Josh McGough, MD
@joshmcgoo.bsky.social
Girl Dad | EM Doc | Nice Guy | Views Mine | Never Medical Advice
I can't get over stranger things pretending that these grown adults are still like, 14
December 4, 2025 at 4:29 AM
I can't get over stranger things pretending that these grown adults are still like, 14
The most common cause of a small bowel obstruction is adhesions from prior surgery. We know this from Step 2, but I wonder which operations give the most? Whipple > partial hysterectomy? Lap chole/appy vs hernia repair? Any surgeons have good insight on this?
November 30, 2025 at 9:07 PM
The most common cause of a small bowel obstruction is adhesions from prior surgery. We know this from Step 2, but I wonder which operations give the most? Whipple > partial hysterectomy? Lap chole/appy vs hernia repair? Any surgeons have good insight on this?
The boards loves electrical alternans for tamponade, but tbh if they're tachy with a narrow pulse pressure that's enough to get me to do an Echo (but I also love doing echos)
November 30, 2025 at 5:21 PM
The boards loves electrical alternans for tamponade, but tbh if they're tachy with a narrow pulse pressure that's enough to get me to do an Echo (but I also love doing echos)
5% of traumatic renal injuries and 20% of renovascular injuries present without hematuria - which makes me wonder about the times I've had a clean UA to justify not doing a CT in mild trauma. I feel like if they're not tender, UA clean...probably safe.
November 30, 2025 at 4:24 PM
5% of traumatic renal injuries and 20% of renovascular injuries present without hematuria - which makes me wonder about the times I've had a clean UA to justify not doing a CT in mild trauma. I feel like if they're not tender, UA clean...probably safe.
Fournier’s is still a bedside diagnosis. Fluctuance crepitus and pain out of proportion are your red flags, but at least half the time there's no crepitus, and it's they're old and altered they may not even be in too much pain. Call surgery before CT or the lactic of 10
November 29, 2025 at 9:07 PM
Fournier’s is still a bedside diagnosis. Fluctuance crepitus and pain out of proportion are your red flags, but at least half the time there's no crepitus, and it's they're old and altered they may not even be in too much pain. Call surgery before CT or the lactic of 10
I always find hydration in pancreatitis interesting. Just an ambiguous amount of "a lot of LR". One of those things that makes me wonder how hospitalists de-escalate. I guess it depends on whether it's gallstone/alcohol/scorpion bite leading to it, but even then it makes me wonder
November 29, 2025 at 5:21 PM
I always find hydration in pancreatitis interesting. Just an ambiguous amount of "a lot of LR". One of those things that makes me wonder how hospitalists de-escalate. I guess it depends on whether it's gallstone/alcohol/scorpion bite leading to it, but even then it makes me wonder
Peds is Scary: Ewing sarcoma is the second most common bone tumor in patients under 18, with peak incidence at age 15.
November 29, 2025 at 4:24 PM
Peds is Scary: Ewing sarcoma is the second most common bone tumor in patients under 18, with peak incidence at age 15.
Sialolithiasis is a clinical diagnosis, and easier to do than pronounce. Pain with eating, dry mouth, reduced saliva, and a palpable stone point you there without imaging.
The Bonus is getting to put "eat sour candies" on the patient's discharge papers
The Bonus is getting to put "eat sour candies" on the patient's discharge papers
November 28, 2025 at 9:07 PM
Sialolithiasis is a clinical diagnosis, and easier to do than pronounce. Pain with eating, dry mouth, reduced saliva, and a palpable stone point you there without imaging.
The Bonus is getting to put "eat sour candies" on the patient's discharge papers
The Bonus is getting to put "eat sour candies" on the patient's discharge papers
I don't know many things, but I DO know that Alkaline ingestions cause liquefactive necrosis and that is somehow worse than it sounds
November 28, 2025 at 5:21 PM
I don't know many things, but I DO know that Alkaline ingestions cause liquefactive necrosis and that is somehow worse than it sounds
For boards, If a patient presents within 2 hours of STEMI symptoms and transfer to a PCI center will take over 90 minutes, give lytics and transfer. I saw this ONCE in training. Lytics pre-transfer, and after they left, initial troponin came back over NINE THOUSAND. Scary stuff.
November 28, 2025 at 4:24 PM
For boards, If a patient presents within 2 hours of STEMI symptoms and transfer to a PCI center will take over 90 minutes, give lytics and transfer. I saw this ONCE in training. Lytics pre-transfer, and after they left, initial troponin came back over NINE THOUSAND. Scary stuff.
Just hit 1000 subscribers on YouTube. Been posting a short nearly daily for months. Feeling proud of myself.
Would mean a lot to me if you’re in medicine and subscribed!
youtube.com/@joshmcgoo?s...
Would mean a lot to me if you’re in medicine and subscribed!
youtube.com/@joshmcgoo?s...
Josh McGough, MD
youtube.com
November 24, 2025 at 5:18 PM
Just hit 1000 subscribers on YouTube. Been posting a short nearly daily for months. Feeling proud of myself.
Would mean a lot to me if you’re in medicine and subscribed!
youtube.com/@joshmcgoo?s...
Would mean a lot to me if you’re in medicine and subscribed!
youtube.com/@joshmcgoo?s...
Epic chat is just AIM
November 16, 2025 at 10:11 PM
Epic chat is just AIM
1000 days sober today
November 15, 2025 at 12:53 AM
1000 days sober today
40 million Americans are about to lose SNAP benefits. That’s 1 in 10 people losing access to food.
Probably won’t see scurvy in the ER, but you’ll see hunger, stress.
Number needed to treat for a turkey sandwich if you’re hungry? One. Feed your people.
Probably won’t see scurvy in the ER, but you’ll see hunger, stress.
Number needed to treat for a turkey sandwich if you’re hungry? One. Feed your people.
October 31, 2025 at 3:24 PM
40 million Americans are about to lose SNAP benefits. That’s 1 in 10 people losing access to food.
Probably won’t see scurvy in the ER, but you’ll see hunger, stress.
Number needed to treat for a turkey sandwich if you’re hungry? One. Feed your people.
Probably won’t see scurvy in the ER, but you’ll see hunger, stress.
Number needed to treat for a turkey sandwich if you’re hungry? One. Feed your people.
Happy Late October, premeds!
Just got your med school acceptance? Do nothing.
Don’t study anatomy. Don’t open Anki. Don’t “get ahead.”
No one halfway through anatomy has ever said, “Glad I skipped seeing friends for flashcards.”
Touch grass. Eat a vegetable. Celebrate.
Just got your med school acceptance? Do nothing.
Don’t study anatomy. Don’t open Anki. Don’t “get ahead.”
No one halfway through anatomy has ever said, “Glad I skipped seeing friends for flashcards.”
Touch grass. Eat a vegetable. Celebrate.
October 28, 2025 at 3:24 PM
Happy Late October, premeds!
Just got your med school acceptance? Do nothing.
Don’t study anatomy. Don’t open Anki. Don’t “get ahead.”
No one halfway through anatomy has ever said, “Glad I skipped seeing friends for flashcards.”
Touch grass. Eat a vegetable. Celebrate.
Just got your med school acceptance? Do nothing.
Don’t study anatomy. Don’t open Anki. Don’t “get ahead.”
No one halfway through anatomy has ever said, “Glad I skipped seeing friends for flashcards.”
Touch grass. Eat a vegetable. Celebrate.
Apparently they’re called “arginine vasopressin disorders” and not “diabetes insipidus” anymore.
No one told me
No one told me
October 25, 2025 at 4:21 PM
Apparently they’re called “arginine vasopressin disorders” and not “diabetes insipidus” anymore.
No one told me
No one told me
I somehow have not evaded the Philadelphia chromosome - it’s on the EM Boards
October 25, 2025 at 3:24 PM
I somehow have not evaded the Philadelphia chromosome - it’s on the EM Boards
I've never seen Acute Necrotizing Ulcerative Gingivitis, but the treatment is antibiotics and oral hygiene. Augmentin + metronidazole for 7 days.
October 24, 2025 at 8:07 PM
I've never seen Acute Necrotizing Ulcerative Gingivitis, but the treatment is antibiotics and oral hygiene. Augmentin + metronidazole for 7 days.
According to the boards, 90% of nosebleeds are anterior, coming from the Kiesselbach plexus.
In my experience, they're all 85 and on warfarin
In my experience, they're all 85 and on warfarin
October 24, 2025 at 4:21 PM
According to the boards, 90% of nosebleeds are anterior, coming from the Kiesselbach plexus.
In my experience, they're all 85 and on warfarin
In my experience, they're all 85 and on warfarin
Recent travel + watery diarrhea = traveler’s diarrhea. Most cases are self-limiting and don’t need antibiotics. Don't be fooled be colitis on CT either unless there's some severe immunocompromised/c diff at play. The boards wont be subtle
October 24, 2025 at 3:24 PM
Recent travel + watery diarrhea = traveler’s diarrhea. Most cases are self-limiting and don’t need antibiotics. Don't be fooled be colitis on CT either unless there's some severe immunocompromised/c diff at play. The boards wont be subtle
The average Step 2 score in 1995 wouldn’t even pass today.
That’s how fast the goalposts have moved.
We keep selecting for test-taking machines instead of future physicians.
Soft skills matter. Empathy matters.
Medicine isn’t multiple choice.
That’s how fast the goalposts have moved.
We keep selecting for test-taking machines instead of future physicians.
Soft skills matter. Empathy matters.
Medicine isn’t multiple choice.
October 23, 2025 at 8:07 PM
The average Step 2 score in 1995 wouldn’t even pass today.
That’s how fast the goalposts have moved.
We keep selecting for test-taking machines instead of future physicians.
Soft skills matter. Empathy matters.
Medicine isn’t multiple choice.
That’s how fast the goalposts have moved.
We keep selecting for test-taking machines instead of future physicians.
Soft skills matter. Empathy matters.
Medicine isn’t multiple choice.
If you’ve never used GoodRx, try it once.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
October 23, 2025 at 4:21 PM
If you’ve never used GoodRx, try it once.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
If you’ve never used GoodRx, try it once.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
October 23, 2025 at 3:24 PM
If you’ve never used GoodRx, try it once.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
Type in any common med and watch the prices swing by hundreds of dollars between pharmacies on the same block.
Print the coupon. Hand it to your patient.
At minimum, they’ll know you care. At best, you’ll save them real money.
13 years ago, still smiling with you, just with a developed frontal lobe
October 18, 2025 at 3:24 PM
13 years ago, still smiling with you, just with a developed frontal lobe
As I go into some peds shifts as an attending I always remember there’s a nonzero chance every kid with knee pain has an osteosarcoma
October 17, 2025 at 4:21 PM
As I go into some peds shifts as an attending I always remember there’s a nonzero chance every kid with knee pain has an osteosarcoma