Some days I really shouldn’t be allowed to be a doctor
I told a PEM attending that “this baby does not pass my vibe check” as justification for wanting bloodwork on them.
ICU scenarios (and pet peeves):
- Hey doc, this patient with ileus in bed 6 has a blood pressure of 186/68. What do you want me to give?
- Any worrisome symptoms with this BP?
- No, I am just worried she will stroke out
- Don't give anything
- No hydralazine then?
- No, please
ICU Pharmacology Secrets:
Some drug side effects, even if relatively rare, are well entrenched in our memory. For example, most intensivists & hospitalists are aware of cefepime-induced neurotoxicity or clindamycin’s association w C difficile infection (or even the seemingly
@armyemdoc@11brickbat I think that’s a bit overly reductionist. Mortality is not the end all be all. The IABP itself may not, but the unloaded LV on ecmo won’t develop a thrombus, and the unstable patient with 3x vessel disease will live until their plavix washes out to get a CABG with ⬇️complications
An unintended side effect of medical training is accumulating names like this in your phone contacts:
- Alex Surgery
- Pharmacy Joe
- Elise Resident
- Tall med student
ICU night shifts in a nutshell: closing the a-gaps, giving Lasix to people who got fluids during the day, giving fluids to people who got Lasix during the day
Fresh blog: New ARDS guidelines reveal a shambolic state of affairs
🫣 two major guidelines on "ARDS" were released in 2023
🫣 there is ongoing confusion about how to define "ARDS"
🫣 guidelines disagree on basic aspects of "ARDS" therapy
blog:
https://t.co/vDOZSLylhD
@MohitHarshMD Funny that people are talking transfer. I’ve had plenty of hospitalists at the tertiary hospital push back on admitting sicker GI bleeds than this because they’re “stable” or not actively bleeding. Have been asked to get a 4 hour repeat hgb and if stable DC for GI follow up.
@reverendofdoubt 48 hours because that’s what I’ve been told is the standard and don’t want to deal with medicolegal risk
More importantly only time I’ve done it is younger people with FIRM onset. IE I woke up from sleep and my heart was racing and I’ve never felt this before.
@leah_lovelyy @brandonsomwaru Other hospitals I’ve worked at have all dosed it in mcg/kg/minute with a starting dose of .05 and that’s how it would be reported. We basically never got above doses of 1 or 2 (which would be 70-100mcg) so 5 sounds crazy in that context
You opt to wait 10 mins until the patient is brought back and get a stat repeat EKG. The patient is in his 30s, the pain is a burning sensation and is definitely present at the time of this EKG. Risk factors: family history of CAD in late 40s early 50s, smoking. Does not have PCP
You opt to wait 10 mins until the patient is brought back and get a stat repeat EKG. The patient is in his 30s, the pain is a burning sensation and is definitely present at the time of this EKG. Risk factors: family history of CAD in late 40s early 50s, smoking. Does not have PCP
You are the ER doc and get handed this EKG. The only info you get is chief complaint of chest pain. Do not know if pain was present at time of ekg. Do you activate cath lab. Will be multi part series with follow up