Recent content by TrailRun

I was just thinking about this post during a run. Thats so frustrating. I wonder if you could just self study for a bit and just open your own clinic? I imagine the liability in a field like sleep is exceedingly low. If NP and PA can do it then why not. This entire movement in medicine to...

I get the premise, but what if they are worse in 6 hours? How is that defensible? I would suggest they need to be at a place with the capability to intervene, or else you’re trying to facilitate transfer perhaps too late (however long that will take; maybe it’s a snowstorm and no one is flying...

I’m surprised that those ER’s that post the wait times hasn’t been interpreted as a discouragement. The DVT thing is a little tricky because I feel like half the time those are cellulitis so it is reasonable for them to be seen. Most docs where I work either just give a dose of eliquis and...

Our triage nurses 'hint' at it all the time. Where EMTALA hurts patients is when they come to a little ER with no OB, peds, etc, and the closest big hospital is "at capacity." Then they end up transferred much further, often out of state. A theoretical example would be a 3 week old just...

I guess I’m wishing there were a PECARN equivalent for >65 not anticoagulated. I see a significant percentage of elderly who hit their head but deny any headache or any symptoms, no focal deficits, no hemotympanum, etc.. The premise of PECARN as I understand it, it’s not to miss any that would...

I think everything you said is correct, but I can’t remember the last time I saw a significant ICH (that required surgical intervention (aside from their recommendation of a repeat CT in 6 hours) in a patient with a reassuring exam, history, GCS

Was wondering if my practice matches others; single coverage community so don't get a lot of feedback kids = PECARN severe mechanism, worrisome story or exam = scan any age anticoagulated = scan (usually even if not headstrike) 65 or over with headstrike = scan Most curious about whether...

I must have missed the day in residency where we were taught how to determine how long someone has been dead for. I definitely feel qualified to determine if someone is dead or not (and can back it up with pulselessness, cardiac ultrasound, etc). I'm sure we could all guess that someone had...

This is such a scary job. At any point someone can bring you a dying (or dead) baby, etc etc, and you’re supposed to manage, often with no support or resources. Add to that the fact that we are trained by necessity to think of worst first. Child with a headache - brain tumor? Non-accidental...

I think the max I've given or would feel comfortable is about 250. Almost never need more than 200. To the poster above, I personally wouldn't feel comfortable giving 200 to a 30kg child, would have aborted the procedure long before that. I'm almost always single coverage in a place with no...

That seems like a unicorn Palliative job. When I was considering fellowship last year, jobs (in northeast) were 185-225 still with call ("our census is growing rapidly").

Are you all ever doing the phenobarb load and DC? Wasn't acquainted with it in residency but seems to be gaining popularity. Aliem "The most commonly recommended dosing regimen starts with a 10 mg/IBW kg bolus followed by titration every 30 minutes afterwards. Patients in the ED often can be...

Yes, but there's that other case where the guy won $28 million after he left the ER and laid down on the train tracks and lost both his legs... https://www.trains.com/trn/news-reviews/news-wire/jury-awards-28-6-million-to-man-who-lost-legs-when-hit-by-amtrak-train/

Only been an attending for a few years, but didn't EM used to pay more (either in relative or actual terms) a decade or two ago, with lower patient volumes (ie less low acuity patients)? To be honest, I would take a big pay cut to only see emergencies without the constant grind of an endless...

I think your latter point is true, but part of my stress is that those low acuity patients wait several hours and then are understandably frustrated. And I'm frustrated because I've just told someone they are dying of cancer, pronounced someone, etc, and then an ankle sprain is berating me...