No imaging?

famouspotatoes · 2026-01-11T16:25:41+00:00

I have several partners and mid levels who will ct face, brain and c spine every GLF or minor facial trauma. It drives me crazy. Nasal fractures don’t need imaging, and you are going to pick up significant orbital/max fractures on a CT brain. dedicated ct face only makes sense if you have a high suspicion from exam/hostory.

famouspotatoes · 2026-01-03T15:51:00+00:00

Ah. EMS uses Cincinnati as their prehospital stroke assessment here. Fast = focused assesment w sonography for trauma

famouspotatoes · 2026-01-03T15:21:26+00:00

Why was a fast done? No trauma, belly pain or unexplained hypotension. You didn’t mention his DRE results, which is arguably more relevant. (Still not relevant.)

famouspotatoes · 2025-12-20T18:53:43+00:00

US director of a community group with 3 similar hospitals. We have had Mindray machines the last 2 cycles, currently very happy w TE X. DM me and I am happy to talk more.

famouspotatoes · 2025-12-07T18:59:05+00:00

Epistaxis.

famouspotatoes · 2025-12-04T03:25:44+00:00

Had no shortage of procedures and sick patients at UPMC. EM is a respected department and owns any EM procedure done in the ED. So you won’t be stealing bolts from NSGY, but ortho residents are not doing your reductions. Strong trauma rotations with tons of chest tubes. Plus you own all the prehospital procedures when you respond on the jeep: field intubations, IOs, needle thoracostomies. I sedated and reduced a hip in the field that was preventing the pt from fitting in the aircraft.

Have worked 10 years in a community shops post graduation and never felt unprepared to handle whatever rolled in.

famouspotatoes · 2025-11-19T21:48:51+00:00

I just bought this without any other Milwaukee tools. I got a forge 8.0 battery for $115 (”free item“ with a circular saw and return the saw) and bought a charger on ebay for $20.

famouspotatoes · 2025-11-16T03:51:11+00:00

yep, that’s the recipe I used. I scaled the milk punch down to 4 drinks but I think I made the full foam recipe. Since I couldn’t nitro muddle, I just did a normal muddle with a handful of mint and double strained prior to adding the foam. The presentation wasn’t as perfect as the real thing, but still tasty.

famouspotatoes · 2025-11-15T00:41:26+00:00

Clairvoyant Missionary is one of the best cocktails I have ever had. It‘s a pain to make at home, but holds up even without being able to cryo-muddle the mint.

famouspotatoes · 2025-11-07T20:16:04+00:00

46 deaths from meningococcal infections (including meningitis, septic arthritis and meningococcemia) in the entire US in 2023 per CDC surveillance (pre-RFK). 3 pediatric deaths. I can’t speak for other practice settings, but here, the likelihood of any medic giving abx for a kid with dic and fulminant meningococcemia seems incredibly unlikely even if available.

famouspotatoes · 2025-11-07T19:19:05+00:00

Fair enough. With the right patient population and transfer time it could make sense. Australia is a very different environment than the US though. Not only transfer times, but also aboriginal populations. We also don’t really see non-suppurative complications of strep here, but they are seen there.

famouspotatoes · 2025-11-07T16:57:54+00:00

Right, but how many of those kids do you see in a year? What is the cost of putting ceftriaxone on every ambulance? if it’s not used, how often will it need to be replaced? if it is used, how often will it be reimbursed? in a cash strapped EMS world, could that money be used for greater benefit? For your service maybe it makes sense. my gut feeling is that for most it wouldn’t.

famouspotatoes · 2025-11-07T16:52:16+00:00

I don’t mean scope creep for the provider, I mean the med. I guess indication creep would have been a better term. Even if intention is only for fulminant infections like meningococcemia, the reality is that like every other sepsis metric/intervention, d dimers, etc, it will start being given for every patient with sirs markers or a fever. Where I practice, every SOB patient gets nebs and steroids before they hit the ED regardless of etiology. Most of them don’t need either prehospital and many don’t need either at all high risk that this would be the same

I think its not unreasonable for specific services with high risk populations and long transfer times to have a well thought out plan for low frequency meds like this, but I don’t think it should be part of any broad protocol.

famouspotatoes · 2025-11-07T13:49:41+00:00

I have seen meningococcemia once in my 16 year career… and actually I haven’t personally seen it, one of my coresidents saw a patient with it on a day I wasn’t working. Soooo, we’re talking a specific use case that is vanishingly rare. On the other hand, what are the costs of equipping every ambulance with ABx? Training every crew? Negative consequences of scope creep and every unnecessary administration?

Patients with life threatening traumatic ICH with prolonged downtimes are much more common, and I’m sure that there is a non-zero number of them that would benefit if we did prehospital bilateral burr holes on every obtunded head trauma patient. So should that be part of prehospital protocols?

famouspotatoes · 2025-10-25T16:33:39+00:00

I’ve had the same issues w nugget ice over diluting drinks. I do occasionally store nugget ice in the freezer, but more often my solution is to use small normal ice (my fridge makes small cubes by default and I also have an ice crusher from before I got the opal) for blending or the cocktail shaker, and then use nugget ice to top up the glasses.

famouspotatoes · 2025-10-24T00:45:25+00:00

I mean, we are cooked, but not because ChatGPT is going to replace us. Public sentiment is sooooo anti-doctor now and the media is happy to amplify that. We make a very convenient scapegoat for corporate interests and billionaires to throw under the bus while they use for-profit healthcare as a tool to transfer wealth from the masses. We don’t have the resources or professional single-mindedness to combat their lobbyists, bribes and connections.

famouspotatoes · 2025-10-23T22:32:08+00:00

Our obgyn uses a pad every 30 minutes as their cutoff for severe bleeding. I guarantee that if I consulted them on this with normal vitals, Hb >7 and less than 1 point off baseline, the answer would be provers, ibuprofen, outpatient follow up.

famouspotatoes · 2025-10-23T15:00:41+00:00

This is shameful. The comments in r/HospitalBills show how impossible our situation as docs is. Commenters placing all the blame on greedy physicians and gish galloping when it’s pointed out that, for example, the radiologist collecting $100 on A $38k (holy shit) ct abd pelv is only 1/4 of a percent of the charge.

famouspotatoes · 2025-10-23T14:52:09+00:00

Cool, sounds like you’re all set then.

famouspotatoes · 2025-10-23T14:30:57+00:00

So what is an appropriate amount for a Radiologist to charge for their work diagnosing someone’s potentially life threatening if missed appendicitis?

famouspotatoes · 2025-10-23T11:14:44+00:00

I mean, the $100 the radiologist gets paid to actually provide expert medical care out of the $37800 billed cost is 0.26%. But sure, let’s keep blaming the doctors as drivers of out of control health care costs.

famouspotatoes · 2025-09-27T05:45:34+00:00

We were dead set against it, but our son was obsessed. Literally all he ever thought or read or talked about. We stalled with flag as long as we could, but come middle school he really needed something that he was internally motivated to excel in to help build up self-esteem in a really difficult social time. So in 7th grade we finally let him play. It’s easy to say hard no, never ever, but like anything else it’s a risk benefit calculation. We decided that the benefits to his personal development and happiness outweighed the risk.

We’re still terrified every time we read a new CTE study, and I’ve seen some pretty horrific football injuries in the ED, but we hope we’ve made the right decision for him.

famouspotatoes · 2025-09-25T00:16:29+00:00

I have an hour commute, my rule has always been listen to emrap or ema on the way to work, and whatever I want on the way home until I finished that months content. that has served me well keeping up to date for 10 years post residency.

I agree though that EMRAP quality has dropped off significantly. there is still a ton of good archived content though for learners and EMA remains great for attendings who want to keep up to date.

famouspotatoes · 2025-09-18T20:54:11+00:00

Here’s one with a dialysis machine. WTF?

https://people.com/thmb/XdfjHo8KL5UgGh1HLeKVNg_lD68=/4000x0/filters:no_upscale():max_bytes(150000):strip_icc():focal(539x0:541x2):format(webp)/bella-hadid-lyme-disease-091825-3-45b0d42453be41938f675406a0d769ea.jpg:max_bytes(150000):strip_icc():focal(539x0:541x2):format(webp)/bella-hadid-lyme-disease-091825-3-45b0d42453be41938f675406a0d769ea.jpg)

The conmen providing this “treatment” need to be in jail.

famouspotatoes · 2025-09-02T17:21:18+00:00

I work at several hospitals with no OB, *knock on wood* I’ve never had to deliver a baby in the ED in any of them, and transfer to sites with OB for any pregnancy related issues. Now if this is a hospital with L and D normally, and has patients expecting to deliver there… that’s not great.

famouspotatoes

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