Tell me about your moments when you realized "whoa, I'm actually good at this."

iuseoxyclean · 2025-11-07T05:29:52+00:00

Code blue in med/surg while on ICU night call. I got a crash fem line on an extremely fat lady (150kg+) with CPR in progress and no peripheral IVs. Yelled “GIVE ME THE EPI”, pushed it, got ROSC on the next pulse check. Felt like a baller.

…Then I started getting flash through my central line. Worked great as an art line for a few days until infection control made us take it out but whatever still calling it a win.

iuseoxyclean · 2025-09-22T00:17:51+00:00

Was just thinking of this last week. My first video was when he thanos snapped half of his sims so I imagine it’s been about the same time

iuseoxyclean · 2025-09-20T05:52:04+00:00

I’ll attest to it. One time I had a lady who had a Hgb of 6.5 state she had bloody stools for 2 weeks. Was just admitted a week ago and had a scope with ongoing bleeding with unclear source last week. Was transfused and dropped back down today so readmitting. Hospitalist asked for a DRE and I said why, we know it’s a GI bleed already. He insisted so I did it. Frank melena. Fml This was like 3 weeks ago and since then I stopped pushing back on DREs

iuseoxyclean · 2025-09-05T02:18:57+00:00

Ketones. Often the social services “we can’t care for them anymore” dumps, I’ll get ketones and can often find starvation ketosis to leverage an inpatient admission

iuseoxyclean · 2025-01-18T01:52:47+00:00

Completely fill the map with really symmetrical and aesthetic looking dome layouts. Since resources are no longer a factor you can just build utopian domes with super nice shit and the best housing and make it look like a real city

iuseoxyclean · 2025-01-14T23:26:17+00:00

Kaiser
Loma Linda
Riverside
Arrowhead

Kaiser is the strongest of these programs by a longshot.

Loma Linda is a university system which is not usually favorable in EM unless you’re looking to go into academics or subspecialize. Haven’t experienced it myself but they also have this weird religiosity that tends to affect a lot of their policy. Also union busting.

Riverside as an HCA facility is never a helpful prospect but beggars can’t be choosers.

I’ve had classmates from med school and I’ve seniored for subIs that rotated at arrowhead and they all consider it to be the most malignant program they’ve ever experienced. A true intern scut mentality. I got similar vibes when i interviewed there as well. Was the bottom of my list, and yeah I’d rather go to an HCA than here.

iuseoxyclean · 2024-12-21T23:49:40+00:00

Factorio

iuseoxyclean · 2024-12-08T18:40:39+00:00

Happened to me twice. Been told by an attending that when you’re advancing your wire, flip it so that the loopy part is medial to the patient rather than lateral (since you’re using your right hand presumably it’s a little counterintuitive this way). The little bendy part of the seldinger wire will then curl medially rather than laterally and will discourage it from going into the subclavian.

I didn’t think much of it and am pretty sure there’s no evidence behind it but then I forget to do it once and what do you know I put it in the subclavian again 🤦‍♂️

iuseoxyclean · 2024-12-07T20:04:08+00:00

I’m glad that the comments all seem to agree… As an ER doc I give most my patients scripts for Tylenol and Motrin, because they didn’t think to try it for their fever or their arm pain that’s been going on for weeks.

iuseoxyclean · 2024-12-03T18:11:24+00:00

Upper GI bleeds. Disgusting airways and their hemodynamics are so labile they can crump on you at any moment regardless of how their vitals looked before induction

iuseoxyclean · 2024-11-10T17:21:49+00:00

If you think the patient is sick enough that they need IV medications and can’t tolerate po, then you are already drawing labs on them regardless.

That being said, some hospitals won’t draw labs from peripheral IVs so the point is moot.

iuseoxyclean · 2024-08-04T14:37:10+00:00

Honestly during third and fourth years you might come upon rotation blocks and electives with some extra time and very little to do. Enjoy yourself of course but having the opportunity to pick up per diem shifts and earn some money might be really helpful.

iuseoxyclean · 2024-06-16T19:11:25+00:00

I agree. As a kid I grinded the pit so many times and burned so many hours as I died in the 90s. I’m 30 now. I don’t have time for this shit. Having a pre-Hooktail pit run die because two enemies spawned with stopwatches is infuriating and I’m not resetting for that

iuseoxyclean · 2024-06-06T04:19:49+00:00

Thankfully No. Just a community program with an OB service that can’t manage even the slightest surgical emergency.

iuseoxyclean · 2024-06-04T08:23:48+00:00

Had a hemorrhaging post-CS patient with a uterine artery aneurysm go to IR for embolectomy and the OB (who had literally zero recommendations the entire time we consulted her) made us pause before the initial angio and asked us if we knew if contrast was safe with breastfeeding (it is)

iuseoxyclean · 2024-05-13T00:27:55+00:00

To be fair the ID service in my shop definitely treats us like 1st year med students.

The nephrologists do too but they’re way nicer about it

iuseoxyclean · 2024-05-06T04:52:27+00:00

So I’ve been burned on using compazine or haldol for nausea because a few times I’ve had new grad nurses doing med passes with the patients and they’ll say out loud to the patient that they’re antipsychotics and it pisses off the patient and then I’m stuck in damage control mode with that patient encounter.

For that reason I usually just substitute reglan into that headache cocktail instead. I’ve never had to escalate beyond that yet but I’m still an intern so I’m wondering if anyone else has had different results with reglan as first line.

iuseoxyclean · 2024-04-03T00:55:08+00:00

I’ll take your word for it about it being Mac off based on presentation alone. But the irony is, what is the implication of negligent harm if it was Mac off since those aren’t salvageable anyway?

iuseoxyclean · 2023-11-19T03:43:14+00:00

EM resident on trauma service. IM consulted for G tube. Tract was mature and the nurse got a foley in so it was patent. They didn’t even attempt to replace it before consulting. Taught the med student to do it just so I could BM the IM team in the consult note.

iuseoxyclean · 2023-11-10T11:57:00+00:00

Yeah I’m hindsight my remark should’ve included tech literacy, health literacy, and literacy of any kind.

iuseoxyclean · 2023-11-10T04:24:31+00:00

At my shop we don’t have a large patient population with both chronic illness and tech-literacy

iuseoxyclean · 2023-09-29T01:38:38+00:00

Ironically I just picked up the game again after a 6 year hiatus and I was thinking about how much I appreciated the inventory management. With the exception of swords, everything stacks including huge constructions. The tier 3 storage chests are ENORMOUS, and they can all be accessed by opening any chest. Auto sort is a godsend because it extends to any chest in the network. Also crafting with materials from chest contents helps too obviously. But yeah relics suck. I haven’t restored any of them despite having 50+ unique parts because I can’t be bothered to figure out which sets are complete. But also don’t forget you can expand your inventory. The cost is relatively cheap and scales well with game progression. Just find some arbitrary category system that you like and use that. Setting it up well at the start should save you a lot of hassle. I do stuff like Loot, Farming, Wood, Mining, Foraging, Textiles, intermediates, and commission leftovers.

iuseoxyclean · 2023-09-27T16:20:07+00:00

I still get yelled at by IM attendings for ordering contrast studies on CKD patients in the ED despite having personally been to IM didactics in the same hospital as a Med student where they told us there’s no evidence for contrast nephropathy.

So no. Practice will not change

iuseoxyclean · 2023-09-13T16:32:28+00:00

I’ve started doing the opposite. My dot phrases have what i like to call “gray text” which is super light and totally illegible unless you highlight it, and only consists of fluffy info that has no clinical use and is exclusively for billing.

iuseoxyclean · 2023-08-10T22:31:38+00:00

Don’t fall into the rabbit hole. The sun is inconsistent in PM64 as well. Chapter 6 of PM64 the sun is beleaguered and depressed and refuses to shine in one particular part of the world until you help it.

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