If so how would you say your experience is compared to others? Or do you say it’s the same?

My last patient of the day.

It was a good shift. No one died; even the CPR patient with stage 4 lung cancer got ROSC.

He wasn’t even my patient, but I wanted a bit more practice with G-tubes. The man barely reacted while we fought with his shredded, dysfunctional G-tube, finally getting the balloon to drain and switching it out. He waited patiently, wordlessly, a well-worn stuffed friend by his side in the bed.

Unable to walk, unable to talk, unable even to participate in the simple act of eating. What must it be like to live this way? Our lives collide for just a few moments, and then the G-tube is replaced and I return to my life where every motor neuron works and words flow and I complain when the uncrustables in the doctor’s lounge have the nerve to be stale.

Between the back and forth of pick up and discharge I see it, a small stuffed animal perched atop a clean chuck, discarded in the waste bin. “Who threw this out?” I find myself asking the nursing student. “I guess the patient left it behind when transport picked him up. They told me to throw it away.” I shake my head. How unfair that someone with so little should lose even his favorite stuffed animal.

I make a few more laps. Bones the beanie baby stares up at me each time.

The universe may not be fair, and it may be that I have to watch bad things happen to good people month after month, but not today. Today, I have a small errand to run in the name of evening the score.

Today, Bones is going back home.

MS3 interested in EM but worried about burnout.

My idea situation would be locums in rural areas or more permanent in semi-rural areas.

Are these places better for preventing burnout? Or worse?

Edit: any suggestions to prevent burnout?

Incoming EM intern here inquiring about residency graduation date. I am currently in the process of signing a lease to rent an apartment throughout residency (4 years) and wondering when EM residents typically graduate so that I can adequately plan when to move in without having to extend or pay for an extra month.

This isn't for research or anything. Purely personal curiosity. If this isn't the correct sub, please let me know and I'll happily redirect there! :)

As the post states, how often do you see injuries or complications as a result of intubation?

In 2022, I had a PE, was in DKA, and had double pneumonia. So because they kinda wanted to keep me alive, I was intubated for 9 days and in a medically induced coma for 8 days.

It's kinda of a fun story because a nurse literally killed me on accident on day 5 of the coma. Lol

Anyways, I now have some life long issues due to the intubation. Is this common, or is it just my regular ole shitty luck?

Not looking for any medical advice, not gonna sue (they did kill me, but made up for it by the whole reviving me thing), just curious to hear your stories!

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I’m a big fan of reading (preferably physical media but don’t think I have many options in that department) over listening to podcasts or watching videos. JEMS has basically just become a newsletter of ads for equipment and the EMJ is more than I can afford on a paramedic wage. Are there any other publications on emergency medicine out there that won’t break the bank?

Disclaimer: I realize that there are nowhere near enough primary care providers for anything, especially those who are underinsured and that we, in the ED are the lifeline for many of these patients.

I’ve been doing this for 10+ years and have never really found my own answer to this. If someone has had several months of symptoms, has a benign exam, and normal vitals is it really an emergency - obviously not, but if I don’t do more of a (probably) unnecessary ED work up and it turns out the patient has some malignancy, am I on the hook for delayed diagnosis of a potentially terminal disease?

I feel like throughout the years I have done so many unnecessary outpatient work ups due to this fear and the knowledge that if I send the patient out, depending on the insurance, it will likely take months to get to what will likely be no answer anyway.

Do you give oral antibiotics routinely for finding of epididymitis on ultrasound? Specifically for patients with normal urinalysis and no STI risk factors. Our urologist suggested antibiotics are not always necessary.

Inspired by a previous post.

Hi! In about a year I'm gonna be finishing my emergency medicine residency program and will become an attending physician (in Europe). I know it's normal to be stressed, but to ease the transition, I would like to be as prepared as possible. Beside doing my best during last residency year, I would like to read more books and other medical literature, maybe podcasts or videos and wanted to ask for recommendations here. Any advice is welcome.

Thanks!

No joke.

Recently heard from a fellow ED doc about an independent free-standing ED. The independent means they opt out of federal health programs so EMTALA does not apply. These facilities will generally list cash vs. private insurance prices upfront. From a business standpoint this would operate more like a super urgent care, staffed by ER-trained docs who are often co-owners, with more resources such as MRI and a higher level of procedural capability. Some of these will also have an inpatient side for lower-acuity admits.

I have experience working at a standard FSED for a few years and it was a great experience despite the associated CMG and the low pay. Doing 24’s and getting to usually sleep for 4-6 hrs/night was a great lifestyle at the time.

Really interested to hear about anyone’s experience with an IFSED. I’m sure a lot of outpatient diagnostic imaging and lab work is done at these facilities. On the surface it seems this would be a good blend of using ER trained skills but also being in private practice.

There would be something very satisfying about telling a patient who is being disrespectful to nursing staff that they have to leave the premises immediately. On the other hand, I’d feel like a huge ass turning someone away who was self-pay but really needed help potentially forcing them to call 911 from the parking lot.

Here is an example of the type of facility I’m referencing: https://nwindianaer.com/

Thoughts? Experience?

Is anyone using an AI ambient documentation app in the ED? If so, which of the apps (DAX, Augmedix, Ambience, Nabla, etc) do you use/recommend?

I’ve seen a 9yo and 10yo in the past 2 weeks and two co-docs have seen a 10yo and a 12yo in the last few days.

Editing to say we’re not a pediatric ED. We see them of course but not at the rate a lot of other facilities do.

Are there any Team Health firefighter docs working on the other side of the Ascension St. John Detroit union issue willing to disclose how much Team Health was willing to compensate for ER coverage today?

Do you feel any animosity towards either Team Health or the docs striking today?

My job is giving me the option. I’ve paid out of pocket since residency for disability and life insurance, have riders in place that prevent increased cost as I get older. Retirement has a cash balance ace 401k set up through actuary. So really only need health.

Leaning towards 1099 as I can write off many things.

Thoughts?

Vituity might be buying out my hospital’s ED contract. What does that mean for physicians with 8+ years of experience in terms of salary? Do you start back at “year 1” as if you’re a new grad?

Hi so I have always wanted to be in the ER, its been my biggest passion, I did volunteer hours and shadowing in multiple hospitals’ ER departments and I am currently in nursing school but I am thinking of changing my major to go get my doctorates and was just wondering if anyone else has done this/what their experience with med school was like. I get decent grades and I honestly just cant decide what to do lol.

I'm so nervous about this exam. I've never been the greatest test taker, but I've managed to pass the countless number of exams to get to this point. The Oral board exam is the last step before becoming a BC EM physician. I've done all the cases in Okuda and watched some EMRAP videos. I didn't do the prep course.

Any last minute tips for this poor anxious BE doc?

Thank you!

Just curious what everyone's practice is on replacing the fingernail in traumatic nail avulsions. Nail or aluminum wrapping of suture package, doesn't matter. I have always personally done it, but have spoken with some colleagues who don't and am wondering what everyone's take is.

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A pt just told me that she “caught the cannabinoid hyperemesis again”. She was also expressing frustration that she wasn’t discharged (yesterday) with any pain meds. Good morning.

EM attending

Anyone want to give me a crash course short of talking to a few local colleagues and finding a CPA?

I've been W2 but landed a 1099 gig. What are some pointers for tax strategy and other things to start doing? Not starting this gig for at least another 4 months or so therefore I have time to get things set up. What should I research and/or start doing now? Thanks!

I have no debt minus one of our vehicles which would be the commuting car. That one is titled to my wife. Do I transfer it to me or my "company" yet to be formed for tax savings? Do I make an LLC or S-Corp? I'm a noob with this stuff.

When looking at EM residency it seems like a preference if you choose a LVL1 or LVL3 program.

What’s everyone’s thoughts on a level one vs level three ED for residency?

Title pretty much says it all. Interesting metaphor I thought of. Is the “corporatization” of medicine with a push for less physician coverage and APP autonomy essentially jeopardizing patient safety in the name of profit? If so, why doesn’t CMS function more like the FAA?

My group has become increasingly insistent that when we ama people we only document the ama discussion and don’t click ama (click discharge) Is this common or normal practice for anyone else? This isn’t just moderate risk heart score either but now asking me to do so on people that have left ama in respiratory distress or severely septic and seems fraudulent and a risky documentation practice in the likely event they have a bad outcome and now I have a charting discrepancy Would love to hear others insight