EM/EMS physician, EM at @christianaEMed, EMS w/ @GFACEMS, Creator EM Basic podcast-Airway Nerd, Olympic weightlifting, proud supporter of PPP @pppforpatients
Philadelphia, PA
Joined December 2011
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Please tell me this person had another criteria for admission to an ICU besides a PE with a chronically dilated RV
My approach-depends-do they have a CT in their recent lifetime?
Makes it a lot easier to not do it in the future confident that this isn’t the one in a million you are missing something terrible- “they went to the doctor and it kept getting missed” reads the headline
If I am doing this then there is something seriously wrong and all my fingers and the IO drill are broken 😂
I call this “tachycardic afib” in contrast to afib with RVR
I tell my learners- pretend this is sinus tach at the same rate and then ask yourself what” would I do if it were sinus tach instead of afib”…and then do that!
Great video and teaching points- I have found the issue of lack of tongue control to be a big issue with HAVL so I wonder if that is the blade used here- regardless of blade geometry it’s the perfect example of why your blade must be midline to optimize tube delivery
Well said- the numbers he cited in his original post are insane to the point where you can categorically call it slop
Reward one or two genuine research efforts with significant involvement not an arms race to the highest slop number
To be fair, emergency medicine people are a different breed 😂
The full story here is NUTS 🤯
TLDR dude hikes 6.5 hours to avoid a helicopter medical bill impaled while his friends make kebab jokes…
> 32yo ER nurse named David is day-hiking Montana’s tallest mountain with his boys
> He slips on a rock near the top and full-on impales himself on his own trekking pole that goes clean through his lat with like 8 inches sticking out both sides
> nurse brain kicks in immediately, checks himself, realizes nothing vital got hit and he can still breathe fine
says screw the helicopter bill and just starts hiking the entire 10 miles back down with the pole still stuck in him
> takes SIX AND A HALF hours, friends are spotting him the whole way, one even runs ahead to warn families so kids don’t see this gnarly shit
> about 4 miles from the car they realize they’re actually gonna make it… and start cracking kebab jokes 😂
> dude never complained once, stayed in weirdly high spirits the whole time
> walks himself all the way to the trailhead, gets the pole pulled out later at the hospital, and already says he’s going back next year to finish the summit
And as a consequence of selling to PE he’s made generations of docs that follow beholden to PE with no escape
The cost- negative CTs in patients whom you think are fine but that chart won’t look good in 100 pt font in a courtroom with a plantiff’s attorney asking you how many feet it is from the pt’s bed to the CT scanner
I disagree that its upsetting
The harms of CT are way overblown and the models predicting cancer rates are exactly that- models using (mostly) data from Hiroshima, many highly touted studies using CT radiation doses much higher than current scanners
Yawn
The malpractice environment has radically changed since you started practice
Until someone thanks me for NOT getting a CT scan I’ll continue doing what I think I need to do to keep patients safe*
*This doesn’t mean to do dumb stuff like CT a PECARN neg peds head trauma
This was tweeted less than an hour after Ruth Bader Ginsburg died
May he have the day he deserves
No matter your political beliefs or party affiliation, some moments rise above politics.
Please join me in praying for Senator Mitch McConnell as he faces what may be the greatest battle of his life. In times of illness and uncertainty, compassion should always triumph over division.
May God grant him strength, wisdom, comfort, and peace, and may his family be surrounded by hope and grace. AW