Wick

1/Radiologist not answering the phone? Just want a quick read on that stat head CT? Here's a little help on how to do it yourself w/a thread on how to read a head CT!

@IM_Crit_ I’ve noticed this cognitive bias even rotating through the icu and I’m EM. Sometimes it’s easier starting from nothing and thinking of everything versus revisiting the diagnosis (such as when patients get sent in from an OSH).

I know I am stating the obvious but whenever an ICU patient crashes & septic shock is *obviously* in the differential diagnosis, please send blood cultures When someone presents to the ED even with nausea/weakness/"etc", he has blood cultures drawn before being sent "upstairs"

We are expected to do more, in less time, with more complicated patients, less societal respect, less affordability for patients, and with a healthcare system that was sold out to private equity by the previous generation of doctors.

@bukkytab This. My own experiences in healthcare are why I don’t get as frustrated as some of my colleagues do when patients come to the ER instead of PCP, specialist, etc. It can be really difficult to access care, even for the highest functioning and privileged people.

It truly breaks my heart when I am mistreated by the health care field and it takes bringing up I’m a resident to get standard care. It breaks my heart not for myself but for patients who look like me who are not in medicine that are often mistreated and not taken seriously.

Doing continuity well is hard in the ER. I won’t claim to provide the care patients deserve, but we are the care that is available. The moral injury is there. So we make the best of what we have and what little resources exist… hoping that it makes a difference to somebody.

We refill chronic medications because if we don’t who will? We take care of boarding patients for days in a row sometimes. We start treatment for addiction after seeing the same patient overdose multiple times. We give out food, water, bandages, socks, clothing.

Always makes me laugh when people say “but don’t you miss continuity in the ER?” 🤯 For much of the underresourced community we are their PCP, psychiatrist, OB/GYN, endocrinologist, neurologist. We care for the chronic issues of arguably the most vulnerable patients of all.

@thePuneetSquare Would also already be thinking if this person was an ECMO candidate/what interventions they want.

@thePuneetSquare My guess - ECG, trop, bnp, ESR/CRP if story isn’t classic, CTA. Get a central art line as the patient is probably peripherally clamped down. Start dobutamine and O2. Call cards and CT surg. I would also give some blood if hemoglobin < 10 (probably).

Patient gets transferred to you from a standalone ER intubated on max Levo epi and phenyl looking completely mottled. Not much info is sent with the patient. ultrasound shows this. What are your next moves

@jjfitzgeraldMD We all would do better to learn more about menopause. I’ve prescribed vaginal estrogen in the ER for recurrent post-menopausal UTIs. But I’ve also experienced ovarian failure myself so I’m aware of just how bad side effects can be.

OB/GYN is a specialty of female reproductive organ disease, and cannot be reasonably expected to be multi-organ, lifetime women’s health experts. Criticizing OB/Gyn for not having enough menopause training is inappropriate. Menopause medicine is a requirement of ALL specialties.

Ranchers are the OG ER doctor. Visited my partner’s family farm and ended up delivering a goat with dystocia. Last time it was a goat dying of bloat who needed bicarb + needle decompression + an OG tube. No shortage of clinical challenges on the farm!

I delivered at 22 weeks into a toilet. It is panic. Absolute panic. My body told me it was a bowel movement. I was in a hospital and an OB/GYN and all I could do was scream. The fetus is very small. I can see someone doing this. It's not abusing a corpse. FFS

Pt. with dyspnea and hypotension. No known PMHX. What is the primary driver of hypotension? (see next for poll and more clips) #medtwitter #echofirst #pocus #CardioTwitter

last winter I came to a crowded four way stop but my car started sliding on the ice and I couldn’t stop and I was like ok neat here comes death but since this is the Midwest everyone just watched my car slowly slide through the intersection and waved and smiled as I slid along

Me and the resident waiting for the rhythm to show back up on the monitor after pushing adenosine

@amyfaithho @doximity @ACEPNow @EmergencyDocs A single shift in an ER would I think change the way most human beings think about their place in the world and how life really works.

The theme of residency this week is that a negative test 1-4 weeks ago doesn’t mean that the patient doesn’t have something new or more noticeable NOW. If a concerning symptom hasn’t improved, has changed, or has gotten worse it probably warrants looking into.

Most fun autocorrect is tacro being replaced by taco. All my transplant patients are on regular, twice daily, tacos. Remember tacos are good and everyone loves them.