@rbarbosa91 @Asiritrauma1 @ZhiVenFongMD I think this is the actual genesis and I wish they would just come out and say it
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Mike Lallemand
6.4K posts
Mike Lallemand
@GroundLvlFall
Trauma and General Surgeon via @VUMCTrauma. likes Sugar Free Red Bull and resuscitation. Dislikes: bleeding
Portland, OR Katılım Ekim 2018
810 Takip Edilen923 Takipçiler
@ZhiVenFongMD I wonder if some of this is not really about IOC itself, which has been debated from the beginning, but rather an effort to prepare for later: if surgeons are going to be increasingly expected to do duct stuff (LCBDE), then IOC’s are the first step in starting to get that comfort
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Am I the only one who thinks that this is an absurd recommendation?
Routine Intraoperative Cholangiogram for Elective Laparoscopic Cholecystectomy Is Now Recommended
facs.org/for-medical-pr…
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@HalletJulie And…. Implications of radiographically occult stones found on IOC is likely nothing since most pass spontaneously. And can’t count the number of times I’m on call and readmit pts with retained stones after they had a chole with IOC 2 days ago.
So many counterfactuals ignored.
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@ZhiVenFongMD @georgoff It’s an absurd recommendation and the rationale for making the recommendation is non-sensical.
Gonna love all the post-ERCP pancreatitis for all the “previously unidentified” and likely asymptomatic and never would be a problem CBD stones.
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Hospitals should follow suit. Flu shot has never been shown to prevent hospitalization or death. I ended up in the ICU with pneumonia and sepsis the last time I got one. Never again!
Nick Sortor@nicksortor
🚨 JUST IN: The Pentagon is DROPPING its flu vaccine requirement for service members effective IMMEDIATELY, per Pete Hegseth “Our new policy is simple: if you’re an American warrior entrusted to defend this nation, and you believe that the flu vaccine is in your best interest, then you are free to take it… But we will NOT force you, because your body, your faith, and your convictions are NOT negotiable.”
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@VikingRobVWO I find it annoying that I have to update my DD214 and SGLI every year even though nothing has changed but I do it anyway because the tracker says I have to.
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@VikingRobVWO Who are the “many” advocating for this? I don’t read this as JAG lady knocking MDs and nurses IQs. Most of us in the medical world still believe in the effectiveness of vaccines. Flu can be hit or miss. Some years it works real well. Some years it’s a flop.
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Any nurses or MD's care to chime in on the JAG lady's assessment of your IQ?
Legal Eagle 🦅@AllThingsCivil
“Many have been advocating for this” Nobody cared about the flu shot until COVID and the anti vaxxers popped up. The lowest IQ, most gullible people you know are the only ones excited by this.
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@nickmmark Yes. You’re absolutely right. But this is like a true, true, and unrelated situation. If you follow him he absolutely understands compounding interest and he’d make more money in the long run by putting it into something with more than a 3.75% interest rate
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@DrChadHall @rbarbosa91 And depending on the setting/practice the fundamentals of critical care
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A trauma/acute care surgery group with, say, 10 surgeons, is not comprised of 10 individuals that are equally good at all of the things.
For example, all 10 surgeons cannot be rib platers or abdominal wall people. You have to find and carve out your niche(s) within the group. 🧐
GIF
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@crypto_condom @SalaryDr There isn’t that much of a difference in pay
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@SalaryDr Then don’t spread misinformation.
Big difference bw a board certified SCC trauma surgeon and a general surgeon pal. Ffs get your facts right
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@crypto_condom @SalaryDr Lol. Where do these $300-400/hr jobs exist? $295 is the highest hourly I’ve found
And places offering $150 for trauma coverage are very common. They’re also very commonly begging for coverage cause no one wants to take that job
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@SalaryDr This is ridiculous. No trauma surgeon in the us is paid that. $200 without fellowship training may be possible but a fellowship trained SCC certified trauma surgeon makes $300-400/hr. Your data is flawed.
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Mike Lallemand retweetledi
This post was 100% written by ChatGPT but it is so important to know that missed or non-diagnosis because of using noncon CTs is much more likely to lead to renal injury (and death) than using contrast on a CT and getting your PE/aortic dissection/appendicitis diagnosis correct
Dr. Chacón-Lozsán F .'.@franciscojlk
🩻Contrast-induced AKI: one of the biggest myths still shaping clinical decisions For decades we were taught: 👉 “Contrast damages the kidneys” 👉 “Avoid CT with contrast in CKD” 👉 “Hydrate, protect, delay imaging if needed” But what if… most of this is wrong?🤔 ->The uncomfortable reality Modern evidence shows: 👉 Low-osmolar contrast rarely causes true nephrotoxicity 👉 Even in CKD, AKI, and ICU patients 👉 The risk is often overestimated—or nonexistent So where did the fear come from? 📍 1950s high-osmolar contrast (actually toxic) 📍 Poorly controlled observational studies 📍 “Creatinine rise = contrast injury” assumption 👉 Correlation became causation 👉 And the dogma stayed ⚠️What recent data tells us ✔ No difference in AKI rates with vs without contrast ✔ No benefit from bicarbonate, NAC, or aggressive hydration ✔ Even ICU and AKI patients show no worsening outcomes ->Translation to real life 👉 The patient was going to develop AKI anyway...Not because of contrast!! ->The real problem: “Renalism” 👉 Avoiding necessary imaging 👉 Delaying diagnosis 👉 Choosing inferior tests And that leads to: ❌ Missed PE ❌ Delayed sepsis source control ❌ Worse outcomes ->Clinical mindset shift Instead of asking: 👉 “Will contrast harm the kidneys?” We should ask: 👉 “Will NOT doing the scan harm the patient?” ->Who still deserves caution? ✔ eGFR <30 ✔ Severe hemodynamic instability ✔ Multiple nephrotoxins Even then: 👉 Optimize volume 👉 Minimize dose 👉 Don’t delay critical imaging 🤓Bottom line ✔ Contrast nephrotoxicity exists… but is rare ✔ The fear is bigger than the risk ✔ The harm of NOT imaging is often greater In critical care 👉 We don’t treat creatinine 👉 We treat patients And sometimes… 👉 The most dangerous thing is NOT the contrast 👉 It’s hesitation. 📃Reference Florens N, Demiselle J. Kidney360 7: 445–449, 2026. doi: doi.org/10.34067/KID.0…
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@GroundLvlFall @BrokenTruthTV @neoavatara @DogeBonkBonker I am over the age of 50 and have never had a colleague in this country able to enter med school without a BS first- it’s not a new thing. You’re dreaming.
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Foreign-educated MBBS "doctors" claim they are MDs on hospital websites and in medical board certifications.
As part of informed consent, should patients know that their MBBS provider has less education and does not have an actual Doctor of Medicine degree?
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@Fynnderella1 @BrokenTruthTV @neoavatara @DogeBonkBonker Everyone I know that has is over the age of 50. Apparently now it is a requirement to have a bachelors. They’ve changed it from the minimum 90 hours of course work with the above pre-reqs
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@GroundLvlFall @BrokenTruthTV @neoavatara @DogeBonkBonker Never saw a US student go this route and match.
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@BrokenTruthTV @neoavatara @DogeBonkBonker It does appear that this has changed since I went through the process nearly 20 years ago ¯\_(ツ)_/¯.
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@BrokenTruthTV @neoavatara @DogeBonkBonker The only school I’m aware of that requires a bachelors is the Uniformed Services University because it’s a requirement to commission and be an officer.
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@BrokenTruthTV @neoavatara @DogeBonkBonker Yes. I know several. That are around my age. There are a lot I know that are of an older generation. Different schools will have different requirements. The minimum is 2 semesters of chemistry, 2 of organic chem, and 2 of physics. Some require biochem. Some require calculus
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@JohnAnthonyMD @RepFitzgerald Seeing as how resident salaries are paid/subsidized by CMS/medicare and that amount hasnt changed since when? The 90s?
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@GroundLvlFall @RepFitzgerald Elaborate. You are wrong, but I'm curious how you arrived at your incorrect conclusion.
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The Match, shielded by a medical residency antitrust exemption, controls where future doctors train and what they’re paid. This monopoly leaves thousands of qualified applicants without a residency slot each year. ⬇️
House Judiciary GOP 🇺🇸🇺🇸🇺🇸@JudiciaryGOP
#BREAKING: New Report Exposes How Medical Residency Hiring Monopoly Harms Patients and Doctors Newly obtained documents reveal how the Match placement system for resident physicians operates as a monopoly in the medical residency hiring market. Its monopolistic practices harm resident physicians, impede patients' access to care, and constrain the growth of America's physician workforce. A special-interest antitrust exemption currently shields the Match’s anticompetitive conduct from scrutiny, allowing it to harm the public while avoiding judicial oversight. Read the full report here: judiciary.house.gov/sites/evo-subs…
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@rick_sherwood85 @molsjames Do you think residents being able to negotiate salaries would increase the number of matched US medical students?
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@GroundLvlFall @molsjames And said algorithm eliminates competition, leaves residents helpless against any sort of reasonable compensation or work conditions, and inevitably results in hundreds of Us students not matching each year, further exacerbating HCP shortage. But other than that, it’s perfect
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“The match” is a horrible process.
In what other professional capacity do you interview people, choose the best, then put it into a secret lottery system?
Everything about medicine is designed to devalue quality and merit.
House Judiciary GOP 🇺🇸🇺🇸🇺🇸@JudiciaryGOP
#BREAKING: New Report Exposes How Medical Residency Hiring Monopoly Harms Patients and Doctors Newly obtained documents reveal how the Match placement system for resident physicians operates as a monopoly in the medical residency hiring market. Its monopolistic practices harm resident physicians, impede patients' access to care, and constrain the growth of America's physician workforce. A special-interest antitrust exemption currently shields the Match’s anticompetitive conduct from scrutiny, allowing it to harm the public while avoiding judicial oversight. Read the full report here: judiciary.house.gov/sites/evo-subs…
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