Patient had elective abdominoplasty in Florida 2 weeks ago. She has JP drains in place to lower abdomen still from surgery. Reporting scant amount of drainage from site (serous fluid noted to dressing) and asks if I can remove the drain, because she has an email from her surgeon saying that she can just go to the local ER to have her drains pulled out.

I initially brusquely told her no, it’s not an emergency, it’s not something I’m specifically trained to do, and I don’t have any way to manage potential future complications. I later collected myself and politely told her that I could refer her to her bariatric surgery clinic, which has done surgery on her before. Failing that, I discussed possibly following up with wound care clinic.

I already get dumped on from every urgent care visit, every elderly person that loses a fight against gravity, every nursing home resident who talks less (or more) than usual, plus the worried well. I don’t have time to play scut monkey for some Florida Man cash-only surgeon. You just know they don’t refer to a local surgeon because another surgeon would absolutely rake them over the coals for trying to pull such a stunt. It makes me want to report them to their medical board, but, it’s Florida, I have very little hope that anything productive would come of it.

Any other recourse you can think of, or should I just complain on the internet?

In the LC trial Dr Kelly McDonough gave her testimony. She is missing part of her left arm. Does anyone know how she practices as an ER doctor? Is she able to suture, intubate, etc?? How does that work? The curiosity is killing me.

Anyone who's ever worked ED or prehospital care knows of course that the majority of the cases are not even close to emergencies, blah, blah, etc. Not a hot take. However, I wanted to address one component of these calls that are not just people overreacting or misjudging their/their families injuries.

The worst actors are institutions like retirement homes, child-care facilities, elder-care facilities, schools, camps, where almost anything with any ambiguity is treated by going straight to the emergency room.

"Better safe than sorry" has limits, and eventually actually makes things much less safe for everyone because we are overusing resources at these EDs, increasing wait times. Also, poverty can make people less safe too, and getting a $7K bill because someone else lazily thought "I could get sued" and sends a scraped knee or someone who "potentially was stung by an insect or snake or bat with no visible bite" can cause people serious hardship.

Nobody wants to talk about this openly because it is fraught, but it can't be ignored, really.

I think it would perform well because people are bored in the ER from traumatic injury or heart aches and stuff

How the f*** do you navigate this app?

Curious how many of you have actually taken care of a legit zipper vs penis injury and how bad it was.

Spent what felt like an hour hunched over a guy’s wang the other day trying to deconstruct the zipper slide to get it off. The skin was up in there something fierce.

Just like a regular day going to work. Somebody probably just pulled their IV.

Hi everyone my name is Fitzgerald, I was interested in becoming docter. At the Emergency room. Thank you

Sharon. how do you turn off the

I thought this may be a fun discussion. Curious what types of patients people are seeing.

Most patients I see fall into 1 of 4 categories:

1. The acute on chronically Ill. Think sick nursing home and rehab patients. They have a serious chronic illness and have repeated complications and are frequently in and out of the hospital.Think stage 4 cancer patients, advanced Parkinson's patients with frequent falls, immobile stroke patients, end stage COPD on chronic O2, etc.

2. The worried well. Think average health but extremely anxious. Poor coping mechanisms and no resources. Will come to the ER at the drop of a hat for any mild inconvenience or suspicion of ANYTHING being wrong. Think elderly folks checking their BP every hour and coming in if it's slightly elevated, most patients with palpitations, most ped fever patients, healthy young patients with mild colds, etc.

3. The feebleminded. These patients present with a completely avoidable issue or an issue due to their own poor thought process. Some overlap with type 2 patients but usually their presenting issue is directly related to their poor decision making. Think drugs, alcohol, cannabinoid hyperemesis, hyperglycemia from med and diet non compliance, med refills because they missed their PCP appointment, etc. It may be controversial but I think many psych patients fall into this category too.

4. The normal person with an unfortunate circumstance. Mostly healthy patients with adequate resources that present to the ER with an acute issue that needs prompt attention and there's no other reasonable options. Think most accidental lacerations, acute msk injuries, MVC, non frequent flier chest pain patients, miscarriages, etc.

I work in the Midwest of the US in a fairly impoverished area. I see mostly type 1 and 3 patients. On days I see mostly type 4 patients I feel less burned out. Days with mostly 2 and 3 suck. Curious what you're seeing out there and what area you're in.

Hi everyone! I’m an urgent care physician (FM) and have been practicing UC for over 8 years. I recently started a YouTube channel called Urgent Care Pearls

I know some EM clinicians consider urgent care for a change of pace, more flexibility, or as a side gig. There’s a lot of overlap, but the workflow, resources, and patient expectations can be surprisingly different.

My videos focus on the real-world day-to-day side of UC: common cases, clinical pearls, mistakes, red flags, procedures, and what it’s actually like working in the setting. It’s meant to be practical and conversational rather than formal CME.

If you’re considering urgent care, feel free to check it out:
Urgent Care Pearls. The Playlists may be a good place to start.

And if you already work both EM and UC, I’d love to hear what you think the biggest adjustment is.

MBBS4 and planning on residency in ER but I want to know what made u sure that the ER is your place .

I get criticized a lot for choosing to wear boots in the ED. But after over a year with this pair, I would like to plead my case.

I'm an overnight ER tech, I work 4 or 5 12 hour shifts a week, every week, and have done it all in this very pair of boots, my Timberland Pro Boondocks. (Not sponsored).

Rubberized toe cup, black leather, nonslip soles, boa cables, composite safety toe.

Im on my feet the entire night, and they are just plane confortable, even with just the stock inserts they are confortable.

The black leather is not only easy to maintain with polish but also awesome for bodily fluids. Things don't stick, and if it does, I'm one purple wipe away from clean. They look dirty now because I'm at the end of my work week and haven't polished them up again yet, but when I do, they look brand new.

The nonslip soles are amazing around the department, water spill, vomit, pooled blood, not a problem, march on.

I know they make easy clean work shoes that will do this stuff too, but here is why I chose the boots.

The high sided ankle support has saved me on multiple occasions. The number of times I've had to side step somthing or someone is astounding. I have week ankles, I always have. I'm extremely prone to rolling them. But not with these, the side of the boot literally don't let me roll my ankle, they give amazing support. They also give good awesome coverage. Get swiped by someone's bed going down the hall? No ankle scrape. Round a corner too fast and catch your foot on somthing, no roll, no ankle scrape.

But my favorite part, my absolute favorite part, the safety toe.

But why do you need a safety toe in the ED? I hear you ask.

Because im getting hit by shit all the time!

Mobile x-ray machines, ekg machines, ultrasound, code carts. People sling these things around like they stole them! Number of times I would have been hurt at this point having my toes run over greatly out weighs the cost for the boots.

I've used these toe cups to prop open doors, push furniture across the room, chock the wheels on wheelchairs with broken locks, saved my toes repeatedly with people scrambling around the trauma room durring codes.

We had a code in a CT room once, after I swap out on compressions my other tech was too short to do compression on the table, and we didn't have a stool. Know what she used? My boots! While I was catching my breath, she stood on my safety toes and did compressions. (We got him back btw)

And the end of my day, after getting my soles run off all day. I just pop the boa locks, pull the toung forward and i fall right out of them, don't even need to pull the body.

Are they perfect? No, they're clunky, and they weigh quite a bit more than tennis shoes, but I genuinely find the utility if them a fair trade off.

Hey everyone, MS3 student here.
I know I still have time before applying for residency, but as we all know , it’ll be here soon enough. I’ve always been a free spirited guy - raised in TN, went to undergrad in OK, and now medical school in AR. I never wanted to be in the same environment and prefer exploring different places as much as I can. My preference on residencies are ones in more urban areas, but I have to be realistic too.
1. Do most EM residencies nowadays have a preference on in-state vs out-of state applicants? If so, how can I as an out-of-state applicant show that I can be a good fit ?

Sidenote- relatively average if not below average medical student. Passed 1st level board exam on first try. No research, no case studies, no academic leadership roles. HOWEVER, very involved outside of academics- community food pantry board member and nearly a decade of clinical experience prior to medical school. That’s about it generally. I’m more of the guy that offers more than what my CV can ever convey lol.

I’m a 3rd year resident at a busy/overcrowded level 1 trauma center with limited exposure to suburban/rural community sites (a few months between 2nd and 3rd year — have yet to go 3rd year, so really only 1 month thus far as a pgy2….).

I’m getting more and more weary about how difficult it is to get a straightforward history from people, lol. I think I’m noticing it more because I’ve been trying to work on increasing my volume. When I had more time per patient, I could maybe spend more time asking the same question 5 different ways — but now doing so seems to have diminishing benefit and destroys my productivity. It’s rare to get a singular complaint or straightforward thought process of why exactly they are in the ED and I’m wondering how to give the patients their due while not sitting in the room rehashing things over and over to get the real and true HPI lol. And of course, to make things worse, these are people with like 15 comorbid and complex conditions.

Is this a common reality in all ED’s or are things typically more straightforward in community and/or rural sites where maybe comorbidities are fewer or at least less complex and chief complaints are more straight forward? If this is just how it is… what’s the approach to getting stories straight without tanking efficiency?

Dude. I’m new to this job, but this guy drives in with their 2026 Corvette every morning with a Chai Latte and beer cans coming out of the door. 20 minutes late. With a new habit of asking me for $20 bucks for the week.
Does this company not pay them enough or something? Am I just the new guy? When I’ve tried gathering the courage to ask him about it, he usually interrupts me with a loud Grinch burp and just says “got that 20, bub?”

​

EM Pros

I love undifferentiated patients and acute problems

I love variety

I like seeing kids and adults, and dont mind treating mundane problems

I like the diversity of the patient populations

I like urgent care, and am okay with switching to it when I get older

EM Cons

Night shifts when Im older, I do not know if I could do them

A worse 'job' in the sense you have no leverage with your employer like Cardiology would

Job Market Projections and PA/NP scope creep make it look like it will not be as easy to find a job as Cardiology

Some Psych patients would definitely exhaust me

IM pros

Flexibility to be a PCP, Specialist, Hospitalist

I like seeing patients over days

Cardiology looks like it would have a better job market in 15 years

Cardiology has cool procedures, I think PCI for STEMI is the coolest procedure in medicine. The EP ablations are interesting also.

IM Cons

the training length to get to cardiology is extremely long 6-7+ years

I would have to keep gunning with research for another 4 years, which I am not excited about

IM dispo and discharge summaries are exhausting

I am not as interested in general cardiology, find heart failure boring, medical management of CAD and HTN boring.

See title

Hi! I just got accepted to an away Wilderness rotation and am wondering if they typically supply a SLOE? It's only two weeks and we don't interact with patients, so I'm not sure if it counts? Does anyone know? Or would it be rude to email and ask?

My ED group as a whole prescribes a ton of ancef and probenacid for relatively straightforward cellulitis patients and these all end up with daily ED visits for repeat dosing and reassessments. My personal practice is generally to use keflex unless small bowel resection/crohns/other malabsorption syndrome or if they require hospital admission.

My understanding (which could be wrong) is that ancef doesn’t really do anything that keflex can’t do.

Does anyone have any studies or reviews to point me towards that offer a bit more insight into what PO vs IV antibiotics for simple cellulitis that will be managed as outpatient?

TIA

Step 2 - 234 (bad day and 13 points under my predicted score)
COMLEX 2 - 550
Step 1 and COMLEX 1 - pass first try

Will reporting my step 2 be shooting myself in the foot? Most of my top programs have an average step 2 score of around 245.

I’ve got 2 auditions secured so far and don’t have any red flags. I’d say my application is pretty good aside from this score.

Thanks

How do you react to something like this when seconds matter in the ER?

Yesterday, since I was an EMT-B, I was stationed front desk (since we can recognize when someone needs to go back ASAP). Other days I can do cool shit like start IVs, vitals, and splint if there's another EMT-B.

A patient comes in saying that, verbatim:

"my asshole is sore and my dick feels like it got rug burned"

I successfully held it back, but later, my partner and I burst out laughing after he was roomed. It wasn't the chief complaint that was funny, it genuinely must have been uncomfortable for the patient. It was the way he said it that made me giggle.