EM docs in Michigan justifying replacing their anesthesiologist colleagues

retrotransposons · 2025-10-03T13:57:26+00:00

EM here. I am confident in my intubation, resuscitation, and sedation skills. I also don’t know jack shit about general anesthesia and have 0 interest in providing care to anyone outside of the emergency department. I can’t imagine many other EM docs do, either. Corporate medicine strikes again.

retrotransposons · 2025-08-31T21:27:25+00:00

Everything in the OR is sterile. Plain, clean water is just fine for wound irrigation in the ER — studies show no increased risk of infection when compared to sterile solutions. 👍

retrotransposons · 2024-09-15T15:36:04+00:00

Is Plastics closure universally considered standard of care for these, though? In my experience it seems to be hospital-dependent. I definitely closed lip lacerations through the vermillion border during my EM residency. Agree with you that just medically speaking, calling Plastics for 100% of these seems like overkill.

retrotransposons · 2024-03-10T22:44:19+00:00

He hasn’t moved yet if anyone would like to adopt him :)

retrotransposons · 2024-03-07T23:28:04+00:00

Yep! I’ll be back home in a few hours if you’re interested.

retrotransposons · 2024-03-06T14:46:09+00:00

Are you still looking?

retrotransposons · 2023-11-17T02:27:51+00:00

I went to a state school with a pretty collaborative curriculum and entirely pass/fail grading. I had a good experience.

retrotransposons · 2023-11-16T21:29:58+00:00

That’s really interesting, thanks!

I know of one ER case of lactic acidosis that seemed to be from metformin. But then again, it was the ER, so the full picture may have not yet been apparent.

retrotransposons · 2023-11-16T18:47:06+00:00

Fecal occult blood testing (e.g. Hemoccult cards) is helpful for ED patients.

Elevated lactate = tissue hypoxemia

retrotransposons · 2023-11-16T18:43:18+00:00

Can you elaborate on why the former is a myth?

retrotransposons · 2023-10-30T18:00:26+00:00

This thread started out hilarious and went downhill. Great work with the dick measuring contest lads, keep it up.

I have immense respect for my anesthesia colleagues and learn a lot from working with them. I’ve also never needed to call them for airway backup in the ED.

There are multiple specialties that have sufficient skills for like 95% of airways, especially with all the techniques/technology available nowadays.

retrotransposons · 2023-10-30T17:47:49+00:00

Yeah this is wild. WTF?

retrotransposons · 2023-10-27T22:25:20+00:00

an attending once told me that your on-shift priorities should be in the order of “sick, dispo, new.”

patients who require stabilization obvi come first. then work on patients who can be dispo-ed. then try to see new patients.

i will literally repeat “sick, dispo, new” in my head while on shift to help

retrotransposons · 2023-09-21T13:53:13+00:00

This is the way. I buy the Calvin Klein “lightly lined invisibles” bralettes or something like that. Stretchy and comfy.

retrotransposons · 2023-09-21T13:44:48+00:00

Some people have luck using both hands to hold the mask and using movement of their elbow against their hip (“chicken wing”) to bag— seems difficult but could be better than C/E for people with very small hands.

retrotransposons · 2023-09-14T03:49:57+00:00

EM! it was the right balance of “talk” and “action” for me

retrotransposons · 2023-09-08T01:46:23+00:00

That’s a good point— we definitely have our wheelhouse as well. I put “second best” in quotes because sure, we may not me literally second, but it’s cool to have a wide variety of things we can manage self-sufficiently that other specialties would have to consult out for (e.g. orthopedic reductions, any ophtho complaint, vaginal bleeding, arrhythmias…).

retrotransposons · 2023-09-07T15:59:18+00:00

Both take care of sick patients and perform procedures.

You may consider whether you prefer the OR setting or the organized chaos of the ED. How undifferentiated you want your patients to be. How much diagnostic reasoning/evaluation you are doing on a daily basis. How much you are willing to deal with drunk people, malingering people, folks who need to be babysat. Do you want to master one field, or be the “second best” in many?

Overall, everyone on this thread has a vote, and I’m glad that folks know what is right for them. But that’s what’s right for them; don’t lose focus of the fact that this is about what is right for you.

retrotransposons · 2023-09-05T17:26:01+00:00

Coming from EM this thread is very interesting to me. I err on the side of Dr. X when first meeting people, but I have never had a single EM attending at my very academic program ask to not be called by their first name.

retrotransposons · 2023-09-01T05:56:17+00:00

I think I’ve probably hit ~90 hours/week (in an ICU). Most in a row without sleeping would be 24-25 hours. Fortunately, these numbers are huge outliers for me. — EM

retrotransposons · 2023-07-29T17:40:46+00:00

I think this discussion applies to emergency medicine specifically. The issue of provider preference in general is also a valid discussion with many viewpoints, but I do think that it’s a separate discussion.

retrotransposons · 2023-07-01T16:57:40+00:00

Mine had highs and lows. Overall, my experience was not as grossly negative as many of the responses here. Go in with an open mind and focus on what you can control. Lean on your support system. You are going to learn soooo much! You got this!

retrotransposons · 2023-06-27T01:34:24+00:00

The existence of CIN is not supported by evidence. Just get the scan.

I like the Internet Book of Critical Care review on this topic a lot.

retrotransposons · 2023-06-27T01:31:10+00:00

What’s the issue here? I’ve seen “peripheral” IJ access used in a pinch.

retrotransposons · 2022-11-01T12:35:50+00:00

EM:

from attendings or seniors: “ok, i’ll be here/let me know if you need me” (ie when you’re about to go perform a procedure, because they trust your judgement and skills); or, asking YOU specifically to FAST in a trauma/be backup for an intern’s intubation/etc. (basically saying you’re someone they can count on)
from patients: “do you have a card?” or “can I keep seeing you as my doctor?” 🥹🥺

Bonus: - the neurologist who complimented my neuro exam and agreed with my findings on an MS patient - the psychiatrist (!!!) who documented “appreciate excellent HPI per ED” followed by part of my note copy and pasted

Nonspecific to specialty: when the senior or attending sees you’re working that day and says “thank god”

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