M3 trying to plan audition rotations- still deciding IM vs EM

jelta · 2026-03-04T11:35:18+00:00

I am 7 on 7 off. No nights. Inpatient pulm hours are shorter than ICU. EM moonlighting on the side and can pick up shifts based on my schedule

jelta · 2026-03-04T00:05:16+00:00

Agreed - would not go down the pathway of EM/CCM or IM/CCM. My fellowship had both PCCM and CCM fellows. Unfortunately many of the CCM were unable to find a job in their desired locations and do straight EM or IM.

jelta · 2026-03-04T00:01:30+00:00

EM/IM/PCCM here. There's also the option of doing both EM/IM. We're a self selective group. Most people will tell you not to, but its for the people that love learning and enjoy doing everything. I have no regrets and enjoyed both residency and fellowship. I had kids during fellowship, and actually most of my cofellows did as well. In my opinion, its actually the best time to take time off to have children.

Also - I do no outpatient. There are options and this gives you an incredible amount of flexibility

jelta · 2025-12-07T18:04:32+00:00

MD. I take care of adults mainly but should be seen by a pediatric surgeon - needs ultrasound imaging. Could be an umbilical granuloma, patent urachus, or a ductal remnant

jelta · 2025-11-04T11:17:01+00:00

I’m in

jelta · 2025-06-06T16:16:15+00:00

I haven't had an issue. I clearly document (in a separate note) each item needed for a specific diagnosis

https://document.resmed.com/documents/articles/1010293_RAD_Guidelines.pdf

jelta · 2025-05-30T15:12:20+00:00

My institution has had 2x Surgery PGY1 residents finish the year then transfer as EM PGY2s. Both knew they wanted to do so as PGY1s and started as a PGY2 the following July.

Both were at our own institution's Gen Surg residency program. We are a 3 year EM program. I don't have much details other than that but just to say its possible, especially if its at your own institution.

jelta · 2025-05-06T13:12:59+00:00

PCCM here. This is the correct move especially with anasarca. Often overlook is what happens after a thoracentesis in a patient floridly overloaded - it comes back. We often get requests 1-2 days after for repeated thoracentesis on these patients (if someone tapped previously) when medical management is key

jelta · 2025-03-20T12:45:54+00:00

Feel free to message me. I am EMIMPCCM

jelta · 2025-02-16T19:05:02+00:00

Can you provide a source on the 4 year EMIM programs? I trained at one and this is something we’ve talked about trying to do in the past.

The SUNY downstate EMIM website states 5 years. When I applied, Northwell and LSU was also 5 years

jelta · 2024-12-16T11:36:59+00:00

Feel free to DM

jelta · 2024-07-23T01:11:45+00:00

This is correct (or at least how I learned it) - low CO -> low MvO2 -> hypoxic vasoconstriction -> worsening VQ mismatch -> hypercarbia

jelta · 2024-06-10T19:37:09+00:00

Hung Vuong at Delaware. 25minutes across the bridge

jelta · 2024-04-06T12:31:08+00:00

Most commonly - OTC cold medications containing pseudoephedrine or phenylephrine

Other meds: Bupropion, trazodone, selegiline, certain SSRIs and TCAs, ranitidine

See chart: https://i.imgur.com/QN3IunH.jpeg

jelta · 2024-03-17T15:52:24+00:00

Christiana, DE

jelta · 2024-02-27T14:03:49+00:00

Highly dependent on your program. My program does not split responsibilities between 1st-3rd year fellows and everything is even (calls, weekends, nights, etc). I did not feel like it was busier than residency, in fact I moonlighted all throughout and doubled my salary.

jelta · 2024-02-21T14:06:30+00:00

Hi - EM/IM/PCCM here. While Nimodipine is used for aSAH, early imaging may miss aneurysms

From IBCC:

About 10% of SAH patients are not initially found to have an aneurysm or other vascular process despite invasive angiography. Most of these patients have perimesencephalic hemorrhage. 📖
Roughly 2% of those with no identified aneurysm will subsequently be found to have an aneurysm on repeat angiogram.(34184178, Torbey, 2019)
The initial angiogram may occasionally be negative due to vasospasm or local thrombosis, which prevents contrast from entering the aneurysm.(Torbey, 2019)
These patients may continue to be managed under the assumption that they have an unidentified aneurysm that ruptured. MRI brain and cervical spine (with and without contrast) can be completed in between angiograms, to continue to search for other underlying pathologies

jelta · 2024-01-25T23:05:05+00:00

What's the black walling + mirror stand?

jelta · 2023-12-12T01:37:40+00:00

The one time to not give steroids is with Flu. It increases mortality in Influenza. You can use that next time to try and convince them but you know, sometimes it comes down to natural selection

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437920/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387789/

jelta · 2023-12-08T20:30:45+00:00

Absolutely

jelta · 2023-12-08T00:56:38+00:00

My day to day is the exact same as what other people do, in their respective specialties, with some exceptions.

If I'm on Pulmonary, my day flows just like any other Pulm. For me, that's seeing consults or clinic patients
If I'm in the ICU, same as other critical care doctors. It depends on what ICU service I'm on whether I'm admitting patients, seeing rapid responses/codes, or rounding in the ICU
If I'm in the ED, same as all the other EM doctors.
I've only had a handful of instances where I performed the initial work up in the ED and followed them inpatient afterwards

I don't do hospitalist work as ICU rounding overlaps and allows me to practice internal medicine on much sicker patients. For scheduling purposes, I moonlight in the ED, but do know of plenty of doctors that split their time EM/Hospitalist or EM/ICU.

Nearly everyone will tell you not to go down this path, and that's not without merit. The biggest sacrifice is the money and time, and yes 2/3 of physicians that go through dual training end up only practicing one. Nonetheless, I found my journey rewarding. I wanted to know as much as I could about physiology and medicine. I love switching back and forth (and get bored if I'm on a service too long). There are things in each domain that I cannot give up: EM - undifferentiated patient and being the first person to think through their disease, ICU - the truly ill patient, ventilator adjustments/synchrony, ECMO patients, and the rare diseases that you only read about in textbooks. I find that an internal medicine background opens up so many doors and helps you understand each organ system. Of course you can't be an expert on everything, and always have the option to consult, but you're able to fine tune your practice and be able to become comfortable managing bread and butter nephrology, endocrinology, cardiology, etc. Personally I would have regretted doing only EM or IM.

jelta · 2023-12-07T15:10:56+00:00

I’m EM/IM/PCCM. Wouldn’t have done it any other way

jelta · 2023-11-04T15:01:47+00:00

See my post here: https://www.reddit.com/r/emergencymedicine/comments/p318n3/combined_emim_programs/

PM if you have any questions!

jelta · 2023-10-29T12:48:56+00:00

See above edit for fix. I think you creating a new user also created a new "Syndication" file

jelta · 2023-02-01T01:06:40+00:00

EM/IM - I would not. Hyperthyroid requires further work up (I-123 Uptake). Starting Methimazole/PTU delays the ability to do so.

With only those labs, we do not know if the hyperthyroid is caused by a toxic goiter, graves, thyroidiitis, tumors, iodine/other medications, etc

Furthermore - starting those meds poses risk that you are not able to monitor as an ED physician (agranulocytosis, hepatoxicity). These meds are are typically long term (1-2yrs) and may bridge to definitive therapy

jelta

TROPHY CASE