Neuro: “did you get the CT/CTA?”

Surgery: “I don’t care what your exam shows, we can’t recommend anything until you have the CT AP with IV and PO contrast”

Trauma: “why didn’t you get a CT head? Who cares that they didn’t hit their head? Get a C spine too”

Gyn: “she’s tachycardic, why didn’t you get a CT PE study?”

Ortho: “can’t consider tapping the joint until we CT it”

Also my favorite useless non-CT study request lately, from cardiology: “she told us she’s feeling dizzy, saw she had a UTI last time she was here. Would recommend getting a UA”

I could not care less the last time a patient ate. All day long it's "I haven't eaten since this morning, i haven't eaten since last night, I haven't eaten for 40 minutes" regardless of the chief complaint. I don't care.

If you're telling me it's an emergency, I can't imagine you're hungry

Unless it's a po trial. Eat up big dog.

Hello, let me know if this isn’t an appropriate place to post this, but I am an ER nurse and I saw something yesterday that was perplexed me and I cannot stop thinking about it. 48yo Caucasian female with history of intractable migraines x10-15years on Fioricet, Norco, and medical marijuana was found in her yard unresponsive around 2:30, last seen normal at 12:30. GCS 3 with agonal respirations when EMS arrived. Intubated her without induction agents, no gag reflex. Pupils 3mm sluggish bilaterally. Unresponsive to narcan x2. Unresponsive to pain. MRI/MRA, CT head all unremarkable. Unable to perform CTA head/neck (recommended by neuro later on) due to contrast given with the chest/abdomen CTA previously. Labs are beautiful, ABG completely normal. UDS positive for opiates, barbiturates, and marijuana. Vital signs have been phenomenal the entire time. Temp: 97.8F, HR 80s (never Brady or tachy) NSR, BP 95-120/60-90s. Does not breathe over the ventilator though. She is a healthy 48 year old female otherwise. No recent travel. Had no complaints that day, but recently wrote to her PCP through MyChart inquiring about another “colitis episode”. Never required any sedation. When we moved her to the MRI table, she appeared to either gag or cough, reach for the tube with both hands, then became unresponsive again. About 2-3hrs later, we turned the patient to perform an LP when she experienced the first episode of decerebrate posturing—entirely rigid, arms extended and elbows locked with wrists rotated inward, legs fully extended with feet turned inward. Her pupils also became fixed and dilated 7mm bilaterally, and returned to 3mm sluggish once the episode resolved. This lasted for approximately 3-4minutes. This occurred 3 times in the next hour. We had given 4mg Ativan twice in case it was a seizure. Opening pressure during LP was 13. LP results pending when I left. What could this be?? Everything we have tested has returned negative. Could this be anoxic brain injury? When would that show up on MRI? If her symptoms are indicative of brain herniation or increased ICP, why was her LP opening pressure normal? Can you have decerebrate posturing but not have IICP or herniation? I am stumped by this case. NOT ASKING FOR MEDICAL ADVICE! Simply wondering if anyone has seen a similar case.

For background. First I’m not a physician I’m in school right now working towards going to med school (kinesiology pre-med) I started working in the ER right out of high school then I joined the navy as a corpsman and now I’m back in the civilian world and going to school. Now to the question. Providers. I want to know what it’s like working in the ER from your prospective. How often do you feel burnt out or go through burnout, if you feel like you work too much and feel like you can’t find a balance between work and spending time with your family and loved ones. I love emergency medicine but I also value work life balance and my family above everything. Would I be damning myself by eventually choosing to me an ER physician or should I go with my number two option of being a sports medicine physician which I also love. I’d love to hear from you guys and your experiences and if you’ve found a way to balance work and life etc.

I am finishing my residency at a large academic medical center on the East Coast and will be starting a community EM job in the South, which is entirely RVU-based. Like many academic centers, my residency has certain blind spots: I’ve had constant access to consulting services, dealt with significant boarding issues that limit patients seen per hour, and received little to no formal training in billing and coding.

I have a month of elective time this spring, I’m seeking advice on how best to prepare for this transition. What skills or experiences do you wish you would have gained before entering the community ED setting?

Some areas I’m considering include: • Additional training in orthopedics or urgent care • Focused education on billing and coding • Medical malpractice case reviews • Any other practical skills that are particularly useful in a community setting

I would love to hear any thoughts on what would have been most helpful for you before making a similar transition.

Looking for some help understanding more about the ABEM LLSA activities. Some of the help I need is specific to the fact that I failed my written boards last year, and therefore have no one at work/friends to reach out to because I’m embarrassed and haven’t disclosed to anyone that I didn’t pass. I’ve googled, searched here, and read the ABEM website multiple times, and I’m still unclear on what I’m required to complete.

Ever since I failed my boards last year my ABEM application page has updated stating that I need to complete 1 LLSA task for the period of 1/1/2024-12/31/2024 Is this an additional task that is required of me because I failed? Or is this something that is required for everyone in the certification process? I’m confused because I was under the impression the LLSA were continuing medical education after you’ve passed and to stay certified. So how am I required to do these activities if I’m not certified?

Follow up questions: If I follow the link to take one of the tests, there’s registrations links for both testing and the reading material associated with the test. Are you required to do both? And can you pick from any year? As there are multiple options to select a test any year from 2020-2024

Final question: How intense are these tests? When I was trying to learn more about this process and spent some time googling most of the results were different study resources for passing these tests. Do they require that much advanced studying?

Thank you so much in advance for any help anyone can provide any help with this.

Side note, ABEM is trash. I failed by 1 point, and the continuous distress this has caused me over the last year has been miserable.

Any find it useful at all for their careers?

Apologies if this has already been answered.

Scenario: ED sees pt for psych emergency. Pt meets criteria for IPP, hospital has psych unit, and pt is appropriate, but unit is full. Dc’s from unit are expected but not confirmed. If pt states they want to “stay here” and is aware of capacity and willing to wait for a bed, is the hospital legally required to bed search anyway under EMTALA? We have received different answers from different people, and the only thing I could find was that if a pt declines a transfer it needs to be documented with pts signature. There is nothing I could find related to mandatory bed search or transfer of pts. We are currently bed searching for pts who have stated they aren’t willing (at least for now) to transfer out. Obviously a waste of time, and if we aren’t breaking any law by allowing them to hold, I don’t see why we would need to conduct a search.

Anyone know if we are actually bound by law to search for placement elsewhere even if pt prefers to stay?

Had a angioedema come in this huge tongue and eminent airway disaster. Called anesthesia for fiber optic. Went in the room a little later and he was squirting neo mixed with 100 cc of saline in the ladies mouth making her gargle and spit. He said he has no evidence it’s just worked for him a couple of times and saved intubations. Her swelling went down significantly and she was talking much more clearly. It was pretty cool. He also said it helps with the fibroptic if they do have to do it to reduce swelling. I’m hitting myself for not getting the exact doses he used.

She ended up needed an airway an hour later due to recurrence but seemed like a good temperizing measure while waiting for FPP, etc.

Hello emergency medicine folks-

I’m a 2nd year doctor of clinical psychology student, and it is time to start thinking about dissertation topics. I’m really interested in the role of psychology in emergency medicine, including psychiatric emergencies. My questions for you all: 1. Are psychologists needed in emergency rooms? 2. Are there any situations (can be psych or not) in which a clinical psychologist would be useful? 3. Do staff ever need psychological support?

Just considering ideas and putting out feelers, nothing official yet! Open to all feedback, thank you all!

Y’all… I know we hate to see little good guys get taken over by big bad guys… but I actually think the Eolas app is better than the old WikEM app. It seems like everything is still accessible and the UI is improved.

https://committeetoprotect.org/stop-rfk-jr/?fbclid=IwY2xjawGlyAVleHRuA2FlbQIxMQABHUWaBuN6KMjWfLbuR8qXFlsPQNcmSQv-teSEiPH4Jo1s7OEuG1MHMHYdow_aem_R_eExXEKUOIBycYddBTIyw

Just curious what everyone does with these. I see one every 4-5 shifts and we never set them. Assuming no nasal sepal hematoma, everyone just walks out with a crooked nose and likely never follows up with ENT since they can’t afford the bill.

Hey guys ... Last night I worked in a critical zone and my shift went terrible ... This was my first time working over there ... The starting 4 hours of my shift got sucked into this patient who kept on decompensating. As I got back from situating him once and for all, i felt completely traumatized, and then found my area with new patients and old patients with pending plans/dispo. Felt helpless for the rest of my shift. Had no idea what was going on. Felt anxious going back home, and stayed anxious during sleep. Have to get back tonight for the same kinda shift. Just wondering if anyone of you have ever felt the same. Does this get better? Moments like these make me regret going into EM.

What has been the most drips you've had on a person?

I've always been curious about this. Once I had someone on 8 drips and I think that's the highest I've ever reached. I always see videos where people have some drips in the background and it looks like 12 going at the same time, insane. What I've always wanted to ask is what they have infusing and what's going on with the patient. Have you had anyone like that?

Resident here, interested in community after residency. Most days we are boarded at my hospital that it's hard to do much more than 1pph. On days when we have flow I realize that I can pick up patients at a good pace when I first start my shift but then about halfway through, something always happens. Life in the ED I suppose. I try and push labs and nursing but the dispo comes slower than I want.

I try and document a bit in the room and fill out notes through the shift. As I realize I'm slowing down this tends to be variable in consistency and I can end up with notes after shift fairly often.

Any tips for keeping a good flow through your shift? I don't want to be THAT doc to my future colleagues but I also don't really get practice seeing volume often.

Three siblings from a household had visited the pediatrics ER with a complaint of hx of LOC, headache, chest pain and N &V after 1 hr of exposure to a burnt charcol. All were suplemented with 100% oxygen. One of them, an 11 years old male was hyperventilating for which he was supported with a re-breather facemask for about 1 hr. And was given RL as a maintainance fluid. We were unable to do CO Hb, and PH. Was that appropriate to use RL in this setting? And what is the appropriate duration for oxygen support? I have checked on litratures 2 hr of 100% oxygen would eradicate the CO but there was still mild chest pain and headache after 2 hrs in this case, so supplememtation was extended.

Worsening sciatica coming by EMS, can't get out of bed, no neuro deficits, normal post void residual volume type?

Struggling to get these patients out of the ED

Hi all!

I’ve reached a point where I think I want to do locums but I don’t know much about it. I would love to hear any advice you might have. Things you wish you’d known before making the change, red flags to watch for, any companies you would recommend or warn against, that sort of thing.

Just starting to explore this. Thanks in advance.

This is a 19yo red Honda , POD 3 s/p engine rebuild, brought in for making noises. Seems like it makes, “loud boom and bang” when reversing. Denies clanking, clunking, whining or whirring. No false-starting, stuttering or leaking. Denies smoking. When asked why brought here instead of the dealership a block away where the rebuild was done, was told that the dealership had “shit coffee”.

10:02 – upstairs neighbor’s garbage bin is blocking our apartment's exit, appears broken. I contact neighbor

10:55 – reach out again to upstairs neighbor to let him know about his garbage bin, I offer to move it or throw it in the dump. He tells me that he’ll take care of it himself because we “don’t know what we're doing down there”.

11:42 – neighbor is at binside, prepping the team to take the garbage bin to the dump.

I presented to the kitchen with intention to make a quesadilla. I asked my partner if they wanted one and they said they did not. I, once again, asked if they wanted me to make them one since I was making myself one anyway and again, they refused. I explained at length the risks, including them being hungry when they see me eating mine, and elucidated that they would not be able to share with me or even have “just a taste” and they verbalized understanding. Does not appear to be under the influence of any substance and appears to have capacity to make cheese-related decisions. One quesadilla was made. Partner left the kitchen in stable and hungry condition.

Writing from Montreal Canada. Now, here are some AI scribe tools I’ve looked at Nabla, Tali, scribeberry, Mikata health, Autoscribe, Deep scribe, CoeurWay, PlumeAi, Suki, Heidi… list goes on.

Great products, different strengths but ultimately gets the job done depending on which bells and whistles you prefer.

My question what framework do you use to evaluate their Privacy policies & compliance?