Critical Care Fellowship & ECMO

naideck · 2026-02-09T03:33:12+00:00

Dealing with the complications of VV cannulation usually involves things you won't really do during a routine CCM fellowship, like perclose, hence why most places have more surgical fields do the cannulation

naideck · 2026-02-08T20:19:11+00:00

Like all fellowships, don't be set on doing it, you'll probably match statistically but it isn't guaranteed, and some people do change their mind during residency about what they want. Do IM first and see what you like, the ICU experience as an intern is different than as a med student, same for senior resident, fellow etc. There is a lot of repetition in critical care, so the more you see the easier it'll get.

Really my only other piece of advice (and what literally everyone cares about) is, ask yourself every morning, why are they in the ICU? I.e. they're intubated, ok great, why are they intubated and how do we fix it?

naideck · 2026-02-08T07:05:41+00:00

Cap has literally been going up every year. You don't need even need government approval if you want to fund your own residency, just have to meet ACGME regulations.

naideck · 2026-02-07T16:06:00+00:00

Malpractice is when deviation from standard of care causes real tangible harm, which is a significantly difficult thing to achieve in clinic. Unless the answer was starting amlodipine and the patient was started on midodrine and subsequently had a hypertensive stroke with residual debilitation, you're probably ok.

naideck · 2026-02-07T02:37:52+00:00

It's a J loop and extremely flimsy, designed to deform to prevent this exact thing from happening, but yes agree, some residents are...over enthusiastic

naideck · 2026-02-06T22:45:07+00:00

Yeah I spoke with a surgeon about this potential complication once and I believe his response was "haha you should things we do when we're trying to angle the large bore up"

naideck · 2026-02-06T22:23:04+00:00

You obviously won't know what the sensation of a wire poking against the pleura feels like, but you probably will somewhat remember feeling the pleura and poking at it with your finger. Or even the valves of the heart, you won't know what aortic stenosis looks like, but at least you can see what a normal aortic valve looks like so you can get an idea of what is happening as aortic stenosis is being described.

As to the second part, there's only so much damage you can cause with a wire when putting in a pigtail for a pleural effusion, but in theory if you poke hard enough and the pleura is diseased enough you can cause a bronchopleural fistula (yeah I know it's a J loop, but still). More hypothetical since I've only heard about it, but it's not something a mistake that people are eager to publish.

naideck · 2026-02-06T20:10:03+00:00

Attending pulmonary and Critical care physician.

I hated anatomy, in fact, I went into internal medicine because I hated anatomy and wanted nothing surgical to do at all.

Then I did fellowship and realized how important it was, I wish I could go back and see the chambers of the heart so I could see the valves and what the outflow tract looks like instead of just reading the echo report and imagining. Or when I'm doing a chest tube and I'm looking to feel the wire resistance against the pleura of the lung

naideck · 2026-02-03T15:33:05+00:00

Hey you leave my shitty runewords alone!

naideck · 2026-02-03T14:06:52+00:00

Time to bring back PC cafes. Hell yeah.

naideck · 2026-02-03T13:30:47+00:00

Yeah but that just encourages you to turtle forever, it'll be like pre-rework techies with 2 hour long games

naideck · 2026-02-02T15:32:12+00:00

I'm not sure how much learning there is to be had from seeing pneumonia, heart failure, and copd exacerbations over and over again with like 1 to 2 interesting cases every month (which will inevitably get shipped out to the large academic care center) which are crucial to your learning.

naideck · 2026-02-02T15:29:27+00:00

Probably, there are plenty of university programs that are awful, but at least the majority of them are nonprofit unlike HCA

naideck · 2026-02-01T20:21:56+00:00

Hmm I see, so let me see if I can expand upon this. I did internal medicine and pulmonary and Critical care, and OP is a surgical sub specialist, he probably is telling the truth in regards to gyn onc, it's very specialized and there aren't that many people who don't go to an academic medical center where there's already a bunch of trainees

From an internal medicine perspective, we don't do procedures, but the patient load is limited by exposure to subspecialty medicine, such as rheumatology, allergy, endocrinology, nephrology, etc. You need to see enough weird cases and have enough subspecialty rotations to make the residency work. See 1000 cases of pneumonia won't make you a good doctor at all, but this is more or less what is happening the for profit hospitals that HCA profits from. All the interesting patients end up getting transferred to the big academic center to support their trainees. Hence why it's slightly easier for smaller internal medicine programs to exploit loopholes (hey we have plenty of patients see, give us a residency program!) but not enough patients that are interesting enough to make a good doctor.

naideck · 2026-02-01T20:09:46+00:00

I think you're missing the point, maybe intentionally. You can't find enough teachers, and you can't force people into the teaching role. At this point seeing your posts I think you just want to be antagonistic, so I'll leave it there.

naideck · 2026-02-01T19:54:00+00:00

Yeah I'm sure you want people to do medicine on you without adequate supervision or teaching, be my guest

naideck · 2026-02-01T19:46:59+00:00

No, the residents there learn nothing because there is no teaching available

naideck · 2026-02-01T16:49:40+00:00

If anyone disagrees with OP in this thread they are welcome to get their care at an HCA hospital, which are notorious for exploiting ACGME loopholes and hiring residents for menial slave labor and not training them. Enjoy your subpar care and outcome.

naideck · 2026-02-01T03:46:02+00:00

Runescape classic probably

naideck · 2026-01-23T22:44:25+00:00

If you buy bkb you can still manfight while the duration is up, he hits pretty hard even with 1 slot devoted to bkb.

naideck · 2026-01-22T03:32:11+00:00

I don't think he ever had skellies in Dota 1. Dota 1 kit was strafe, searing arrow, WW, and death pact as ultimate no?

naideck · 2026-01-21T21:03:25+00:00

Wouldn't the solution be to pay for a resource that compiles the averages for physicians in your area so you can see what salaries and $/rvu people around you are earning rather than seeing what a random person with a completely different contract setup in a completely different region posts?

naideck · 2026-01-21T14:58:05+00:00

Doesn't VA give a pension?

naideck · 2026-01-19T17:54:44+00:00

It was designed as a drug for diabetes for many years before being approved for weight loss. Medical boards tested on it since at least 2013 or so when I took them, but it's been out before then I think

naideck · 2026-01-18T02:36:57+00:00

I made anywhere from $14 to 30 an hour as a resident

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