r/emergencymedicine

I’ve got another one for the community. in a patient with an INR >10 without signs of bleeding, do y’all generally admit or discharge with close outpatient follow up?

Specific case prompting the question: 50s male with TAVR 2 weeks ago for infective endocarditis cause symptomatic regurg, small septic emboli stroke 4 months ago without residual deficits, also on linezolid and amiodarone (cytochromes in shambles). Supratherapeutic INR on routine outpatient labs, medical sub specialist sent patient to ED. verified INR. No other lab abnormalities. Received oral vitamin K. Patient has ability to get lab draws tomorrow and to follow up closely with PCP. Partner able to monitor patient at home.

Couldn’t find any solid literature about bleed risk in the acute/ED setting beyond that there’s more risk. Got a wide variety of impressions between ED docs, hospitalists, and pharmacists.

I have been in a major depression about this the past semester, so to reddit we go. I am a rising junior at a small liberal arts college. My GPA is very low (Freshman year was a terrible year mentally and socially, my priorities were all messed up, it was bad) and although sophomore year has been a lot better (mostly high B's and A's) my gpa is still below a three. I've been considering both law school and med school, but I want to get an opinion on if I should even consider going to med school if I literally cannot get in due to my low GPA. My school itself is not very set up for a medical career, as my degree amounts to a dual philosophy/theology with a minor in math. I would be able to take the extra pre-req's after I graduate, then study the MCAT, then apply.

I want to be a doctor because I love people. I work in food service constantly and love the fast pace and the communications. I also grew up on a ranch, and very much enjoyed tending and caring for sick animals on our ranch (giving them shots, working with deliveries, suturing wounds, etc). However, if my GPA is just too low at this point, then it is what it is. Please help ya girl, she is struggling :)

Alright guys, would love to hear your post-shift routines/habits if you have them. Personally, have a hard time unwiring after a shift no matter the time and i find that it negatively impacts my sleep. In residency everyone did post shift drinks which i didn't regularly partake in because i don't drink (though fun to still hang), but i feel that i didn't intentionally build up a transition. Anyone else have this issue/what are you doing about it?

I'm a community EM doc and the unofficial scheduler for our group. Have been for a few years. Every cycle it's the same loop with pulling last month's spreadsheet, copy-forward the rotation, manually rebalance AM/PM, try to honor day-off requests while keeping everyone happy, send it out, get six "can I trade with X?" texts within an hour.

I'm trying to understand whether what I hate about it is universal or just our group's spreadsheet being bad. So:

• What's the single most painful part of building or maintaining your group's schedule?
• What's the part of the published schedule providers complain about most?
• For groups with residents — what does your block scheduling hell look like?

Not selling anything in this post. I have been building a tool to make this less awful for our own group and I'm trying to figure out where the real pain is for other groups before I assume our spreadsheet is the universe. Genuinely just want to know what you'd want different. Excited to share what I've built with anyone who replies — DM is fine.

Any guidance on how to make a one year crit care fellowship cater best to EM ? I had prior gen surg years so got a year waived off my scc fellowship, since it’s literally half than what other em graduates would get a little anxious as to not get enough training, anyone who did em-cc what would you suggest having done during fellowship that helps tremendously with job prospects later?

44% of an ED shift goes to data entry. 28% to actual patients.

How is anyone else dealing with this?

Scribes? Voice-to-text? Or just eating the extra hours?​​​​​​​​​​​​​​​​

For context— i’m an intern starting in july hoping to start a family in chief year. Partner in IM

Hello I'm a Internal medicine trained critical care fellow I'm in my last 2 months of fellowship. I've spoke to a few EM residents and they are trying to convince me to do an EM year and see if I can be triple boarded. I never even knew this was an option but according to some it is. I'd love the Idea of going to a critical access hospital to do it all; but is this even a career path? Is there truly 1 year EM pathway for someone in my position? Thank you.

To preface this, I work in a pediatric setting. I know they aren't new, but good night. From experience, it feels like we already are seeing a)more injuries and traumas and b) the outpacing of injuries and traumas caused by analog bikes by their battery-powered counterparts. The acuity is typically higher and it is an absolute nightmare. They can reach speeds as high as 30+mph(48+kmh). There is no regulation surronding them. Summer just started and it looks like it will be a busy one.

For those of you using ambient AI dictation software, you still ought to proofread your notes.

Over the past few years, I have noticed a few posts about EM docs looking into pain management as a specialty. I would have loved to know this information when I was first starting. I am double board-certified through ABEM in emergency medicine and interventional pain medicine. Feel free to ask all the questions! Here to help!

Hi everyone, I'm an EMT-B with about a year of caregiving experience now, and my previous jobs were mostly retail and farmers markets. I've been looking for work in the ED, and I've applied to Stanford and El Camino health, without much success. The job postings state that they only require a BLS card, and no prior work experience. It's surprising because I'd expect them to look for someone with prior experience, but anyways ya I've just been getting rejected and it's just been really hard. My resume isn't that lengthy, I only mention related experiences and my certifications. I just really want to work and it's been hard. I don't know why and I'm starting to think I'm overqualified. I don't plan on leaving after like a month or two, I want to work for as long as possible to fund my college education and build more clinical experience.

Anyone have insight as to why this program SOAPed 5/6 spots. Or even generally what are some of the red flags to look for in an EM residency? Difficult to tell as a rising 4th year just trying to figure out auditions and plan for the fall

I asked for McGill forceps at my hospital and nursing staff had no idea what I wanted and then I was informed it has to be brought from the OR. So I’m putting together a personal bag of must needed supplies. Either materials that are time sensitive or not readily available. Do any of you maintain something similar? What’s in your bag?

Throwaway.

I’m so tired of everyone checking in & never leaving & most people not getting real help.

I’ve been a night clinician full time at an ER for a little over a year now, and honestly, it’s gotten so awful. It used to be healthy mix of people needing help, the occasional dementia patient with a bx disturbance.

But the last 6 months have been brutal. I switched hospital sites within my company (same bosses, often I’d have to leave the old site & go to my current because current has higher census), and while it was a little better, the same issues hit my current ER.

We are a revolving door of nursing homes sending out dementia patients for hitting, and needing them until we admit them to GPU. 90% of our GPU patients are people that have been there over 6 months to multiple years, as nursing homes won’t accept them because of their pasts. Then the ones we have in the ER, they have to get IMs & restraints so they don’t wander around & possibly get hurt. Most of them are dementia with bx problems, not even true Geri psych. Our ER doesn’t have a separate place for Geri & adult psych, either, and I’m always so scared something’s going to happen.

Then I have nurses sending out paralyzed stroke patients & 95yo hospice patients for “SI statements”.

The unhoused come in so frequently looking for a warm bed, and it’s just gotten worse and worse since policy changes. If we admit them, they often times walk back in the er once discharged from the unit. Or they go back out & go right back to their patterns again…People will ask to be admitted because of the weather or something else sad. People also don’t want to take their meds, at all.

The aggression & attitude is also so bad recently. I’m constantly being spoken over or yelled at before I can finish a question.

My bosses are also asking way more of us for things with no compensation. I haven’t received a raise since hiring or moving to the new site, as well as was never offered reimbursement for time spent going back & forth between the sites.

Has it always been like this and I was just naive? Or has it been horrific for any other states lately? I’m from New England, USA.