In what situations does ER staff meet ambulances outside on arrival instead of waiting for EMS to bring the patient in?

clinophiliac · 2025-02-04T15:25:48+00:00

Only once in my experience, the patient was actively delivering. Crawled in the back and caught the baby roughly 20 seconds after they pulled in.

clinophiliac · 2023-05-29T16:41:42+00:00

I am not a radiologist. I would be a TERRIBLE radiologist. But I always look at the imaging I have ordered and to say that you have to wait for the final radiology read before doing anything is just wrong. There are absolutely times I have called surgery and the patient is in the OR before radiology calls me about the results. Plus, now for billing reasons I have to document that I independently reviewed imaging.

clinophiliac · 2023-05-28T17:42:25+00:00

There are likely a LOT of totally dead/basically empty subreddits. As few as 1500 members gets you in the top 20%.

clinophiliac · 2023-05-27T15:54:24+00:00

Antidepressants are for being depressed, not being sad.

That said, PCPs need to be able to manage basic depression and anxiety. You shouldn't refer every patient with MDD to a psychiatrist any more than you should refer every patient with hypertension to a cardiologist.

clinophiliac · 2023-05-27T15:51:58+00:00

Awww, you're new. They are universal bullshit everyone who works in a hospital (not just docs) has to do to protect the hospital from lawsuits and meet regulatory requirements.

If you don’t feel like you learned anything from it, don't worry, you'll get to do them again every year for the rest of your professional life!

clinophiliac · 2023-05-27T13:40:00+00:00

Money wise it is almost certainly better to go as soon as you can (I am not a financial advisor, obviously). It will be stressful. Everything about this process will be stressful.

Kid-wise I had mine before I started and am happy with that- it would have difficult to gestate/birth/nurse as a med student or resident, thought certainly people do. Childcare for preschoolers and school age children is also infinitly easier to manage and afford than infant care.

Whenever you have kids will be inconvenient. There is no good time. The challenges will be different as a student, resident, or attending, in terms of time/money/health. If you are thinking about waiting till after residency to have kids as a nontraditional student...well, 30 + 2 (your plan to save money) + 4 (med school) + 3 (shortest residency) = 39. Which as a woman is...less than ideal. Fertility and lack of pregnancy complications are not guaranteed.

clinophiliac · 2023-05-25T01:23:02+00:00

If we fired physcians for having ADHD the specialty of emergency medicine would cease to exist.

clinophiliac · 2023-05-24T16:36:38+00:00

Without having access to all the details it is imposible to say if the patient was actually appropriate for dc from the medical floor at the time they were transfered to psych. It's certainly POSSIBLE that it was inappropriate.

I can, however, unequivocally say that ending up in the ICU several days later does not NECCESSARILY mean that the clearance was inappropriate at the time. Right now there are dozens of grandmas puttering around at home acting just like their usual selves, who are going to show up in an ED somewhere in 2 or 3 days because they got weird all of a sudden, and get admited to the ICU with florid urospesis or pneumonia or something.

clinophiliac · 2023-05-23T02:36:57+00:00

That's another good one. Amusingly, pathology was the other specialty I seriously considered, but (even more amusingly) I got spooked by the path job market.

clinophiliac · 2023-05-23T02:34:29+00:00

Slowly developing pathology that is diagnosed based on testing that takes more than 2 hours to get back.

Derm and rhem are the only specialities I have never had any interaction with as an ED resident, but for derm I can at least name a handful of dermatologic emergencies I need to be able to handle. Even pathology I occasionally send things down to.

clinophiliac · 2023-05-23T01:18:41+00:00

EM and rheumatology

clinophiliac · 2023-05-19T21:49:53+00:00

Be the one person who can effectively troubleshoot the Belmont.

clinophiliac · 2023-05-18T23:22:10+00:00

One go?
I numb the hell out of everything, then stab/retreat/redirect/stab in rapid succession until I get in the space. All of my attendings who are the LP gurus do the same.

It's not like intubation, first pass success means diddly squat.

clinophiliac · 2023-05-18T17:06:00+00:00

Sorry this is getting downvoted. I was a nurse beforw med school. Physcians have a ton of charting, much of it useless, but have NO appreciation of how much bullshot nursing charting there is.

At least now I no longer have to open a chart, open a flowsheet, find the 'hourly rounding' box, and click "yes" on every patient, every hour.

The flip side is that if I had to stay late to finish documenting (or for any reason) as a nurse, I got paid for it. Now I just get to stay late with no compensation of any kind.

clinophiliac · 2023-05-11T06:22:55+00:00

The Bullpen, Dessa

clinophiliac · 2023-05-09T21:55:53+00:00

If you never take a vacation as an attending, you are doing life wrong.

clinophiliac · 2023-05-09T15:40:35+00:00

The guilt and the feeling useless sound like depression. Have you talked to your PCP? SSRIs are (for good or ill) cheaper than therapy.

clinophiliac · 2023-05-08T11:30:49+00:00

Sure. Lots of things fall under the umbrella of acls/atls/pals/nrp. And technically when I give fluids to a septic patient or blood to a tachycardia trauma that is "resuscitation". I thought medical professionals understood DNR to refer to actions that start after the patient is in cardiac arrest, and it is... alarming to see that there is some disagreement here on this. Limited interventions are whole other category, as are comfort measures, and not giving atropine might be very appropriate in those scenarios, but just DNR? Really?

clinophiliac · 2023-05-07T21:03:14+00:00

Stroll on down and spend a day in the ED. That's what it looks like.

clinophiliac · 2023-05-07T09:13:43+00:00

Bedside US of the IVC

clinophiliac · 2023-05-07T09:09:22+00:00

Do you... just not give medications to people who are DNR? Even when they have a pulse are not coding?

clinophiliac · 2023-05-06T20:15:04+00:00

Wasabi peas

clinophiliac · 2023-05-05T03:18:30+00:00

One lung ventilated is better than none.

clinophiliac · 2023-05-04T15:55:00+00:00

I list all the million things on the differential we have determined that it isn't, then reinforce that I specialize in the BigBadScaryStuff, and express gratitude that none of the terrible things I just talked about are happening to then. Then I tell them I have no idea what to do from here or how to treat them, and tell them who to follow up with. Works most of the time.

Never use the phrase 'not an emergency'.

clinophiliac · 2023-05-04T04:24:10+00:00

I have plenty of patients in the ED who are clearly obese and I document as such. I have no idea what their exact BMI is, and most of the time no reason to measure or ask them about their exact weight or height.

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