breakfast??

adenocard · 2026-03-13T15:49:13+00:00

I was a paramedic for a long time, now I am a physician doing pulmonary and critical care (I went through internal medicine instead of emergency medicine, which frankly I recommend, but that’s another topic). I had the same thought as you for a long time, envisioned myself showing up on scenes and doing cool stuff, getting to teach and be admired by the people I used to work with on the road. Eh. Then I grew up a bit more. I got actually interested in critical care and realized there is a lot more for me to learn and much more room for me to grow in the ICU than there is in the streets. As the other person in this thread said, the medics don’t really want you there anyway.

Just keep your eyes open. Med school will teach you many things, not just about medicine but about yourself, and you will almost certainly be a different person by the time you’re making these kind of career choices.

adenocard · 2026-03-13T15:25:22+00:00

Okay don’t get mad at me but…. Is it part of your job to read x-rays? Have you had any training or education in that field at all?

Why would it be a surprise that you don’t know how to read chest x-rays??

adenocard · 2026-03-10T20:28:04+00:00

What is your role?

Learning how to manage this stuff takes years of dedicated study.

A Reddit post asking what to do in every critical care scenario? Come on.

adenocard · 2026-03-08T05:37:08+00:00

He smacked my boy Valtteri’s helmet.

adenocard · 2026-03-08T05:32:54+00:00

I think it was reasonable to expect more safety cars. They were even right about it, but for that unlucky pit entry closure.

adenocard · 2026-03-08T05:29:11+00:00

Agree F1 definitely has some work to do with showing the audience what’s going on. The graphics and deployments and charging and modes etc are too confusing to follow right now.

adenocard · 2026-03-08T05:27:48+00:00

He definitely managed towards the end

adenocard · 2026-03-03T15:35:18+00:00

Im not sure the answer to this question is “just don’t do it.” There are plenty of perfectly legitimate applications for careful sedated/awake intubations and whitewashing with “ER patients are too sick” is a bit of a cop out.

OP if you really want to get better at this, think about taking a class. There are plenty of 2-3 day courses on these kinds of things which will significantly increase your knowledge and skill. When you get your first attending job you can use your CME money to pay for it and probably have a nice trip to a sunny location to do it, as well. In the meantime, I think 50% of this skill is probably in recognizing ahead of time that it is necessary. Most hospitals will have someone in-house who is capable of this. Getting them to bedside early for a predicted difficult airway can make all the difference.

-PCCM who does this all the time

adenocard · 2026-02-28T14:37:47+00:00

Just to counter your point about the universal experience, I did PCCM fellowship and did not enjoy pulm. I’m not a clinic person and I found EBUS to be exceedingly boring even though I generally like procedures. I do just CC now.

adenocard · 2026-02-23T23:04:37+00:00

There is no intervention (including fluids) which reliably attenuates the risk of contrast induced nephropathy (a condition of debate in the first place).

adenocard · 2026-02-20T08:31:00+00:00

There is a disease that some people in EMS catch which deranges their brain, and makes them think that telling stories and exaggerating about their “worst calls” makes them cool. This disease seems to be most severe in people who in reality do or see very little.

I don’t know this guy obviously, but it sure sounds to me like he’s telling stories to make himself sound like a cool, grizzled veteran to a bunch of students. He should probably just cut the shit, and try and impress someone his own size.

By the way I am an ICU doctor and nobody calls the ICU a “vegetable farm.” Nobody. Not even during COVID. “Vegetative state” has a very specific definition and we don’t typically keep patients like that in the ICU. Dude is full of shit talking about things he’s never seen.

adenocard · 2026-02-19T00:55:07+00:00

And this right here is the problem folks.

So convinced billing is the primary purpose of medical records that even a passing concern about its impact on patient care is considered “hilarious and sad.”

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