r/emergencymedicine

Intern here, a very common pt concern and question is whether they can eat or not. Other than the potential to undergo surgery, I am not really certain when a patient can, and cannot, have a turkey sandwich. Truthfully, not certain which procedures they definitely cannot eat before, and which do not matter. Any hard rules or guidelines I can employ?

Edit: this appears to be a pretty debated topic; enjoying reading all the answers though

obviously not asking about anything medical, but are there generally positions like admin, security, etc that could be done without school?

Hi. My daughter had brain surgery 13 years ago, and I’ve been sorting through thousands of records. When she had a medical crisis and RRT was called, the only record I have of that is the ICU mentioning that RRT brought her in. Does the RRT generate a medical record separate from the ICU’s note?

i (17M ) 5'11 do not take any medicines

i always feel sleepy after taking caffeine like i could drink a can of redbull and sleep like nohting happened

and i also have very bad focus on things (i am not addicted to social media and have not fried my attention span) i cant voncentrate on on thing and have many thoughts going through my mind at the same time

and i cant even sit still for a minute since like 4 yrs old ( old vids )

and my parents have always said that i was never able to concentrate on things

what should i do is something wrong ??

911 ambulance in a major city. We've had two patients try to harm us in the last two weeks, one bite and one attempted stabbing.

I was bitten by one pt who became violent in the back of the ambulance because I had no idea how to restrain them with just my partner and I. One also tried to stab my partner during transport, known psychosis and abruptly decided we were trying to kill her. I keep replaying them in my head because there was no structure, schema, or script in my mind for wild and abruptly dangerous scenarios. I felt so out-of-control in these situations and found myself tripping over my words and moving ineffectively in the moment-- I had no idea what to do in the critical gap between calling for help and the cavalry showing up. Does anyone have recommendations for these types of situations going forward?

I've been an ED attending for yrs, and lately I've been thinking about opening my own urgent care instead of staying in the ED. For those who've made the switch, was it worth it? I know owning a clinic comes with a whole different set of problems, but the idea of having more control over my schedule is really tempting. Just curious to hear your experiences before I make any big decisions

Graduating this year. My desires for my first time attending job are very different than what I want long term (ideally something more rural)

In terms of attire, would you wear a full suit and tie as usual for the interview? Any other tips? (I have only worked in busy community and academic EDs before). Thanks.

Edit: For what it’s worth, I do want the job (as another commenter asked), it’s a “group interview”, and the rate is quite good. I believe it will be other ER docs but also possibly administrators at the interview. Not sure if that changes anything.

Example case: mid 30s female presented as anaphylaxis.

States acute onset of throat tightening without known precipitant - maybe some itching to chin but no rash and no angiooedema.

Took own epi but called ambos who gave another and came to ED.

Similar hx few weeks before.

Apparently under immunologist for years but no cause found.

BG of depression, acute on chronic headaches and presented once with multiple syncope but normal ED investigations and discharged against medical advice.

Important to note - never any obvious objective findings apart from a hoarse voice in last 2 admissions.

I (as a consultant doing what we call VMO work I.e locum work) assessed and something didn't add up to me and my treatment plan was to hold any further treatment I.e. no steroids or further antihistamine or adrenaline as the patient was well without any stridor/swelling/rash and normal obs.

I wanted to do a nasoscope to investigate paroxysmal vocal cord pathology.

Another consultant (who works in the place full time) also reviewed and instead decided on IV hydrocort + further antihistamine.

I then decided to do a nasoendoscopy anyway, due to ongoing hoarse voice, and found no oedema or anatomical abnormality at the cord level but did find paradoxical movements which was confirmed by ENT review of the video.

I personally think this lady is suffering from PVCD and not anaphylaxis but the other consultant has written notes basically just stating it was another anaphylaxis again.

The reason I am a tad annoyed is the failure to consider other pathologies which unfortunately will continue the mismanagement of the patient.

Granted I am aware it is often safer to treat for anaphylaxis than not but in this situation I felt we could have observed and not rushed to enforce a potential misdiagnosis.

I am tempted to call the patient tomorrow and explain my thoughts to guide her to see an appropriate speech/ENT specialist.

In the future if this similar interaction occurs how would you handle it - as 2 senior doctors.

I have had similar interactions with this consultant who has failed to act quickly enough (in my opinion) resulting in poor outcomes.

Hello fellow ER docs,

I just found out I’m pregnant (about 6 weeks). We are estatic! This is my ever first pregnancy. We need to submit our schedule limitations next week and I’d really appreciate advice from fellow ER doctors moms who’ve been through this.

I work in a large teaching university hospital with high acuity. Nights are 2 doctors coverage. I’m currently at 12-15 shifts/month and love working nights. Our schedules can be somewhat adjusted, so I could avoid nights if needed.

The schedule would cover 18 to 35 weeks period of my pregnancy. How many shifts would you recommend? Did you keep doing nights? If yes, how many in a row felt reasonable? When did you start cutting back or stop working?

Any tips is welcome.

Thanks ❤️

Edit: I’m staff, not a resident ☺️

Academic EM doc here, fellowship trained. 6 years out.

Curious what many of you are doing to make extra money on the side that doesn’t involve working more shifts, moonlighting, locums etc

Real estate?
Ownership stake in urgent care/medspas etc?
Car wash?
Brewery?
Uber/lyft?
Crypto?
Options/day trading?

In all seriousness, how did you get into it? I’ve thought about real estate syndication deals but some of the people running these deals seem very shady and over promise. I’ve thought about trying to have equity in an urgent care or something but don’t even know where to start or if it’s worth it.

I love my job and have lots of protected time to do what I want and work only a few shifts a month. I dont want to leave my current W2 position. That being said the academic world does place constraints on how much money you can make so was curious what my options were. I’ve already done the basics like max out all retirement accounts/tax deferred accounts. I have my emergency fund, and a brokerage account with some potential high growth stock but it’s a very small percentage of my portfolio. I have my Roth from residency that I maxed out. Also have about 40% equity in my house and trying to pay it off as quickly as possible. Paid off all student loan debt

This is just something extra looking to do, maybe that I enjoy/hobby as well, but curious what others have done and what worked/didnt. Seems like many of these types of endeavors fail and I only hear about the 1 percent success stories.

I’m trying to find a hot/new topic in EM/trauma/tox to do my pharmacy grand rounds on that would take up about an hour. I’m having a bit of trouble bc everything I wanted to do has either already been done last year (so it’s off limits) or has been already claimed by the second yr residents. If anyone has any ideas your help would be much appreciated!!

Off-Limits:
- Push-dose pressors
- PE guideline update
- Surviving sepsis update
- ACLS update
- TXA and anticoag reversal
- Alcohol withdrawal
- Magnesium use in the ED
- Ketamine for pain

Things I’m Considering:
- technically stroke was already done but it was before the recent update so I might ask if I can do it again with a focus on giving lytics to patients on DOACs
- Kratom/nitrous oxide/cychlorphine abuse (but I’m honestly not loving this)

A Gilbert police report reveals an 18-month-old boy was found alive in a hospital morgue five and a half hours after being pronounced dead
By: Nicole Grigg , Ashley Holden

GILBERT, AZ — An Arizona toddler was found breathing inside a Gilbert hospital morgue after being declared dead hours earlier by an Arizona doctor, according to police records.

A police report and body camera video reviewed by the ABC15 Investigators show that two Gilbert police officers saw signs of life multiple times, but the toddler was still taken to the hospital’s “cold room,” which is also considered to be the morgue.

One officer wrote in the police report that the baby was pronounced dead “in error” by the Mercy Gilbert doctor even after a tense exchange about a pulse possibly being detected.

The 18-month-old was rushed to Mercy Gilbert Medical Center after he was found inside the family’s pool on Super Bowl Sunday in February.

It has taken months for the Gilbert police to release public records related to the near-drowning.

The ABC15 Investigators reviewed a half dozen body camera videos, including videos from the initial drowning scene and videos inside the hospital. Most of the videos are heavily blurred, and most of the audio has been muted, but one critical moment was captured between the doctor and the officer.

According to the police report, the officer wrote that a nurse in another room said: “I have a pulse.”

The officer wrote that when he tried to alert the doctor who was with the family in another room, the doctor appeared to dismiss the concerns, “[The doctor] arrogantly told me he was the doctor, he has the medical degree, he went to medical school for a reason, and to let him do his thing.”

Records show that shortly after that exchange, the doctor went on to declare the baby dead.

Over the next hour, two Gilbert police officers continued to document signs of life in their police report.

One officer wrote, “The release of air was audible and visible,” later writing, “It also began to sound like [redacted] was gasping for air.”

The report goes on to say that when medical staff went to move the boy’s body to the morgue, the officer wrote that she “observed what appeared to be another audible gasp.”

That was not the last time she heard signs of life, either.
While inside the morgue, the officer said, “I again observed what appeared to be a gasp or air release, which was now almost an hour later.”

A nurse who was there said those sounds could be a response to efforts to save the toddler.

Some of the last audio recordings heard on the body camera videos were of an officer telling the family that they could say goodbye.

The report says, hours later, at 11:52 p.m., the Medical Examiner's transport showed up and found the toddler was breathing inside the hospital morgue. He was then flown to Phoenix Children's Hospital for treatment.

An MRI said that the baby had brain damage, and we are told he will need lifelong care.

An attorney representing the family declined to comment.
Mercy Gilbert said in a statement, “This is a heartbreaking situation. We immediately conducted a thorough review of all aspects of the care provided to learn what happened and to make meaningful changes to strengthen our care. Out of respect for the patient's privacy, we cannot discuss details. We continue to work with the family and their representative. Patient safety and exceptional care is our highest priority.”

US Docs / anyone with lived experience - UK Doc here.

What are waiting times like in your ERs? Subsequently, how long do patients typically wait for admissions?

I’ve been hearing from US friends that they’re usually seen within the hour, but wanted to hear if this was normal.