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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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    Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

    Despite Philadelphia's best attempts to destroy me on trauma call the day of the Superbowl, I live...to destroy #theresident tonight on Fox.pic.twitter.com/PnfHLtBylp

    2:39 PM - 5 Feb 2018
    • 16 Retweets
    • 130 Likes
    • Beth Dr. Jen "Vaccinated *and* Masked" Phillips Arghavan Salles, MD, PhD Scaly Wag Twins sadboy ascian CHAOSposter Jessica Biller, DO Purely Positivitea Ria Dancel, MD Koshka Goddess
    8 replies 16 retweets 130 likes
      1. New conversation
      2. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        I think this is the week the conspiracy theorist writer is going to unleash her pet theory that oncologists only give chemo for pharma kickbacks.

        1 reply 1 retweet 10 likes
        Show this thread
      3. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Yes, when you have multi-trauma call an internist? Wait, what? Why is he just standing around like a putz?

        2 replies 0 retweets 10 likes
        Show this thread
      4. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Is anyone actually triaging these patients or are they just piling them in a back room?

        1 reply 0 retweets 6 likes
        Show this thread
      5. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        They keep shocking asystole. That's not a thing.

        2 replies 1 retweet 21 likes
        Show this thread
      6. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Yeah that's not how you replace a dislocated shoulder. It's traction, not shoving it back in the socket, unless you're just a big Lethal Weapon fan.

        2 replies 1 retweet 7 likes
        Show this thread
      7. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        My best guess is a subdural, he needs a burr hole. I don't know where, because I just pulled that out of thin air, but thats drama.

        3 replies 0 retweets 4 likes
        Show this thread
      8. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        The best way to deal with medical error is to harangue the triage nurse.

        3 replies 2 retweets 12 likes
        Show this thread
      9. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Hawkin's affect is so bizarre. He doesn't come across as confident but just rage-filled and petty.

        1 reply 1 retweet 8 likes
        Show this thread
      10. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        I like how the trauma patients are covered with blood in the beds, in their street clothes, not exposed to, you know, figure out what is injured.

        2 replies 1 retweet 11 likes
        Show this thread
      11. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        That mass looks a lot like...cholecystitis. And he just orders EUS based on ultrasound? I think you would need better cross sectional imaging.

        1 reply 1 retweet 6 likes
        Show this thread
      12. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        This is just terrible special effects, is that supposed to be an abdominal operation? The abdomen appears to be between the patients knees. There are no retractors or Bookwalter, just instruments shoved in a dark incision with viscera hanging out.

        3 replies 1 retweet 12 likes
        Show this thread
      13. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        It's also not a thing to dissect with a kelly unless you're talking about a chest tube, it's a big and blunt. Try a tonsil or a right angle, something with a finer tip.

        2 replies 0 retweets 7 likes
        Show this thread
      14. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Oh boy. I can't wait to see how these jackasses do trauma.

        1 reply 0 retweets 6 likes
        Show this thread
      15. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Why are they going straight to a surgical airway without looking? Just because he coughed up a bit of blood? How bad do they suck at intubating?

        1 reply 0 retweets 20 likes
        Show this thread
      16. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Now for a cricothyrotomy, which they incorrectly refer to as traching the patient. And no, it's not normal to get sprayed with blood because you sliced the neck like a hack. This is frequently done in the ER. I did two in the last week.

        1 reply 2 retweets 13 likes
        Show this thread
      17. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        This is the one instance in which if indicated you specifically would NOT wait for an attending if there was a delay. Airway first.

        1 reply 2 retweets 9 likes
        Show this thread
      18. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Then the trauma workup kind of just stops...It's not clear what the injuries are. I also like how he has a nice HR of 80 despite being trauma without an airway. Either tachy or brady, cmon.

        1 reply 1 retweet 10 likes
        Show this thread
      19. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        I like how he shows a picture of the patient's face ON HIS PHONE to the dad. Don't take pictures of patients' faces, yikes.

        2 replies 2 retweets 16 likes
        Show this thread
      20. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Now the trauma patient is seizing, probably because they have no idea what has happened to him or any attempt to identify his injuries. Why couldn't this guy have a magical subdural causing his problems? So many questions about this scene.

        2 replies 1 retweet 7 likes
        Show this thread
      21. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        What is the magic "seizure monitor" that beeps until the seizure resolves than makes an "all clear beep"? Why doesn't he use an IO in this instance? This is when trying to get a vein would be hard, yet last week they did the IO on a young healthy lady holding perfectly still.

        2 replies 1 retweet 14 likes
        Show this thread
      22. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Have they explained what any of this patients injuries are? Why are they doing surgery? What is the injury? Why is calcium the first Rx, rather than say, ativan? Why is the patient seizing under anesthesia? Why was the patient not paralyzed? Why is any of this happening?

        1 reply 1 retweet 28 likes
        Show this thread
      23. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        There are certain meds nurses can give without orders. Epi for anaphylaxis would be a good example.

        2 replies 0 retweets 9 likes
        Show this thread
      24. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        #Theresident has a common theme, protocol interferes with care, except when it's necessary to protect people from mistakes. Also, everything they think is a protocol is wrong, and is the exact opposite of reality.

        1 reply 3 retweets 17 likes
        Show this thread
      25. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Why is #theresident coming in and commenting on the surgical resection of a gallbladder tumor rather than a surgeon? He doesn't know shit about doing that resection. And it's really not a "minefield", it's actually pretty easy. And if they're anemic, guess what? We have blood!

        2 replies 1 retweet 16 likes
        Show this thread
      26. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Oh no, maybe in HODADs hands this is a bad idea. I like how he goes from doing urologic surgery to hepatobiliary.

        1 reply 1 retweet 6 likes
        Show this thread
      27. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Hawkins doesn't come across as a risk taking doctor who just wants to do right. He comes across as a creepy sociopath.

        2 replies 1 retweet 11 likes
        Show this thread
      28. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Isn't Okefor a 2nd year resident? That's a case for a 4 or 5.

        1 reply 0 retweets 4 likes
        Show this thread
      29. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        I like how she objects to being treated like an intern. A 2 is basically senior intern. (sorry 2s)

        1 reply 1 retweet 16 likes
        Show this thread
      30. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        Now the nurse is investigating medical overuse by, taking pictures of patients! Stop taking pictures of patients!

        1 reply 2 retweets 13 likes
        Show this thread
      31. Mark Hoofnagle‏ @MarkHoofnagle 5 Feb 2018

        There is a good reason insurance companies won't pay for "experimental therapies". Because there is no evidence for them. If it's experimental, why isn't she enrolled in a protocol? Insurance absolutely shouldn't pay for therapies without evidence!

        2 replies 1 retweet 8 likes
        Show this thread
      32. Show replies

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