I had a patient come in with multiple different complaints. He has been having AMS, vague symptoms from msk to gi to conjunctivitis to nosebleeds, rash, recent head trauma, GU sx. Unable to provide clear history, mildly confused, under the influence of cocaine. His partner at bedside was very helpful with contributing to history much better than pt could which was great.

Weeeell patient is positive for an sti.

His partner was there for the entire ed visit. I came into the room and notified him of the results with the partner there. I then offered the partner treatment which she accepted. He asked if he could’ve gotten it from xyz and I stated no it’s primarily through transmission of bodily fluids.

They expectedly were arguing a bit after I stepped out but didn’t cause any big outbursts or issues. The patient then thanked me for caring for him and the partner thanked me as well -shocking Ik

I was speaking with coworkers and they stated that they would’ve had the partner step out? What would you have done in this situation?

I admit I am very pessimetic in general about this country, the character of the people that inhabit it and our future. I generally try to stay out of things happening outside my immediate area. I don't get involved in politics or anything besides begrudgingly voting every 4 years. My view point generally is I'm never going to change anyone's mind about anything so there isn't any point in trying, nonviolent protests are useless because the government doesn't give a shit, neither party and no politician cares about any of us and only act to further enrich corporate overlords. Though I can admit that one party has gone completely off the rails to an absurd degree. I generally try to stay in my lane, help as many people and do as much good in my personal/professional life as I can and hope it will make at least some small positive difference in the world.

But these protests today sparked a tiny bit of hope in trying to change the course of what is going on. As physicians in the ED, what else can we do? I hear people talking about "resisting" the current regime to fight against what is going on... what does that look like for us?

The only answer I'm really not looking for that I'm sure is coming is donating any money. You cannot convince me that money donated to pretty much any cause isn't just going straight into someones pocket that is laughing all the way to the bank

What do you feel about long term partnerships when it comes to working healthcare/first response?

Do you think you’re most compatible with those who understand all the trauma that goes with what we do?

Or do you find it beneficial for your partner to be removed from it all? acting more as an escape or even reality grounding.

My first marriage failed, for a lot of reasons, but one reason was we just couldn’t connect. He was an electrician and I a trauma nurse. A lot of times he couldn’t even handle a true response to “how was your day?” So I had to just keep silent.

I am a non-US IMG and from what I am seeing SLOE is the maker or breaker of EM application, but so far it appears from what I’ve read here that SLOEs are given to medical students on rotations and I am a graduate.. is this dream dead for me?

If you're in emergency medicine you do more resuscitations than anyone else, and I'm curious if any of you have even seen or heard a fellow professional screaming at a hemorrhaging or asystolic or otherwise on-the-verge-of-death patient.

I'm thinking things along the lines of

"Fight!" "Don't you die on me, man!" "Don't close your eyes!" "Stay with me!"

Etc...

I'm aware of the vast gulf between emergency medical practice and emergency medical melodrama, but the screaming-while-resuscitating trope is so common and universal among fictional depictions of life-saving that I can't help but wonder if there's any truth to it.

Thanks!

Hey Y’all!

EMT here who wants to become an MD. Been an EMT for almost a decade (currently 28yrs old) - are there any 8 year programs people recommend for BS/MD? Most of the ones I’ve seen online state high school seniors to apply but haven’t seen any for those who are a bit past their high school years haha.

Any advice would be great!

Not sure how to choose where to do an away. What would you guys choose?

Was thinking about buying some equipment to help with otic foreign bodies. Looks like there’s a decent number of options out there. Has anybody tried any of these or have any recommendations?

Hello everyone. I'm starting to look for EM Attending positions and will have interviews coming up. I wanted to hear your thoughts on how to best prepare for these? I have a list of questions that I'm interested in asking, but I'm not entirely sure what I'll be asked or how to best prepare for that. I'd appreciate any insight or advice. USA-based, if that matters. Thank you!

How do you guys deal with such patients especially when they are brought by family and they don't give full history? Do you immediately start the resuscitation or just look for the signs of death? Most of them have asystole and we don't know how long they have been dead. I am talking about a low resource setting.

I’m a 3rd year medical student and I just found out that there will be a AAEM medical conference in Miami April 6-10. I’m considering getting a last minute ticket and going but I’m wondering if it’ll even be worth it? The registration cost is $275, which is pretty hefty. Are the students sessions and skills lab really worth $275?

Hi all,

I’m sure like many of you I am enjoying The Pitt. A great spiritual successor to ER and very well done. Also hilarious how every resusc they do would be a once every two year best case for me lol.

SPOILERS

In the latest episode a patient suffers from an RV air embolism. They treat it by catheterizing the heart with a perforated pigtail. Do you think there’s any logical basis to do this ? Why would I catheterize the heart with a small bore chest tube when I can literally suck air from a 14 gage catheter. Thoracentesis and paracentesis needles also have perforations.

I realize it’s just a tv show and not supposed to be realistic, and there are other cases that aren’t accurate but this just seems particularly pointless to write this way, so I wanted to see if this generates any discussion.

Signed a job at a certain $/hr mid-to-late last year, it’s in a particular location we want, lifestyle that it sounds like we want, with a group that gives me good vibes. EM Docs Job postings have lately been like 20-30 more per hour than what I signed and I can’t help but feel like I should have negotiated harder. Yet at the time, it did not seem like the rates were hovering at this number. Of course there’s so much that goes into a job, profit sharing, bonuses, retirement contributions, vibes, etc.

I guess solace in the fact that it’s a democratic group so there is a group incentive to make more money if there is money on table to be made.

Just a small rant.

My husband and I are both ER doctors practicing in Los Angeles and are interested in leaving the US. I had some questions for US trained doctors practicing in BC. I work in a busy community ED and am growing tired of the direction that our country and ER is going here. The huge administrative presence, private equity infiltration, the whole insurance industry necessitating lateral transfers, rudeness of consultants/patients etc.

I have read a number of news articles (Surrey ER) regarding the current state of Canadian health care and some of the frustrations of ER doctors- overcrowding, long wait times, high LWBS numbers, etc.

1. Even with some of these challenges, would you say practicing in Canada is much better?

2. Where did you practice in the US and how do you feel this compares in your current hospital?

3. What's your work schedule like?

4. Even with some of the challenges that you face in the Canadian health care system, do you find practicing in Canada more satisfying

5. How is your work-life balance? We have two young girls and would love a much safer, less stressful life for them.

Any insight would be much appreciated. My husband has applied for his Canadian citizenship (2nd generation) and we are seriously considering a move. Thanks in advance.

I recently came across an interesting concept introduced in this article: a “chain of survival” tailored to road traffic accidents, inspired by the one already well-established in cardiac arrest management.

The idea is to structure a coordinated response that starts with early alert and bystander intervention, through EMS response, and up to definitive hospital care — aiming to increase survival chances in complex pre-hospital trauma scenarios.

I believe this could spark useful discussion, especially for those working in pre-hospital emergency systems or trauma care.

Do you think this model is applicable in your context? Which links in the current trauma chain do you think are the weakest?

Would love to hear your thoughts.

So we had a coworker at the very end of his shift stop answering the radio. About 10 minutes later we heard there was still no contact with this person. We found him unresponsive and hardly breathing. Our estimates are up to 45 minutes from last contact to being found. We had to do cpr, used an aed which it did detct a heartbeat, and breathing bag. Last I was told he was being air lifted. My shame is there was one point when rendering aid i looked at my hand and I was shaking like a leaf on a windy day. Paramedics said we did everything we could have with the cpr, aed, and whatnot but I just can't stop thinking if I should/could have done more. Hos status is still unknown.

Ok, I've been able to mostly keep up with the medicine until this episode (minus the burr hole, thought they wouldn't do it without CT) but I have zero clue how realistic aspirating the air embolism from the RA/RV under US guidance + xray confirmation in the ED is. Any thoughts?

Also, it feels like you shouldn't wait for ABG confirmation of methemoglobinemia to give methylene blue when sats are 85%, patient is near unresponsive and the blood is brown, but idnk.

Highlights:

And that is when it all started because my chest pain started immediately after that," Lacera, a family medicine physician with Riverside Medical Clinic said.

Recognizing the symptoms of a possible heart attack, Lacera alerted a flight attendant, who quickly called for medical assistance.

“I tried to get a pulse-ox monitor - it didn't work. We tried listening with a stethoscope, but it was a disposable, non-functional one. We couldn't hear anything," Haley said.

🧐

Lacera's Apple Watch showed an elevated heart rate, but they needed a more accurate assessment of her heart rhythm. That's when they located an onboard automated external defibrillator (AED), but the readout wasn't good news.

"I remember looking up at her, and she's looking at me, and she's like, 'Okay, it's saying I should shock.' And I said, 'Do it,'" Lacera recalled.

Haley followed the AED's instructions, delivering a shock .

😳

"She was amazing, she was amazing. It was a total angel sent from God," Lacera said.

She was diagnosed with afib later.

Hi, paramedic here, I brought in 2 STEMI in to 2 different docs. Both of which seem irritated that I had not done bilateral BP's.

I didnt inquire or bring it up at the bedside as it didn't seem appropriate. Never I had I been asked that before.

But is this something new? Nothing I know of the literature or pathology supports this. In Alberta, Canada if it matters.

What's the general vibe between the programs? It's difficult to gauge info when previous posts don't make distinctions when referring to "Henry Ford."

Hey EM physicians!

If anyone know will there be any updated latest editions of Tintinalli's Emergency medicine textbook, Rosen's Emergency medicine textbook, and Tintinalli's Manual any time soon?

Don't want to spend a fortune in haste if there are anticipated new editions.

Thanks! 🙂

Today I had a laceration on a patient. The patient took a saw to the hand. The wound was clean, good margins, and he cut him into the fatty layer of his finger. I wanted to do an x-ray as soon as he was brought the back to make sure that bone wasn’t involved. The bone was intact, but the x-ray detected some tiny foreign bodies.

I definitely soaked his hand with saline and chlorhexidine. I looked inside of the wound. I didn’t see any foreign bodies. I definitely irrigated it with saline. Is that enough to dislodge the tiny foreign bodies? I’m a little nervous now. I already sutured finger. Should I be worried?