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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 19 Mar 2018

    It's 9PM on a Monday, do you know where your medieval elephant is? (It's on Fox.) #theresident livetweet starts shortly.pic.twitter.com/0ml0o9PQFQ

    5:59 PM - 19 Mar 2018
    • 2 Retweets
    • 8 Likes
    • Carrie with a ‘C’ Amanda McNicholas Piotr Golenia, PharmD, BCPS, WXYZ Heightsmomma 🏳️‍🌈Jenny🍭 Tall Orange Angry 🏳️‍🌈 Roxanne Amanda Rose 𝐀𝐧𝐝𝐫𝐞𝐰 𝐖𝐞𝐭𝐳𝐞𝐥
    3 replies 2 retweets 8 likes
      1. New conversation
      2. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Swanky black tie event, for some reason a second year resident Dr. Okefor is there, and now, for the show on patient dumping! Again a great topic and complex issue. Are they planning on having an intelligent and nuanced episode on the unfunded mandate that is EMTALA? Nah.

        1 reply 0 retweets 3 likes
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      3. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Realistically, the surgical resident would stay at the party once the medicine resident and NP took the confused lady to the ED. We will not pass up the opportunity to destroy a shrimp plate.

        1 reply 1 retweet 6 likes
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      4. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Our heart transplant patient has returned by wandering into the ED. One of the realities of modern hospitals is security, especially in the ED. How is it that this guy is able to walk back into patient care areas? Especially where you're taking trauma victims?

        1 reply 0 retweets 3 likes
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      5. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Now for a true realism test. There is a patient with eye trauma. Will it somehow become Okefor's problem, or like all general surgeons, is she creeped out by eyeballs? (It's a pet theory I have because I hate eyeballs) This is the only time I'm grossed out watching TV.

        1 reply 0 retweets 4 likes
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      6. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        The confused lady presents a dispo problem for the sociopath and the NP, they need to treat her but worry she won't take care of herself if dc'd. Solution? Fabricate a complaint on the medical record. Not contact social work or case management, straight to lying.

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

        And here is where the dumping comes in. The NP recognizes the EKG lead! It must have come from a specific hospital she knows dumps patients because...only one hospital uses that kind of EKG lead? Seems fishy. Nurses what do you think? Aren't they all kind of the same?

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

        The chief of surgery and random oncologist for some reason become involved in an admission decision. Not, the ED attending? The admitting service? Some other lowly administrator? Ahhh eyeballs! The intern would not be pulling glass out of eyeballs!

        1 reply 0 retweets 4 likes
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      9. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Do they not have optho to come in lugging a suitcase full of fancy tools? I always spot optho by their carry-on baggage. And now the NP has gone from the ED to the heart transplant clinic to see our transplant guy. Seriously, they need more than 3 staff in this hospital.

        1 reply 0 retweets 6 likes
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      10. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Confused lady who was dumped now GI bleeding? Hemoptysis? They have no idea what happened to this lady. Conrad intubates her easily despite airway full of blood, and pulls the stylet himself (ask for an assist to do that so you don't lose it).

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

        You also don't need to turn it 90 degrees to mainstem it. You just keep pushing, it will go right. Conrad somehow manages to say bronchoscopy funny.

        1 reply 0 retweets 3 likes
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      12. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Okefor uses a rigid biopsy forceps through a flexible scope. Yeah. Not a clever bunch.

        1 reply 0 retweets 1 like
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      13. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        The intern is doing a great slit-lamp exam of eye-injury guy's cheek. The optho should really be doing this stuff.

        1 reply 0 retweets 4 likes
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      14. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        I didn't realize the intern was related to Raj on Big Bang Theory.

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

        I love that actor though, he does grumpy dad really well.

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

        Wow, they've already extubated the Confused/Dumped/Hemoptysis lady. All in the time this party is going on they've admitted, intubated, bronched, and extubated her and have planned her discharge back to Atlanta Gen. Chastain Memorial is reaching god-like efficiency here.

        2 replies 0 retweets 2 likes
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      17. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Eye guy is charming. But somehow has developed tension PTX from esophageal perforation after vomiting? Not likely, more likely missed lung injury from their half-assed trauma workup, you're not going to get tension from the esophagus. And he needs a chest tube, not a CT.

        1 reply 0 retweets 3 likes
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      18. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Capturing your tension pneumothorax on a chest CT is poor form.

        1 reply 0 retweets 3 likes
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      19. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Conrad (sociopath MD) and NP don't like that the parents want to check out the Confused/dump/hemoptysis lady. I agree, she was coughing up blood like 5 minutes ago. Rather than discuss with the family though they immediately go to lying and undermining family wishes.

        1 reply 0 retweets 4 likes
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      20. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Most people are pretty reasonable, and if you at least explain your reasoning they'll give you an hour. I don't know why it's admirable that the constant recourse of our hero is lying and fraud.

        1 reply 1 retweet 4 likes
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      21. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        This is the stupidest dramatic conflict ever, the patients parents can't wait a single minute more to discharge her because they have to treat her schizophrenia this minute. Said no one ever.

        1 reply 0 retweets 3 likes
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      22. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        The writers of this show seem to think it's cute when men can't take no for an answer. I find it rapey, not charming. Okefor was very clear why she is not into heart transplant dude. His response, "you can't just leave me here." Yes she can. She said no. Go away.

        1 reply 0 retweets 3 likes
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      23. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Apparently this patient passes out when she sees bad art.

        1 reply 0 retweets 1 like
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      24. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Wegeners. Of course. And again, the most unrealistic thing about this show is their pathology service. They did immunofluorescence in the middle of the night? Seriously, 5 business days minimum.

        2 replies 1 retweet 6 likes
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      25. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        Esophageal perf guy has already had surgery, the same night, and is awake and talking? Like in the same hour. His dressing is on his neck but he seemed to be having a tension pneumo before with crepitus on his R chest and SOB. I feel like I'm taking crazy pills.

        1 reply 0 retweets 3 likes
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      26. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        This show is happening in a parallel universe where time is frozen, so all procedures and tests can be completed during a swanky party. Or... This party has been going on for 7 days.

        1 reply 0 retweets 6 likes
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      27. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        I think everything that happened in this episode could have been accomplished without Conrad constantly lying. This is the worst aspect of this show. Conrad is a bad person and a bad doctor.

        1 reply 0 retweets 3 likes
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      28. Mark Hoofnagle‏ @MarkHoofnagle 19 Mar 2018

        And they didn't go into dumping at all, why it happens, why hospitals do it, why EMTALA is an unfunded mandate, really superficial coverage of a serious problem. This show sucks. But it looks like denouement is next episode, the end is in sight!

        1 reply 0 retweets 4 likes
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      29. End of conversation

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