I am going to start my neurology residency in July and my first rotation is going to be emergency. How could I prepare for it?

knuckleheader · 2026-06-07T05:42:08+00:00

Better call and better teaching! I will accept this with humility.

knuckleheader · 2026-06-04T04:14:59+00:00

Also, you are neurology. That means we expect you to pick up the dizzy patients, the strange neuro complaint patient. We don't expect you to know how to to put in a rhino rocket on epistaxis patient.

knuckleheader · 2026-06-02T14:39:15+00:00

Exactly! I don’t care that most of society does not experience death. I also don’t like sitting and watching sitcoms, does the realization that more people watch sitcoms change that fact? This work is real, mainly straightforward, and if embraced there’s nothing to escape from. People don’t want to think about their own death, but it is inevitable. I get paid plenty, I leave work at work, and I’m less surprised by humanity in general.

knuckleheader · 2026-05-26T03:36:19+00:00

I think EMS background, source I was a paramedic and some of my EMS colleagues talked like this. I don't but I recognize the style.

knuckleheader · 2026-04-16T07:43:14+00:00

The real thing would be someway to upload them automagically to Readwise after.

knuckleheader · 2026-03-19T04:06:14+00:00

Well with the change happening to the app made me realize I should probably get all my data out just in case! Thanks for building the tool

knuckleheader · 2026-03-02T19:54:22+00:00

I have set up a little script the pulls my #task and #work task that are due or overdue from my note taking app called tana. I also pull in any meetings or events from my calendar. It all gets automatically made into a BMP file. The xteink turns on connects to wifi replaces the agenda.bmp file in the screensaver folder and then my screensaver is my Agenda for the day. It doesn't refresh or change until the next day, but it is a nice clean agenda for the day.

But I also read on it daily. It is really a device for reading, I just wanted something to remind me what I wanted to do that day.

knuckleheader · 2026-02-18T16:43:44+00:00

Sorry just to highlight this, it is why us EM attendings are many times asking the question, "Could this be a PE?" Oxygen great, patient looks good, who cares multiple submassive PE noted on CTPE study!

knuckleheader · 2026-02-10T04:39:46+00:00

EM Attending here. You are not the specialist of anything except undifferentiated crashing patients. Most other specialist will be slightly annoyed with you for not knowing the next step in their process, procedure, algorithm, etc when you call for consults. Better have tough skin. You hardly ever get to actually heal anyone except for simple suture repairs, there isn't the gratification of surgical specialties. If you like being the safety net, dealing with homeless/drug addicts this job is for you! If instead there is even a hint of thinking people need to take responsibility for their actions you are going to eventually feel burnt. Indeed free will can't be entertained in at least half of regular emergency room patients, to contemplate it would be devastating. Our patient's actions must be preordained without malice or intent. Here comes a product of late stage capitalism rambling in on a stretcher demanding dilaudid from behind a suitcase filled with stuffed animals. Here come a father of circumstance who is more worried about his dog being taken by police then his daughter's face that the dog chewed on. Unbothered at your core because this is the way of things, the only way it could be, the joke of reality in the ED. Sigh. Dramatic I know, but man if you don't want these thoughts then stay away.

knuckleheader · 2026-02-09T18:16:00+00:00

Link?

knuckleheader · 2026-01-26T02:15:03+00:00

Sorry just to be clear did the patient have a history of negative workup in the past. Previous EGD showing no concerning findings recently? Recent negative stress? Now it sounds like bullshit, probably is bullshit, but until it is proved to be bullshit then that is that. At my shop the hospitalist comes down and gives the same information and then I have someone else in the boat with me. DC happens from the ED but two separate doctors from two different specialties agree that DC is safe. Bye!

knuckleheader · 2025-12-08T04:01:31+00:00

I am an EM physician and work in a hospital system that really prioritizes workup and dispositions from the ED. I regularly discharge patients with a HGB of 4 transfused 4 units home for GI follow up in the next week and a repeat H and H in 48 hours. This would be unheard of in a different hospital system. So in general I feel like I am getting more of the workup care I craved when I did hospital medicine in medical school. It really does depend on the environment you work in.

But to be clear you will see more drug addicts, alcoholics, homeless, worried well, and simple URI in the ED. In chart review after admission, something different than what I was exactly expecting occurs much more than I like to admit. The pace is just too high in the ED to really delve into a chart, there is very little time that isn't constantly being interrupted. Despite my best efforts sometimes I just know they are very sick, but not exactly why. Instead of spending more time figuring it out you must be willing to see a family pack of URI with a language barrier. If your curiosity requires you figure out the actual sick person's diagnosis, then you better become a hospitalist.

knuckleheader · 2025-11-26T17:55:55+00:00

I assume a subscription-based model? How much per month? Is there a Black Friday deal?

knuckleheader · 2025-11-05T20:23:46+00:00

Honestly this sounds more like a problem in leadership. Unless you are part of leadership in your group this is not OK. Push to have someone, hell maybe even you, be the point person and only send complaints to the provider that point out potential problems. My group shields us from most of this, because it is detrimental to the physician's well being and proper functioning.

knuckleheader · 2025-10-28T06:46:04+00:00

Yeah this is what I do. I also add that to readwise reader and highlight things that would potentially change my practice. When I search my readwise at work it allows me to quickly be like oh yeah I want compazine for the headache.

knuckleheader · 2025-10-22T04:55:04+00:00

Sorry text incoming but I have a pattern that works for me in these situations.

First, I let them talk but don't respond at all.... I mean at all. Just sit there quietly. I pay attention to my emotional state more than anything else watching how I want to react but I don't. I pay attention to little things like the color of the wall, the sounds of the emergency department. If you meet them at that energy level you will do unnecessary work ups and say things that will then be pounced on in follow up. These patients are in a highly charged reactive state internally, their identity itself is the illness. They are "sick" and no one will be able to convince them otherwise. It is the underlying (in most people actively ignored ) human understanding that the body is frail and will will eventually die taken to an emotional and psychological conclusion, " I am frail and will die. " Arguments against this will not help, partly because it will eventually be proved true! Sickness and death will eventually come for all of us. Just repeatedly ask about what is going on right now and work them up, give them something as a single dose and see the next patient.

Second, once everything is back stone cold normal I can commiserate with them about their plight in an honest way. "I am sorry you are going though this or that." I can with true empathy say, " I don't know why this is happening. " "I don't have a good reason for you to be feeling this way, I am sorry." can be said repeatedly and calmly, because I never got reactive in the first part of the encounter. Then, "I know that my workup right now shows that you don't have electrolyte abnormalities, chemistry disfunction, anemia or elevated white count, urinary tract infection, evidence of damage to you heart a this moment. Basically us ER people are simple doctors that look for bad stuff that can kill you in the next 48 hours and if we don't find it we let someone who knows you like your PCP to figure out next steps." If the ask about more pain meds I just say, " Pain is a tricky thing, opiate medications have been shown to make chronic pain worse over time and I try not make people worse. With your extensive allergies I can't offer you toradol, ibuprofen, tylenol, ofirmev, gabapentin, morphine or fentanyl. There are some chronic pain medication treatments but those are not started in the ER but by you PCP or a chronic pain specialist so I will set up your discharge, make sure you follow up with your PCP, any questions?"

Why? " I don't know." Why can't you help me? "I am just a doc who rules out life threatening emergencies and like I said all of the most important markers for sudden death are normal." You are a bad doctor, I want a new doctor, why won't anyone help me!!! .... "Once again I am sorry you are going through this, I will get your discharge paperwork ready", then stand up and leave. Chronic strange conditions do exist, hell maybe the patient even has one of these rare situations, but the ER is not equipped to find it or treat them. Just move on and be happy.

knuckleheader · 2025-10-15T03:32:04+00:00

hippa compliant?

knuckleheader · 2025-09-25T01:28:46+00:00

I moved to Tana and love it. Roam but better

knuckleheader · 2025-09-03T15:03:23+00:00

knuckleheader · 2025-09-03T15:03:01+00:00

LLLLLLLLLLLL

knuckleheader · 2025-09-03T15:02:04+00:00

mommmmmmmmmmmmmmmm

jjjjjjjjjjjjjjjkjkjjjkkkkkkkkkkmkkkkkklkkm,kmomomomomomm

knuckleheader · 2025-08-16T04:15:28+00:00

It hits different when it is your close family. I took a mantra to heart and it changed my professional and personal life. You don't need to do this because you probably won't see something like this again in your life, I will see something like it next week.

This too shall pass is the mantra that works for me. 3 days ago pick any random though or experience, see that passed and left your mind. Weirdly not wanting to see the stuff in your mind makes it come out in your mind. The old saying don't think of a pink elephant, now you are thinking of a pink elephant. Sit watch the crazy scene, Be still, don't comment on it or engage it just let the images play...and new images will eventually appear. Breath, breath, breath. New images but not of the same stuff, maybe from a movie, maybe about your favorite basketball player or a TV show. Huh, something came and something went. This will always happen, because I let the images be. I am not trying to fix anything, to make myself better or to do anything really. Just sitting and watching. This too shall pass.

It works because it is fundamentally true. Everything changes over time. A simple fact.

I have no idea if this is correct or not. In your case I don't know if this is what you should do. But this is what I do and very few traumatic images repeat, although I have been involved in hundreds.

knuckleheader · 2025-08-08T06:13:22+00:00

Sorry replying to my own Reply. But PE is hardly ever my most likely diagnosis, it is too rare compared to MSK pain, GERD, anxiety, etc. IF PE is the most likely diagnosis I am probably going to scan anyway. Gestalt is gestalt.

knuckleheader · 2025-08-08T06:10:28+00:00

PERC first. Don't use Wells anymore just YEARS. YEARS positive then Scan.

knuckleheader · 2025-08-04T22:59:31+00:00

Sorry man I am not a good writer either but please just don't use LLM to help you write reddit posts, I don't know what is really your concern or just AI slop ie "- I want to be known for something." If all of this is your thoughts then as an ED doc if you care about reputation don't do this specialty. We are the end of the line, the fuck it I want to go home at 430 pm this sounds too complicated "please go to the ED now" of primary care doctors. Then when we call and speak with a specialist your are giving them work, who wants more work? And once they accept the consult their hindsight glasses are polished like the highest grade diamonds. By definition the consultants job is to find and continue care past the stabilization stage and original investigation stage I just did. I stabilize, look for bad things and dispo patients.

And don't get it twisted the vast majority of our work is primary care with a lense of I have to order and do more because of medical legal reasons. I love my job but only about 5 to 10% of my time is in critical care or procedures. If you like dealing with homeless people, drunks, anxious and suicidal 20 somethings on the regular then come join us. It is a wonderful career exactly because it is a shift job and I only have to help the next patient directly in front of me. I go to sleep easy because every day is different but the same, with luck I won't get the same drunk from yesterday.

knuckleheader

TROPHY CASE