built on hope

Melissa. Finally post-residency and getting around to exploring tumblr as a method of archiving my nerdiness. Ravenclaw. Emergency medicine geek. Team #rebelcaptain.

[rebel-mel30]

Hi tumblr. I haven’t been around in a while. Just wanted to stop by and remind y’all to social distance. Let your loved ones in essential roles know that you’re thinking of them.

I just found out today that we’re probably going to run out of surgical masks. Which is pretty scary, because I work in an ER and my region has several weeks until we hit our peak.

I don’t know guys. I know we’re going to get through this eventually. Just feeling a bit overwhelmed today.

[dot-nursingstudent]

I’ve learned that there are two main ways of dealing with the madness of the ER

- “I am the eye in the calm of the storm”

- “this is a roller coaster, and I love roller coasters!”

[rebel-mel30]

Both. Both is good.

I’ve always said that EM pharmacists are the least Type A brand of pharmacists.

[pharmdup]

Yeah, but you’ve got a bit in you, otherwise you wouldn’t be a pharmacist. You’ve just got that one thing you’re Type A about

[rebel-mel30]

“STOP DRAWING UP MEDS IN SALINE FLUSHES YOU HAVE A PERFECTLY GOOD VIAL OF NS AND EMPTY SYRINGE RIGHT HERE”

[pharmdup]

Never in a million years would I have guessed that would be your line in the sand!

[rebel-mel30]

Lol there’s an ISMP recommendation against it somewhere out there. I’m too lazy to find it at the moment. It’s too easy to grab a flush and think that it’s just saline, especially when it’s not labeled.

(Not that I agree with all of ISMP’s recommendations. They want to get rid of injectable promethazine...my docs would riot)

[dot-nursingstudent]

I’ve learned that there are two main ways of dealing with the madness of the ER

- “I am the eye in the calm of the storm”

- “this is a roller coaster, and I love roller coasters!”

[rebel-mel30]

Both. Both is good.

I’ve always said that EM pharmacists are the least Type A brand of pharmacists.

[pharmdup]

Yeah, but you’ve got a bit in you, otherwise you wouldn’t be a pharmacist. You’ve just got that one thing you’re Type A about

[rebel-mel30]

“STOP DRAWING UP MEDS IN SALINE FLUSHES YOU HAVE A PERFECTLY GOOD VIAL OF NS AND EMPTY SYRINGE RIGHT HERE”

[dot-nursingstudent]

I’ve learned that there are two main ways of dealing with the madness of the ER

- “I am the eye in the calm of the storm”

- “this is a roller coaster, and I love roller coasters!”

[rebel-mel30]

Both. Both is good.

I’ve always said that EM pharmacists are the least Type A brand of pharmacists.

[lankybrunettepartdeux]

THE MOST PURE!!!

[wizardnuke]

[milady-666]

“He didn’t want to disturb the silence as they rested against each other, hurting and relaxed, listening to the hum of machinery and the distant billowing of fires. He stowed thoughts of old missions and thoughts of the future away; decided to focus on what he could see and hear and smell for the last moments of his life on Scarif.”  — Rogue One novelization

[rebel-mel30]

Shoutout

To the resident who laughed at me when my hospital cafeteria food was way spicier than I expected, but then said “trade!”, took my food, handed me his ID badge, and told me to go get new food from the physicians lounge. You rock, dude.

[pharmdup]

Valid reasons where I’ve introduced myself as doctor:

The two (2) patients so far who have required validation from a drug expert to feel reassured by their provider’s plan

Fishy reasons where I’ve introduced myself as doctor:

To get that telemarketing firm to stop calling me

To try to get the realtor to call me back about that one house I want to view

Times when I’ve insisted on being addressed as doctor and I was utterly correct to do so:

When my teenager is acting like I’m an idiot while asking for an expensive favor from me

When my cooler siblings make jokes at my expense

Times when I haven’t insisted on being called doctor but I probably should have been called it anyway:

In the initial email that a pharmacy student sends to me before starting my rotation

I am grading you come on

I will tell you to call me by my first name but that first email is the only time in my entire professional life when I can reasonably expect the Dr.

[rebel-mel30]

THANK YOU. This just happened to me and my friends acted like it wasn’t a big deal. I went on a bit of a Twitter rant about it. But come on, this student goes to the same school I went to, I KNOW they taught him/her better. Like I’m already judging how seriously they plan to take my rotation before they even start...

[rebel-mel30]

I’m back in my hometown for the weekend, and got to spend the evening catching up with some college friends. We got on the subject of Captain Marvel, and I mentioned how much I really enjoyed the movie.

One of the guys there (a friend of a friend who I’ve only met a few times) started actually YELLING at me that it was a horrible movie, that it “ruined everything the last twelve years of Marvel movies has worked towards”, and DEMANDED that I defend my reason for enjoying it.

Now ok. There’s a lot I could rant about: fanboys hating movies with feminist undertones, the whole “girls aren’t real fans” crap, trying to escalate a friendly conversation to a shouting match, etc. BUT it’s been a long day and I’m tired, Tumblr, so please enjoy this mini-rant:

For the love of all that is good, let people enjoy things. What does it matter to you whether I liked a movie or not? Why do you think I owe you an explanation? In all honesty, I’d just finished a terrible week at work that involved a lot of traumatic patient events, I’d already been crying over a difficult patient death that morning, and the 2.5 hour escape that the movie offered me was a blessing. I’ve been a Marvel fan for years now, and the stupid, witty, sarcastic humor in each of the movies is what keeps me coming back. So what if there’s a few plot holes? It’s a damn superhero movie. Get over yourself.

[lilcowgirl7-deactivated20210223]

You cannot live alone on the fantasies you feed to your mind, eventually you have to touch your life for real, assess and analyze your habits, understand your character, try not to hate yourself for your character as it was shaped when you were very young by circumstances outside of you, and begin learning how to cope with your character, how to build habits that work for you, finish small projects, finish big projects, expose yourself to more uncomfortable situations, assess why you want to leave that friendship before you leave it, raise your anxiety levels on purpose, so that you can grow, raise your work load on purpose, so that you can grow, so that you can build resilience, so that your life expands, and can be experienced by you in full and in reality

[rebel-mel30]

Between work taking over my life and trying to study for board certification, I haven’t been on tumblr much lately. But I wanted to drop by and share with y’all:

THE STORY OF THE TOE

So my ER is divided up into two halves connected by a hallway. I have a desk on one side, but I cover both sides and walk back and forth frequently. The other night was actually kind of quiet (I know, I know, that’s a bad word in healthcare) on my side, so I walked to the other side and had the following conversation.

Me: Anything interesting going on over here?

Nurse: There’s a toe on Tom’s* chair.

Me: Umm

And indeed, when I went to look, there was a specimen cup with a toe in it on Tom’s chair.

In conclusion, it is impossible to have a boring day in the ER, because there will always be people who do silly things like cut off their toes and I frequently have conversations that I never thought I’d have.

*Name changed

[cranquis]

“But… I can’t be sick THIS week! It’s the anniversary of when My Chemical Romance broke up!”

— Teenager with influenza (and most likely a Tumblr as well. Hi, kid. Get well soon. Don’t give away my secret identity.)

[hilarioushumorfromouterspace]

[teaboot]

And I would’ve fuckin gotten away with this, too

[pharmdup]

Me: Okay, so, I know that this might seem like a stupid question but I honestly can’t tell.

Me: Would you like me to make a regular lactulose enema, or did you mean oral solution lactulose and marked rectal route on accident, or is there some evidence for concentrated lactulose via rectal administration that I’m not aware of?

Attending: …

Attending: *meekly* I’d like a regular lactulose enema please.

[rebel-mel30]

Pharmacists: solving problems you didn’t know you have in ways that you don’t understand.

[bottleoftonic-blog]

Most bang-for-buck things every intern should know before starting inpatient wards

Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.

Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong

Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.

Pretty thorough review of fluid management on openanesthesia.org

2) Nausea. When to treat, how to treat and at what dose.

3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%

4) “Reflex” antibiotic choice for routine inpatient infections.

http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight

5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).

6) Initial work-up and treatment of oliguria/anuria.

7) A sensible initial approach to suspected ileus.

8) Blood. When, how, why to replace.

9) Pain. Optimal management without inducing narcosis.

Managing cancer pain: Frequently asked questions: CCJM

10) Potassium. When, why and how to shift or replace.

A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld

11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.

12) Resuscitation aka commit the ACLS algorithms to memory.

Current ACLS guidelines. https://www.acls.net/aclsalg.htm

Would love a video series, interactive cases etc.

13) Basic EKG interpretation.

Whole EKG video courses

A whole free youtube EKG video review course by meddit’s own u/ericstrong

An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/

I have to admit I haven’t used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.

EKG video cases

Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu

– If you like Dr. Mattu’s cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.

Practice EKGs with answers

Watching videos isn’t enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.

EKG blogs

I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:

http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)

http://www.ems12lead.com

http://ecg-interpretation.blogspot.is

http://jhcedecg.blogspot.is

EKG resource libraries

Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.

http://www.practicalclinicalskills.com/ekg.aspx /u/collidge

14) Know when to order ABGs and how to interpret them.

Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)

Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg

Bonus 15) Basic CXR interpretation

CXR video lecture course

Again, Dr. Eric Strong has an excellent video course for free on youtube

Step-by-step guides to basic CXR interpretation

The Radiology Assistant: Chest X-ray - Basic interpretation

Radiology Masterclass step-by-step basic CXR

University of Virginia’s step-by-step basic CXR

All inclusive resources

The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.

UPenns CXR learning website

Loyola Universities excellent CXR Atlas Most outdated look but amazing content.

Checklist approach to CXR

Bonus 16) Overnight o-shit-what’s-that Head CT interpretation

Midnight radiology: Emergency CT of the head

University of Virginia’s guide to the Head CT

[sothisisnursingschool]

Hey, self: review before NCLEX. Xo, me.

[md-admissions]

Oh hell yes

[populationpensive]

For future reference.

[doctorkintsugi]

Must. Study.

[modernathenamd]

Scheduled to post right before intern year starts. Gulp.

[aspiringdoctors-blog]

Reblog to save a life. You got this, bbs.

[medicinasanguis]

we need it all

[jenzmed]

reblogging this for my future self. you welcome.

[yaaasssdoctor]

Things I routinely forget and scramble to relearn.

[nothingbutnetters]

Need this since I’m finally about to be an intern!

[pharmdup]

Dude the IV fluids thing terrifies me. Everyone gets IV fluids in the hospital. Clinicians are gonna be pissed if I start calling them out on it

[pharmdup]

Match day

Match day for pharmacy students is a bit uneventful. On mine, it was a regular rotation day. Afterwards me and one of my friends went out for a beer. One of our friends, who was by far one of the brightest, most together, compassionate of our cohort didn’t match. He became the oncology pharmacist at a rural ambulatory clinic immediately after graduation, but he was awfully sad at the time.

One of the best medical students that I’ve ever had the good fortune to work with was going for primary care. One of his parents was a neurologist and the other a cardiologist so I understood this was a disappointment to them, which blows my mind as a first generation student. I was was on a psychiatry rotation with him and he is still the only medical student I’ve met who believed in the power of pharmacy. He did the physical assessments and the things medical students do as I did my pharmacy drug assessments and together we’d advocate for our patient. He was very interested in learning outside of the box that he grew up in. He studied the culture of poverty and his gender privilege. He had a great scientific mind and truly cared.

He didn’t match that year. I understand that medical school has some weird Hogwarts banquet on match day, and I wonder if he found out there. I was astounded.

He’s since gone on to match the following year, but I wanted to tell you guys about him and my brilliant, compassionate oncology pharmacist friend. The match doesn’t determine your worth or your future value to your patients. Right now the opinions of other professionals seems to matter, but it really doesn’t. The opinions and lives of your patients matter.

If you’re struggling after medical or pharmacy school and don’t match, I think it will make you a more empathetic provider in the end. Sometime you’ve been working so hard that the free time will seem like a big blank wall of depression and you won’t know what to do. Some of your patients face the same thing. They will face the battles you’re fighting and your perspective will help to heal them.

Take a deep breath. You are enough.

[emedpa]

Every day in the Emergency Department