Great quotes from the emergency dept

[8744]

Who authorized the medications used for rapid sequence induction, or did you do an awake intubation?

You know, I am doing an ICU month and we almost never use RSI, usually opting instead for just versed. As I understand it the use of paralytics requires anesthesia to be present and puts you in a hurt-lock if you lose the airway.

They do RSI in the ED but I also understand that it is only really indicated trauma or other situations where you really want the patient not to move at all while you put the tube in.

I'm not claiming to be an expert. I just started my residency four weeks ago so if I am mistaken I will no be offended to be corrected.

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[southerndoc]

You know, I am doing an ICU month and we almost never use RSI, usually opting instead for just versed. As I understand it the use of paralytics requires anesthesia to be present and puts you in a hurt-lock if you lose the airway.

They do RSI in the ED but I also understand that it is only really indicated trauma or other situations where you really want the patient not to move at all while you put the tube in.

I'm not claiming to be an expert. I just started my residency four weeks ago so if I am mistaken I will no be offended to be corrected.

There is research to support paralytic use in medical and trauma patients, and there is also research that suggests that utilizing a sedative without a paralytic actually makes it more difficult to intubate.

We do RSI in the ED, and anesthesia does RSI on the floors and ICU's (only anesthesia and ENT can intubate outside the ED).

I have become so comfortable with RSI that there really must be a strong contraindication to a paralytic before I would intubate someone with a sedative only. Even our dialysis patients with known hyperkalemia gets a paralytic. We use rocuronium for them. We believe so much in paralytics that we are willing to use a long-term paralytic to achieve optimal intubating conditions.

I would be curious to hear how others feel on the use of sedatives alone in intubating patients. Particularly the "old guys" who have been around a while.

 

[BKN]

I would be curious to hear how others feel on the use of sedatives alone in intubating patients. Particularly the "old guys" who have been around a while.

Sedative Bad. RSI good. Anesthesia supervision required very bad, they never showed up in time.

friendly neighborhood stone age EP

 

[DropkickMurphy]

friendly neighborhood stone age EP

"Bedrock ER......we are en route to your facility with....."

 

[southerndoc]

Sedative Bad. RSI good. Anesthesia supervision required very bad, they never showed up in time.

I had one of my most difficult intubations yet. PGY-2 took 2 stabs at it, I took a stab at it, attending took a stab, and then while anesthesia was on their way down I took a final stab at it and got it with a grade III view. 600-lb woman with no neck, Mallampati IV, and this huge tongue that prevented you from inserting the blade in with ease. I probably should've used our Shikani a lot quicker. Luckily she was "baggable" between attempts.

 

[Homunculus]

friendly neighborhood stone age EP

my stories are mostly "parent hotline" phone calls we cover while on call in the NICU.

"can i give my 3 day old tylenol for teething?"

"why is my son's temperature under his left arm differnt from his right?"

"my 3 month old hasn't pooped for 12 hours"

"my 6 year old has had a cold all day"

"my son has scratches on his back and worms are coming out" (wtf? lol)

"my daughter swallowed a penny 3 days ago"

--your friendly neighborhood approves of BKN's prehistoric-ness caveman

 

[8744]

Sedative Bad. RSI good. Anesthesia supervision required very bad, they never showed up in time.

friendly neighborhood stone age EP

As it was explained to me by one of the attendings, you can reverse benzodiazepams, your can reverse opioids, but you can't reverse paralytics which is why they like to use just sedation most of the time. This kind of sort of doesn't make sense because presumably you have enough people around to bag the patient indefinitley if you can't get the tube in and it would seem to me that if you're going to lose the airway, you'll lose it whether the patient is paralyzed or not.

I think it does make the intubations more difficult because sometimes the patients fight the tube or just don't seem to be as "compliant" as they are with RSI.

 

[southerndoc]

As it was explained to me by one of the attendings, you can reverse benzodiazepams, your can reverse opioids, but you can't reverse paralytics which is why they like to use just sedation most of the time. This kind of sort of doesn't make sense because presumably you have enough people around to bag the patient indefinitley if you can't get the tube in and it would seem to me that if you're going to lose the airway, you'll lose it whether the patient is paralyzed or not.

I think it does make the intubations more difficult because sometimes the patients fight the tube or just don't seem to be as "compliant" as they are with RSI.

Only 1 in 1000 intubations result in a can't tube, can't ventilate situation where you're forced to do a surgical cric or find alternative means of airway control.

The evidence is clear: paralytics facilitate intubations. You can either paralyze, and take that 1 in 1,000 chance, or you can not paralyze, and fight to get the tube in. Some studies have reported as high as 30% failure rates when using sedation alone.

 

[waterski232002]

A series of overhead pages heard throughout the hospital...

2:00pm - "Anesthesia... report to room T502"

2:05pm - "Otolaryngology... report to room T502"

2:08pm - "Code Blue... report to room T502"

2:12pm - "CT surgery... report to room T502"

2:20pm - "Chaplain... report to room T502"

I think the last overhead page was a little unneccessary

 

[DropkickMurphy]

An exchange that I heard in the ER one night beginning with one of the local paramedics who was calling in with a trauma:
Paramedic (on radio): "Adult male, unresponsive, massive head and chest trauma. GCS of 3, unable to secure an airway, one IV established, unable to obtain a blood pressure, very weak carotid pulse, rate of 160. Do you request or require any further?"
Nurse (on radio): "Negative, trauma one upon arrival. We will have the bag down awaiting you."

Overhead page a few moments later: "Orderlies, respiratory, anesthesia and surgery to Trauma 1, stat. Orderly covering pathology please call 2547 (the ER number)"

 

[bulgethetwine]

As it was explained to me by one of the attendings, you can reverse benzodiazepams, your can reverse opioids, but you can't reverse paralytics which is why they like to use just sedation most of the time.

Sure you can, at least if you use sux. Just a little time. Give IV for best results.

 

[ERMudPhud]

As it was explained to me by one of the attendings, you can reverse benzodiazepams, your can reverse opioids, but you can't reverse paralytics which is why they like to use just sedation most of the time. This kind of sort of doesn't make sense because presumably you have enough people around to bag the patient indefinitley if you can't get the tube in and it would seem to me that if you're going to lose the airway, you'll lose it whether the patient is paralyzed or not.

I think it does make the intubations more difficult because sometimes the patients fight the tube or just don't seem to be as "compliant" as they are with RSI.

first check this thread out http://forums.studentdoctor.net/showthread.php?t=276440

Second, that is crazy. If they need a tube they need a tube and you want to optimize your chances of getting it. If you can't get it and you reverse their benzos and opiates now you have a potentially seizing, puking, miserable patient who probably still needs to be tubed. Its not like reversing them and making them miserable takes away the need for the tube unless they were being tubed for a benzo/opiate overdose

Third, If that argument was true then why does anesthesia, virtually all EM programs, and most ICU's use RSI?

Get good at BVM ventillation, make sure you have an appropriate oral AND nasal airway at the bedside, have your rescue devices (LMA, bougie, fiberoptic, whatever) ready, and then push the Sux

 

[docB]

As it was explained to me by one of the attendings, you can reverse benzodiazepams, your can reverse opioids, but you can't reverse paralytics which is why they like to use just sedation most of the time. This kind of sort of doesn't make sense because presumably you have enough people around to bag the patient indefinitley if you can't get the tube in and it would seem to me that if you're going to lose the airway, you'll lose it whether the patient is paralyzed or not.

I think it does make the intubations more difficult because sometimes the patients fight the tube or just don't seem to be as "compliant" as they are with RSI.

That really is the old, OLD way of thinking. I also don't like the idea of reversing benzos with flumazinil because you will frequently run into patients with benzo dependence and you'll induce status seizures that you can't stop with benzos. Then you're really screwed.

 

[southerndoc]

That really is the old, OLD way of thinking. I also don't like the idea of reversing benzos with flumazinil because you will frequently run into patients with benzo dependence and you'll induce status seizures that you can't stop with benzos. Then you're really screwed.

I think her opinion will change once she spends time in the ED getting comfortable with RSI.

 

[docB]

my stories are mostly "parent hotline" phone calls we cover while on call in the NICU.

I can't believe you don't have ready answers for these questions. If you can't help people with these kinds of problems then you are really hopeless. Let me educate you.

"can i give my 3 day old tylenol for teething?"

Sure but since your 3 day old will be teething for a long time it really should be treated like a chronic, intractible pain syndrome with tricyclics, SSRIs and Duragesic patches.

:"why is my son's temperature under his left arm differnt from his right?"

He clearly has been stricken with the dreaded dextropyrexia. To cure him you must pack the feverish side in ice and apply heating pads to the hypothermic side until his temps equalize.

:"my 3 month old hasn't pooped for 12 hours"

You should give him the full adult course of GoLytely followed by enemas until clear. When finished you should set a stopwatch. Repeat the regimine every time he goes even 1 second more than 12 hours without a boom boom.

:"my 6 year old has had a cold all day"

Go directly to the airport and fly to Rochester, Minnesota. Immediately take your child to the Mayo clinic. They are the only ones who can save him now.

:"my son has scratches on his back and worms are coming out" (wtf? lol)

Have you child lie very still with a damp cloth on his forehead. Go to your medicine cabinet and look for any bottles labeled Haldol or Zyprexa. You should take your prescribed doses of these medicines then reevaluate your child.

:"my daughter swallowed a penny 3 days ago"

Go to you sofa and pull off all the cushions. Stick your hand in the space between the base of the sofa and the back. You will likely find a replacement penny so you're good as new.

 

[Apollyon]

I think her opinion will change once she spends time in the ED getting comfortable with RSI.

Uh, Panda Bear is a guy. A hard-chargin', heart-breakin', life-takin', former USMC rifleman and tank commander, at that.

 

[FoughtFyr]

Go directly to the airport and fly to Rochester, Minnesota. Immediately take your child to the Mayo clinic. They are the only ones who can save him now.

No, no, no, no, no, NO! Absolutely not! Don't send them to us! The right answer is "Here is the home address and number of your pediatrician (who presumably hired the nurse line). Go immediately to his/her house and show them your child. Your kid needs his/her help right now!"

- H

 

[8744]

...Some studies have reported as high as 30% failure rates when using sedation alone...

The funny thing is that that's my failure rate for intubations lately.

 

[BKN]

The funny thing is that that's my failure rate for intubations lately.

QED .

Don't worry it'll get better in the ED in the hands of people for whom every intubation is a crash RSI.

 

[RuralMedicine]

As it was explained to me by one of the attendings, you can reverse benzodiazepams, your can reverse opioids, but you can't reverse paralytics which is why they like to use just sedation most of the time. This kind of sort of doesn't make sense because presumably you have enough people around to bag the patient indefinitley if you can't get the tube in and it would seem to me that if you're going to lose the airway, you'll lose it whether the patient is paralyzed or not.

I think it does make the intubations more difficult because sometimes the patients fight the tube or just don't seem to be as "compliant" as they are with RSI.

I think most of the more current literature on Flumazenil does not support it's use due to the seizure risk and also the fact that even when you use it it doesn't counteract the respiratory depression (so what's the point?).

I'm surprised no one but anesthesia and ENT are allowed to intubate outside of the ED. Where I trained IM did the majority of adult intubations in codes, semi-elective in the ICU etc. I'm not sure ENT was allowed to intubate as I intubated (at the request of the ENT resident/ fellow) several crumping ENT patients each year.

In practice now outside of code scenarios I use RSI.

 

[DropkickMurphy]

In practice now outside of code scenarios I use RSI.

My case that started all of this was practically a code scenario, otherwise we would have RSI'ed the guy. The time sensitive nature of the case precluded its use.

 

[southerndoc]

I'm surprised no one but anesthesia and ENT are allowed to intubate outside of the ED. Where I trained IM did the majority of adult intubations in codes, semi-elective in the ICU etc.

Our medicine and pediatric residents get absolutey no experience in intubations. They never intubate patients in the hospital (anesthesia does it; they are even part of the code teams). They never intubate patients in the ED either because all intubations must be done by EM residents who have attended and been certified on our airway course.

 

[southerndoc]

Uh, Panda Bear is a guy. A hard-chargin', heart-breakin', life-takin', former USMC rifleman and tank commander, at that.

I'm now wearing my ballistic vest while surfing SDN. Sorry Panda Bear!

 

[DropkickMurphy]

Hell, I wear my vest most of the time anyhow.....guess I'll add while surfing SDN to that list.

 

[Anuwolf]

DropKickmurphy, Which vest do ya wear?????

 

[Homunculus]

Our medicine and pediatric residents get absolutey no experience in intubations. They never intubate patients in the hospital (anesthesia does it; they are even part of the code teams). They never intubate patients in the ED either because all intubations must be done by EM residents who have attended and been certified on our airway course.

at my program we're encouraged to intubate. the NICU is full of intubations ready to happen. i imagine (hope) your peds residents at least get that. apart from the NICU though, a lot of programs may let their residents slide-- mainly because it's a rare occurance a pediatrician ever needs to intubate (most community pediatricians will just 911 or send to the nearest ED), and the personality types that go into peds aren't the most procedure oriented people.

at my program (a large military program) we're of the mindset that 1) we may be the kid's only hope at a base in BFE and better know how to do basic life saving stuff (intubations, chest tubes, needling pneumos) and 2) we can (and frequently are) deployed overseas to fun places like "iraq" and "afghanistan" where we will be taking care of patients much bigger and much sicker than our 2 and 3 year old well child visits. because of this i think *we* emphasize the procedures more (and the military, too. we get ATLS and all that fun "operational" medical training). that being said, most of our intubations and procedures come from our intensive care blocks. it's a shame your residents take advantage of the opportunity. i guess you can always bag 'em until help arrives, but i prefer to intubate, give them to the RT's and go back to bed, lol.

--your friendly neighborhood ATLS certified pediatric caveman

 

[Homunculus]

I can't believe you don't have ready answers for these questions. If you can't help people with these kinds of problems then you are really hopeless. Let me educate you.

Sure but since your 3 day old will be teething for a long time it really should be treated like a chronic, intractible pain syndrome with tricyclics, SSRIs and Duragesic patches.

He clearly has been stricken with the dreaded dextropyrexia. To cure him you must pack the feverish side in ice and apply heating pads to the hypothermic side until his temps equalize.

You should give him the full adult course of GoLytely followed by enemas until clear. When finished you should set a stopwatch. Repeat the regimine every time he goes even 1 second more than 12 hours without a boom boom.

Go directly to the airport and fly to Rochester, Minnesota. Immediately take your child to the Mayo clinic. They are the only ones who can save him now.

Have you child lie very still with a damp cloth on his forehead. Go to your medicine cabinet and look for any bottles labeled Haldol or Zyprexa. You should take your prescribed doses of these medicines then reevaluate your child.

Go to you sofa and pull off all the cushions. Stick your hand in the space between the base of the sofa and the back. You will likely find a replacement penny so you're good as new.

duly noted for future usage. thanks DocB!

--your friendly neighborhood DocB > Dr Spock caveman

 

[QuikClot]

Our medicine and pediatric residents get absolutey no experience in intubations. They never intubate patients in the hospital (anesthesia does it; they are even part of the code teams). They never intubate patients in the ED either because all intubations must be done by EM residents who have attended and been certified on our airway course.

If there is one thing I worry about moving out of the prehospital enviroment, it's the creepy* ultra-specialization of hospital practice. In civilian life, I am happy to have my house cleaned, my food prepared, and my car repaired by experts, but when it comes to pt. care, I like to be self-sufficient.

Let's see, an ED story:

[enters ED] Me: M331 with the forearm lac.
Nurse: Triage.
Me: This is the patient with the self-inflicted cut.
Nurse: Triage!
Me: This patient stole a light bulb at her facility, concealed it, broke it, and put a 12 inch lac on her forearm down to the fatty tissue. She bled through two dressings. She's not appropriate for triage.
Nurse: Is she on a hold?
Me: What do you think?





* To me

 

[southerndoc]

If there is one thing I worry about moving out of the prehospital enviroment, it's the creepy* ultra-specialization of hospital practice. In civilian life, I am happy to have my house cleaned, my food prepared, and my car repaired by experts, but when it comes to pt. care, I like to be self-sufficient.

In the ED, airways are secured in less than ideal situations. This is not the time nor place to have an inexperienced operator try to intubate someone for their first time.

 

[emtp6811]

In the ED, airways are secured in less than ideal situations. This is not the time nor place to have an inexperienced operator try to intubate someone for their first time.

That's funny. There were quite a few times as a brand spankin new medic that the ED docs pulled me into the trauma bay to intubate for them because I needed the practice. Also got a couple of subclavians and a needle chest that way.

 

[southerndoc]

That's funny. There were quite a few times as a brand spankin new medic that the ED docs pulled me into the trauma bay to intubate for them because I needed the practice. Also got a couple of subclavians and a needle chest that way.

Right, but you also trained on mannequins and probably did an OR rotation as well, correct?

Our medicine colleagues do not practice on mannequins and do not complete an OR rotation. It is not something that we are going to allow them their very first intubation to happen in the ED. If the medicine residents complete our airway course on our simulation mannequin and pass the test, or if they do an OR rotation getting some real life experience intubating, then they can intubate in the ED. To date not a single medicine resident has done this. Our medicine program has such a strong fellowship rate (>95% pursue fellowships), that most won't be practicing in a rural setting where they will be intubating.

 

[SoCuteMD]

Triage nurse to patient brought in by EMS: Why are you here?
Patient (who is, by the way, perspiring quite appropriately): I'm dehydrated
Resident jumps in: how do you know you are dehydrated?
Patient: I was out all last night partying, drinking, smoking weed. I walked outside and I got so dehydrated I just couldn't walk.
Resident: Why didn't you walk back INSIDE?
Patient: I just couldn't walk, man.
(five seconds later)
Yo, can I go to the bathroom.

Ugh...nothing like a hungover @$$hole who is too lazy to chug water for himself...

 

[blotto geltaco]

The other night in the ER was insane. I was on an RT and was standing at the nurses station charting when this newbie FP resident who is doing his ER rotation comes walking up:
FP Resident: "Hey RT!"
Me: "Yeah....what?"
FP Resident: "It's a good sign in an asthmatic patient when you can't hear wheezing anymore, right?"
*pause as I briefly debate in my head if it's possible this kid is really so stupid to be asking about the situation I think he is asking about*
Me: "Please tell me you mean he has clear and equal breath sounds"
Resident: "No, I really can't hear anything."

I take off running back to where the patient is at....the ER attendings were in the middle of dealing with multiple traumas, so I wound up tubing this guy and getting him on the vent. When I came in he was using every muscle in his body to breathe, but not moving much air (if he was moving 100cc with each breath, I'm the next Pope). Needless to say after we stabilized this patient, I had a talk with this resident and this is where the really great quote comes into play.

Me: "How could you not tell he was crashing?"
Resident: "Well he was still breathing....that's why I came to ask you about it."
Me: "That doesn't count as breathing....it's breathing in much the same way a dog humping your leg counts as sex. It's going through the motions but it's not doing much for the person involved."

Your post reeks of paragod syndrome as well as physician wannabe syndrome. You really have no idea how ridiculous you sound.

 

[mfleur]

Your post reeks of paragod syndrome as well as physician wannabe syndrome. You really have no idea how ridiculous you sound.

Who, in their right mind, would want to be a physician? Oh wait...now stop acting like a child or I'm turning this car around.

 

[signomi]

Our medicine and pediatric residents get absolutey no experience in intubations. They never intubate patients in the hospital (anesthesia does it; they are even part of the code teams). They never intubate patients in the ED either because all intubations must be done by EM residents who have attended and been certified on our airway course.

Very true. I never once tubed anyone during my medicine residency and now I just started a job that requires intubation. I've watched videos and practiced on dummies, but boy is that first intubation going to suck. They are trying to get me into the OR for practice but it doesn't look like that will happen soon. Any advice? I'm nervous about this.
And wayyy off topic.

 

[Anuwolf]

Your post reeks of paragod syndrome as well as physician wannabe syndrome. You really have no idea how ridiculous you sound.

oh come on! be nice to DropkickMurphy.

 

[Jeff698]

They are trying to get me into the OR for practice but it doesn't look like that will happen soon. Any advice? I'm nervous about this.
And wayyy off topic.

This may seem strange, but I'd recommend talking with the folks at your local community college if they have a paramedic training program. They teach people to intubate for a living and do it in a very procedurally oriented way. I'm sure they'd be happy to help.

Take care and good luck!
Jeff

 

[BKN]

Very true. I never once tubed anyone during my medicine residency and now I just started a job that requires intubation. I've watched videos and practiced on dummies, but boy is that first intubation going to suck. They are trying to get me into the OR for practice but it doesn't look like that will happen soon. Any advice? I'm nervous about this.
And wayyy off topic.

I see youre a hospitalist. You might talk to the EPs on duty when you're on duty. They might be willing to call you down when somebody needs the tube and teach you. Nobody does more crash RSIs than us. But you'll have to get there fast in the <5 minutes we're preoxygenating.

 

[SoCuteMD]

Not to hijack the thread or anything (well, ok, maybe just a little hijacking).

How often would you say dental damage occurs during an emergent intubation?

 

[DropkickMurphy]

Your post reeks of paragod syndrome as well as physician wannabe syndrome. You really have no idea how ridiculous you sound.

I don't think I have to tell you what part of my anatomy you can very firmly plant both of your lips upon. Oh, wait.....you're obviously not that sharp judging by the fact that you don't realize those are in fact the same condition , so I'll just come out and say it: KISS MY ASS. Have a nice day.


(Sorry to everyone else for the interruption to the thread. Now back to our regularly scheduled discussion.... )

 

[WakeMedHeel]

More of an amusing story than a great quote...

Around 2am on a night shift a guy rolls in and needs his head lac stitched. I get him patched up and our attending decides we need to scan his head...so the guy is waiting around for a bit. I go back in to check on him after finishing the lac and the guy is squating in the middle of the room, completely naked, taking a dump.

Me "What the hell are you doing?"
Him "I told you I had problems going to the bathroom."
Me "No...you didn't, but that (pointing at his terd in the middle of the floor) is clearly a problem."

 

[emtji]

I don't think I have to tell you what part of my anatomy you can very firmly plant both of your lips upon. Oh, wait.....you're obviously not that sharp judging by the fact that you don't realize those are in fact the same condition , so I'll just come out and say it: KISS MY ASS. Have a nice day.


(Sorry to everyone else for the interruption to the thread. Now back to our regularly scheduled discussion.... )

i think blotto geltaco could have put it more gently, but your post rubbed me the wrong way as well. pre-hospital folk (i was an EMT and did this too) tend to criticize people freely, perhaps because of our relative position on the totem pole. most pre-hospital folk who go onto med school tend to grow out of this. Fact is, every time I've seen someone else make a really stupid mistake, I've probably done something worse. The most confident and best clinicians are the ones who can poke a little fun at themselves.

 

[basementbeastie]

guy comes in last week...." i was smoking crack then i had sex with some
hookers last week....i came....and i am *still*
comin'!" (pulls out penis w/ discharge)

me: "hookers?"

guy: "yeah, some hookers!! you've had sex with hookers, haven't you?"

me: "oh...no...besides i'm married" (shows wedding band)

guy: "married!! what the hell does *that* have to do with it!!!"

me: "......uuuhhhh..."

 

[DropkickMurphy]

i think blotto geltaco could have put it more gently, but your post rubbed me the wrong way as well. pre-hospital folk (i was an EMT and did this too) tend to criticize people freely, perhaps because of our relative position on the totem pole. most pre-hospital folk who go onto med school tend to grow out of this. Fact is, every time I've seen someone else make a really stupid mistake, I've probably done something worse. The most confident and best clinicians are the ones who can poke a little fun at themselves.

I can poke fun at myself (ask anyone who has talked to me off this forum; most of what I say here is said with a healthy dose of tongue in cheek sarcasm). Also, I wasn't working as an EMT-I at the time. I was the RT on duty in the ER, so I was speaking to an area that happens to be my specialty.

 

[Siggy]

EM Doctor to nurse: I need a surgeon for this patient.

EMT (sitting down finishing his report on a different patient): I stayed at a holiday Inn Express last night.

EMP and nurse: I don't get it...

 

[gree0411]

Your post reeks of paragod syndrome as well as physician wannabe syndrome. You really have no idea how ridiculous you sound.

You couldn't have said it better. This Dropkick guy is full of himself. Obviously his ED couldn't run without him.

 

[emtp6811]

Right, but you also trained on mannequins and probably did an OR rotation as well, correct?

Our medicine colleagues do not practice on mannequins and do not complete an OR rotation. It is not something that we are going to allow them their very first intubation to happen in the ED. If the medicine residents complete our airway course on our simulation mannequin and pass the test, or if they do an OR rotation getting some real life experience intubating, then they can intubate in the ED. To date not a single medicine resident has done this. Our medicine program has such a strong fellowship rate (>95% pursue fellowships), that most won't be practicing in a rural setting where they will be intubating.

Ah. Thanks for the clarification. Once again I shot off my mouth without knowing what I was talking about. And really I am surprised that they don't get ET training. Aren't most hospitalists IM? If a pt goes into respiratory failure, they just wait for someone to run up and bail them out? I, for one, would have a hard time being in that position. Guess that's why I don't plan on going into IM...

 

[EM_Rebuilder]

n/m

 

[mfleur]

You couldn't have said it better. This Dropkick guy is full of himself. Obviously his ED couldn't run without him.

Stop it...you're ruining this forum for me.

 

[QuikClot]

Stop it...you're ruining this forum for me.

There are only two kinds of funny stories; ones about our own ignorance, and ones about somebody else's.

DKM's dog-humping analogy for an asthmatic's "breathing" is funny and absolutely dead accurate. As such, it is both a funny story and a good teaching story. You will remember that about asthmatics -- that their breathing often becomes ethusiastic but ineffectual.

It can be read as mean to the resident, but it all depends on tone. If you imagine it in a sarcastic, aren't-you-supposed-to-be-a-doctor voice, it does have a paragod sound to it. If you imagine it in a gentler, let-me-show-you-something-I-had-to-learn-too voice, it doesn't sound mean at all. Insufficient evidence for conclusion. So why don't we suspend the rush to judgement and get back to the stories.