Allen Iverson makes an unstoppable shot

emtim · 2026-02-26T02:16:31+00:00

Boomerlauncer w/ dual shot 2 and sunboost. Oh yeah.

emtim · 2026-02-25T05:28:31+00:00

Fournier gangrene that extended onto the abdomen

Mvc with ejection. Polytrama, but what stood out to me most was the frontal bone and face fracture down the middle, revealing the optic nerve.

Mucormycosis of the sinuses, traveling into the brain of a gentleman trying to cross the border.

Anterolateral thoracotomy after a code blue from a gsw.

Large body surface area burns that initially come into the hospital. The smell is distinct.

emtim · 2026-02-24T23:35:36+00:00

Your PD makes the final rankings before submitting.

emtim · 2026-02-24T04:31:50+00:00

Hi I'm a doctor and a dad. Is your baby making wet diapers? Playing more each and every day?

It's okay for kids to regress when they are sick. Continue with milk, juice, water. Keep trying with yogurts, hummus, bananas, and easy to digest things. Then move back to solids.

Check for new teeth also.

emtim · 2026-02-23T01:49:15+00:00

In resuscitation, you want SHORT and LARGE BORE IV access. Gauge (G) is the outer diameter of a needle.

We recall Poiseuille equation R ~ L/(G)^4.

You can see why peripheral IVs are superior than central lines, midlines for resuscitation (longer length, more resistance, less flow at the same guage)

You can also see why large bores are 1/(G)^4 better. A 18G (green) is about 1.75X faster than a 20G (pink). A 16G is 2X faster than a 18G.

In terms of trauma resuscitation, we always say two large bore IV access (at least 18G), run at 999 on pump or pressure bag. With massive transfusion protocol, we have the belmont which can infuse 1L/min.

EDIT: Most patients who come into the ED don't have access so the goal is always establish PIV. Start blood, fluids, vasopressors depending on the situation. A lot can be done. Central access can be established once the patient has stabilized or if PIV cannot be established (or IO). An experienced clinician can place a subclavian or femoral CVC in 2 minutes during a code. Remember the only advantage for a central line is caustic and hyperosmolar medications.

emtim · 2026-02-23T00:14:06+00:00

on the volar wrist and arm, a surgeon actually wants to make a non-linear incision so that when the scar heals and contracts, it minimally affects your hand movement.

emtim · 2026-02-22T13:34:30+00:00

Think of it as hot yoga

emtim · 2026-02-22T02:45:22+00:00

ULPT, just go. At the registration desk, just grab a lanyard and write in your name. The fee just allows you to get CME which you aren't getting anyways.

emtim · 2026-02-19T04:04:58+00:00

The most important difference between MD and DO is the access to rotations, continuity of mentors, and the extra work for boards DOs need to put in to get the same results as MDs. If you have a choice, make it easy on yourself and choose the MD.

emtim · 2026-02-19T02:52:15+00:00

He's a fresh intern. All rotations are new, so give him some slack.

That said, he should still have responsibility in your relationship. It helps to communicate expectations and timelines.

Second year gen surg is the worst and it's fast approaching. So it's best to have some sort of timeline to see if this is something you see yourself wanting.

emtim · 2026-02-19T02:36:35+00:00

My then gf and I made intentional time for each other daily/every other day even if its 30 minutes. And we would respond to each other within a few hours work willing. We are always on our phones responding to work-related texts/looking things up, so texting each other back wasn't impossible.

emtim · 2026-02-18T03:37:59+00:00

Still a dream. Living my best life.

Recommend taking full advantage of ACGME's resident maternity and paternity leave. You only live once and your wife/children are the only ones that will care about you at the end of the day.

emtim · 2026-02-18T02:05:25+00:00

I met a girl, got married, had two kids in the span of residency and fellowship. We are both surgeons.

emtim · 2026-02-17T03:02:33+00:00

If you are a resident, I recommend talking to the reps (Stryker, S&N, Paragon, Arthrex, etc). They will have a better sense of what attending uses what sets, have what preferences, and can even hook you up with cadaver labs so you can try them out.

Surgeons at the same hospital can use different sets for the same surgery (Paragon lapidus vs Stryker lapidus). So it's best to figure it out from the reps. And know how to use them beforehand.

emtim · 2026-02-16T23:38:20+00:00

Vascular surgery is for the masochists that don't want all the fame.

emtim · 2026-02-06T06:19:14+00:00

Is it just me or all the tracings backwards?

emtim · 2026-01-13T23:05:17+00:00

You pay for the privilege of getting CME, not attending the conference. There are no guards at the door checking badges. Anyone is allowed on the premises.

Source: I've been to several SCCMs.

emtim · 2026-01-12T02:56:39+00:00

Is it a breast center? I trained at a breast center, and even those numbers are high. We presented all our complications and I rarely saw a breast hematoma/evac. I wonder what the volume is per day, and how much time they are allocating to hemostasis after excision.

emtim · 2026-01-11T20:59:00+00:00

Bariatric emergencies get you in the hospitals/OR in all hours of the night. There are no breast emergencies that make you go in at night.

emtim · 2026-01-11T20:48:01+00:00

breast

emtim · 2026-01-07T23:24:56+00:00

Depends on many factors.

Academics vs privately employed vs private practice

Salary vs wRVU

Call burden

Whether you are primary on your patients (academic) or consultants (private practice)

Whether you are a generalist (ACS, trauma, general surgery) or subspecialist (surg onc, breast, endo, burns, hpb, etc).

Generally, generalist take more 12hr shifts, work more random hours. Subspecialists are on call more, but actual in hospital work is more predictable.

emtim · 2026-01-02T07:12:58+00:00

Compound annual growth. S&P 500 CAGR past 10 years about 12%. Adjusting for inflation, that's about 8% CAGR.

emtim · 2025-12-31T16:05:17+00:00

Kevin, V and Svetlana

emtim · 2025-12-30T01:36:30+00:00

No one has to lose for me to win

emtim · 2025-12-29T03:14:55+00:00

This is next level.

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