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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

8) Growth. Flipping your body's schedule, triaging an overwhelming amount of cross-coverage requests, admitting patients w/o much supervision, doing procedures, and running rapids all were scary before this rotation. But I feel amazing growth & confidence after just 2 weeks. /🧵

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

In one case, it was 3 AM, but a patient was acutely decompensating and I knew we had to call the attending on a consulting service. When he picked up the phone, I began with, “I’m sorry to wake you up, but I’m worried about this patient and I need your help.”

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

Speaking of shit hitting the fan: this will happen. Patients got dangerously sick fast. If you're in a time-sensitive situation and don’t know what to do — and if you’re an intern, you often won’t — your job is to call for help from people who do. Your senior, the ICU, a consultant, etc.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

We felt safe asking each other questions. And when shit hit the fan, we stopped what we were doing and had each other’s backs.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

7) The people you work with matter. On night float blocks, there really isn’t much time outside the hospital for anything besides eating and sleeping. You invariably lose contact with friends and family. My night co-residents became my friends and support system.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

Likewise, when the night team signs out a new admission to you, spare them your curiosity. Unless you have a question that would change your pre-rounds management, you have more time during the day to dig into things than the night team did.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

And for day teams — don’t Monday-morning quarterback your night team’s management. They don’t have the luxury of time and focus that you do in the afternoons. As a friend says: “Nights are for survival. Plans are for the day team.”

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

And our attention is constantly being pulled away overnight by cross-coverage for the 40 patients already admitted. So I have new-found respect for any overnight resident who is able to produce an even half-coherent H&P.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

6) It’s really hard to admit new patients overnight. Not just from fatigue, but because doing so requires intense thought and focus to wrap your head around their history, presenting complaints, all of their objective data in order to make diagnoses and plans.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

And I’m really grateful anytime someone in the ED has already called relevant consults and received/acted on recs before handing them off to us to admit them.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

Because of boarding, you’re often getting sign-out from someone who was not involved in their triage or initial treatment. If there’s something urgent you need done before admitting their patient, like a repeat lab, they’ll be happy to order it for you.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

The job of an EM doctor is not the same as an IM doctor. EM’s role is to resuscitate acutely sick patients, decide whether to admit or discharge, and keep flow moving through the ED. Their attention is also being pulled in all different directions.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

5) Admitting new patients from the ED. The ED is a hard place to work. I know first-hand because I did two EM sub-Is when I was still undecided before settling on IM. So be kind to your EM colleagues who are handing patients over to you.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

If a nurse asked me to see a patient, I always tried to. Part of this requires triage, and if I determined it wasn't urgent, I’d let the nurse know that I’d be by to lay eyes on the pt the next time I was on their floor. If nothing else, it helped to build trust.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

4) Going to bedside. Because of the aforementioned duties, I can only come to bedside for patients requiring time-sensitive clinical reassessment, and my determination of who requires that may not always be the same as a nurse’s. That said, take nursing concerns seriously.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

Nurses don’t always know the ins and outs of our complicated and ever-changing schedules, so I found that offering a polite reminder that I was covering 40 patients and admitting new ones helped to address a perceived delay in addition.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

3) Appreciating grace from nurses. If we take a while to respond to a non-urgent message or seem short in our replies, don’t take it personally. We're getting bombarded with msgs about our other pts while also trying to get tasks done, resuscitate sick pts, and admit new pts.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

If a patient had a vital sign abnormality eg tachycardia: did you repeat it? How are the other vital signs? Are they having any symptoms? If they have a new rash or blood in their emesis/stool, send a photo. Good nurses give this context up front which makes triaging and decision-making faster.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

2) Gratitude for nurses who manage up. Given time constraints and lack of familiarity, context is helpful. So if you’re reaching out because patient is in pain, it’s helpful to also know: is this pain new or similar to prior? Have they received their PRNs? Did any of them help?

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

1) Good anticipatory guidance is gold. I didn’t know these patients nearly as well as their day teams do. I’m grateful Penn uses a dedicated platform for this because clear guidance from primary teams for pain, agitation, or decompensation made for a smoother and safer night for all.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

Like most night float rotations, I covered those 40 patients in addition to admitting new patients and responding to rapids in the hospital. Some observations and reflections:

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 23/11/2025

I covered the 40 patients on our inpatient pulmonary and hepatology services. Our pulm service is a de-facto MICU step-down unit and our hepatology service is comprised mostly of patients with decompensated cirrhosis or acute liver failure. So these were all very sick patients.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 28/09/2025

Me hyping myself up to try, again, to place an ultrasound–guided IV

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 15/09/2025

This is intern year except every 2 weeks you go back to rolling a wooden box filled with patients you know nothing about, subspecialty services you have no experience in, new attending and senior resident preferences, and bathrooms you don’t know the codes for 😀

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 02/08/2025

Wow! Glad you’re doing well. Thanks for reading.

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 01/08/2025

4/ THC wasn't immediately known to be the cause. Emergency services initially tested the restaurant and the homes of several customers for carbon monoxide but found no leaks Instead, one of the pizzeria patrons who went to the ED had a UDS collected which was positive for THC

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 01/08/2025

3/ The owner of the pizzeria told officials they'd run out of cooking oil and grabbed what they thought was canola oil from the shared commercial kitchen In fact, they had grabbed hemp-derived THC-infused cooking oil They didn't know 'D9' was short for Δ9-tetrahydrocannabinol

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 01/08/2025

2/ the restaurant's food had been contaminated with THC. Oops. The pizzeria operates in a building that shares a commercial kitchen with a state-licensed maker of edible THC products. What happened, exactly?

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 01/08/2025

1/ Last October, 85 people ages 1-91 developed dizziness, drowsiness, anxiety, and/or memory distortion. Some went to the ED. They'd all recently eaten at a Wisconsin pizzeria. Local public health officials investigated. As reported in last week's CDC MMWR, they found

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 30/07/2025

Case-control study in @jamanetworkopen.com suggests living in close proximity to a golf course substantially increases the risk of developing Parkinson's Disease, likely related to pesticide use.

jamanetwork.com

Proximity to Golf Courses and Risk of Parkinson Disease

This case-control of older US adults examines risk of Parkinson Disease by proximity of residence to a golf course.

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Reposted by Brett Biebelberg, MD

Nick Mark, MD @nickmark.bsky.social · 30/06/2025

It's that wonderful time of year when new residents are joining the ICU team! Here are a few of my favorite @criticalcaretime.bsky.social infographics to help you understand key concepts: ⚡️Undifferentiated shock 💉 Vasopressors 😮‍💨 The physiologically difficult airway & 🧪 Metabolic acidosis

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Reposted by Brett Biebelberg, MD

josh farkas 💊 @pulmcrit.bsky.social · 09/06/2025

ZODIAC trial: For ischemic stroke patients who are awaiting thrombectomy, flat positioning reduced the risk of neuroworsening or death Premature termination but seems reasonable Statistically robust results Best available evidence; should change practice pubmed.ncbi.nlm.nih.gov/40465238/ #EMIMCC

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Reposted by Brett Biebelberg, MD

josh farkas 💊 @pulmcrit.bsky.social · 02/06/2025

when perfusion falls, the most vulnerable tissue suffers first. so for someone with a chronic carotid artery stenosis, urosepsis can manifest with focal neuro symptoms.

media.tenor.com

a rabbit from the secret life of pets is angry and says `` i 'm sorry ... what ? ''

ALT: a rabbit from the secret life of pets is angry and says `` i 'm sorry ... what ? ''

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 18/05/2025

My palliative care elective in med school was my most impactful rotation. I’m eager to rotate on PC as a resident. It felt like another world of medicine. A reprieve from the cog-in-the-wheel, task-rabbit medicine we practice. A version that prioritizes patients, dialogue, and bedside care #medsky

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 14/05/2025

Could it be that simple? Hanging a folding chair on the wall in patient rooms increased the patient-reported likelihood that physicians sat at the bedside, spent enough time, and checked for understanding. shmpublications.onlinelibrary.wiley.com/doi/10.1002/... @jhospmedicine.bsky.social #medsky

shmpublications.onlinelibrary.wiley.com

Wall‐mounted folding chairs to promote resident physician sitting at the hospital bedside

Click on the article title to read more.

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Reposted by Brett Biebelberg, MD

Amy Maxmen, PhD @amymaxmen.bsky.social · 01/05/2025

A 25% reduction in research funding in the US would lower GDP by 3.8%— a decline similar in magnitude to that in the Great Recession. A 75% reduction in research funding would lower GDP 11% — a larger decline than in any recession since the Great Depression. www.nytimes.com/2025/04/30/b...

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Reposted by Brett Biebelberg, MD

Brett Biebelberg, MD @bbiebelberg.bsky.social · 20/04/2025

Takeaways from @nejm.org acute abdomen review: ➡️ Don’t withhold analgesia ➡️ CT angio abd/pelv w/ IV contrast is usually ideal image; ultrasound for others but high performance variability ➡️ Consult surgery ASAP ➡️ Beware of cognitive bias www.nejm.org/doi/full/10.... #medsky

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 20/04/2025

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Reposted by Brett Biebelberg, MD

Walid Malki 🍉 @wanderinger.bsky.social · 29/03/2025

Diuresis and fluid status comes up on almost every single ICU patient (especially in a cardiac ICU🫀) It’s very important to understand how each diuretic works, how they can be combined to augment urine output & their limitations Check out my starter guide for diuresis in the ICU #MedSky #Nephsky

Infographic reviewing main diuretic options in the ICU as well as a proposed algorithm for a diuretic challenge

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 19/04/2025

Wellness will be when I don't have to do a module on how to use hand sanitizer

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 21/03/2025

I'm thrilled to have matched in internal medicine at Penn! @pennmedicine.bsky.social Endlessly grateful for my family, friends, and mentors on whose shoulders I stand. #Match2025

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 16/03/2025

When the recipe calls for 2 cloves of garlic #docswhocook

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Brett Biebelberg, MD @bbiebelberg.bsky.social · 16/03/2025

Cigna and Jefferson Health failed to reach a coverage agreement, meaning Cigna is now out-of-network for Jefferson patients. Was shocked to see that Cigna's reimbursement rates have only increased by 3% since 2020 vs. an inflation rate of 21% www.jeffersonhealth.org/about-us/new...

jeffersonhealth.org

Important Update for Cigna Members: Jefferson Health Now Out of Network | Jefferson Health

Jefferson Health and Cigna have been unable to finalize a new contract. As a result, effective midnight on March 15, 2025, Jefferson Health will be considered out of network for Cigna commercial membe...

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