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About CJMO

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  1. Rads did not make mention of the mass and it looks unchanged from CXRs approx 8-12mo apart.
  2. Hello, I'm not sure if this is the right area but the oncology subthread looks like a ghost town. My question is does anyone have experience with diagnosing/managing lymphoma patients? If so what is the expected rate of progression of "Mediastinal Mass" growth on serial CXR regarding lymphoma?
  3. Also, I have come to believe that the most important trait an EM provider can have is resilience. Absolutely necessary!
  4. "In-Flu-Enza... Then immediately turned around and flew over the cuckoo's nest." With flu being on the last quarter stretch this season I thought it would be fun to share some stories of how you went down the rabbit hole chasing patients triaged as "Flu-like symptoms"; ultimately leading to a complete 360 diagnosis. For example: Triage note: 23AAF here with "Flu-like symptoms" (Fever, cough, body aches). + sick contact at home with similar sx. 23AAF previously healthy, sexually active female, presents with fever (Tmax 104), dry cough, HA, N/V x 1 episode, and body aches that start in right lower back area then radiates to her entire body. Onset 1 day ago. Reports that her son is having similar sx that started a day before hers. Endorses +malaise, +Rhinorrhea, +congestion, +lower abdominal pain, +anorexia, +yellow malodorous vaginal discharge, Denies Vision changes, sore throat, neck pain/stiffness, chest pain, SOB, diarrhea, dysuria, hematuria, pregnancy. On Exam she is afebrile, VSS wnl. HEENT exam unremarkable. Neck supple, FROM without meningismus. Lungs CTAB. Heart RRR no mgr. Abd +bs, non distended, moderate suprapubic, LLQ, and RLQ ttp most appreciated, no CVAT b/l. *Sigh... really I have to do a pelvic on a "Flu-like sx"?!* Pelvic exam no discharge seen, +CMT, b/l adnexal ttp without masses, uterine ttp. Ddx: 1. Viral syndrome - high prob based off hx, however no objective findings, flu swab negative. 2. GYN path - Mod prob for PID, sexually active, hx of vag d/c, pelvic exam with CMT, b/l adnexal ttp, uterine ttp, WBC wnl, mild pyuria on UA, G/C cultures obtained. Will treat clinically. TOA unlikely, afebrile, NAD, no adnexal masses, sx x 1 day. TAUS neg for masses. UPT neg. 3. Appy - Low probability, Alvarado score 4. RLQ US neg for 2nd signs of appy. 4.UTI - no dysuria, mild pyuria/hematuria, no cvat. Dx: Viral syndrome and PID Anyone else have good ones? **G/C culture grew + 3 days later too.
  5. My first Fast Track patient EVER was a high speed mvc, unrestrained driver, +LOC, delayed ED presentation, with neck/back/shoulder and chest pain. Dx: C3 fx, T5 fx. Triaged as a drug seeker because he had dingy clothes on and meth mouth. Clearly you could see signs of trauma (Abrasions on extremities and head, dried blood, etc). Plus the guy couldn't turn his neck at all. Lmao. I'll never forget that.
  6. Regarding OP: Hello, **Disclaimer** I am an EMPA with almost 2 years experience under my belt. I am EM postgrad fellowship trained, now working at a different level 1 inner city teaching hospital)... Still feel like I don't know shit... Still ask too many questions. But I thoroughly enjoy it! After touching the hot stove too many times; here are a few basic rules of communication while working in the ED: #1 When in doubt ask the PA/NP first. - We have all been in your shoes. Our feet have only grown. - There is no such thing as a stupid question... Just stupid people (just kidding). #2 Keep it Simple. Stupid. Your a Salesman! - The "One liner" is absolutely critical anytime you talk peer to peer. - Sell that shit! - Applicable to everything regarding medicine. (Acronyms, mnemonics, explanations, etc..) #3 The 5 C's of Consultation. - Google search it. Great for consults AND admissions AND presentation. - Evidence-based, Effective and Efficient. Very useful method. #4 Horrible phone conversation? Know how to end it. - Is the consult/admit team asking for every little detail after your pitch? Are they asking for more test to rule out other diagnoses that would significantly increase time in ED (CT scan, MRI)? - A good out is to simply say, "I do not have time to give more details over the phone. I'd gladly discuss this further with you in person after you see the patient here in the ED. In the meantime, who is the admitting attending, and are there any other tests (Blood work) you'd like me to check?" - Be cognizant of objections that are likely to arise prior to speaking with consult/admit. - Google search "Horror story consultations while in the ED" and you can read about other good ways to end phone calls. I did this after yelling at a cardiologist on the phone at 3am in the morning, and it stuck like glue. Now I'd like to share some other words of wisdom; the amount equivalent to a pea-sized pituitary gland: #5 When in doubt... whip it out! - EMRA antibiotic guide that is. - Other sources of knowledge. (LIFTL, Radiologymasterclass, UpToDate, Your hospital's EM Manual), etc. -Read, read more, then read some more! (Before, during, and after shifts). The best is when you read about an unstable condition right before your shift, and then sure as shit it's your first patient! #6 Emergency medicine: Jack of all trades; master of resuscitation. -And primary care. #7 Tincture of time eventually tells all. - Assume all patients are dying. - See patient's sooner than later, especially Airway related complaints regardless of triage vital signs. -Call that consult back if an absurd amount of time goes by. For example: Renal forgot to see ESRD pt needing urgent dialysis. 8hrs later... Pt goes into flash pulm edema. Leads me to my next point. -That simple cough might not be that simple in the patient with ESRD and HFrEF 15%. -Don't be afraid to change pt disposition. #8 "We're all just swimming around with sharks in a fishbowl full of landmines." - One for all and all for one in the ED, but before you trust you must first VERIFY...At first and whenever possible. - Diseases, patients, consults, and hospital are all against you. - Working in the ED is like playing Minesweeper. Eventually you win, right? My 2 cents.
  7. I'd say it all depends on the supervising physician support/training you will receive. If the docs are more then willing to show you the ropes and teach you, then by all means take the job. I did an EM residency my first year out and I took a very large pay cut, but the experience I obtained and excellent support I received from my supervising physicians was absolutely worth it. Now going into my second year I feel comfortable and confident in my ability to handle whatever walks in through the door, and I am well versed in 95% of the procedural skills needed in the ER, Including bedside US.
  8. Tell the truth. I've been arrested/charged 4-5 times and disclosed everything. After disclosing it I was required to write a formal paper explaining the arrests, charges, disciplinary actions, and resulting convictions. I was scared I would't get my license (On paper I look like a grade A criminal). Sure, It did delay the process but that's about it. Think of the license application as a test of your current character. Boy did I sweat about it during that time while waiting!
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