r/emergencymedicine

I’m an attending entering my 5th year out of residency and I don’t know how much longer I can do this. I have a true disdain for the majority of my patients. They are a combination of people with no coping skills, no personal hygiene, no manners and no common sense. No one wants my expert opinion on anything. They come in wanting certain tests or medications and when I tell them why it isn’t indicated I’m yelled at. I can hardly remember what drew me to EM in the first place but it certainly isn’t what I’m doing now

Awhile back I had a patient who presented for an MVC. They were very shifty from the beginning . The story didn’t make sense and then I also found out he came to our hospital which was nowhere near where he lived or where he had the accident . He showed me a picture of the vehicle to show the severity . Around the same time one our nurses alerted me that the accident was on the news and the police was looking for the driver . Everything including the car model and the location of the accident matched up . The patient was also under the influence at the time . He ended up admitted for some traumatic injuries and I never followed up .

Does anybody know what would have been our legal obligation . While in the ER, we had this discussion with our admin who said it was not reportable but it always bothered me that we’re not allowed to report something like this . It seems unfair especially when they were innocent victims who got hurt but thankfully lived.

I’m feeling more and more a desire to call patients and families for follow up and or condolences.

I usually keep charts for a while just to see what happens and sometimes there will be a death or I won’t get a sense of how things are going just from the following records and feel an inclination to call the patient or family to check in or lend condolences.

I feel hesitant to do this and wondering if anyone feels similarly and acts upon this desire?

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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.

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

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.

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" 🙏

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.

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?

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?

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?

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!

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’m at a loss of what to do. I’ve worked in the ED before and felt I did really well. I’d be able to handle the patient load and adapt well.

But since I’ve had a baby and started at this new hospital in the ED (since March) I feel like I’m drowning. The preceptors are very “eat their young” and gang up on the new people. They constantly shit talk others behind their backs, and throw the newbies into the deep end. I went from feeling confident to dreading coming to work each shift. Im having to pump on the floor while seeing patients because charge and other nurses don’t really look out for or cover me. We usually swarm with a new patient and yet I’m left to intake my own patients solo. I get patients put into my room with no communication so I come back from passing a med or putting my pumps away and I have a new patient that’s been waiting and charge is like “um are you going to take care of your patients?!” Like im the f*ck up for trying to feed my baby. I’m looking for advice because I’m feeling burned out. I told my husband I want to quit and also start applying to other hospitals because this department is so TOXIC.

So here’s what I’m asking. Would it be better to just ask to go to med surg for a while (if not permanently)? I know the patient load is bigger but I’m wondering if the more organized style of nursing would lower my stress levels. I’m drowning and getting burned out and it breaks my heart because I LOVE nursing, I just can’t take the dog eat dog, clique, mean girl ED.

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?

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!

I must have warned my husband one hundred times to make sure to take off jewelry before feeding the dog, but he just doesn't listen.