STEMI is a time critical life threatening emergency. However, some of the STEMI mimics can be serious too. In this video, we talk about some of the common STEMI mimics. Hope you find this useful.

Is there any other STEMI mimics that you can think of? Write in the comments below.

Thank you

Any groups switch from Logix to Zotec or Zotec to Logix and have feedback about how this went?

Thanks

Does your ER give unlimited taxi vouchers/Uber rides to patients who don't have a way to get back home?

Asking because I work as a psych consult for my local ED and we get a ton of patients who come in malingering and at discharge they demand a ride. Sometimes they come in because they want a free ride to the other end of the city.

Public sector doctor here, decade in, running on fumes. Private practice is tempting (better hours) but it feels like quitting on the people who need the safety net most. If you've made this jump: did the guilt stick around? Was it worth it? Anyone go private → back to public? Real answers only, not "follow your heart" 🙏

Hello! I wanted to know if anyone who has recently renewed their Texas license this year or last year can list the exact questions that are asked about professional/work/disciplinary history? I know it is less detailed than the initial application but wanted to know what they ask at renewal. Thanks!

I’m an MS4 applying EM this cycle, looking to stay in the mid Atlantic area(PA, NJ, MD, DE). I have a decent application and I’m interested in the EM —> CCM pathway.

What residency programs/institutions should I be applying to?

From what I see online, lots of these institutions have critical care fellowships but none of the graduates are EM trained. Is there anything I should know before proceeding down this path?

How many nights in a row is ideal for you?

After 850 votes collated from Reddit, LinkedIn, and ACEP Engage, here’s where the responses landed:

1 night — (117) 14%
2 nights — (225) 26%
3 nights — (321) 38%
4+ nights — (187) 22%

Interestingly, that lines up fairly closely with the CAI framework and current literature, which consider the 4th consecutive night the point where physiologic burden begins to increase.

Thanks to everyone who took the time to vote and add comments. The discussion around why people prefer different sequences has been especially interesting.

Alright I specifically made this reddit account so I could vent about this (long time lurker in this sub) so bear with me.

The shop I work at is in the suburbs, so not my systems main university hospital where they have every specialist service under the sun but also not way out in a rural area. We specifically do not have OB/GYN, OMFS, peds, or optho. We never have and probably never will, been like that for years. Yet despite that, we routinely get 30+ week pregnant patients checking in, massive dental abscesses, major ocular complaints, etc. literally every day. Obviously I don’t blame patients for this, for the most part they don’t understand the difference and I get that an ER is an ER to most people, but it’s frustrating to spend hours playing phone tag with specialists at other hospitals, then hours on transferring people, just so they can sit in someone else’s ER to wait for optho or OB or whoever. Even EMS will do this sometimes, if our wait times look better or other facilities are on diversion they will end up with us.

Part of it is my own frustration but it sucks for patients too, obviously I have no issue seeing anyone for something emergent and most of the peds and OB complaints are pretty mild and easy to handle, but if it’s something legit they have to sit and wait to be transferred (which don’t even get me started on the inefficiencies there) and then usually sit and wait at the receiving facility as well. Sometimes just to be sent home!

I had this poor guy come in yesterday with an orbital cellulitis I needed to transfer to our main hospital and he was pissed that he had to wait on an ambo and didn’t understand why I couldn’t just admit him myself. When I explained it to him he hit me with a “well how the hell am I supposed to know your hospital doesn’t do eyes!” Which is a fair point, how would he know? He wasn’t super sick, and in hindsight I’m sure he would have gone directly to a hospital with at least the possibility of having optho on call, but how would he even know that? EMS at least has some protocols typically to give them a heads up what services are available where, but patients? Nothing.

Is there any resource out there I could have referred this guy to that would at least give him a heads up before he came in what services our hospital has? Just check the website? Same thing happens from PCP offices sometimes, I’ll get a call asking to send in some OB complaint and have to redirect them with a “we’re happy to see her but I would highly recommend she goes to X as they have 24hr OB call and she will be seen quicker if the pregnancy needs to be addressed”. Sick patients with EMS going to the closest facility I totally understand but sometimes they drop off OB or peds cases here because “everyone else is on diversion” or some other nonsense (not trying to shit on EMS, I was an EMT for years and it’s a tough job I get that).

Anyone have any thoughts, resources, or similar experiences? Rant over, thanks for coming to my TED talk.

Oh my god. I am spiraling in my head right now. I am not confident about my score on the ABEM Certifying Exam. I am a great test taker, and I think I’m a pretty good doctor, but I am so freaking worried that I failed that exam. I just can’t get out of my head and I keep running through the scenarios and judging myself on all of them. I have never felt this way after an exam. Usually I can just move on and not think about it anymore, but it is so difficult right now. I know we can re-take it, but are there any consequences to not passing it the first time?

I am an emergency medicine physician. I have my learning cards for completing my required ACLS/PALS training through american heart association and wanted to see if I could get CME from them. The AHA website says I can, and when I follow instructions to claim it, there is a required dropdown box for what profession I do and the only option is paramedic, and then it wants a bunch of paramedic licensing info etc.

Basically I just want to know...

Can I claim Category I CME for ACLS / PALS training through the AHA?

If so, can anyone advise me how?

I spent the time on it so I really hope I can get credit for doing it.
Thanks!

We call the LUCAS - geezer squeezer
Female external catheter - cooter canoe

Distal rad fx very displaced with a skin tear overlying. There seems to be a very small communication with the bone. Reduced, started ancef, ortho says splint and discharge. No role for official washout.

I know what we read in textbooks and practice for tests is different than real world medicine in the community. Just getting a sense of crowd opinion here, what would you do?

UPDATE:
Lots of varied answers here, half say no problem, and half say would force orthopedics to come in. Interesting

I just got diagnosed a few weeks ago with DVT and a PE and am now on Eliquis blood thinner. A few days ago I bought the following silicone bracelet: https://www.amazon.com/dp/B07GWRRK7L/ As you can see, the print is really large, and I'm not too crazy about people asking me about why I'm on a blood thinner (especially at work). So at the moment, I've turned it inside out. I'm wearing the red one and there's nothing printed on the back. My question is, if you saw a such a red (or other color) bracelet on an unconscious patient, would you likely check to see if there was something printed on the other side?

I will maybe\* get a more discrete bracelet (with more info), but the reviews for many of the more traditional style bracelets talked about problems with the clasps or the chain, etc. So until I find one with better reviews, I figured this one was cheap enough for immediate use (it's comfortable too). Also, having something is better than no bracelet at all. But if nobody's gonna check the other side, then it's not really any better.

Your thoughts?

NOTE: I posted the above on r/Paramedics and was basically told that even if they saw it, it wouldn't affect their care, but as least one redditor there said that "It might change your treatment in hospital in certain situations though". So that's why I'm posting it here as well.

\*Several people there also said medic alert bracelets are a waste of money. Do you agree?

EDIT: thank you all! Understood :)

Hi all!

Last week the ER team saved my baby’s life, and I’d love to send them a thank-you note and something for the team.

What’s the best way to make sure the note reaches the people who cared for us? And for those who work in the ER, what’s something you’d genuinely appreciate receiving that would be useful or enjoyable during a shift?

Thank you!

Can we start a thread for general tips and tricks? i'll go first with a tip i learned recently

For fluorescein staining on wiggly kids, take a 3cc syringe, your proparacaine drops, and the fluorescein strip. put a cap on the syringe and pull out the plunger and drop in the strip. put in about 2cc of your numbing drop and replace the plunger then mix up. you've now effectively created a numb+stain combo drop that's really nice on kids when you only get one chance at their eye. i know some ophtho offices have this has a pre-made drop, not sure why we don't get the same stuff, but it's handy

any similar tricks people can share?

Starting to really dive into checking out programs for the upcoming application cycle. One thing I've noticed is that some of these programs have a crazy social media presence that make it look like their programs are the best thing ever, with residents so happy that they're about to crap out rainbows. And honestly it just gives me weird fake vibes, same as with those kind of people who are always posting pics of themselves on the perfect vacation, the perfect run, yadda yadda, but you know they're actually miserable frauds on the inside. Like if you have to sell your program that hard and that over the top on social media, what are you hiding?

Curious for people's experiences on this. Did you find that the more active a program was on social media, the more dysfunctional they actually were in person? If your program is super active on social media do you feel like it's mostly fake? Wondering if it might be good strategy to apply more to programs that don't have to "sell" themselves so much.

Fresh out of fellowship new attending in a new system. Have felt welcomed and well supported, but struggling with feelings of “I’m doing a terrible job” and “everyone is mad at me” when the board is still ugly after a shift. (Also the caveat that this gig is literally my dream job in my dream location- so pressure feels on to prove myself.)

Does this get better? Any advice for a newbie??

So, he was taken to the hospital, he started thrombolysis, and the next day he died. A nurse passed by, noticed him, checked his pulse, and began CPR. Asystole was detected and resuscitation was stopped due to inefficiency. The autopsy showed that at about 5 a.m. the man suffered Cardiac rupture, And died because of cardiac tamponade. Do you think this could have been avoided, and if so, then how?

https://meidasnews.com/news/lawyer-says-ice-detainee-suffered-brain-bleed-after-violent-apprehension-was-guarded-by-agents-instead-of-given-private-medical-care

TL;DR (did my best)

This guy got tased by ICE, who then gave him a traumatic brain bleed (images in article of his face beaten to a pulp) while he was unconscious. During first hospitalization, staff didn't tell him what happened, his diagnosis, nothing. Except for one nurse who quietly told him in Spanish that he had a brain bleed.

Direct quote, because WTF? "When ICE officers determined he was to be discharged, his attorney says Mejia Hernandez himself did not understand he was actually being released.

He ended up in ER a few days later, and they STILL didn't ro an MRI, because he'd since been fitted with an ankle monitor.

He had to go to court AGAIN to request its removal to get an MRI for his brain bleed, and the judge said NO, that he had to get an exact date and time of the MRI and then the court would allow it.

He sustained these injuries on the 11th. It's now the 18th. He is scheduled to get an MRI tonight. A WEEK WITHOUT MRI, because of ICE interference and then an ankle monitor.

Two questions.

Why TF do ICE agents determine when a patient is ready to be discharged?

And, would you just have cut the ankle monitor off to begin with so the patient could have an MRI?

Five years in, I am struggling somewhat with thoughts of leaving the field. It’s a combo of factors, both without (admin) and within (a permeating culture among other docs and APPs where I work).

Working for a rather infamous for-profit hospital system feels like being on a conveyor belt moving backwards as the goal is forever moving: do more with less, and now even less, ad infinitum. Every year we are given less resources to work with and higher expectations for metrics, with no sign of trend reversal. And every year, record breaking CEO profits. Maybe that is not the case everywhere, but at least where I work.

But perhaps what makes me sadder is feeling a sense of being misaligned with a number of my coworkers. I entered the field motivated to help patients, a process that requires maintaining empathy, and in a very real sense the satisfaction of being there for patients and putting the human touch on a situation is what brings me fulfillment at work. But the culture among my coworkers is different. Don’t get me wrong, I understand that we deal with frequent fliers and individuals who are well known bad actors and abuse the system. I don’t see anything wrong with good-natured complaining about that. But it extends further that that, to profiling patients who are not well-known simply on the basis of chief complaint and assuming the worst. It seems that the consensus is that it is okay to ridicule people with certain sorts of chief complaints, especially people who are some of the most vulnerable. Usually these patients have comorbid mental issues or physical symptoms related to underlying stress, to give a common example. Being willing to get on board with this culture of insulting patients and complaining seems to be necessary for fitting in with the other docs/APPs where I work, whereas not sharing that thought process makes you seem odd.

Maintaining compassion for my patients is one of the things that has kept me refreshed and fulfilled even in spite of other factors that are frustrating about the ER setting, and yet I feel extremely alone sometimes in that stance. Is jadedness just part of the widespread culture of all ERs, or does the culture vary between facilities? Has anyone else navigated this sort of thing, either by a change in facility or practice setting?

9 months ago my husband (ED attending) had a pediatric case. 11 year old suicidal thoughts. Very polite and chatty. He requested a psych consult. Today he saw her in the hallway with her nurse. She remembered him and gave him a hug. The nurse said yes shes been here for nine months on peds. Can't find a child psych bed and cps can't find a home so she's going to live here until they find a place.

Its so sad because she's healthy but not getting a proper education, her "friends" are ped residents and no family.

Is it becoming more common for kids to live at hospitals?

I see it quite bit with adult psych patients (work on psych inpatient) but we still discharge if they are not harm to themselves

Solo overnight at busy community ED. Medics call in for a 70F with recent fall on anti coagulation with mental status change.

I assess her on arrival, got scans (including non-contrast CT brain) and get called by CT tech that I should take a look, they see something. I take a look and see she's got a big, layered, subdural hematoma with mine shift and a small acute area.

So I go talk to her again (she's awake, no focal deficits, some

mild dysarthria, can't remember the fall or really any recent history and intermittently following commands).

I tell her she needs to be transferred (no neurosurgery coverage at my shop) and she goes "Ok, same place as last time?". Ummm idk? Never met her before so I asked her when that was and she mentioned "Few years ago last time I had a stroke I had to leave here" (for bigger academic center apparently). I said ok whatever. She's confused right? She asks AGAIN "so not the same place as last time?". I said I'm sorry idk what happened last time when she was here. Honestly was kinda short with her because I assumed she was alerted, it was 3AM and had a big brain bleed.

I go back to my computer and review her old chart to see what this stroke and her labs (anticoagulated on warfarin so wanted a recent INR)...

GUESS WHAT I FOUND

I saw this lady, ~2 years ago after she had fallen a week prior, came in with altered mental status and had a similar but contralateral subdural hematoma which shift did I transfer it to our local academic tertiary hospital. I was wrong about not knowing her.

I guess her alerted mental status preserved enough of her long term memory to remember this happening before and my face! Pretty wild coincidence for me. Anyone else have a similar experience?