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MarkHoofnagle's profile
Mark Hoofnagle
Mark Hoofnagle
Mark Hoofnagle
@MarkHoofnagle

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Mark Hoofnagle

@MarkHoofnagle

Trauma/Critical Care/Acute Care Surgeon. MD/PhD. FACS. UVa/UMD/UPenn. Asst Professor of Surgery at Wash U. Blocking is curating.

St Louis, MO
surgery.wustl.edu/people/mark-ho…
Joined March 2012

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    1. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      Dad provides "credit card and insurance" outside the room. That. Never. Happens. No one has listened to breath sounds yet on this kid who repeatedly says, "I can't breath."

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    2. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      ABC people. He's got an airway. No one has done B. FAST positive, so his ABC (for mass transfusion) score is a 3. Someone wisely asks for blood but a MTP would be more appropriate weight based since this is peds trauma. Unfortunately AJ 'in the flesh" Austin walks by.

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    3. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      Austin says he's triple board certified, "Cardiothoracic, General and Trauma." Okefor appropriately says, "kill me now" because guess what? There is no board certification for Trauma. You can be Surgical Critical Care certified, but there are no "Trauma Boards."

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    4. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      He is covered by his general surgery board certification which should train you for trauma. Trauma as a specialty is still relatively new. He also mentions his Scuba certification. He is a bigger tool than Conrad.

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    5. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      Now the intern tells his medical students they will see their first patient and don't worry, "there are no wrong answers." Umm. What? Sometimes we say, "there are no stupid questions" but this is also false.

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    6. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      The medical students get in an argument about the patient's murmur. One says it just sounds like, "ken-tuc-key" and I like that answer. It's 2018, if you hear a bad murmur, just get a goddamn echo and stop guessing.

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    7. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      The female medstud says, "I don't hear anything abnormal" and is ignored, she is, of course, correct. Because there are correct answers.

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    8. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      AJ Austin in the flesh seems to be struggling with this trauma. Maybe if he actually were a trauma surgeon he wound start by say, packing, and placing a retractor, rather than fumbling around blindly in a bloody pit like the buffoon that he is.

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    9. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      More drama, some rando girl steals random drugs from an unlocked cabinet, because this is the 80s. Anyone ever hear of a Pyxis? Like they broke into last week when the power was out? Never let facts get in the way of a plot.

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    10. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      True facts, free food is a powerful enticement. The rep says, "gunners skip residency and go to silicon valley." Umm, no. It's hard to invent devices without procedural knowledge. This rep apparently represents all devices. Also she has a hip replacement (on her flank).

      2 replies 1 retweet 4 likes
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      Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

      Sorry, a hip replacement scar that extends to your costal margin is a sign of a very confused orthopedist.

      5:59 PM - 1 Oct 2018 from St Louis, MO
      • 4 Likes
      • Heightsmomma Jorge M. Escobar 🏳️‍🌈Jenny🍭 joypath
      2 replies 0 retweets 4 likes
        1. New conversation
        2. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Somehow this kid survives an AJ Austin splenectomy. Conrad starts working up apparent jaundice in the skating kid. Everyone around him in his family has had cancer. I wonder if they're trying to suggest Li Fraumeni or something.

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        3. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Intern says, "Every doctor needs to know how to place an IV." Which is a little bit funny, because most of us have fully delegated that to nursing. I can place an U/S guided, but if the nurses can't feel the vein, I don't have special doctor magic, they're *way* better than me.

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        4. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          "Ken-Tuc-Key" mocks a bad stick colleague with, "this is why you're going into radiology." but I bet interventional radiologists are pretty good sticks. Then the idiot says, "the pulsing thing." No! Not the pulsing thing! That's an artery. You don't want an a-line.

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        5. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Or the gush of blood he just got. These are not geniuses. Also, don't stick the brachial artery if you don't know what you're doing.

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        6. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Skater kid has pancreatic cancer, shocker. Rando drug thief somehow managed to have gotten opiates out of that unlocked cabinet, now ODing in supply closet. Because this is the 80s. Maybe the 70s.

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        7. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Surprise twist, it's insulin! Because we don't lock up insulin? One of the most dangerous medications we prescribe if misused? They get her in a bed and split between an EJ and IO, she's got a great visible EJ which Nic gets. Good shot. Nice line in a pinch.

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        8. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Sneaky medical rep knows the most effective way to get someone to believe them is to mention someone we know and trust uses a product. Because, naturally, humans trust their friends more than they trust strangers. Good manipulation.

          1 reply 0 retweets 3 likes
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        9. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          I guess the girl is homeless because she's wearing a flannel shirt, and is stealing insulin to live, vs the "prince" who gets all the care for his trauma and cancer. People dying from insulin rationing is real and happens and is pathetic, but she would have been treated in ED.

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        10. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          The tumor is bleeding into his abdomen now per the CT, and Conrad runs to stop the transport. Debatable whether that's emergent, a contained RP bleed is going to go where exactly? You could probably follow crits if vitals are stable.

          1 reply 0 retweets 4 likes
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        11. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          The intern is super-bad at teaching. He says, "that gunner nearly killed Abby." No medical student should ever be in a position of such responsibility that they can nearly kill anyone. That means *you* nearly killed Abby because you improperly delegated. It's *you* that sucks.

          1 reply 0 retweets 11 likes
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        12. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          So time for a pancreatectomy on this kid, despite an incomplete staging workup, for a bleed which likely would be self-contained. They try to make out like they're taking out pancreas but it looks like a patch of skin. Then they make up some BS about "speed pathology."

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        13. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Now they're doing Moh's pancreatic surgery. Ummm...

          1 reply 0 retweets 3 likes
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        14. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Now with chunks the size of three pancreases out, the margins are still not clear. Now they're headed for a Whipple/total pancreatectomy. HODAD is recruited for Whipple and everyone apparently has *nothing else to do* but sit around outside of this surgical patient's OR.

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        15. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          They then tell the parents afterword Jack is, "likely cancer free." These are the worst doctors.

          2 replies 0 retweets 7 likes
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        16. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          OK, now I hate this rep, she literally butts into a patient room in the middle of a discussion to hawk a product. Reps don't see patients. This is gross. Abby the insulin-seeking, uninsured girl is comatose and "going to cost Chastain a fortune."

          1 reply 0 retweets 4 likes
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        17. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          COB asks, "is there any way this could be prevented." Universal health insurance and cost controls on pharma cranking costs on a 100 year old drug. Once again the writers seem to think this is a hospital problem. This is a social problem. Individual hospitals can't fix this.

          1 reply 1 retweet 7 likes
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        18. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Okefor is saying putting her patient/boyfriend in a car for rehab. Yes, that is an accurate sentence describing something treated as not icky by this show. HODAD is in trouble for his prostitution. He has to self-report, what?

          1 reply 0 retweets 2 likes
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        19. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Pretty sure medical boards cross reference criminal complaints to their licensees each month and criminal complaints are routinely referred to the board for docs. He's in for a bad day when he finds out this self-reporting is BS.

          1 reply 0 retweets 1 like
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        20. Mark Hoofnagle‏ @MarkHoofnagle 1 Oct 2018

          Also every time you apply for anything - a license, a job, privileging, re-privileging, background checks get run. He has maybe a 2 year reprieve even if that's true. Anyway, another week of #theresident stupidity. Not the dumbest episode - that was last week. But still.

          1 reply 0 retweets 5 likes
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        21. End of conversation

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