Attending at busy level 1 center here; we were just told via a memo that ERs are considered “public spaces“ and that while ICE agents are not allowed to enter private rooms without a warrant, we are not to stand in their way if they do.

I have no interest in being part of this shit show and I honestly do not anticipate some showdown-like situation with a federal agent. But wtf. Leave us, our patients, and vulnerable spaces like the ER out of this national nightmare.

I’ve been an RN in the ED for about a year now. Me and my educator are just curious about why this pt got a chest tube instead of a thoracentesis for a pleural effusion.

No collapsed lung, just a large right pleural effusion. This pt has had multiple thoracentesis in the past for this as it’s recurring. This time they decided to do a chest tube in IR instead.

Was wondering a bit on why? Just curious and want to learn :) The doc who ordered it never came around so I didn’t have a chance to ask him.

I’m stumped.

I’m a 3rd-year medical student aiming for emergency medicine and looking to join a professional organization to strengthen my application. I’ve been interested in EM since before med school and worked as an ER scribe. I know there are a few options, like the American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM)—which one do you think is the best for networking, mentorship, and residency applications? Any other recommendations? Thanks!

My interactions with attendings are usually very limited and mostly consist me handing them EKGs or offering coffee. I understand that ER docs are busy and already have company from their scribes and nurses.

I would like to know how I could make relationships with doctors in a busy ER, and possibly receive guidance if I wanted to pursue EM?

It seems like there is a common branch point between ER and anesthesia.

Why did you do it? Are you happy about your choice?

Doctors, I'm here asking you on your opinions of motorcycles, do you or do you not ride? If your either of those then what do you think of them?

I passed. Holy shit.

Now just to finish paying down those loans.

Thanks for putting up with my neuroses reddit. I appreciate you

Hello all!

I was a frequent flyer patient at my local ER, due to multiple co-morbidities. I'm doing a lot better now, and I wanted to give back to said ER. If I got Jimmy John sandwiches catered and donated them, would that be an okay thing to do?

Thank you all!

Edit: Admin, please delete if not allowed

Hey everyone,

I’m a non-U.S. IMG who graduated in March 2023 and am currently doing a postdoc research fellowship in neurology at a university in New York. I’m planning to apply for the Match this year if everything goes well. While my research experience has been great (even though I don’t have publications yet—quality over quantity here), it hasn’t helped me secure a SLOE for emergency medicine. That said, I will have three strong letters of recommendation from doctors I’ve been working with and shadowing.

It feels like every EM rotation is closed to IMGs once they’ve graduated.

At this point, it seems like my only options are to give up on EM, apply to IM/FM/Peds, and then redo residency later—or just change my career path entirely. It’s really discouraging.

I’m willing to travel, pay for rotations, or explore non-traditional options, but I honestly don’t know where to look anymore. Has anyone else been in this position? Any advice on how to get a SLOE as a non-U.S. IMG?

I’d appreciate any insights, tips, or recommendations.

Let it be known that oral board results for December 2024 are finally up!

Well at least it says I’m board certified what a long wait! Honestly. It was nuts because it only took 3 week for the rest of my friends.

Inspired by the recent post that had a question about high CRP in patients with influenza, I wanted to point out an interesting practice variation.

Most people made fun of the poster for sending a CRP and mocked them, clearly not knowing that CRP is the "infection marker of choice" in many countries. It's not as crazy as you'd think, particularly because our marker of choice (leukocyte count), is essentially garbage too. CRP and WBC have somewhat similar test characteristics and can frankly be used quite interchangeably, so basically their question would translate to "anyone seeing flu patients with crazy leukocytosis?".

In case someone is interested in a study comparing CRP/PCT/WBC for respiratory infections in peds (as an example): https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01756-4

Fancy AF

Had three patients recently who presented with paronychiae - two had it on the index finger and one on the middle finger - with slightly elevated basophils. I was able to order MRIs on them and the radiologist said to correlate clinically (big help!🙄). I threw in a triple lumen in the right IJ just in case they decompensate and I consulted hand surgery and admitted all three. Anyone else noticing this trend of borderline basophilia?

I was scheduled for oral boards next December, which I was slightly bummed about, until I heard a rumor that some people were punted to the in person oral boards in 2026??! I have not confirmed someone is actually in that situation, but I not sure why someone would make that up.

Interested to find out where Emergency Physicians/Residents seek education related to career development but not clinical training. e.g. for senior med staff looking to advance into leadership roles, where would you look for leadership training? I know Harvard courses are popular in the USA.

My organisation runs Emergency Department Leadership (specifically focussed on leadership skills and administrative/financial/management skills within the EM setting) that takes place in Italy. We're based in Australia and often have international European enrollments from english-speaking and nordic countries but I'd like to reach out to EM specialists in other regions.

Just had two patients with Influenza A, one with a CRP of 200 and one with CRP 330. CT scan doesn't really show any other focus. The one with 330 had maybe a tiny pneumonia which - under normal circumstances - would never explain a CRP that high

Is anybody else seeing influenza patients with CRPs that high *without* any clear indication of a superinfection?

Edit: just a to be clear, not a single comment answers my actual question.

CRPs are usally done right when the patient gets in here, at least when it looks serious enough. I wasn't aware that the rest of the world didn't use that parameter, like at all.

The CRP 300 patient looked like total shit, had to actually stay at the hospital, hat mild DKA as well and some abdominal pain. CT didn't show anything for that either.

MY POINT is, a CRP of 300 is usually always indicative of bacterial infection. But apparently it's not something that's used or understood in this US-centric sub

Invite only beta version of a website where attendings can share their salary info. It links to your NPI number so not just anyone can join to view the info. I thought it was interesting to view the info and will help with pay transparency so I thought I’d share it here.

https://www.marithealth.com/invite/mnw-rjf

Edit: residents can view the data too but can’t add their info obv.

I need some tips of lacerations suturing especially face lacerations

what size is the most appropriate for face and/or forehead lacerations ( 5-0 vs 4-0)

What suture material is best for such wounds (absorbable vs non absorbable)

What suturing technique is best (running subcuticular vs simple interrupted vs buried simple interrupted vs others? )

Hi everyone, not sure if this breaks the rules, let me know if it does.

I'm an emergency physician in a busy community hospital. My elderly 90 yo grandma who is reasonably functional ADL/IADL independent fell and hit her head. The emerg doc (in a different city) didn't want to scan her because it happened 12 hrs ago and she looks at baseline.

When I discussed with the doc, she said 8 hrs of good obs and her clinical acumen is enough to rule out a bleed. Is there any guidelines/studies to support this? I tend to have a very low threshold to image elderly head traumas but am curious if I'm overstepping by pushing a little harder for the scan.

Hi! I am conducting a research survey for my AP Research class. If you are a high stake medical professional and have watched either Grey’s Anatomy, ER, or House please consider filling this quick survey out. Thank you so much! Link: https://docs.google.com/forms/d/e/1FAIpQLSfWq2V-d1PlymYL6aJ1pytJ4hUPXtx3fwRM5XMsP1SPf-xlDA/viewform?pli=1&pli=1

I’m leaving my job with Envision because it’s been a nightmare, my contract says I have to pay back my start date bonus of $5,000 if I leave within the year. Totally willing to pay it back but I was hoping they would forget and not ask for it back. Anyone have experience with this?

Surprised this hasn’t come up. Maybe I don’t understand this correctly, but with Medicaid being frozen and EMTALA stating everyone gets treated, how will ERs and hospitals get reimbursed? Majority of our patients are in Medicaid. Obviously this is “temporary” but given what this administration is known for, it could be weeks or even months.

Thoughts?

The old adage about "the standard of care for aortic dissections is to miss them" always seemed frustrating to me. After doing some reading, I've been seeing some promising data in the literature regarding using Aortic Dissection Detection Risk Score (ADD-RS) in conjunction with D-Dimer.

https://pubmed.ncbi.nlm.nih.gov/29030346/. This was a prospective multinational study with a high disease prevalence that found a failure rate of only 0.3% for ADD-RS of <2 AND a dimer <500.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11192411/. This is a systematic review that demonstrates 98.3% sensitivity and 51.4% specificity for ADD-RS>1 OR dimer >500.

I was curious what the community's thoughts were on this clinical tool and if anyone incorporates it in their practice. Do you think it's valid when applied to low risk/intermediate risk patients?