Dr. Karen Miley DNP, LPN, LVN, CCN, ESP, RBF, ROFL

Over the weekend I learned how to read EEGs. There something magical about being able to read someone’s thoughts. Another Doc couldn’t contain their excitement when they were on the monitor and just started thrashing around and grunting. I mean just look at those thoughts!

J-point elevation is such an oddity to me. Case in point, last night a sweaty 68 yo farmer came in with severe heart burn. Of course the triage tech did an unnecessary EKG. A GI cocktail and 8mg of dilaudid later, he’s ready to go! Stop triage orders! They only cause confusion!

As it warms up, remember snakes are coming out. Please carry Benadryl, a tourniquet, and a suction kit when hiking. Having the medical director of Venom 1 & 2 on speed dial like @benabo is a huge plus! Be safe and stay indoors!

Dear PhDs, please leave diagnosing patients to healthcare professionals. With the exception of Reiki practitioners, we actually touch our patients.

Those thinking about getting your DNP, now is the time! In 3 to 4 years there won’t be enough emergency residents to take jobs. Get that 18 months online and 500 hours done now and beat them to the punch! With TikTok to guide the way, we’re going to take over! Muhahahahaha.

@MBrigmon @RBeaverDO @ErinMcCreary Ugh. Have they never heard of Gorillicillin?!? Vanco, ceftiraxone, meropenum, and gorillicillin will do just fine. Must be a PA doing the medical advising.

@RBeaverDO @ErinMcCreary @miley_dnp ? She has too many titles to let this happen!

medical tv that has me in shambles, part 3

@Genericspicy Wait? How did you know that? Was I talking with you?!?

@miley_dnp Did you mention that her tachycardia was strangely refractory to the metoprolol you were giving??

Ugh, why are ICU docs always so rude?!? 50 yo woman with a big PE. Started O2 and 10mg morphine for SOB. They felt better. Waiting for transfer. 2 hours later they get worse. Time for TXA! ICU doc wouldn’t even let me order it! Just take the transfer and let me do my job! 🤬

@JuanCLarach1 No. Sea level.

@miley_dnp Elevation?

60 yo M with so much shoulder pain he couldn’t breath well. 10mg dilaudid and some toradol fixed him right up. Some PT should do the trick! Weirdly, in all my year in emergency medicine, I have never seen such weird j point elevation. EKGs are still so odd to me.

@MedicalMoFo Great idea! Reduce that inflammation!

@miley_dnp Don't forget the Medrol Dose-pack

@miley_dnp good call on that J point elevation. I’m so glad you’re #holistic and treat the entire person and not just the disease.

As an ER doctor, I just can’t anymore with the disrespect. I called a consult to the local baker at 1am to see how someone just falls on a jar of honey. They just hung up! I mean seriously. This is a 1 in a million fall. Guess I’ll see if Yogi is available to retrieve it.

This note is fantastic! Short, to the point, and legible. Strong work by a fellow DNP!

Has anyone used ChatGPT to pass their online fellowships yet? I’m thinking about adding a few more letters to my name, but I’d prefer to maintain my fabulous lifestyle. This new IA thing looks like the perfect solution. Thanks!

Quick twitter poll. 25 yo M came in with a change in his voice and feeling like something is stuck in his throat. He looks fine. Healthy, but likes his cocaine. A biopsy was needed with how it looked, so I cut it out. It’s now bleeding…a lot. Like A LOT. So what do I do now?

I commend this fantastic Doctor practicing healthcare and asking for help. I mean who really knows how to treat a low sodium off the top of their head? I’m so glad we have Facebook and Medscape to help find the answers.

6 semesters?!? That crazy. You can do it way faster and still call yourself doctor. These programs are huge rip off of your time. 18 months online or bust!

With this tripledemic and lack of progress with my clinic being able to add psilocybin as an adjunct to ketamine and adderall treatments, I’m getting burnt out. It’s time to switch from the ED and go do Peds ICU. Kids, especially quiet kids, are so much fun. It’ll be a fun break.

While doing a pelvic exam, I found a glass eye staring back at me. Apparently the patient put it there for safe keeping, but can’t get it out. When I called ophtho, I heard a parrot in the background screaming “send it to clinic!” No birdie, this needs out now!