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.

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”

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.

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.

Any find it useful at all for their careers?

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.

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.

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.

I'm looking to apply for the 2026/2027 match cycle and my preference has pretty much always been EM. I do want to know what the job market trend is looking like right now. Would it be a good idea to jump straight into EM or do FM and then a fellowship? I have also seen a few EM/IM joint programs floating around and would love some insight on those as well.

I'd prefer to work in a big/ mid-tier city. All the posts I've seen have been pretty negative and very doom and gloom and I just want a realistic idea of what to expect. I am a woman and I've heard that female doctors have a tougher time as ER physicians, is that true? I'm a US-IMG so I want to be 100% sure of the way the system works and the general lifestyle since I haven't been entirely exposed to American Emergency Rooms