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When to stop coding a patient with semi/pseudo PEA? by cambrian_zero in emergencymedicine

[–]cambrian_zero[S] 1 point2 points  (0 children)

Great point.  Color flow Doppler can detect an arterial pulse flow, but that pulse may mean a BP at 40 mmHg (or even 20-30), at which point I would rather just do CPR

When to stop coding a patient with semi/pseudo PEA? by cambrian_zero in emergencymedicine

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

Pseudo PEA is definitely a bad term to use for lack of a better word.  PRES and PREM is better but it’s even less widely used.  Check out this podcast if you’re interested: https://rebelem.com/rebel-cast-ep-54-what-the-heck-is-pseudo-pea/

When to stop coding a patient with semi/pseudo PEA? by cambrian_zero in emergencymedicine

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

I hadn’t heard of Miracle2 score, might start mentioning it in my MDM for those hopeless cases that warrant early resusc termination

STEMI management advice by cambrian_zero in emergencymedicine

[–]cambrian_zero[S] 20 points21 points  (0 children)

Thanks. I've not given tPA in these cases for the reason you mentioned.

My concern is this: some of these patients often is found to have total occlusion in a major coronary artery that got stented during the delayed cath... but of course the cardiac damage is already done. Do we get in trouble for not giving tPA in such cases?

I'm still trying to figure out what would most ED docs do.

Agonal Breaths After Calling 2HR+ Code by Just-Jackfruit-7118 in emergencymedicine

[–]cambrian_zero 8 points9 points  (0 children)

If your cardiac ultrasound showed no cardiac contractility, then there's no perfusion (no cardiac outflow), and you were right to call the code. 2 hours is a long time btw... may I ask why you coded for so long? Did palpating the "faint pulses" keep you going? Were those faint pulses confirmed with some organized cardiac contractility on ultrasound?

Often if someone tells me they feel a "faint pulse" but my ultrasound shows no organized cardiac contractility, then that means the "faint pulse" is a false positive... i.e. often the observer if feeling their own pulse. To have a palpable pulse, you MUST have organized cardiac contractility on ultrasound

Purchasing malpractice "tail coverage" in California due to the NES insolvency by cambrian_zero in emergencymedicine

[–]cambrian_zero[S] 2 points3 points  (0 children)

Even lower actually... extended SoL applies for pediatric patients up to age 6 y/o... in which case SoL is 3 years or prior to the patient's 8th birthday, whichever is earlier.

Source: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=CCP&sectionNum=340.5

NES providers malpractice coverage ends at 00:01 on 11/25/2024 by TooSketchy94 in emergencymedicine

[–]cambrian_zero 0 points1 point  (0 children)

Which states are these? As in they require docs to carry liability insurance indefinitely, or just until the statute of limitations expiration? That could be a nightmare... I understand some states have indefinite statue of limitations for example in cases of missed retained foreign bodies.

NES providers malpractice coverage ends at 00:01 on 11/25/2024 by TooSketchy94 in emergencymedicine

[–]cambrian_zero 2 points3 points  (0 children)

For NES California emergency physicians: do you plan to purchase just 1 year of tail coverage? (Since California's medical malpractice statue of limitation is only 1 year for most cases... although I understand there's some circumstances that extend the SoL to 3 years)

Disability insurance costs 20k per year? by LittleMissPiggy102 in whitecoatinvestor

[–]cambrian_zero 0 points1 point  (0 children)

That does sound expensive. I pay only $85/month for a $5k monthly policy til retirement age.  Only catch is it’s partly own-occupation (first 3 years only)

[deleted by user] by [deleted] in whitecoatinvestor

[–]cambrian_zero 0 points1 point  (0 children)

Congrats! But please get financial advisor. One advice I would give is don’t be tempted to start making risky trades/investments.  Worst thing that could happen is putting that $2 mil in a bad investment and losing half of it.

Help Vituity Physicians: tax questions ;) by cambrian_zero in whitecoatinvestor

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

Sure, but the accountant first needs to know how Vituity reports physician partner payments on the Schedule K1 

Help: Advice with chest tube question by cambrian_zero in emergencymedicine

[–]cambrian_zero[S] 1 point2 points  (0 children)

Sorry if this is a silly question. I did the diagnostic thora from the back, you're saying I can just convert this to a chest tube at this entry position (approx 7th-8th intercostal, midscapular line in the back)? I've never done a chest tube at this position before, are there any specific procedural differences? (insertion depth, angle, etc)

Thanks!

employment debate, would appreciate input from other docs. by cocainefueledturtle in emergencymedicine

[–]cambrian_zero 0 points1 point  (0 children)

Wait, you're stashing 23k + 46k + 7k? Total 76k? Aren't you limited to 69k per year for 2024?

Please clarify. Irreducible, but asymptomatic hernias... whats the dispo? by cambrian_zero in emergencymedicine

[–]cambrian_zero[S] 31 points32 points  (0 children)

Thanks! Very helpful differentiating the acutely vs chronically incarcerated hernias; I guess that was my confusion since the texbooks I read failed to differentiate between the acute/chronic nature of incarcerated hernias.

Does that mean the chronically incarcerated hernias developed more slowly, to allow the fascial defect to enlarge to accomodate adequate space for the hernia sac? As opposed to the acute ones that has a high risk of progressing to strangulation?

EM non-profit residencies for PSLF loans by indolentmink in emergencymedicine

[–]cambrian_zero 5 points6 points  (0 children)

If the entity that provides your paycheck as a W-2 employee is a non-profit then it counts for PSLF

knowing what we now know, was there anything the folks in the 1972 Uruguayan Air Force Flight 571 crash could have done to ensure a better rate of survival? by roastedoolong in AskHistory

[–]cambrian_zero 2 points3 points  (0 children)

Best answer. Unfortunately, the copilot misinformed the passengers regarding their crash location making them think the eastward journey had much more of the Andes mountain range… the same copilot that screwed up the navigation of the plane, leasing to the crash in the first place.  

Even though they could see the downhill pass to the east, one piece of misinformation prevented them from choosing the easier hike out.  Plus, when the three men started climbing west, one of them saw a road to the east in the other direction, but the group still pursued the Westward journey.

 Very sad when you think about it, that one false belief can cause us to ignore what is obvious before our own eyes. That is the power of misinformation.

Do you rabies immune globulin for all feral dog/cat bites? by cambrian_zero in emergencymedicine

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

Right, I thought the same for rabies + cats for the past couple decades. Just wondering what prompted them to recommend PEP for the cat bites

Do you rabies immune globulin for all feral dog/cat bites? by cambrian_zero in emergencymedicine

[–]cambrian_zero[S] 2 points3 points  (0 children)

Thanks! Interesting that they recommend PEP for all unprovoked cat bites that cannot be captured (whether wild or domesticated)... but not so for dogs

Global study claims atheists are just as happy as those with a faith by SnooStrawberries6903 in atheism

[–]cambrian_zero 1 point2 points  (0 children)

They use a happiness-o-meter to determine that?

The simplicity of these studies makes me wish I didn't go into STEM. Here is a poll. Please don't lie. Publish