Things I Learn From My Patients

If you have chest pain, and you are a veteran of our armed forces, its ok for you to go to the local ER. However, if you decide that you would like to drive 4 hours to the closest VA hospital, you will impress the hell out of the doctors when they I show them your PE CT with huge bilateral pulmonary emboli. Some of those vets are some tough motherfockers.

If you're a female prisoner and somehow swallow your nipple ring and develop rectal bleeding while in jail, you really should tell the emergency doctor so that I don't have to tell him after I see your abdominal x-ray that the ring that was on you nipple on the previous x-ray is now in the desending colon.

Whisker Barrel Cortex said:

If you have chest pain, and you are a veteran of our armed forces, its ok for you to go to the local ER. However, if you decide that you would like to drive 4 hours to the closest VA hospital, you will impress the hell out of the doctors when they I show them your PE CT with huge bilateral pulmonary emboli. Some of those vets are some tough motherfockers.

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You speak the gospel truth. Vets forgive many housestaff sins and errors, and they are some of the most gracious, thankful patients I've ever had. It's truly hard to kill a vet.

Sessamoid said:

And the taste of N-acetylcysteine is extremely unpleasant!

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Then you get to come to the nearby liver transplant center and undergo the million dollar workup for a liver transplant. And the transplant coordinator will come talk to you and tell you about how you will have to take hundreds of pills daily for the rest of your life, and you will get lots of weird infections, get fat and suffer from diabetes and osteoporosis, and wind up with not only a liver transplant but also bilateral hip and knee replacements. Plus you'll probably need billiary reconstruction for a billiary stricture.

1) Craft glue is not to be used as a sexual aide, mmmkay?

2) Had a horrible, horrible time a few weeks back. Caucasian mother and father present in the ER with imminent delivery. Infant delivered is black. Security called.

3) When a patient claims that she read on a website that she can continue to smoke throughout her pregnancy, with no adverse effects, it's recommended you beat your head against the desk, not the wall.

And, my greatest victory of all. From us at OB/GYN services to the new interns in the ER. A pocketcard of how to manage a woman's normal period. That should cut my workload in half. This has been bugging me for years. I hope they use it.

IdiotBoxen said:

And, my greatest victory of all. From us at OB/GYN services to the new interns in the ER. A pocketcard of how to manage a woman's normal period. That should cut my workload in half. This has been bugging me for years. I hope they use it.

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What? You don't like the 3 am call for stable nonpregnant vaginal bleed? I thought you guys liked not sleeping?

jashanley said:

What? You don't like the 3 am call for stable nonpregnant vaginal bleed? I thought you guys liked not sleeping?

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I've always wanted to include "take some midol, eat some cheesecake, and watch Lifetime movies, just like my wife does" in the "vaginal bleeding, not pregnant" discharge instructions.

I've never called gyn for this... once maybe, but that lady was GUSHING... like trauma patient gushing and was getting syncopal, etc.

Hopefully, there's not too many attendings out there making their residents call for this BS.

mike

I've called Gyn on a non-pregnant vaginal bleeder before. Her Hct was like 12.

She was worried because no one had called her parole officer and her electric ankle bracelet was going to go off and she was supposed to be under house arrest.

mikecwru said:

...and watch Lifetime movies, just like my wife does" in the "vaginal bleeding, not pregnant" discharge instructions.

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Now that's the funniest thing I've heard in a while!

IdiotBoxen said:

1) Craft glue is not to be used as a sexual aide, mmmkay?

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Uh, should I even ask ... ?

You can ask. Yes.

Pt apparently believed that craft glue and KY jelly are interchangable.

IdiotBoxen said:

Pt apparently believed that craft glue and KY jelly are interchangable.

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Some people just have to learn the hard way

#1- That it's possible to (try to) walk around a yard without a face. It was a failed suicide- gunshot wound to the face, everything from the superior margin of the left orbit over to medial margin of the right orbit down to where the nares should have been was gone.

I was the EMT-I on the call and we pulled up and this guy was in the yard trying to get away from the cops. We had to tie him down just so we could try to control the bleeding and get him to the hospital. I'm still amazed he lived, but I would loved to have been in with OMS guys on the reconstruction of that guys face.
-----------------------
#2- That if you are a lieutenant colonel and you're going to shove your pager (his military issued pager complete with the clip holder thing) up your ass, and need to go to a hospital to have it removed, a few pointers:
a. Don't go to a military hospital
b. If you are going to go to a military hospital, remember not to go to the one on the base you work at.
c. The respiratory therapist (me) shouldn't be asking you for the pager number, not even "because we have to have the number for the report."
d. Don't be surprised when the ER staff amuses themselves for several hours while waiting on an OR to become available, by paging you repeatedly and watching you jump.

Fiat justicia ruat coelum.
(let justice be done, tho the heavens fall)

Thank you for the correction.....I just wrote it the way it was written on the office door of one of the foreign language professors.

Don't eat fentanyl patches.

(Actually, this one could land you beyond the ED ... the path resident at the ME's office had a wtf moment when he collected the stomach contents and found a small plastic sheet. He then slowly turned to look at the bag of meds that accompanied the body ...)

I haven't read the entire list, so sorry if there are repeats from others. Here is just a short list from a many memories...



1) Clorox is not a great substance to kill yourself with. It is also impossible to deny that you just drank it as the smell will permeate you breath for quite some time.

2) Hydrogen peroxide is not a good substance for a suicide candidate either. Although it is difficult to smell, the foam coming from your mouth will probably give you away.

3) TCA's however, are surprisingly effective, even if you didn't intend for them to be.

4) Don't expect sympathy when you call for an ambulance at 3am because you cannot sleep; "That's funny, neither can I...."

5) Never tell anyone in emergency services that you only had the amazingly common amount of "Two beers." They will not believe you. Personaly I would prefer to tell a state highway patrolman I had four than to say two, even if it is the truth.

6) Do not assume that just because pedestrians have the right of way that cars are obligated, or even capable, of screeching to a halt to allow your safe passage. Famous last words: "I don't care about that car, he's gotta stop."

7) The more fractures you have, or the more pain you are experiencing, the less you she scream profanities and insults at the person that is considering how much morphine to give you.

8) Likewise, don't assume emergency personel are obligated to care for you when you are cursing them and making threats. I told a gunshot patient with a briskly bleeding leg wound after being cursed and threatened repeatedly, as I stood back with my arms folded, "You are the one bleeding to death, not me." You'd be surprised how much a statement like that can change someones demeanor.

9) Sometimes bulky dressings just do not work to stop arterial bleeding. Surprisingly, sticking your finger in the hole does.

a_ditchdoc said:

5) Never tell anyone in emergency services that you only had the amazingly common amount of "Two beers." They will not believe you. Personaly I would prefer to tell a state highway patrolman I had four than to say two, even if it is the truth.

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A good list, thanks!

And you are right on about the "two beers" - unless the patient decides to "really tell you the truth", and that it was 3 beers. I still marvel with incredulity at the pedestrian struck 13 years ago that told me he had "about 10 beers". I've developed a way I ask the patients who say they drink "occasionally" - I say, "how often is that? For some people, every day is an occasion!". (I say it in a very charming way.)

IdiotBoxen said:

You can ask. Yes.

Pt apparently believed that craft glue and KY jelly are interchangable.

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Though I can see why the pt may think that since KY jelly does turn superglue like (very non lubricatory) after using it for a few minutes when the water evaporates/is absorbed... So, they might think hey craft glue does the same thing!!?!

When you and your buddy have a few beers [that would be two] and take the motorcycles out for a spin, and you see your buddy lose control of the bike and go careening off the road, don't follow him to see where he is going. (I don't know if I can communicate how funny this pair of matching traumas was).

If you are >70 years old, don't be anywhere near somebody unloading a tractor from a flatbed truck.

23 yo male, busy Friday night
PT: I just need my xanax refilled.
ME: no
PT: Its ok, its prescibed by my psychiatrist
ME: call him then
PT: I did, but he said he no because he was weaning me off them
ME: then why should I refill them?
PT: He said it would be ok just this one time
ME: Bye Bye!

Priceless: The look on the seeker's face when sees that you are the same ER doc he tried to scam narcs off of the night before where you moonlight!

Or the seeker that shows up in your ER with the wrist bands still on from the neighboring ER.

VienneseWaltz said:

Don't eat fentanyl patches.

(Actually, this one could land you beyond the ED ... the path resident at the ME's office had a wtf moment when he collected the stomach contents and found a small plastic sheet. He then slowly turned to look at the bag of meds that accompanied the body ...)

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Nooooooo, that isn't how it is done. Now they take a Duragesic 100mcg patch, freeze it, and use it PR.

Gahhhhh....

I also have a couple of patients that can take a vial of MS04, remove the drug, replace with tap water, and never remove the tamper proof cap. Apparently they use a 31g 1" needle and go at it. Don't think I have the skill to do it myself. I might try someday just to see if I can.

AzMichelle said:

Nooooooo, that isn't how it is done. Now they take a Duragesic 100mcg patch, freeze it, and use it PR.

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And here I thought you were supposed to brew tea out of it... silly me

Cockrings. One of the few reasons for a maintenance worker consult.

mike

Now THAT is an idea for a SDN t-shirt!

Yeah, I've also learned to be careful with nail guns. Once I cut a guys shoe away after pulling off a slab of plywood nailed to the bottom (his coworkers used a jig saw to cut him off the roof). It was a perfect shot right through the big toe. He had disabled the safety on the nail gun in order to work faster.

After a nerve block the doc thought it would be an easy task to just pull it out. Nope. 45 minutes, one maintenance guy, several odd tools, and a lot of pulling later, it finally decided to pop out (industrial vice grips were the magic tool). It had to have been a coated nail. I swear I thought the Doc was gonna pull his toe off. Toes really do have a remarkable tensile strength.

a_ditchdoc said:

Yeah, I've also learned to be careful with nail guns. Once I cut a guys shoe away after pulling off a slab of plywood nailed to the bottom (his coworkers used a jig saw to cut him off the roof). It was a perfect shot right through the big toe. He had disabled the safety on the nail gun in order to work faster.

After a nerve block the doc thought it would be an easy task to just pull it out. Nope. 45 minutes, one maintenance guy, several odd tools, and a lot of pulling later, it finally decided to pop out (industrial vice grips were the magic tool). It had to have been a coated nail. I swear I thought the Doc was gonna pull his toe off. Toes really do have a remarkable tensile strength.

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I had to call a maintenance consult last year for a teenage girl that had a sewing machine needle (thread still attached) through and through her index finger. The wire cutters for the K-wires didn't get it done, but the needle-nose pliers got a good grip, and, you're right - it did NOT want to come out. Finally, though, it just popped out.

mikecwru said:

Cockrings. One of the few reasons for a maintenance worker consult.

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Metal cockrings are so played out! The quick-release silicone doodads are the gold standard among pervs in the know, aren't they?

One thing I loved about watching residents go through training is that by the end, even the good small-town conservative females got utterly blase' about whatever oddball issue patients could come in with. God bless EM. Professionalism at the point of service, and merciless mocking only later.

a_ditchdoc said:

Yeah, I've also learned to be careful with nail guns. Once I cut a guys shoe away after pulling off a slab of plywood nailed to the bottom (his coworkers used a jig saw to cut him off the roof). It was a perfect shot right through the big toe. He had disabled the safety on the nail gun in order to work faster.

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I saw a guy who accidently nailed his patella to his femur with a 3" framing nail thus locking his leg in extension. I was amazed at how easy it was to just pull the whole nail out. He had disabled the trigger on his gun so that It would fire every time the sensor on the bottom of the gun detected it was against a flat surface. This allowed him to work much faster but also meant that when he was walking along carrying his nail gun hanging from his right hand and bumped it into his knee, bang! Ouch!


Something I learned last night: I don't care how hot your new girlfriend is discovering you are out of Viagra late friday night is not an emergency

AzMichelle said:

Nooooooo, that isn't how it is done. Now they take a Duragesic 100mcg patch, freeze it, and use it PR.

Gahhhhh....

I also have a couple of patients that can take a vial of MS04, remove the drug, replace with tap water, and never remove the tamper proof cap. Apparently they use a 31g 1" needle and go at it. Don't think I have the skill to do it myself. I might try someday just to see if I can.

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Ah. I guess we're behind the times here in Baltimore ...

docB said:

Let me begin by noting that this is actually something I learned from a random car owner, not a patient, and that my helipad is a fenced off area across the parking lot from my ER.

Don't park you car right in front of the gate marked "EMERGENCY HELIPAD NO PARKING AT ANY TIME ALL VEHICLES WILL BE IMMEDIATELY TOWED." You see, what will happen is that when a helo calls in security will go out to get the pad ready. When they find your car there they will call the police. Since neither the police or security can get a tow truck in the 10 minutes before the helo lands the cops will decide to let one of the security guards who owns one of those giant Ford F350 trucks that it jacked so high up in the air that it literally screams "I have a tiny penis!" throw a chain around your axel and jerk your car away from the gate. After they do this the cops will be happy to tow what's left of your car to the impound lot.

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Back from my days as a firefighter, I can tell you from experience that a 100' ladder truck IS an effective vehicle mover should you choose to park your car in front of a hydrant I need access to. Just FYI - if that security guard (with the F350) is not on duty next time, I'm sure your local FD can be there is <10 min.

- H

I take you've all seen that scene in Backdraft where they put the 5" supply line THROUGH the windows of the guy's car after he parked in front of a fire hydrant. Well, I've got one better. We did that to the chief's vehicle of another department (with whom we do not get along at all, not to mention that this particular chief is their training officer and a perfect example of the saying "Those who can't do, teach").

The jackass happened up on the structure fire (he was the first to call it in) and he proceeds to park in front of the only hydrant for three blocks in any direction. Needless to say that we made a point and put the supply line through the truck as a lesson. He wound up in handcuffs for threatening me (I was the ranking officer from my department and I was the one who ordered the windows knocked out to get access to the hydrant).

Not quite a doctor yet, but I've been working in ERs over the last year. I'm a med student to be in just 6 days! I saw a 50-something year old female that was on a huge list of psych meds and you could tell just by looking at her that something was off. She had recently had breast augmentation done by "some guy from New York." Now complained of gradually enlarging right breast. When she first came in, you could tell it was slightly enlarged and she was in a lot of pain. A little while later, her right breast was three times the size of her left breast. Unfortunately, I missed this next part while I was seeing another patient with the doc, but I heard a loud scream from her bed. Her breast just filleted open. At least after it happened, she felt way better. I guess in this case, we learn not to get breast augmentation done by "some guy from New York."

Police: Man's Testicles Locked In Padlock
Man Could Not Remove Lock For Two Weeks

POSTED: 4:02 pm EDT August 5, 2005
UPDATED: 4:15 pm EDT August 5, 2005

BRENTWOOD, N.H. -- Emergency workers helped a New Hampshire man out of a difficult situation over the weekend after a friend apparently locked a padlock around his testicles.

According to the Portsmouth Herald, police reported that the 39-year-old man was intoxicated when they arrived at the scene on July 30 at about 3:40 a.m. The man, who was not identified, told them that he had the padlock around his testicles for two weeks.

The man said that a friend put the lock on while he was drunk and passed out. When he woke up, the friend was gone.

"Never in my 13 years have I seen anything like this," Cpl. H.D. Wood told the Herald.

The man told police that he tried to remove the lock with a hacksaw because the key had broken off in the lock.

He was taken to Exeter Hospital, where a locksmith removed the padlock. He was treated and released, and the hospital said he had no lasting injury.

Police said that they did not know the motive for the incident.

my thoughts:
1: nice "friend"
2: I cringe at the thought of a drunken man trying to remove a lock around testicles with HACKSAW

If that had happened in Texas, the words "watch this" and "hold my beer" would certainly have been uttered right before a loud "click" was heard.

Take care,
Jeff

'Hacksaw' and 'testicles,' two words I would not like to see in the same sentance. But what about the two week wait there ... ?

Since we are talking about stupid things people do...

SEATTLE -- A Seattle man died after engaging in anal sex with a horse at a farm suspected of being a gathering place for people seeking to have sex with livestock. The horse involved in the incident was not harmed. An autopsy of the unnamed man concluded that "the manner of death was accidental ... due to perforation of the colon," a police spokesman said. Although sex with animals is not illegal in Washington state, investigators were looking into whether the farm allowed sex with smaller animals that resulted in animal cruelty, which is a crime. "If you're talking about sheep or goats, there could be some issues," said Sgt. John Urquhart of the King County Sheriff's department.


Here is a link

Jambi said:

Since we are talking about stupid things people do...

SEATTLE -- A Seattle man died after engaging in anal sex with a horse at a farm suspected of being a gathering place for people seeking to have sex with livestock. The horse involved in the incident was not harmed. An autopsy of the unnamed man concluded that "the manner of death was accidental ... due to perforation of the colon," a police spokesman said. Although sex with animals is not illegal in Washington state, investigators were looking into whether the farm allowed sex with smaller animals that resulted in animal cruelty, which is a crime. "If you're talking about sheep or goats, there could be some issues," said Sgt. John Urquhart of the King County Sheriff's department.


Here is a link

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Ok -- now how did the man's colon get perforated (Please don't tell me the horse had anything to do with it)? Sex with small animals is cruel and illegal, but sex with larger animals is not illegal?? Are we to surmise that larger animals enjoy the sex? This disturbing little story raises too many questions for me.

emedpa said:

another important lesson: if you are a womean with a clitoral hood piercing you should not have intercourse with a man with a prince albert penile piercing

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who won the tug-of-war/love? I'm guessing the man.

emedpa said:

another important lesson: if you are a womean with a clitoral hood piercing you should not have intercourse with a man with a prince albert penile piercing

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Talk about ruining a good time.

Told to me by an Appalachian ED nurse:

If you have vaginal vault prolapse, it is a good idea to put a potato up your vagina to prevent the walls from collapsing. After you've left the potato in there long enough that it begins to sprout, take yourself into the local ER and exclaim, "There's a tree coming outta my virginy!"

drshorty said:

Told to me by an Appalachian ED nurse:

If you have vaginal vault prolapse, it is a good idea to put a potato up your vagina to prevent the walls from collapsing. After you've left the potato in there long enough that it begins to sprout, take yourself into the local ER and exclaim, "There's a tree coming outta my virginy!"

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I read that in a book somewhere too.

Here's the book

I learned last night that things could always be worse. 30y IDDM on an insulin pump, 5 days post partum by crash c-section of a 35 week baby with hypoplastic left heart went into failure from a blown out MR valve and idiopathic cardiomyopathy.