A Diary Of an ER Doc

I’m an ER doc. I think fast and act now.
I specialize in saving life

[Dr Kamlesh Darji @DrKamleshDarji1]

Some days you'll study twelve hours and feel dumber than when you started. Good. That's what it feels like when your brain is being rebuilt. Comfort is where doctors stop growing. Get used to it. The patient in front of you won't care how tired you were.

[nervemed @nervemed]

Lungs of a organ donor who smoked daily for 30 years. Doctors rejected this lung for transplant.

[MEDICINE MADNESS @Doctors_GUILD]

Doctor, my abdomen suddenly became massively distended

A 45-year-old patient presents with:

- Sudden abdominal pain
- Progressive distension
- Vomiting
- Obstipation

Abdominal imaging shows a massively dilated, displaced cecum.

Can you identify this surgical emergency?

[A Diary Of an ER Doc @DiaryDoc]

#14 – [B] Check blood glucose in every altered patient
Hypoglycemia is a quick, reversible killer.
Symptoms can mimic stroke, intoxication, or seizure.
Always get a bedside glucose early. Treat immediately if low; don’t wait for labs. Reassess after correction.

[A Diary Of an ER Doc @DiaryDoc]

#13 – [A] Burns & airway
Facial burns, singed nasal hairs, hoarseness, stridor = airway edema.
⚠️ Intubate early.
Wait too long → impossible airway.

#EmergencyMedicine #FOAMed #Airway

[A Diary Of an ER Doc @DiaryDoc]

#12 – [P] Don’t anchor on the first diagnosis
ED patients fool you.
Chest pain ≠ always ACS. Could be PE, dissection, pneumonia, pericarditis.
Keep a differential. Reassess when things don’t fit.

#EmergencyMedicine #FOAMed #CognitiveErrors

[A Diary Of an ER Doc @DiaryDoc]

#11 – [B] Silent hypoxia
Patients can look comfortable but be 80% SpO₂.
Seen in COVID, pneumonia, PE.
Trust the monitor, confirm with ABG, escalate O₂ early.

#EmergencyMedicine #FOAMed #Hypoxia

[A Diary Of an ER Doc @DiaryDoc]

#8 – [P] Don’t ignore abnormal vitals
If they’re tachycardic, hypoxic, or hypotensive — do something.
Compensation doesn’t mean stability.
Recheck, investigate, act.

#EmergencyMedicine #FOAMed

[A Diary Of an ER Doc @DiaryDoc]

#7 – [C] Bradycardia can be a sign of shock
In trauma, sepsis, or kids — a slow HR might mean collapse.
Check perfusion.
Support circulation.
Don’t ignore it.

#EmergencyMedicine #FOAMed #Shock

[A Diary Of an ER Doc @DiaryDoc]

#9 – [A] Gastric insufflation during BVM
Over-bagging inflates stomach → aspiration risk + poor ventilation.
Gentle squeezes, chest rise only.
Decompress if needed.

#EmergencyMedicine #Airway #FOAMed

[A Diary Of an ER Doc @DiaryDoc]

#6 – [B] Oxygen isn’t always harmless
COPD/chronic CO₂ retainers: target SpO₂ 88–92%.
High O₂ → CO₂ retention.
Use controlled delivery + monitor ABGs.

#EmergencyMedicine #FOAMed #RespiratoryCare

[A Diary Of an ER Doc @DiaryDoc]

#5 – [A] Pre-oxygenate like a pro
3–5 min high-flow O₂ before intubation.
Mask, HFNC, or NIV.
Better pre-oxygenation = more safe apnea time.

#EmergencyMedicine #FOAMed #Airway

[A Diary Of an ER Doc @DiaryDoc]

#4 – [C] Reassess after every intervention
Fluids, meds, procedures — always check if the patient improved.
Vitals, mental status, clinical signs.
No change? Rethink your plan.

#EmergencyMedicine #FOAMed #CriticalCare

[A Diary Of an ER Doc @DiaryDoc]

#3 – [B] Don’t miss tension pneumothorax
Severe dyspnea + hypotension + distended neck veins + tracheal deviation = act NOW.
No X-ray. Needle decompress → chest tube. Delay = death.

#EmergencyMedicine #FOAMed #Trauma

[A Diary Of an ER Doc @DiaryDoc]

#2 – [A] Most common airway assessment mistake
Don’t skip a difficult airway check. Look for trauma, neck swelling, obesity, small mouth, limited neck movement.
If difficult → have a plan B ready.

#EmergencyMedicine #FOAMed #Airway

[A Diary Of an ER Doc @DiaryDoc]

#1 – [C] Shock can be present even with normal BP
Hypotension = late sign.
Look for: tachycardia, altered mental status, cool skin, delayed cap refill.
Start fluids/blood early + reassess often.

#EmergencyMedicine #ERtips #FOAMed

[EMWOW @orthoEMpearls]

Don’t miss this week’s case on Wednesday presented by @DocTomesch and @LegendaryMhops

What MOI do think think caused this injury? #FOAMed #FOAMrad #MatchDay2022 #EMmatch #EmergencyMedicine #orthomatch2022

[Dr. Glaucomflecken @DGlaucomflecken]

The neurologist goes to therapy

[Josh Trebach, MD @jtrebach]

A 28-year-old scientist comes to the ER with difficulty walking. She says she spilled a few drops of a liquid on her gloved hand 4 months ago.

She is admitted to the hospital and ultimately dies.

☠️☠️

What do you think happened?

[A Diary Of an ER Doc @DiaryDoc]

כרגע זמן המתנה לעליה למחלקה במלרד אסותא אשדוד עומד על 64 שעות

חולים שוהים במיון כל כך הרבה זמן
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