I'd prefer a physical book than online study tool but curious what everyone is using to study. Lots of options on Amazon. I know there are lots of free YouTube videos but I like touchin' books. I just wanna use my fancy colorful highlighters tbh.

At my ER, we have a new edict issued that if a C collar is applied in triage,the patient must immediately come back to the ER and be placed supine. This applies to any pt that we place a collar on. My ER is small and very busy, in a major metropolitan area. This is incredibly infeasible, yet applies to even the “fall a week ago patient” that might have some head or neck discomfort. No one can figure out where this is coming from and can find nothing stating why a c collared pt cannot be sitting up. Looking at some of the newer literature suggesting automatic application of the c collar may be detrimental to a patient, please offer some insight as to what might be happening here.

I'm a visa requiring non-US img, I'd be applying for emergency medicine this year and I'm very confused about the SLOE part of it. I currently have a research job and have been shadowing EM physicians in the same hospital but I'm not sure which SLOE applies to me because all of them require grading or perfomance evaluation, none of which I would have just by shadowing or watching physicians?

I would appreciate any tips or insights on how to go about this?

Almost MS4 here going into EM. My obgyn clerkship like for many was not the greatest experience. We got three weeks on L&D and I feel I got to learn a lot about deliveries and general OB complaints. The gyn stuff was much worse though. I am a guy and I expected to have of course some patients decline to have me do any pelvic exams which I get. However I got to do exactly zero. Not for a lack of trying as I asked all my preceptors and residents. I had clinic only for one week and surgical gyn for the other two during which I didn’t get to do them either. Now as an incoming fourth year I’m wondering if doing basic pelvic exams is a skill that I should be comfortable with before going into residency or not. I’m planning electives for next year and planning to do ones that are both chill and useful skills like ophtho, rads, derm. I’m debating if doing an obgyn elective would be helpful but I’m not too sure it’s the best use of my time.

Posts regarding considering EM as a specialty belong here.

Examples include:

• Is EM a good career choice? What is a normal day like?
• What is the work/life balance? Will I burn out?
• ED rotation advice
• Pre-med or matching advice

Please remember this is only a list of examples and not necessarily all inclusive. This will be a work in progress in order to help group the large amount of similar threads, so people will have access to more responses in one spot.

From my own and many other experiences why is this misdiagnosed so often ? I have stared a sub if anyone would like to visit.

r/aorticdissection

Thanks

Hello. I'm wondering what would be the correct thing to do. I failed my written boards first attempt, and passed the second attempt. I now will take Oral boards this December. So I'm not technically board certified. Credentialing packet is asking me if I've ever failed a board exam Y/N/NA, if yes please explain. The next question is if not board certified do you plan on sitting for boards Y/N/NA, if so when?

So do i come clean right now about my board exam failure? Or do I say NA, not yet board certified? I would hate to start of my job with a huge stigma that I'm a failure if I don't have to. They didn't ever ask about it on interview, this is the first time anyone or any paperwork has asked if I had a board failure. And what would you recommend I type in the "please explain" part? Just all the reasons I think I failed? It just seems like a weird question for credentialing packet-- it wasn't on either of the other two credentialing paperworks for different employers I completed.

I’m a new paramedic but man, our medical system is deeply flawed. It seems like this is the life cycle of most of our patients is:

Patient: “I have (menial complaint), call 911!”

EMS: “This is bullshit, let’s just take them to the ER so we can respond to actual emergencies.”

ER: “Why did they transport this patient? It’s not an emergency, they need a consult from X specialty.”

Specialty consult: “This shouldn’t even be our patient! Their labs are abnormal, just admit them to IM.”

IM: “This patient did not need to be admitted! The family just doesn’t understand that this patient is old w/ multiple chronic conditions. They’re safe to discharge and follow up with PCP.”

PCP: “I’ve done everything I can do from an outpatient perspective. If your condition gets any worse, you need to call 911 and go to the ER.”

And the cycle continues. It seems like all we do is dump patients on one another for the sake of CYA. So many times we take patients to the ER only to later transfer them to a “higher level of care,” and then we transport them back to the ER a week later for the same issue.

Is there even a solution to this problem?

Is it something more profound than just simply insecurity, or burnout?

I have my opinion for this, however, I am curious to know from your personal experience of why this continues to be a problem.

Does anyone have any experience working/rotating at an Intermountain Healthcare ED?

Question for the ED folks, we are in the process of finding a new place to live but also looking where to possibly work. What's your opinion on this? Thank you for your time!

How to you all deal with micromanaging directors in your ED? I am a mid career faculty attending. We have two directors and both of them micro manage. They watch if you are talking to staff or if you ever said anything against management to anyone. If you raise any complaints regarding patient safety issue, they openly call you difficult to work with, not a team player etc. if you explain to them we are not well staffed, and you can’t take care of patient, they label you as unable to manage stress and try and refer you to EAP etc?

I can’t leave this job. But need to know how to survive. We have culture based values the hospital claims they follow but in practice it’s opposite. Chairs and directors harass us and violate our privacy. DEI is all about performative acts only. Retaliation against individuals for standing up or advocating for themselves because it’s considered too aggressive even when stating facts etc.

Are all academic EM programs like this? I feel disappointed with how toxic EM culture has become. I am trying to survive here. Any suggestions/advice?

I'm in the process of recerting (wtf.. I'm 10 years out??). I took the abd/gi one and wasn't bad. For those who have taken them, which would guys consider the most difficult and easiest modules?

Im also having alittle anxiety about the trauma one as I've practiced at a nontrauma center the past 10 years, any recs for latest trauma review?

PGY-3 Here: I have a couples questions regarding board certification.  1-Is the qualifying exam only offered once per year? (this year being 10/28-11/2/2024) 2-When will they implement in-person oral boards?

I’m an emergency medicine physician and always assumed this sub was for emergency medicine physicians but the majority of posts and replies sound like they are from lay people or paramedics.

Have read a significant number of replies that are of the flavour, “My doctor told me….”

Also the sub has 101 000 subscribers. I am questioning whether there are 101 000 English speaking emergency physicians in the world. ABEM in the US has 39 000 members.

Who is the target group for this sub?

I don’t mean to be exclusive but I will respond in a different manner if talking to lay people rather than conversing with colleagues.

This is a mantra that I have heard countless times over the years and it only becomes more true the longer I do this job. It is typically applied to the patient as they withhold important information or don’t tell you the whole truth but I see that it can be applied more broadly as well.

Yes, don’t trust the patient. They have had far more to drink than they are admitting to. They have far more medical problems than they want to let on. They typically cannot recall all the medications they are on. They’ve already been seen multiple times for the same complaint. You must do your own chart review and do your own digging in talking with family members, the EMS crew, the facility they came from or the doctors office that sent them in in order to verify important information.

We all know this in the ED because it doesn’t take long to get burned when you put all your trust in one source of information that turns out to be inaccurate.

I can't even trust myself sometimes. Just when I think I can have some faith in my own gestalt, I get humbled by a patient that turns out way sicker than I initially thought.

Thoughts?

Title above. Genuinely curious as a fresh MS4 applying EM this cycle. My base site does not have an EM residency, and my only exposure to a residency schedule was an IM program where it was six 12s a week. Give or take the random switch of your "off day".

I've heard that EM has more restrictions in regards to residency work hours. (I have no idea if that's true, and that's not what draws me to the specialty anyways.)

But I've heard that some places do 8 hour shifts, some do 10s, and some do a schedule of rotating acuity shifts.

What's the norm?

What is the best stethoscope for an incoming EM resident. I used a $50 stethoscope through med school and now looking to upgrade.

Any other “must haves” for incoming EM interns??

Ill go first.

It's out! Yay!

Hi everyone! I’m wondering if any of you know of ways to work with veterans as an EM physician beyond the VA. This is a population I deeply care about but have heard working at the VA isn’t the best place to be to keep up with skills as an EM doc.

Curious to hear your thoughts. TIA!

Why is it the first thing ABEM wants is more money if you passed -_____-

Hey all, I’m currently a medical student strongly considering applying to emergency medicine within the next year or so. I am also considering getting an MBA before graduating medical school with the plan to transition into administrative roles as my career progresses. The biggest motivators being avoidance of burnout and minimizing night shifts. Does anyone have any insight to this career path and if my goals concerning nights and burnout are feasible? Also, what other options does an MBA open up in EM?

Any advice is greatly appreciated.

My wife had a patient with transaminitis that was waiting in the ER for a meg surg bed assignment. There was an order for 1/2 NS at 100mL/hr. The patient had all electrolytes and glucose within normal limits. The question is why not NS or LR for maintenance fluids?

Our hospital system is seeing a not insignificant incidence of nec fasc in the past few months. Not all of them are ivdu’s, but elderly, etc.

Interestingly enough, I’ve have also seen a number of low risk centor score of 2’s with confirmed group A strep. Ones that I wouldnt have even sent myself which are confirmed +.

Unfortunately I don’t know the organisms with nec fasc that we’ve been seeing.

Anyone else seeing this? Any ideas why an increased incidence?

As a thought experiment I imagined implementing this in our ED and became a little puzzled. Is this a plausible screening tool in any ED or was this designed for PICUs (where the patient is already likely recieving antibiotics and hemodynamic support)?

Are EDs expected to routinely get ABG, dimer, lactate, INR, fibrinogen on many of their pediatric patients? Are kids to stay in the ED until all of these result? What if the child is sent home and two of these values come back aberrant after discharge?

Around me, whenever fire/ems/law becomes a patient they get everything, one of my co workers syncopized at the station and upon arrival to the ED he had a big room and there where 2 different doctors, an RT, and half a dozen nurses waiting

Another time we had a firefighter get maybe 5% 2nd degree burns. I wasn’t there but I heard they had him in a trauma bay, had everyone waiting (including I think like a dermatologist or something I’m not sure)

I’m curious if it’s like this everywhere? It doesn’t happen often because we are all too stubborn to ask for help especially when there will be a lot of attention but when we do the hospitals take it very seriously.

Hello, I’m finishing third year med school. I know I want to do EM, I love it! I love the patient population. I love the easy/boring cases and I also love the true emergency cases. I’m in a large socal research hospital. I don’t mind the typical things that bother people (homeless/drug seeking/drama). But, and this is a big but, I HATE nights. Like despise them, takes me days to recover. Advice for pursuing EM despite this?

Some specific questions: What type of medicine can you practice with EM training outside of a typical ED position? Urgent care? Fellowships? FM?

Thank you!