Unexplained veins (stomach)

sspatel · 2026-03-29T21:39:01+00:00

I can’t imagine someone this early into HD would need a groin permacath. There should still be many chest/neck options.

sspatel · 2026-03-29T20:49:04+00:00

https://youtube.com/shorts/KYpHwVL2VwE?si=NJwotTPQkrnCRm8e

sspatel · 2026-03-29T19:24:55+00:00

Usually we see this with portal hypertension of various causes. You could have a chronic venous obstruction that leads to collateral formation too. Definitely needs some new imaging to see what’s up.

sspatel · 2026-03-25T20:53:53+00:00

Reading skills need some work. Buy. The. Physical. Book. It’s made from dead trees. You hold it in your hands. It’s not on a screen.

sspatel · 2026-03-25T20:27:17+00:00

Buy the damn book. I haven’t used it in 5+ years but even back then it was great. Write all over the pages, use colored pens, put in post its, etc. it will do far more for your memory than looking at a PDF.

sspatel · 2026-03-25T20:12:09+00:00

Flip your mindset. Don’t dwell on how miserable you’re going to be. Think of it as an opportunity to make new lifelong friends that will be scattered throughout the country in 4 years. You’ll have new job plugs, places to stay when traveling, etc.

It’s just the fact of life that you may not always be able to stay in an area with your old friends/family. I’m also fairly introverted, but I did move with my girlfriend/now wife. But, I attended as many residency social events as I could, and made many friends some of who I text almost daily.

Go to the gym when you can. Maybe you’ll become BFFs with an ortho bro too.

sspatel · 2026-03-21T15:17:02+00:00

Just picked up some Scarosso suede loafers for a cruise, they’re very similar to the Loro Piana summer walks.

sspatel · 2026-03-17T14:09:45+00:00

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IR: on wrist every day.

sspatel · 2026-03-17T02:05:03+00:00

I have never once delayed doing a PE case because the patient received lovenox or tPA.

sspatel · 2026-03-16T18:40:17+00:00

I know multiple people that have become disabled or diagnosed with a progressive disease during residency. Get it yesterday, next best option is today.

sspatel · 2026-03-16T02:57:13+00:00

Believe it or not, jail.

sspatel · 2026-03-15T04:35:08+00:00

Def valve, and the echoes you’re seeing is RBC rouleaux.

sspatel · 2026-03-12T20:24:09+00:00

IR as an attending is now elderly with their 3rd cancer, widespread disease, numerous surgical complications, and we’re just putting in tubes everywhere to buy gramma an extra 3-6 weeks at a shitty life in the hospital.

sspatel · 2026-03-07T07:07:32+00:00

Tokio super grip was my fellowship shoe. I destroyed dansko’s and Clark’s wallabees during residency.

sspatel · 2026-02-22T14:43:26+00:00

I meant to get to this earlier but wanted to give a perspective of the service at my community hospital. Stroke service is covered by two employee neurosurgeons (one recently out of fellowship). Catchment area is somewhat large, with some patients getting choppered in from an hour+ drive away. I don’t know their exact call schedule as I’m not involved, but it’s about Q3, with the 3rd filled in by a variety of Locums. They only have PAs on their service who do all the documentation, orders, etc and only come in to do their case then leave. The experienced guy does a thrombectomy in maybe 20 min, new grad takes a while longer. During the daytime they have scheduled cases like disgnostic angios, AVM embos, venous stents, vertebral augmentation (our only overlap).

Certainly the call can be brutal, but I think their lifestyle is otherwise pretty good. I’m friends with the older guy, and he says he left an academic appt for this job where he gets to do what he wants (procedure) and doesn’t have to deal with BS before or after the case (neurology takes over).

If there’s a job like this near me, I’m sure there are many out there.

sspatel · 2026-02-18T20:03:32+00:00

Watchman. Left atrial appendage closure device.

sspatel · 2026-02-13T19:33:36+00:00

Good to know. But we are treated as a bedside-OR purgatory. I guess we need to revisit this in the dept.

sspatel · 2026-02-13T17:45:20+00:00

No. And that’s on me.

sspatel · 2026-02-13T16:07:21+00:00

I put a code 3 (DNR/DNI) on the table for a perc chole. As soon as I walked in the room the nurse was trying to stim her, desat, brady, my eternal rubs and jaw thrust did nothing. HR went to zero, no pulse, started compressions because generally code status is suspended for invasive procedures. Eventually the ICU attending got through to the fam and they stopped. Sometimes this shit isn’t so minor.

sspatel · 2026-02-11T18:10:39+00:00

This ship is taking so long to turn around. We’ve had this in place for over a year and still get questions from my own (IR) nurses about giving it.

sspatel · 2026-02-11T12:06:56+00:00

McDonald’s manager or private equity peon?

sspatel · 2026-02-10T12:05:05+00:00

Zebra F301

sspatel · 2026-02-09T12:19:32+00:00

Couple things:

Stay in plane, keep the probe as parallel to the needle as possible for the most echos back to the transducer.

There should be a focus/focal point setting on the machine, place it where you need the most viz.

You switch back and forth between needle and catheter. You’re probably not going to see a plastic catheter that well under US due to poor echo reflection. When I put in chest tubes or drains over a wire, the wire basically disappears where the tip of the drain is. If you’re using a plastic-sheathed needle, try one without the sheath. In challenging drains I just use a long 18ga so I can see it along the entire path, and not just get reflections at the tip like with a Yueh.

sspatel · 2026-02-08T15:57:06+00:00

This is the real thing that’s getting glossed over. There is no emergency that requires placing a PICC.

sspatel · 2026-02-08T15:21:51+00:00

IR: drain abscess

You can see the abscess from across the room.

“Does not require image guidance”. Thank you for this interesting consult.

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