Things I Learn From My Patients
 

Tonight I learned yet another helpful life lesson from one of my patients. If you're on the street corner selling coke and you see the cops coming to bust you don't eat all your coke. Having been taught this valuable lesson I will now know better than to do this and wind up going to the ER in handcuffs, seizing uncontrollably, aspirating my vomit and doing all of this with a white powder moustache looking like and ad for "Got Coke?"

It's a recurring theme lol....we just had a guy swallow 16 grams worth of meth when a deputy pulled him over. An ambulance was called 3 minutes after the stop, and he died enroute----some pretty quick stuff. Some people.

Lemme add tip #3. Always pay your drug dealer! Bad things happen when you don't pay.

#4. Always be polite to strangers. No matter how tough one thinks he is, there is always someone bigger, badder, or more likely to use violence to accentuate his point.


Last but not least.... If I had a nickel for every time a patient looked at me and said, "Young man, I know my body, and this chest pain isn't from my heart." - as I'm looking at the huge ST segment elevation. I'd probably be able to put a sizable down payment on a nice car.

One thing I've learned from 3 EM rotations is:

#5: Stay away from people named "Some Guy" or "This One Dude", because they for whatever reason, just punch someone in the face or hit them with a crowbar and run off. If I see them on the street, I cross the street to get away from them.

Q

#6 Never, ever leave flashlights, shampoo bottles, beer bottles or any long, circular object on the floor because someday you will fall on it and it will somehow, work its way up your rectum.

1) Never run from the police especially if its a K9 unit.

2) Always wait until finishing your woodwork with the skillsaw prior to using your meth.

3) Don't swerve your Suzuki Samari to avoid hitting a squirrel in the middle of the road.

4) Don't road surf on the top of a moving stickshift car driven by your younger sibling with a learner's permit.

never leave your last refill of percocet in plain site after your docs office closes if one of these 3 friends is coming over for dinner:
1. some dude
2. my friend
3. that bitch

if the two dudes live in YOUR city, don't sit out on your front porch reading the bible and minding your own business at 2 AM unless you are praying to be shot

Ah, that's the best one yet... thanks for the laugh! :laugh:

If those two dudes broke your arm while you were walking home from Church on a Friday night, and the trauma surgeon fixed it via external fixation, DO NOT by any means use a wirecutter to remove it 4 days after discharge.

Q

Well another professor of life came through last night and bestowed some wisdom on me which I'll share. No matter how annoyed you are at being incarcerated dont slash open your scrotum and shove razor blades up your urethra. Now I know, who among us hasn't thought wistfully of doing that but it turns out that it's not a good idea.

Oh, I love these crazy ER stories! More!! I'm going into surgery and I just found out that my program doesn't put me in the ER for a month, so I'll never get to tell the stories of my month of crazy stuff from the ER.

Keep the stories running!

If you are prone to dystonic reactions and are stealing your roomates meds. Make sure you can tell valium from haldol.

Take a look at the two in the PDR. It is amazing how similar they are.

Latex paint, despite being thick and creamy, does not coat your stomach and provide the same relief as pepto bismol.

1. When cleaning a swimming pool with Muriatic acid, if you splash a large amount of it on your face and arms, vinegar is not a good neutralizing solution.

2. Never, Never, for the love of God, let someone with chest pain use the bathroom.

3. If you own a horse named thunder, flash, psycho, or reaper, do not get within 20 feet, and don't even think of just taking them for a quick ride.

Another ER lesson...
 

If you get a cold, or have a runny nose, and don't feel like going to see your GP, just go to the ER and get yourself a Z-Pack!

Someone at my shop forgot this rule recently. Vfib is a bad thing right?

Classic. I've never seen it but I can sure see it happening.

Priceless! Possibly the best yet!:laugh:

If you are a 70 year old man with COPD, and you want to clean the toilet really well, go ahead and mix the ammonia and bleach. Most of us learned not to do this before the onset of pubescence, but give it a try regardless!

Later, after the paramedic has successfully conducted a RSI intubation in the ambulance, make sure your family speaks up for you in the ED. They are there to advocate for you on the most pressing and salient issues.

Have them go right up to the ED attending, and demand that, if they don't find the patient's missing dentures right now, the doc and paramedics are buying him a new set.

Hint: they should demand this while standing in front of the ventilator (the patient's only earthly connection with an oxygen satuaration >70%).

Don't cut off your own penis and testicles with a knife...no explaination necessary.

Some others.....

Patients with chronic (back, neck, head, abd, etc) pain come into the emergency department at 3am because the pain suddenly gets "worser".

If you are going to get into a fight, and have a prosthetic eye, make sure you take it out first.....and, for safe keeping, shove it up your vagina.....the, realize that you cannot get it out and go to the ED for removal (happened to one of the guys in my residency).

No matter how tough you are, don't cross the street when you are drunk because the moving vehicle always wins.

If you have taken 7 home pregnancy tests that are all positive, and you come into the emergency department...chances are that test too will come back positive.

For the guys . . .

Just because the knut fits around your penis when you are not erect, it doesn't mean it will fit when you are.

I guess that does show some forethought. I had a woman who was tweaking on meth and handcuffed to the gurney pull a crack pipe out of her vagina AND EAT IT! She chewed it up and got glass in her mouth and esophagus. I'd never seen anyone eat a crack pipe before and I did med school in Philly (city motto: Crack. It's not just for breakfast.)

:laugh: :laugh: :laugh: So-oo true if you're in North Philly or University City! :laugh: :laugh: :laugh:

My fave patient, by far, was this woman who came in for "kidney pain". She was convinced that she needed a CT or US (and asked for them repeatedly), but we all thought it was musculoskeletal. So she's sitting there with her 2 year old, and her baby's father**, as we try to figure out if she's done any heavy lifting or anything recently...

So finally she says, "Hey Doc, you think I coulda done dis masturbating? Cuz da other night, YOU (points to baby's dad) just wouldn't wake up! And I needed me some lovin'! So I gave myself like 29 orgasms while you be sleeping in da bed next to me! You think that could've done it, doc?"

**Noone in North Philly is actually dating or married to their children's other parent. This particular story was a rare case, and does not accurately represent the population seen at Temple. However, even though this woman was still sleeping with her 'baby's father', she did not refer to him as her boyfriend/husband.

another big no-no...
when the iv drug user with no veins comes in with cellulitis and gets a central line, tell the nurses to not let them "go out for a smoke". pt took off (obviously), brought back in to the E.D. 1 hr later in full arrest by girlfriend after shooting up on the street into central line with"the really good stuff".... survived "intact"

The Law of Inverse Value: the less you contribute to society, the greater the trauma you can sustain with minimal to no physical sequelae, including falls from 3 stories, stabbings (chest, neck, head, slashings to the face), gunshot wounds (chest, neck, pelvis, leg, traumatic arrest (only to be killed 7 years later in a separate GSW incident)), and high speed MVC's, unrestrained, where multiple people in the other vehicle are killed.

Don't swallow quarters. No, not a kid, a 45 y/o guy.

mike

Absolutely, 100% true! If I had to choose between being Superman and being a cranked out parasite I'd be the parasite. Those guys are indestructible. I had this guy that came in dead a few weeks ago after being hit in the head with a 2x4. He was a hard livin' kind of guy (tooth/tatoo=0) but he was dead from one whallop on the head. I was amazed. I spent a lot of time looking for other stuff, OD, hypoglycemia, etc. 'cause I couldn't believe that a dude like that had actually died.

So true. When I was at Temple I don't think I ever actually saw a mother. All children were "cared for" by grandmother or some other maternal relative.

Re: Another ER lesson...
 

Almost every shift I tell someone who was given antibiotics by their PCP for a viral infection and is in the ER now for an adverse reaction(vomiting, rashes, even serum sickness) to throw the rest of the antibiotics away since they never needed them anyway.

I'm more likely to write you for narcs than antibiotics

[QUOTE]Originally posted by FabFrank
[B]Lemme add tip #3. Always pay your drug dealer! Bad things happen when you don't pay.


Similarly, if you're 90 and gonna get a hooker, pay up...amazingly, the slash through-and-through both esophagus and trachea along with at-the-door full arrest was survived and he went home trached, never to speak or eat again...hope she was worth it.

I can't believe I actually have one to share...
 

If you've been admitted overnight, it's perfectly fine to go ahead and have your girlfriend take you "out for a smoke" in order to leave hospital property and shoot up. She can just pull into the ED and have someone like, well, me wheel you back inside.

I was confused as to why the patient in the car was already in a gown, with fresh sutures on his face, but then I remembered: ED people are there not just for live-saving, but for comfort and, y'know, convenience. It's a big hospital; who cares which door you came out of?

NEW LESSON
 

learned yesterday...
if you are given a prescription for narcotics wait until the rx is filled before you try to sell them...
pt yesterday with bs pain complaint gets rx for vicodin and trys to sell them over the phone(loudly) in the E.D. lobby..." they gave me 30 vicodin...how about $250? ok meet me here in 20 minutes".
pt overheard by staff who took written rx from pt and ripped it up in his presence.....

I just hope that people NEVER stop "minding their business." My job will be really boring if that happens.

make sure you are never a SOCMOB* in Newark, you are very very likely to be shot or stabbed by "some dude".

Secondly, You too can run a courier business. you (meaning a 28 year old white female) can make a good living that will support your heroin habit by standing outside the local crack house in Paterson. when other whiteys drive up that are too scared to go inside, volunteer to take their money, get the crack for them and be right back. instead, go out the back door and scramble over the fence.


*SOCMOB- Standing on corner minding own business

Don't forget, "some dude" shot me, but "two dudes" beat me up, since they're tough guys.

No matter how badly constipated you are, a vodka enema is not a good idea.

Drinking Pine Sol diluted in a 5 gallon bucket, shared with 5 friends, is not a good way to get drunk.

is it better to keep it all for yourself....??

1) Do not continue to hump a girl at a party once it's clear that the zipper is causing some major irritation....but do be proud that that's the reason for the irritation

2) Do not suck on snake bite so that you can spread the venom to MORE parts of your body....

3) If "some bitch" is heading towards you with a rubber chicken, of course you're going to get whapped in the eye with it while SOCMOB (useful abbreviation!! :laugh: )

4) If one of your kids needs to be brought to the ED for an asthma attack, that is good reason to bring the other three children in for dental problems

18 year old kids absolutely need new Audis-- especially the kind with the DVD player built into the dashboard so that they can watch "the fast and the furious" while driving along a windy road at say, 3am. the best thing to say (if you are an 18 year old driver of such a car) is "hey, watch my car handle this turn" as you careen into a tree. (unrestrained driver had not one but TWO spiral femur fractures in the same leg. his foot was pointed backwards). tree survived with minor scratches.

Re: Another ER lesson...
 

you should definetly call EMS at 4:30 am for this. they'll be delighted to take you to the ER.

The character Sancho Panza is well known for the aphorism, "whether the pitcher hits the stone or the stone hits the pitcher, it's bound to be bad for the pitcher." This can be extended to many categories. For instance:

Whether the person hits the train or the train hits the person, it's bound to be bad for the person.

Think of how many times you could have filled this sentence structure with two objects during the last 24 hours.



BTW, my brother's a cop. He says, don't ever say, "oops, that's my fake, here's my real one," after showing a cop ID.:D

Hahah!!! Love it! And I definately did see it on my EM elective in Philly!

Just so ya know, the Gulf Coast is just as similar, except its usually the grandmother bringining in all the grandkids.

Q, DO

During my years in Philly I never once saw a mother, always, always the grandmother or even elder maternal relative. I did meet a 50 year old great grandmother once.

Unfortuantely I can beat that.....In Australia I saw a 38 year old GREATgrandmother. She was there with her 12 year old grandchild who was about to give birth. The grandmother was too drunk to come in, she was 25. When I first saw the 12 year old with her big belly I thought she had asistes and said to one of the attending--"oh, that poor kid with liver failure, why do they have her on the maternity ward!"

Oh if you come in with a salsa jar in your rectum, don't give the staff a fruit cake as a thank you present.

You can not make this stuff up!

:laugh: :laugh: :laugh: My fave med pic was an x-ray I saw during EMT training... Pickle jar in rectum. :laugh: :laugh: :laugh:

We had a guy not too long ago who was bored so he thought to himself, ?Hey, why don?t I shove a baby food jar up my wazoo?? (I?m paraphrasing) But this guy actually had a little more foresight than most rectal foreign body patients. He knew he might lose the jar so he poked a hole in the lid, threaded a piece of nylon cord through the hole and tied a knot so he could pull the whole contraption out whenever he decided he was?uh?finished. This might have worked well except that the baby food jar began to turn over in his colon and wound the cord around itself. Eventually the cord disappeared and he had to come on down to the ER. Oh well, the best laid plans of mice and men?

of mice and men.......or Richard Gere and a hamster, some duct tape..........

I once saw an xray of the pelvis and there within was a smaller, dare I say more mouselike skeleton.
I don't know who had a worse day the man or the mouse. I would guess the mouse.

When attempting a self-circumcision do not use dry ice to numb the area... and when the dry ice sticks to the... a.... area, do not attempt to remove the ice with boiling water.

I've never heard of a self circumcision before. I would never even try to cut my own hair but hey, that's just me. You've gotta wonder about all these people who just don't have that filter in their heads that stop them before they act on their wild ideas.

If you have been in your LOCKED APARTMENT for the past 48 hours, all alone, it is highly unlikely that you have been raped in your sleep.

You are not an alchoholic if you drink 2-3 beers per month.

The government problably does not in fact have a microchip in your spine and a camera planted in your eyeball so they can see everything you see. That is, unless those things were implanted in you as a baby when you had open heart surgery...ok, now I can understand that the government has got a lock on you...

If you are bending over, with your head 1" from the door, it will probably be hit when I open it.

If your dentures do not stick to your gums, probably not a good idea to superglue them on!

Despite your recent success at cutting off your own arm with a steak knife, you probably do not need to cut off your scrotum and testicles with said knife.

If the doctor asks you if it hurts where he is touching you, and he is NOT TOUCHING YOU, don't answer that he is hurting you.

The sharps container is an excellent source for needles. But for most efficient use, please be sure to rip it off the wall and shoot up in your bed *only* when the nurse isnt behind your neighbors curtain.

If you are 15 year old G3P0, cocaine is an excellent inducer of preterm labor.

C'mon people! We need more of these crazy stories!

I am not an ER Resident (I have not even started my MS1 yet) but this is something that I just made up off the top of my head and figured if it would have really happened would belong here.

"If you get bit by a stray dog then be sure and go home, get your gun, and shoot five different stray dogs because you could not remember which one it was that bit you. Then be sure to bring all five dogs to the Emergency Room so that we can test them for rabies."