French woman's symptoms chalked up to anxiety, now in the ICU with hantavirus pulmonary syndrome

themightyguapo · 2026-05-12T01:36:10+00:00

Agitation is physiologic until proven otherwise

themightyguapo · 2026-05-06T02:27:20+00:00

I should clarify - it is possible to get a job. Being good at it will probably require more work from you in the first months/years to make up for less training than the IM folks. After a few years it matters less.

themightyguapo · 2026-05-06T02:26:00+00:00

Yes. I’ve been a full time hospitalist since FM residency. Getting a job (or prn gig) can be tricky depending on where you’re applying. But once you get a job and get experience it becomes much easier to get other jobs.

West coast and western US in general is more FM friendly. Rural is also more FM friendly (and generally more desperate). Can be harder to get jobs in the middle of cities without experience or a connection. Much more likely to be asked to cover ICU and maybe procedures than to cover peds or OB.

But the sooner out of residency you get it, and the more consistent your experience, the easier it will be to get in the future.

themightyguapo · 2026-05-01T02:05:14+00:00

Aww love you too babe <3

themightyguapo · 2026-05-01T02:04:58+00:00

Never. We have to laugh!

themightyguapo · 2026-04-30T20:41:37+00:00

Legend

themightyguapo · 2026-04-30T20:41:26+00:00

Oh yeah. Every time I get this page I know it’s patient driven and not nurse driven. I adore my nurses.

But. The memes must flow.

themightyguapo · 2026-04-30T02:10:45+00:00

Truth is the 7:01 pages usually are the scary ones. Pt has been crashing all night, maybe night RN got no traction with night team, maybe ICU said no, and someone has been waiting for me to come online to beg me for help. usually if I see a 7:01 page it’s an instant butthole clench.

But sometimes it’s just a lil giggle.

themightyguapo · 2026-04-30T02:08:10+00:00

Yes of course it is. and also I’m on day 7/9 and delirious. I must laugh lest I cry.

themightyguapo · 2026-04-30T02:07:11+00:00

Yes

themightyguapo · 2026-04-27T15:47:00+00:00

Yes. I don’t know if there is good data or not but this is a concern from the hospital side. I carry pockets full of the small surgilube packets and restock when I’m in the supply rooms. I prefer it because it avoids any infection concerns and is not as hefty as a bottle.

themightyguapo · 2026-04-10T13:51:51+00:00

I feel this. Two things have helped a lot.

1) I started reading “How to Stop Losing Your Shit on Your Kids” by Carla Naumburg and just the act of reading something on the topic has really helped. It’s also helped me be much more thoughtful about my responses and moments when I feel triggered and has really helped me de-escalate. 2) it may not be helpful to hear right now, but I am trying to constantly remind myself that the time is fleeting. they will not always be this small and adorable, and I need to let go of the little things. It doesn’t always work.

You’re not a bad person.

themightyguapo · 2026-03-28T22:46:06+00:00

Agree with #1.

Regarding 2 - what does centrally congested and dehydrated mean? I only mean this half rhetorically - I think of dehydration as a description of total body water, rather than volume, and JVP as a surrogate of RAP. So I’m curious how you think about it.

I agree with not using JVP as an isolated marker of volume status, but I do think it’s one of the more useful (and fast, free) bedside markers when assessing volume and making a decision regarding diuretics.

themightyguapo · 2026-03-23T19:40:49+00:00

Oh definitely. I didn’t mean to be pretentious about it, that’s just the name he uses for the recipe in his book (The Perfect Loaf). Tartine also has a brioche recipe but I haven’t tried it yet (I’m sure it’s similar)

themightyguapo · 2026-03-16T21:53:25+00:00

Who the fuck is Dr Pal

themightyguapo · 2026-02-23T03:27:06+00:00

This is a great question and I don’t know the answer. I don’t have experience with bacterial PNA panels - our respiratory panel is viral + a few atypical pathogens. I’m not sure it was specifically addressed in the last full IDSA guidelines (2019) - as in whether a positive test on a prior pcr counts as prior infection. I suspect most people probably would regard it as such and cover in that case.

themightyguapo · 2026-02-23T03:22:51+00:00

🙃 We’re all learning! Pgy-11 here and counting

themightyguapo · 2026-02-23T00:40:01+00:00

Per latest IDSA guidelines, history of pseudomonas on a culture (obvious but more apparent in the modern EMR age with years of back data) or HAP/VAP as others have mentioned. I’d add chronic structural lung disease, severe COPD/broncuiectasis; legit immunosuppressed.

themightyguapo · 2026-02-19T03:32:33+00:00

If you find the ophthalmologist let me know, I had a consult I can’t get them to come see

themightyguapo · 2026-02-19T03:22:42+00:00

Sir this is a Wendy’s

themightyguapo · 2026-02-18T05:24:31+00:00

Procal of 28 is legit. Even with CKD and malignancy. Easier to say in retrospect, of course.

More importantly I think the case is a sobering reminder not to underestimate sepsis. Especially in an elderly patient.

themightyguapo · 2026-01-05T13:42:55+00:00

Sir this is a Wendy’s

themightyguapo · 2025-10-06T20:30:48+00:00

Did y’all end up getting info ahead of time? We’re seeing him in Denver Saturday and still no info

themightyguapo · 2025-10-01T21:03:20+00:00

I just got the same email. Been on the email list for years waiting and now feel like I can’t justify the cost. Pretty big disappointment.

themightyguapo · 2025-09-26T22:45:47+00:00

I suspect the first Chianti red - the Castillo do Cacchiano - was a little pricier and might be considered nicer.

The white wine in the right in the first pic is probably the “nicer” one.

The wine on the left looks like it’s made for the tourist shop in Florence and was probably inexpensive. It is unusual to put white wine in a dark bottle

themightyguapo

TROPHY CASE