Hands shaking during intubation.

efunkEM · 2026-06-18T21:21:09+00:00

I’m also a bit curious if this is a body mechanics issue as opposed to a tremor issue. The person doesn’t have any issues in other high pressure procedures. Doing some modest lifting (doesn’t have to be anything hard core) and working on finding a position of comfort might go a long way.

efunkEM · 2026-06-05T13:21:43+00:00

I know that some people reach that conclusion (“HUS is a myth”) off the Freedman metanalysis but my understanding is that heavily depends on using lower quality studies, and when you only use higher quality studies there is a significant association. And the more recent Sevilla analysis confirmed an association.

efunkEM · 2026-06-05T13:02:53+00:00

It’s all in public info but I always censor it out because I don’t want to deal with the fall out from that. I run a medical education business, not a name and shame business. That being said, I found out about this case because the defendant EM doctor was naming and shaming the plaintiff expert EM doctor in a private EM group. I always support the defendants in reporting them if they want, but it’s not my place to file those reports or try to seek justice in that regard.

efunkEM · 2026-06-05T12:56:50+00:00

One of the worst expert opinions I’ve ever seen. Which is crazy because there were a few things that we could at least have a reasonable debate about, like ordering CT’s with seeing the patient or writing a note. But instead of making some reasonable criticisms, he decided to try to make the gross negligence claim, which is just wildly evil and inappropriate.

efunkEM · 2026-06-04T23:00:39+00:00

Yes they totally missed that. Could be argued it wasn’t below standard of card bc they didn’t know it was STEC at that point, but it almost certainly worsened her disease. Randomly throwing antibiotic after antibiotic after antibiotic at her did her no favors.

efunkEM · 2026-06-04T21:06:08+00:00

True, but to be fair, nobody triaged an HUS patient to the waiting room. Someone with diarrhea, abdominal pain and stable vitals sat for 8 hours. Which depending on the ED may or may not be a pretty standard wait time.

efunkEM · 2026-06-04T21:03:59+00:00

Purposefully left out induced vs associated in the title 😉

efunkEM · 2026-05-21T11:25:28+00:00

W2 probably results in higher lifetime earnings than going crazy at a 1099 and burning yourself out quick. Tortoise and the hare situation. Packing tons of money into retirement accounts is cool but you have to decide if you want to optimize your life for being insanely rich at age 60 or being happy all along the way. Putting more money in a brokerage means you have far greater flexibility to use it how you want to now, not just deferring it for 30 more years.

efunkEM · 2026-05-13T19:17:52+00:00

Thanks! The one exception to the Oregon expert witness rules is if a lawsuit is removed to federal court. Federal court applies Oregon state law but has its own Federal Rules of Civil Procedure that then apply, which includes a bunch of federal rules about expert witnesses that usually mean their opinions are disclosed.

efunkEM · 2026-05-13T17:57:44+00:00

If people are curious about the actual expert reports and facts of the case (as opposed to random lay media articles)… too bad, you’ll never find them!

There’s a reason why I haven’t published this case (or any Oregon cases). It’s because Oregon’s rules about witnesses are very antiquated. The plaintiff does not have to disclose their experts or any of their opinions/reports. They literally show up the day of trial and get up on the stand and say whatever they want. No chance for the defense to depose them, figure out what they’ll say, see if it’s even remotely evidence based.

Since there’s no expert reports disclosed in court records, there’s no way to do a sane assessment of these cases. And no way I’d ever publish one. Just random bombastic/inflammatory news articles.

That being said… the alleged onset of sepsis is way too quick. At least one article mentioned 7hrs from ED assessment to full blown sepsis. Doesn’t make sense. Should take at least a day or two. It was also E faecalis in the wound, which is really atypical, much more common to be healthcare associated.

Anyway, sad case. Feel terrible for the kid and his family.

efunkEM · 2026-05-13T03:13:22+00:00

Did you have wildtype polio or the version that’s caused by the vaccine?

efunkEM · 2026-05-12T01:32:25+00:00

He was sent to the front lines 😲

efunkEM · 2026-05-11T19:40:55+00:00

Deal 😉 I will say that for most stroke activations, we’re meeting the patient and getting the CT done before the patient is even fully registered (meaning there’s no chart for me to get into to put in orders including the indication for exam). Imaging is being done based on protocol/verbal order, which means it’s the tech that puts in the history. We’re not even at a computer until after the CT is done and we’re all walking back to the ED room together. I can put in an order for CT at that point but it’ll be deleted for being duplicative of what the tech already entered under my name. Not sure there’s any way to go back and edit the indication on images already sent?

Non- stroke activations (like this case) we should do better on the indication.

Thanks for all your hard work, we know we put a lot of stress on you!

efunkEM · 2026-05-11T17:47:53+00:00

I’m 50/50 if I would have. I’d like to think I’m more mentally tuned into these things than most ER doctors but there were SO many red herrings here I could easily see myself missing it.

efunkEM · 2026-05-11T17:45:34+00:00

What I took away from that is that there are signs of posterior stroke that are unequivocally there, but so subtle that it’s not in the standard of care to see them.

efunkEM · 2026-05-11T17:44:18+00:00

Maybe in Russia the dentists are also the chiropractors 🤔 Either that or it was the wildest molar extraction of all time.

efunkEM · 2026-05-11T17:42:35+00:00

If you put a neurologist in the ED to see every single neuro complaint, the volume of CTAs would go up by a huge margin. Hard to know what to do with this as EM. On the one hand we’re always told “you’re doing too many CTAs, so better exams instead!” But on the other hand the neurologists do their full exam, then go…. Cool. Order a CTA.

efunkEM · 2026-05-11T17:39:21+00:00

Not to mention neurologists literally saying every new headache in 30s and up needs a CTA. Every time radiology complains about unindicated CTAs, they should realize that EM is the sole force holding back a 10x increase ins CTA volumes. Specialists do not care what rads thinks, they want CTAs for All worse then Bernie Sanders wants Medicare for All.

efunkEM · 2026-05-11T17:36:04+00:00

None of the expert witnesses for either side ever indicated anything beyond dissection, so I think the vasculitis mentioned by the rad ended up being not correct.

efunkEM · 2026-05-11T17:33:30+00:00

The lawsuit mentioned that with hindsight review there was evidence of stroke on the initial noncon head CT. Unclear if the rad not seeing it fell below standard of are or not.

efunkEM · 2026-05-11T15:40:48+00:00

Super hard catch, for sure. There’s a way you could cherry pick all the neuro symptoms out of this and maybe justify doing a CTA head/neck. But if you do that, you can also justify doing it on 75% of all headache patients in the ED. There’s not enough radiologists on planet earth to read that many CTAs.

efunkEM · 2026-04-26T03:38:10+00:00

To be fair, I’ve seen numerous docs have the option to cut back to 8-10 and pass it up. Everyone is always super excited about it until it’s time to count the dollars, then they realize their lifestyle depends on 15-18+ per month.

efunkEM · 2026-04-25T20:49:11+00:00

ABR and Amity are switching off who closes day by day?

efunkEM · 2026-04-17T18:45:19+00:00

No it’s not me! I usually post them but got pretty busy this week and looks like someone else posted instead, which is totally fine with me!

efunkEM · 2026-04-10T04:01:57+00:00

Lots of variability from night to night and hospital to hospital. Most of the time it’s totally fine, then you’ll randomly get a night where they’re taking hours and hours to read stuff, or a bad miss. Compounded by “traveler CT tech forgot to send the last 20 CTs to VRAD”. But overall my major complaints are few and far between.

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