That's really interesting, thanks.
I guess that screws those carefully derived screening guidelines for preeclampsia?
The calculated values are probably fairly accurate when not way outside normal range. As other posters above have said, they get an art line reading that's super low and a cuff reading that's ok, then they give fluids/pressors and when the art line reading comes up to a more normal range, the cuff reading starts to match.
Strong disagree. You just work somewhere with very low acuity. The dichotomy between mild peripheral pressors such as a sprinkle of Levo at 4mcg and ending up four pressors is pretty small. There’s rarely an inbetween. If you’re sending a patient up on multiple pressors through a peripheral line that’s piss poor lazy medicine.
For the past 2.5 years.
This is wild to me. I didn’t realize there were such drastic differences in acuity at different locations. I’ve always worked at city hospitals so I put a line in just about every shift. Intubate every two or three shifts. Probably a chest tube a month although I agree most are being managed expectantly.
Maybe if you don't see trauma patients? But if you take care of traumas, I think you need to know how to do a thoracostomy.
Will you expand on this please? If you’re saying what I think you’re saying, we need this cultural shift here as well.
I wonder too if folks also look after themselves better and their diabetics aren’t in florid DKA 5 times a year etc.
Hey man, this is America. People shouldn't have to die if they don't want to. In this land we get what we want, when we want it. If I wanted it some other way I'd go live in North Korea.
I think every trauma chest tube I've placed since residency has been for blunt trauma. Kicked by an animal, run over by a tractor, fell off a ladder, slipped on ice probably covers every one of them.
I've aspirated a couple of spontaneous ones and watched a few, but most of the spontaneous ones I've seen have been big enough to need something, and basically every blunt trauma tube I've placed has probably actually needed it done. I haven't had anyone tell me to not place them.
I suppose the question circles back to what we think the point of an EM residency might be?
I dunno, the quality I've seen out of new grads lately has me thinking that the newest metric is door to consult time. From that metric's standpoint they're crushing it.
I dunno, the quality I've seen out of new grads lately has me thinking that the newest metric is door to consult time. From that metric's standpoint they're crushing it.
I vision a traumatic chest tube as being a traumatic insertion as opposed to a chest tube in trauma patients.
Haha. A penetrating traumatic chest tube at least seems more straight forward than a blunt force traumatic chest tube. I just can’t see @thegenius hitting someone in the chest repeatedly with a flimsy rubber tube. Unless of course if working for USACS and the patient is Dominic.I vision a traumatic chest tube as being a traumatic insertion as opposed to a chest tube in trauma patients.
If Dom came in as a trauma, just let the NP take care of him and go see some waiting room patients to keep that door to doc time down. He might die, but I'm sure he'd do so happy in the knowledge that his vision was fully realized before he went.
5) Send chart to liability sponge...errr...supervising MD
Most USMDs might have that option, but there's always a flood of marginally qualified Caribbean IMGs and FMGs, and those with major red flags in med school (eg failing Step 1, having to repeat a year) who won't otherwise have much options. These programs will still eventually fill if they lower their standards enough.
Yep. But at some point jobs won’t be an option. Then what.
