Sewed up several intraoral lacerations lately, one attending never mentioned antibiotics, the other was pimping me on which to give. Looks like there may be some benefit in compliant patients for reducing likelihood of abscess formation .

(Actively bleeding through and through lacs (ie: they go thru the skin and all the way thru the lip and gums into the mouth) are a pain in the ass to close and close well, especially when they don’t respond to lidocaine with epi! That being said, I think I did some pretty good vermillion border work, even with the crappy throwaway instruments and blood everywhere.)

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Resident: “My patient snorted 3 grams of cocaine today. That seems like a lot. Is that a lot?”
Attending: “I don’t know, it seems like a lot.”
Me: “Isn’t an 8-ball like an eighth of a gram or something? So that’s like 24 8 balls?”
Other Resident: “How much did Al Pacino snort before he killed that guy in Scarface?”
Clerk: “Oh, it was a lot, cause it was in a big pile, then he cut it into three lines.”
Resident: “You sure know a lot about Scarface.”
Clerk: “It was just on TV 2 days ago!”
Attending: “I guess it just depends on how wide your lines are.”
Me: “And how long they are.”
Resident: “So… 3 grams, is that a lot?”
Everyone: “No idea.”

An 8-ball is one eight of an ounce of cocaine, approximately 3.5 grams. This is a lot of cocaine for one person, enough to overdose on. So be careful.

So there you go. And much less than that is enough to give you a stroke or a heart attack, because cocaine causes spasm of your arteries and cuts off blood supply, so not only be careful, don’t use it.

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Sorry it went down this way, Flea. via KevinMD

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William Osler, noted physician and noted by many for his truisms, hits the nail on the head with this one:

“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.”

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Talking with a friend who’s moving out here for residency, she told me that almost everyone passes the “Step 2: Clinical Skills” exam, which just started in 2004. Basically, you spend a day seeing standardized patients, writing up your differential and the labs you’d order.

98% of MD candidates last year passed it on their first try, and 97% passed it a repeat try. So out of 16,936 exams, only 10 students did not pass it, and almost all passed it on their first try.

What’s the point of even having a test if everyone passes? Answer: Money.

The USMLE organization took in $1007 per exam : that works out to be over $17 MILLION that they received for this exam. It’s a waste of money, a waste of time, and just more loaned money that I have to pay back later for a stupid, ridiculous test that does nothing to ensure that medical schools are preparing their students for “fundamental clinical skills essential to safe and effective patient care under supervision.”

This of course doesn’t take into consideration that you can only take the test in LA, Philadelphia, Houston, Chicago, or Atlanta, so if you don’t live there, you have to fly there, get a hotel room, etc. That’s at least $500 more right there.

And if you don’t pass? You work something out with your home institution.

What a crock.

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Dearest Mayor Newsom , could you please remove the crazy pills from the water?

The ED was like I’ve never seen it last night, just busy to the brim. And on the drive home, 7, yes, SEVEN people ran across the street in front of my car. They were just *asking* to get a PVA.

And to my patient who the deputies dropped charges on and you pulled out your IV and left, after I did all this work-up AND made the diagnosis of hyperthyroidism based on history alone, with a very low TSH and a very high free T4, you really should have stayed to at least get your diagnosis. I was proud of making it, and you’d probably feel better sooner rather than later if you had gotten hooked up with an outpatient provider. Sorry dear.

Random ED terminology I’ve made up (feel free to add your own):

Laction: The act of suturing/stapling/closing a laceration. “Man, I’ve had a lot of laction today.”
Awheezile: Like afebrile, but for wheezing. “Yeah, this patient with asthma was wheezing really bad, but after a neb, he’s awheezile.”

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May I plleeeease sit at the cool kids table at the ER now? I have conquered the MTFers, withstood the trials of the Neuro Lecture, and even ass-kissed preemptively .

Also, my scrubs do not taper.

Maraka and I’m a Dude ; we will *totally* go to a Bootie Mashup Party .

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The patient’s boyfriend noted leg swelling, dizzy/fainting spells, and severe shortness of breath in a woman on birth control. If someone becomes acutely short of breath, this is not normal, and it really needs to be checked out.

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The season finale of Lost was amazing, but could we get some wound eversion for Jack’s laceration repair, TV ER doctor? Hell, that little thing could be dermabonded. And while we’re at it, you might not want to use absorbable, practically transparent suture since those need to come out in 3 days to prevent scarring. Snark off.

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