Recent content by TheComebacKid

This partially falls upon the senior residents in the pod. A good senior will ensure that they are pushing the off service residents to see more patients, and unpleasant ones (vaginal bleeding, psych patients, lac repairs). In addition, they should be there to support/supervise/oversee them as...

I think this will be an interesting. albeit frustrating experiment. I hypothesize that given the degree of obesity in this country we could probably get away with doing less contrasted scans. Contrasted scans require IVs, I find cause more delays. For perfusion scans and PE/dissection protocol...

If I didn't have fiberoptic... and the patient was tripodding, drooling, hypoxic, looked bad, I would probably just go down the path of surgical airway. Ketamine only intubation would never work, probably worsening whatever swelling they had. RSI would probably kill them. Controlled crich with...

It doesn't matter where you trained, or how much skill you have. We are talking about the 0.001% of airways that are truly the most difficult airways there are. In that case, there is absolutely literally ZERO downside to having help from someone who has intubated probably 10x as many patients...

I have had very little success with nebulized lidocaine. I don't think it does anything. I think atomized lidocaine is a bit better. I use both now. I've had patients snort up lidocaine jelly and that works probably the best. As a resident I did a two week elective in ENT clinic where I got to...

What is the utility to RSI in angioedema? I feel like having them spontaneously breathe is literally the only thing they have going for them and RSI is taking them even closer to COCV scenario. If you go the route of topicalization, it will take awhile, but if you can get in a scope and at...

I think the EM mindset is historically that we should be able to manage every airway and not require backup. While that is a good mindset from a training standpoint, I think it's really egotistical and detrimental to not utilize appropriate resources if you have them available to you, and it...

Follow up question: If you have anesthesia in house and you don’t call, and the patient has a catastrophic outcome (say anoxic brain injury), is there precedent to sue the EP for not calling anesthesia?

Woof, this hit really hard to home. I'm not crying, you're crying.

This is not meant to be a pissing match between the two specialties regarding who is better at airway management (there are prior threads in both forums about this). Lets say hypothetically you work at a hospital that has 24/7 anesthesia in house, and they are available and willing to respond...

Yes this is true. And just for the record, as someone who did a fellowship and does some non-EM stuff... it's not the same as what other specialties offer. Again I applaud you for doing sports medicine, I think you are on the right track. I did an EMS fellowship and do some EMS work on the...

To me some of it is about prediction... the way private equity is infiltrating into specialties like derm is terrifying. I suspect derm, currently considered to be the holy grail of work/life balance and good physician compensation, is ripe for midlevel takeover within the next decade. If some...

People talk a lot about skill atrophy. Yes, it's a real thing. But the only solution to prevent total and complete skill atrophy is to work a good number of shifts in a high acuity shop, with no residents, minimal consultant backup. That's obviously an extreme example, but preventing skill...

You discharge them. Numbness without any specific neurological distribution, that is not reproducible on exam (document the hell out of it), is something that I don't waste time on. You can really go down the rabbit hole and I have found that it rarely leads to anything of significance...

Long term, yes, likely less burnout in academics. Residents do shield you from some challenging patient and consultant interactions. And thank goodness for them doing lac repairs. That being said, from my perspective... when I put in an order, I know its in, and I'm done, and I don't have to...