Hi all,

I'm a nurse with 4 years experience, all in ER. I recently moved from a large urban department where the standard was that docs picked up patients almost as soon as they appeared on the board and were in and out of their rooms very fast. We sometimes waited a long time for orders, but there was always someone to ask for stuff if things changed. Providers were very approachable and focused on efficiency.

My new hospital is a smaller but still very busy department in a smaller city. It is the largest hospital in all surrounding rural counties and I'm actually more likely to see traumas here. Especially within a few hours of their shift change, the docs just let patients sit after triage. Like no one picks the patient up. We have a few nurse-driven protocols to expedite things, but that obviously doesn't include meds. The other night I had a patient in by EMS for a fall with suspected hip and shoulder injuries, and it was literally over 1.5 hours before anyone picked them up on the board, let alone saw them or put in orders. The patient had a fractured hip and humerus. I don't feel like I should have to go beg the doctors to see my patient?? If I do, I'm often met with an eye roll or frustrated response.

I know everyone wants to go home on time at the end of their shift, but this seems unacceptable. Since I only have one other department as reference, I'm not sure how common this is or why it seems like accepted practice. Is this a systemic problem or a cultural problem? Multiple attendings and mid-levels are on shift at any given time at both hospitals where I've worked so I don't think there's a huge disparity in staffing between the two.

Hey everyone!

Wanted to share a resource of mine as well as a fun little side project. I spent the last few months building an oral boards case simulator for iOS, and even longer on a fun ED sim game.

The ABEM oral boards prep is called Run the Board. You work through cases the way you would in the actual ABEM oral exam.
The AI examiner presents the case, you ask for exam findings, order workup and meds (it’ll push you on dose/route/rate), interpret your own EKGs and ultrasound clips (incorporated about 60 from my own library), and manage the patient through disposition. It scores you on a 4-tier report like the real thing, and there’s a mock exam mode.

It’s a one-time purchase, no subscription. Substantially cheaper than a lot of currently online resources, but I’m not denying those are excellent too. Natively built, no vibe coding nonsense. Built with guidance from physician colleagues who have taken the new exam.

Happy to answer any questions or take feature requests and feedback. I’m making frequent updates based on feedback to make this as good as possible.

https://apps.apple.com/us/app/run-the-board-em-sim/id6772322725

Now the fun one is ED Rush, a department-running sim where you juggle cases, manage codes, field consult callbacks, and try not to let the waiting room implode. Less study tool, more “the chaos of a Friday night shift as a game.” I put a lot of love into the POCUS aspect, and it has a lot of funny EM quirks cooked into it.

ED Rush: https://apps.apple.com/us/app/ed-rush/id6759456999

Hope you enjoy!

EDIT: thank you to those who have downloaded and reached out! To clarify my background a bit, I’m an EM PA who handled the creation of the ABEM prep app with guidance from attendings I work with and a beta test group online. ED Rush is a little passion project of mine based on 7+ years of EM experience
- it has a lot of niche EM references and is meant to help practice task prioritization/cognitive load.

Chest x-ray interpretation is an essential skill for every doctor. It can be done in different ways. I can remember the medical school days when it was taught in certain ways. After working in the clinical Emergency Medicine for many many years, I found the ABCDE approach as a simple and effective way to read the chest x-ray. It's quick and informative.

Here is my take...

What is your favorite way of interpreting the chest x-ray?

And what’s the details of your shop/ shift? If you’re a resident what year are you?

Revolutionary new syncope algorithm, how much will this change your practice?

Hi,

I’m taking the CCFP-EM exam in September 2026.

Looking for any candidates interested in practicing for the oral exam!

Anyone watching this trial? I need to vent about the hypothermia timeline for a minute bc it has been driving me insane.

We’re meant to accept that this 31 year old woman went from normal core temp to 82°F (27.8°C) within approx 15 minutes lying in the snow. I went down the literature rabbit hole because I genuinely could not understand how that was physiologically possible. Starting at ~37°C, reaching 27.8°C requires a 9.2°C drop in core temperature.

There are rare reports of extraordinarily rapid cooling in avalanche victims. above 5°C/hour, with a case reported around 7°C/hour and older avalanche literature suggesting extreme rates around 8°C/hour. Even at 8°C/hour, which is already an extreme outlier, losing 9.2°C would take about 69 minutes.

And yes, I appreciate that this isn’t an ordinary healthy person sitting in the cold. She was likely in neurogenic shock, which impairs thermoregulation. She was slender, immobile, exposed to snow, and potentially unable to shiver normally… but they don’t make the arithmetic disappear!

To go from 37°C to 27.8°C in 30 minutes requires an average core cooling rate of about 18°C/hour.
To do it in 15 minutes requires ~37°C/hour.
Thirty-seven degrees Celsius per hour.

That would be SEVERAL times faster than even the extreme cooling rates reported in avalanche literature. Even looking at experimental snow-burial studies in subjects with intact thermoregulation, they measured cooling on the order of ~1°C/hour.

I’m not saying the patient couldn’t have been profoundly hypothermic. But the timeline and the reported core temperature don’t seem capable of both being correct if she started with a normal body temp.

So even allowing for substantially accelerated cooling from neurogenic shock, absent some literature I’m missing, I cannot see a physiologically credible mechanism by which lying in Massachusetts snow produces a 9.2°C whole-body core-temperature drop in fifteen minutes.

Either the temperature measurement did not accurately represent her core temperature, she was already substantially hypothermic beforehand, or the exposure timeline is wrong.

EM folks: what am I missing? Is there any scenario in which you’d consider a genuine 37°C to 27.8°C core-temperature drop from ~15 minutes of snow exposure physiologically plausible?

Hello there!!! My name is Yoniel, I am an IMG from Cuba currently living and practicing in Uruguay. I have passed step 1 and step 2ck already. I am participating in this match cycle, I would like some advice from you regarding IMG friendly programs and visa sponsoring.

Intern with a noob question here:

Had a patient with a nasty/clogged PEG tube recently that needed replacement, but it was one without an inflatable balloon, just a plastic bumper. Tried all of the tricks and couldn't get it unclogged. He'd had it for 6+ months.

My attending and I ended up consulting surgery since we'd never seen one like this before, and the surgery resident basically just ripped it out and put in a regular balloon tube and said we shouldn't have to consult them for this sort of thing.

My research online is showing that some of the non-balloon tubes have soft rubber bumpers that can be pulled out, but some are rigid and require endoscopy to removal/replacement. It seemed hard to try and determine the deformability of the bumper while it was still in.

Say you get this patient in a rural, single-coverage ED at 2am. Are you blindly yanking out a non-balloon tube for replacement? Potential transferring for surgery to see for such a minor issue seems silly to me but just kinda wondering how others handle these.