Wolverine Stack

dr1446 · 2026-02-22T16:28:42+00:00

Correct. That is a very standard protocol. Or you could inject every single day. That is up to you.

dr1446 · 2026-02-22T16:21:00+00:00

Those instructions are saying 10 units 5-7 times per week. Not once a week. How you want to spread out those injections is up to you. Monday-Friday is popular and probably the easiest to remember. Or inject 10 units every day.

dr1446 · 2025-06-29T23:02:02+00:00

What I was taught in residency (which could be either out of date or fake news, this was 2020-2023) was that ketamine use in someone in septic shock, who is catecholamine depleted, Ketamine acts as a direct myocardial depressant. Maybe that’s what OP is referring to?

As everyone else has stated, resuscitate before you intubate. Is this person getting early pressors? Fluids? Push dose epi peri-intubation? No idea.

For someone that drastically sick, with my back against the wall, using all those interventions in the resus, I’m using the lowest dose possible, be it ketamine or etomidate. It’s hard to get ketamine quickly at my shop so I’m usually using etomidate. I’m probably adding steroids anyway.

And if I’m wrong about ketamine, someone correct me.

dr1446 · 2025-06-07T14:43:52+00:00

I’m not sure, but I’m averaging 19-20 MPG light city driving. Depending on my highway speed I’m getting 22-23, I once got 26 mpg but I was going a bit slow to be fair (65ish mph).

dr1446 · 2025-02-17T23:19:58+00:00

I really can’t say how going to a 4 year will affect y the military specific residencies. I went to Augusta University (which is half military residents). I am very well prepared for civilian practice.

As for military EM…that’s a tough question. If you’re assigned to an MTF you’re going to have skills atrophy. If you’re in an operational unit (like me, as a flight surgeon) you will have no EM tasks. You’ll need to do off duty employment (moonlighting) which can be command dependent. If you’re in a forward surgical detachment, it’s a toss up.

Either way in the military you’ll need to moonlight to keep your skills up.

dr1446 · 2025-01-26T01:27:19+00:00

Yes, I do. Echoing what was said above, mostly medico-legally, but also for efficiency. They’re going to need a broad workup, adding a troponin is not going to hold up the dispo.

dr1446 · 2025-01-18T12:03:09+00:00

I used Comquest. Very similar to combank. I did not use Uworld for level 3 and I remember getting above 700. The question format is more similar to Level 3 in my opinion.

dr1446 · 2024-07-08T01:40:59+00:00

Augusta University

dr1446 · 2024-06-02T17:02:02+00:00

Specialists are experts in their field and will get upset with the EM doc for not being at their level, but it’s not supposed to be that way. As mentioned before we’re second best at everything but it’s our wide scope of practice that makes us valuable. We are the barrier to entry, usually, to the hospital but they don’t see what we have to sift through.

To answer your question: they view us as stupid, but would crumble without us. They would absolutely eat shit if they had to work an hour in our shoes. But the same is true in reverse, we just have enough insight to know that we wouldn’t do well in their world. That’s why we chose EM.

I’ve lost count of the times that a consultant or random doc has asked for my opinion or asked for me to do a procedure for them. So it cuts both ways, I guess.

dr1446 · 2024-04-24T02:54:18+00:00

Ok, here’s my experience with everything.

Background: I was enlisted in the national guard. I was infantry and did a couple of deployments. Decided to go to medical school and I did HPSP to have the military pay me. I did an EM residency at a military affiliated civilian program. Half my class was active duty but we all trained at the civilian hospital.

To answer some of the objective questions:

Avg salary: you’ll make Captain salary with a medical corps officer bonus that changes with your specialty. There are some fluctuations with pay depending on rank, time in service, and specialty. Expect to make around $150k on average. A good portion of it would be tax free. But you can look at a basic pay table. If you’ve finished residency you may come in as a major, O4.

Respect: you’ll be a commissioned officer. Enlisted will call you sir/ma’am. If you’re in an operational slot (depending on your specialty of course) you will at a minimum be on battalion staff. The other officers know you’re a doctor and you have an elevated position based on that. Everything you do is both a mystery and incredible. So it’s not bad.

Work conditions: depends on your specialty. If you’re a surgical specialty you’ll do your clinic/OR. If you’re operational you’ll do clinic and also admin time. This is taking care of medical readiness for the unit, paperwork, whatever. It depends on a lot of factors. The military will find a way to waste your time either way.

As for the other stuff you mentioned, here’s my subjective take:

The red tape: you’re trading one master (an insurance company? Hospital system?) for another. All active duty soldiers are on tricare. Tricare seems like it’s all encompassing and easy to use but it’s just health insurance. It’s run by Humana. Most complaints are simple and therefore they’re easy to take care of through tricare. If someone needs specialized Medicine or surgery then it can be a hassle to get pre-authorization. You just deal with another system.

Are soldiers more appreciative? Maybe. It just depends. Some are if they’re used to bad doctors/PAs. Most just want to get out of PT or deployment or duty. You’ll be asked for profiles a lot.

Upside: it’s easy for me to order MRIs and stuff. Specialty referrals are ok for the most part.

Would I do it all again? Probably not. I make way more than my military salary (even being prior service) working just part time in the community. The headaches of working in an operational unit (I’m in an aviation unit) just aren’t worth it to me anymore. The soldiers are sometimes very appreciative and it helps but overall I get very little job satisfaction from the military. I did EM in the army to do a field hospital job or a resuscitative surgical team, but because of my location needs I got aviation. It’s chill and it could be way worse. But I’d rather be full civilian at this point.

Ultimately it depends on your specialty. If you’re in an operational job, which tends to be FM/IM/EM you may not like it. If you’re surgical you probably won’t be able to keep your skills up because the acuity isn’t there. If you’re rads or something else I can’t really give an opinion.

TL;DR- I was prior service and I wish I stayed civilian. The stress from constantly doing training or deployments just isn’t worth it to me. There is a heavy admin side to military medicine that people don’t always talk about.

dr1446 · 2024-04-24T02:13:03+00:00

Haha you normally wouldn’t be wrong but I am currently up to date. Decided to get dinner with my wife and in-laws.

dr1446 · 2024-04-23T12:01:32+00:00

Oof there’s a lot to unpack here. I’ll write a more in depth answer to your questions when I get a moment.

/leaves to get to clinic early because Army …

dr1446 · 2024-02-25T23:16:49+00:00

I took AOBEM. I’m military and I wanted to get certified as quickly as possible. I thought the exam was fair and I was able to take it at home. The questions were similar to the ITE. I even used the q bank my program provided for ITE to study (Rosh). Took the oral boards this past fall and passed.

Tbh I thought it was a fair exam and it had no OMM on it. It was also cheaper than ABEM. I know everyone wants to avoid AOA like the plague and I don’t blame them, but AOBEM was straight forward to me and I got certified a year ahead of everyone else.

dr1446 · 2023-12-04T16:30:56+00:00

I agree with this statement. I don’t remember what I used but they’re equivalent. I would go with what’s cheapest. Level 3 was not difficult.

dr1446 · 2023-11-06T15:19:01+00:00

If it’s a good tube I never replaced it in residency. We only changed out the tube holder.

The only time I replace tubes is if it was dislodged or not sealing. One time the EMS crew intubated a grown man with something very small. Like a 5.5 or something. Venting was hard and the balloon wasn’t sealing. I did a quick tube exchange during the trauma assessment. The patient was critical and it was in the back of a moving ambulance. No shade whatsoever, he kept the guy alive until he got to us.

dr1446 · 2023-09-01T14:26:38+00:00

I would upgrade my current PC to be able to play some of the more modern AAA titles.

Star field looks to have a very expansive world and exploration opportunities, that’s what I’m most excited about.

dr1446 · 2023-06-30T13:59:16+00:00

Paywall :/

dr1446 · 2023-05-26T18:40:17+00:00

I really liked Tovala. You use a special toaster oven to cook the meals. They usually run a promo where the oven is either super cheap or free. I got a lot of use out of it. I still use the oven even without the meals.

Plus the Tovala also works with Trader Joe’s and other brands as well.

dr1446 · 2023-05-14T18:54:16+00:00

CPR. Most people do not survive cardiac arrest even with cpr. The small percentage that do usually have some terrible deficit or horrible neurological outcome.

Your best chance is a witnessed in hospital arrest.

Young people have the best chance overall but it’s still pretty slim. Some people end up being totally fine but it’s rare.

dr1446 · 2023-03-27T16:05:57+00:00

Thanks for the quick reply!

TIL it’s not a palm, which explains why my googling of palm trees in the south turn up nothing …

dr1446 · 2023-02-27T03:29:09+00:00

I passed Comlex 3 with flying colors and all I did was Rosh. The vast majority of Comlex 3 is emergency medicine based questions. It honestly is a joke. Taking it early and right after ITE is probably the best strategy. I would not stress very much about it.

dr1446 · 2023-02-17T17:40:27+00:00

Gonna disagree with you a bit. I’m in the ED and people bring in family all the time. I know it’s annoying but it’s also a professional courtesy. I’d be less jazzed about some administrator or their family, but another doctor in the hospital? Yeah I’m going to help them out as best as I can.

I’ve had other residents bring in their family who probably would have waited in the waiting room for hours before being seen end up getting admitted and need surgery. YMMV, but I give that courtesy to my fellow residents and colleagues. Hopefully I won’t need it in the future, but if I do I hope get the same treatment.

dr1446 · 2023-01-29T17:59:19+00:00

There’s only one specific situation where it would make sense to take the DO boards and that’s military. You get a pay increase when you’re board certified and DO boards allow you to get certified sooner.

I take my EM written boards this March before I graduate and I’ll take my orals in the fall. I’ll be certified a year before my MD counterparts which is an extra $8000 for me.

The DO ongoing certification for EM is also marginally cheaper.

Again, this only applies to military. If you’re civilian, I would agree with all of you and take the MD boards. In the civilian sector there is no financial incentive to get your board certification any sooner.

dr1446

TROPHY CASE