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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 23 Apr 2018

    It's 9PM on a Monday, time to mock Fox's medical conspiracy show #theresident. Tonight's episode "And the Nurses Get Screwed"pic.twitter.com/14yLK2Qzsj

    6:01 PM - 23 Apr 2018
    • 10 Retweets
    • 30 Likes
    • Brian Urbancic Brendan Hilbert, PhD Sarah🌻 Richard Goldman brincando com esquilos Nurse Betty Me 🏳️‍🌈Jenny🍭 ScienceBasedMed
    1 reply 10 retweets 30 likes
      1. New conversation
      2. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Ok, no one can screw up a lipoma excision, even HODAD.

        1 reply 1 retweet 4 likes
        Show this thread
      3. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Dude, an OR fire? During a lipoma excision? And he stands there with his hands in the air? Sterility is less important than fire. Already dumber than I could possibly have expected.

        2 replies 1 retweet 12 likes
        Show this thread
      4. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        The surgery "went perfectly" except for that OR fire. OK plotline two, the intern is in the ER, with a hypochondriac. Let me guess, she's secretly sick.

        1 reply 2 retweets 9 likes
        Show this thread
      5. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        His boss suggests giving her a placebo prescription to make her feel better. Unethical, unrealistic, and stupid. One doesn't treat delusions by reinforcing delusions.

        1 reply 1 retweet 14 likes
        Show this thread
      6. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        I like how their OR cams have complete coverage of every inch of the OR, like there's a director of photography running 4 cameras in every room with such high res you can see every single detail.

        1 reply 1 retweet 7 likes
        Show this thread
      7. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        NP Nic tries to blame Hunter for excessive chemo with no evidence. She finds out it was the K, even though as we discussed, 40meq of K in a hypokalemic patient, diluted in a liter of fluid isn't going to do squat.

        1 reply 1 retweet 9 likes
        Show this thread
      8. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Conrad convinces OR burn patient he will be cured with plastic surgery using the power of...Photoshop.

        1 reply 1 retweet 4 likes
        Show this thread
      9. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Back to Nic, 40meq of saline even in 30 minutes in a hypokalemic patient is not fatal. This is physiologic stupidity.

        2 replies 1 retweet 6 likes
        Show this thread
      10. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        When the test results come back on Lane's patients (not Dr. Hunter because she's female) they "go directly to her", as opposed to into the EMR. Conrad says he hasn't drawn blood since med school. Accurate. Our first accuracy!

        1 reply 1 retweet 23 likes
        Show this thread
      11. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Back to the intern in the ED. Patient with right sided abdominal pain. Xray is sown in the corner, and is "normal", except for all that free air.

        1 reply 1 retweet 10 likes
        Show this thread
      12. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Also a paucity of bowel gas, look out for that. I like the rapid turnaround from the senior from, do nothing to, "yeah, OR".

        1 reply 1 retweet 4 likes
        Show this thread
      13. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Back to Hunter trying to frame Nic, there's no way 40meq of K in a liter of fluid given in 30 minutes is going to kill anyone with low K. Ok a bunch of stupidity is going down.

        1 reply 1 retweet 4 likes
        Show this thread
      14. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Burn patient is going to code for airway threat and Conrad wants to do an escharotomy, but because he's worried about infection, he wipes with an alcohol-containing chlorprep. Awesome. Even if some of the tissue is dead, any living is going to hurt like hell.

        1 reply 1 retweet 5 likes
        Show this thread
      15. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        That's a good place to use betadine if anything, and once again they're obsessed with doing aggressive horrible things for drama. Conrad makes a horizontal incision across the neck to free the eschar, which looks like a great way to hit every single external jugular you can.

        1 reply 2 retweets 13 likes
        Show this thread
      16. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        And why not call anesthesia and at least try to intubate? So many of these people reach extremis before intervention, your patients should not always be reaching a point while monitored where you have to do crazy aggressive lifesaving interventions. So much bad doctoring.

        1 reply 1 retweet 11 likes
        Show this thread
      17. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Now the intern is trying out some phlebotomy, good time for alcohol but it doesn't seem in use. Also, what little phlebotomy I do, it's better to feel for veins than stab randomly in the cubital fossa.

        3 replies 1 retweet 4 likes
        Show this thread
      18. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Also why does Nic being out mean no blood gets drawn? No other nurses? No phlebotomists? Have I missed a sneaky phlebotomy conspiracy? Back to the ER.

        1 reply 1 retweet 7 likes
        Show this thread
      19. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Are these idiots really going around drawing blood on patients surreptitiously for their own medical vendetta against Hunter, without telling the patients what they're doing? That's really messed up. That's battery.

        2 replies 1 retweet 7 likes
        Show this thread
      20. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        I like how a resident can just walk into the hospital administrators office and yell at her and threaten the whole hospital. So many fireable offenses and we're only half way though.

        1 reply 2 retweets 6 likes
        Show this thread
      21. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        And I spoke too soon, someone has shared the hospital video with the burn patient and despite having a neck escharotomy an hour ago to save his airway he's had time to autotune a video of himself singing to it. The hospital PR person has "contacts at NetTube". Uggh.

        2 replies 1 retweet 3 likes
        Show this thread
      22. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        This show is made by people who think, "Wag the Dog" was accurate political commentary as now they're suggesting the hospital is going to import a war orphan to treat for good PR. I can't even.

        2 replies 1 retweet 4 likes
        Show this thread
      23. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        If you can hack into a "surgical learning database" and download sensitive patient information including video of surgeries, this hospital has a bigger problem than a hospital fire, it has total insecurity of all of its hospital records and will be shut down forever.

        1 reply 4 retweets 7 likes
        Show this thread
      24. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        So after a round of illegal battery of patients to draw their blood for their private vendetta against Hunter, with no informed consent, our "heroes" have found everyone is healthy - but like any conspiracists, contrary data should never discourage your belief.

        1 reply 1 retweet 2 likes
        Show this thread
      25. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Again, I have to reiterate, no one could have changed the flow rate fast enough to make 40meq of K in a liter of fluid kill a hypokalemic patient. Alleging someone else is murdering the patient as part of a grand conspiracy makes you sound craaaazy.

        1 reply 2 retweets 5 likes
        Show this thread
      26. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        This show could only be appealing to the conspiracy-minded. It's bonkers. I know that in the end these crackpots will be validated, that's the inevitable narrative arc, but in the real world anyone who thinks this way should be kept far, far away from patient care.

        2 replies 2 retweets 7 likes
        Show this thread
      27. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Intern back in ER, getting cocky, patient c/o snakes in his through. I hope snakes pop out like out of one of those fake peanut brittle cans.

        2 replies 1 retweet 5 likes
        Show this thread
      28. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Again, the doctor, who is apparently "good" treats the patient by participating in their delusional behavior. That's not treatment, that's just abuse.

        1 reply 1 retweet 3 likes
        Show this thread
      29. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        It's a consistent theme of this show, that while complaining about error, and patient harm, this show lionizes characters who lie, cheat, steal, batter, sexually-assault, and deliver unethical, harmful care. In the first episode Conrad even attempted murder.

        1 reply 2 retweets 7 likes
        Show this thread
      30. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        Then when it comes time to finally do something about HODAD, he's finally screwed up to the point that he's vulnerable, our heroes don't want to be whistleblowers, don't want to go on record about observable, ridiculous criminal behavior.

        1 reply 1 retweet 3 likes
        Show this thread
      31. Mark Hoofnagle‏ @MarkHoofnagle 23 Apr 2018

        I've said it before, there's a great smart show that could be made about the complex relationship between care, error, and hospital profits, but this is not it. People are harmed by good people with good intentions more often than ridiculous comic book villains.

        2 replies 2 retweets 13 likes
        Show this thread
      32. Show replies

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