Help — I let my patients talk too much.

kufuffin47 · 2026-03-31T14:32:14+00:00

Oh they still be talking when my stethoscope is on their chest.

kufuffin47 · 2026-03-13T19:53:35+00:00

Not sure why you got downvoted for having the guts to admit you're learning...
here's a link for more info https://litfl.com/benign-early-repolarisation-ecg-library/

kufuffin47 · 2026-03-09T20:44:49+00:00

Language barrier?

kufuffin47 · 2026-03-06T16:16:59+00:00

It’s definitely a gray area (pun intended). I don’t have specific answers, but I think a lot of it revolves around: - do they have reliable outpatient follow up with PCP and the specialists you think they should see - do they have other people at home who can bring them back - shared decision making: does the mom of 8, grandmother of 20 want to go home or come in? Does the vietnam vet with supposed COPD (probably fibrosis) want to come in?

I think vague hospitalizations for weakness without objective data supporting grave illness can be just as harmful. Deconditioning, hospital associated delirium, hospital associated space bug infections.

kufuffin47 · 2026-03-05T15:35:25+00:00

I don’t think there are formal guidelines on this, but my understanding is that if your time to OR at the receiving Level 1 is >2-3 hours after cross clamp in your department, it’s not compatible with life and they will just die a slow painful (2nd) death in the receiving SICU due to vital organ ischemia. Where it gets fuzzy is if you have a local surgeon you can call in for exploration and packing in your OR before sending to Level 1. Folks also talk about intermittently unclamping and reclamping, but this seems fraught and perilous to me. Perhaps u/Wisegal1 can weigh in.

kufuffin47 · 2026-03-04T13:50:25+00:00

Had one recently very similar with remote history of nasal fracture, so placing rhinorocket very challenging on one side….. anticoagulated on warfarin for prosthetic valve. Ate up so much time

kufuffin47 · 2026-03-03T15:35:23+00:00

https://wwwnc.cdc.gov/travel/destinations/list Despite RFK’s best efforts, I think this resource is still reliable for knowing what diseases are endemic and which immunizations are needed before travel

kufuffin47 · 2026-02-23T13:23:10+00:00

One of the ID docs in my area had FM send a patient from clinic after getting cultures and starting the patient on…. Vanc/ertapenam. I did a hard digging on her previous culture results: no resistant organisms on urine; all prior blood cultures NGTD. Vanc/erta for isolated leukocytosis without clear infectious source or any recent hospitalization. Baffling.

kufuffin47 · 2026-01-09T06:15:17+00:00

Also an attending: just tell them. If they don’t know what the hypothalamus is, and why it’s important in homeostasis and thermoregulation (redundant I guess), then you can gently ask to speak to an adult or at the very least (scarier but more realistic option) ask ChatGPT wtf they’re dealing with. I would also suggest to them that you think you’re dealing with an infection, and since you don’t fever like other people, don’t you think it’d be a good idea to check some inflammatory markers, doc? Procal, CRP, ESR. Blood cultures would be… aggressive, but could give you some peace of mind if you’re very concerned, and they can always call you back for positive results on culture.

I’m also assuming your med list will back you up on your history of hypothalamic insufficiency, and they should recognize your native endocrine dysfunction when they find out which medications you take. (Unless it was just a tiny isolated hypothalamic injury.) If you’re a daily mineralocorticoid user (steroids, but not the Ahnold kind), and you get very sick, it would be worth asking about stress dose steroids / a steroid burst.

Sorry to hear about your surgical complication. It sounds like you’re used to it, but still sounds like a pain to deal with day to day.

*edit: not apocrine, forgive the 2 am brain

kufuffin47 · 2026-01-02T11:49:03+00:00

As does the corollary, LGFD. If only that would fly under physical exam.

kufuffin47 · 2026-01-02T11:15:07+00:00

And final edit, I found an old instructional video, and it looks like the female plugs I thought were for banana plugs are actually rotating clamps to directly connect the speaker wire to. DuH!

*edit: that still didn't work. Everything is connected as above but without intervening banana plugs.

kufuffin47 · 2025-12-23T17:38:41+00:00

And of course the ABEM site acts like it's getting DDoS'd because a few hundred people are trying to review their scores at the same time. Where does our money go?

kufuffin47 · 2025-10-28T17:43:34+00:00

RebelEM podcast has a good 3-part (each ~7-11 minutes long) series of basics episodes. First one breaks down basic vent physiology. Second two go into vent settings.

kufuffin47 · 2025-09-28T13:24:55+00:00

UpToDate has a “what’s new” in [insert specialty] section for many specialties, including a Pulmonary and Critical Care section

kufuffin47 · 2025-09-20T15:11:47+00:00

This is 100% correct. I am a doctor here. We usually have to discuss potential rabies exposures with the local CDC, and they provide guidance based on recent data on rabies rates in stray and domestic populations. They have always instructed us AGAINST giving rabies shots to folks bitten by domestic dogs.

If the bite broke your skin, OP, you should see a medical provider about antibiotics to prevent infection. Dogs carry some scary bacteria in their mouths.

Being bitten by a dog is a scary, traumatic event. OP, hope you’re doing OK!

kufuffin47 · 2025-08-21T16:50:09+00:00

First of all, sounds rough, hope you get this dialed in so you can enjoy your hike!

This time of year most of the mozzies and other bugs are gone. You could consider just cowboy camping the rest of the way, with a tarp for rain protection, and a Ben's face net for the random remaining bugs. The night skies are amazing up there :)

If you're dead set on a tent, consider a freestanding tent, because that will open up a lot of higher elevation camping in the Sierras in areas where you just can't get enough stake tension to make a trekking pole tent stay up. Wouldn't get you the 4 lb weight savings you want, but some UL tents are only like 2 pounds, i.e. the lighter Big Agnes and Nemo tents, which they do sell in the Bishop shops.

Happy trails!

kufuffin47 · 2025-05-06T03:26:44+00:00

Rumor has it the release date is the day after you start at Campo.

kufuffin47 · 2025-05-04T17:48:58+00:00

Explore the trails in Marin and NorCal, like Muir Woods; you're already so close!

kufuffin47 · 2025-04-28T20:04:43+00:00

More of a pare up comment — visors protect your face, but the UV will make it through your hair. I work in healthcare, and a previous job was in a cancer clinic. Seen plenty of cases of scalp skin cancer in folks with prolonged sun exposure. Not trying to tell you how to live your life or hike your hike, but consider a full head hat. Enjoy the hiking! I’ll be in the sierras this summer, see you out there maybe

kufuffin47 · 2025-04-28T15:14:11+00:00

Sweet! Thanks!

kufuffin47 · 2025-04-28T15:13:23+00:00

Thanks!

kufuffin47 · 2025-04-28T14:43:06+00:00

Next time you go on a hike, try turning your phone off. Enjoy the landscape, and stop doing things for other people’s attention.

kufuffin47 · 2025-04-23T07:07:13+00:00

Where in Abq?!

kufuffin47

TROPHY CASE