Things I Learn From My Patients

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Turn of the snowblower before you try to manually disimpact it.

When crossing the US - Mexico border be cautious of the minutemen.. They (someone) fired a high powered rifle thru this guys femur!

If you have a cyst on your face and are scheduled for surgery to get rid of it, by all means, pop it in front of a mirror, at home, with your "friend" videotaping.

Be sure to say "I swear to god, I'm not going to need the surgery" while your friends retch in the background.
Then, wait a week - by which time you will have a fairly large staph infection taking up a quarter of your face (that's a bad thing, right?) - and take a picture.

Since you're in the younger generation, by all means, post it on the Internet. http://www.liveleak.com/view?i=e240c00440

This may be fairly disturbing, but I'm sure you folks have seen worse. The retching and flying pus might get to you though.

Best part of the video is the picture of the staph infection (including a good bit of swelling around his eye) at the very end. I'm no doctor, but do ya think that could of been cleared up with only antibiotics?

BTW, this thread - Awesome. Sad in some parts (the wife of the burned soldier was pretty depressing)

Originally Posted by loraksus

Best part of the video is the picture of the staph infection (including a good bit of swelling around his eye) at the very end. I'm no doctor, but do ya think that could of been cleared up with only antibiotics?

The secondary cellulitis? Yeah. The primary lesion, without seeing it, I would venture a maybe. Usually I&D works better though (even without ABx). I can't diagnose a man I've only seen in a mirror on camera through the internet though. It would render a hole in the fabric of space.

My recent story... (personal experience, yeah, I know I'm brilliant...)
When doing electrical work while renovating a bathroom, make sure that your alcoholic dad turns the power back on.
Then, after you come to an unknown number of minutes later, seated on the floor and not realizing what the hell has happened, don't bother to go and see a doctor until you break your hand 4 days later.
ER doctors love that and will tell you that you made an extremely wise choice in not dropping by...


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And another... from years back while in Cadets up here in Canada (or, why my experiences at summer camp strongly influenced my decision to not to go into the military)

Not really my patient (although I did get my first aid qualification a few weeks earlier and I did tell everyone to get the hell out - having uhh, some previous experiences with chlorine gas)

By all means, when cleaning the head, pour a bit of bleach into an ammonia bottle. If it starts to get warm and starts making gas try to "put it out" with more bleach (cause, you know, it looks sort of like water and must work the same way)

Even better, do it while several people are taking a shower and in their frantic attempts to run out, one guy slips and rips his scrotum open on the shower drain.
Do this just as I walk in to pull your dumb ass out of there so I get to see the most horrifying and emotionally scarring thing that I've ever seen at that point in my life.


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On a somewhat related topic...
It's also really cool to run around with a broomstick in the shower and poke people in the behind. Especially if you get splinters in someone's derrière that requires a trip to the doc.

Getting arrested at 14 by MPs, chewed out by a extremely pissed off RSM and threatened with time in a military prison is something that everyone should experience in their early teen years.
Oh, your parents will really appreciate that the military flew you back home on a military aircraft, especially when they get the bill for the transport and for the medical treatment of the victim.

Originally Posted by loraksus

Even better, do it while several people are taking a shower and in their frantic attempts to run out, one guy slips and rips his scrotum open on the shower drain.
Do this just as I walk in to pull your dumb ass out of there so I get to see the most horrifying and emotionally scarring thing that I've ever seen at that point in my life.

Ow

Originally Posted by MirrorTodd

Ow

I've heard that story before.

Originally Posted by loraksus

Even better, do it while several people are taking a shower and in their frantic attempts to run out, one guy slips and rips his scrotum open on the shower drain.

We had a guy come into the ER after crashing his bike into a chain link fence, his only injury was an ?avulsed? scrotum. Either way it was ripped open and his "little guy" was hanging out. The docs were verrrrrry generous with the pain meds, lol.

Originally Posted by Taaki

We had a guy come into the ER after crashing his bike into a chain link fence, his only injury was an ?avulsed? scrotum. Either way it was ripped open and his "little guy" was hanging out. The docs were verrrrrry generous with the pain meds, lol.

Owwwwwww......pardon me but DAMN. OWWWW!

Soooo...I've officially spent hours here that I should have spent reading my text for class next week instead. Great stuff!!! Thanks for all who have contributed to my procrastination!! Now that I'm finished, I think I hear Cecil's and Henry's and Mosby's calling my name!!

Don't jerk off with a foley in place.


mike

Originally Posted by mikecwru

Don't jerk off with a foley in place.


mike

I have to admit I'm curious. What happens if you do?

Is it impossible to orgasm that way? Nevermind the pain, but where would the semen go? Assuming we're talking about a guy here.

After your suicide attempt, check into the ED with your brother's name. No one will eeeeeever pick up on that and your brother totally will not mind.

Sticking your fingers up your butt and pulling stool out and wiping it all over your bed and everything within reach is a great new hobby. And roommates love the odor.

If the fentanyl patch isn't working well enough, just eat it.

A blood transfusion running into your arm vein can directly exit through your anus. Who knew?

Originally Posted by ERMudPhud

I have to admit I'm curious. What happens if you do?

Thank God.....that means I'm not the only one wondering that.....

Originally Posted by ERMudPhud

I have to admit I'm curious. What happens if you do?

You'll dislocate the foley and gum up the inside of the foley so it won't drain.

Plus, you'll provide hours of laughs for the attending ED doc on overnight.

mike

If you (41 year old female) come in with terrible stomachache and you are worried that it is some cancer and we pull out a condom.. don't accuse us of planting it there..
It's your problem if your husband doesn't use them

Or if the police drag your overdosed father into the ER combative and in cuffs, Once we call the code and pronounce him is the perfect time for the toothache/chronic back pain/carpal tunnel kids (yes, all three of them) to check in to be treated.

And hey, mom may as well get some ativan for the funeral while we're all here, right??????

(

Originally Posted by DrQuinn

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

Mine was a 38 yr old female crack addict who gave discounts for the colostomy cuz she "dont have to take my pants all off"

rural south georgia

Dont think for a minute this hasn't been considered. We in Texas believe every patient has the right to a REAL reason to visit the ER and some nights wouldn't mind giving them one.

Kinda like when dad used to say "stop whining before i give you something to cry about" i reckon

How about a co-worker with a near complete BKA from a rotary mower she lay trapped under for 3 hours. Thank God she had the fortitude to use her shredded blue jeans as a tourniquet...... Her request on arrival to ER: "can you just put some lidocaine in it for me?"

The doc's name was brown, but I dont recall the name of the book. It also highlighted the story of a lady with purple vaginal discharge. Her OB/GYN had recommended using "jelly" as a lubricant and she chose grape........ go figure

Originally Posted by Silvertip

I once read a book written by an ER doc in which he told the following story (in my words):

Woman comes into the ER. States that she has a sore belly/abdomen. A pelvic exam reveals some interesting findings. First, her vaginal vestibule is being held closed with a number of safety pins that are beginning to rust (if I remember correctly). When these are removed, several pieces of chicken- presumably making up a whole bird, were subsequently removed from her vagina. She then revealed that she was desperate to get pregnant, and thought that shoving a chicken "up there" and fastening it closed woud do the trick.

I'm not kidding- I read this book many years ago, and this story has stuck with me since. Anyone else read this anecdote? I think the doctor's name was Brown- maybe not?????

Originally Posted by f4nt4

Dont think for a minute this hasn't been considered. We in Texas believe every patient has the right to a REAL reason to visit the ER and some nights wouldn't mind giving them one.

Kinda like when dad used to say "stop whining before i give you something to cry about" i reckon

You, uhh, may want to kind of quote the posts you're replying to, so people aren't so confused

Originally Posted by loraksus

You, uhh, may want to kind of quote the posts you're replying to, so people aren't so confused

Are you sure that'll help? Aren't we all in a perpetual state of confusion??

Originally Posted by loraksus

You, uhh, may want to kind of quote the posts you're replying to, so people aren't so confused

There was an issue with the servers. He/she probably did quote the post they were referring to.

- H

I actually in a (and only once) replied to a pt asking ME to tell HER why she came to the hospital sweetly replied "Hun, this is the ER, not psychic friends network"

Imagine my surprise at earning a 3 day vacation for that.......

Originally Posted by docB

If you're a crotchety old lady and you called 911 to have the ambulance bring you to the ER you probably shouldn't take the attitude "I don't know nuthin' 'bout 'nuthin and I ain't answering no questions no how." It really makes it tough to figure out what to do with you.

My new favorite is an original that just fell out of mouth one night...
FTI (Failure to Impress)

I have found it to be quite an effective diagnosis for a large majority of ER pts

Originally Posted by Annette

My attending enlightened me today to an almost house-universal dx: resistant to common sense.

This totally does not give adequate credit to the pt with multiple abcesses who is allergic to "some kind of antibiotic"

Originally Posted by v-tach

I know what you mean with that. It drives me crazy when I am on a squad call and ask a pt what medications they take and they respond with "some heart pills" or "blood pressure medication" or some completely non-helpful answer like that.

Your lady is alive and well in Texas, I see her about twice a month out here.

Originally Posted by stoic

this one takes some sort of cake guys. i don't know what i learned from her, other than some people are just unbelievablely stupid.

44 y/o frequent flier. previously diagnosised CAD... BUT has refused to get cathed (i don't know why they didn't do it at the same time as the angiogram either). lives on a diet of fast food and cigarettes and comes to the ED several times a month complaining of severe chest pain. obviously this isn't someone you can just let walk out the door, seeing as how she could have an AMI at any time. she's openly non-compliant with her meds (she can't afford them... wouldn't want to take away from her big mac's and cigarettes), and says if you try to admit her she'll sign out AMA (she's done so many times before... as soon as she gets moved onto the floor she bolts). however, she demands that you treat her chest pain. 20mg's of MS (that's right, 20... it takes a lot when you weight 350lbs) she's getting "some" relief but still having chest pain. the best we've ever been able to do is get the pharmacy to fill some of her meds for free and have her sign out ama from the ED. I haven't seen heard anything about her in awhile and honestly i don't know if that's because she got tired of us being rude to her or if she finally died.

this patient =

Originally Posted by f4nt4

Your lady is alive and well in Texas, I see her about twice a month out here.

Oh, sure. Bring all the crazy ones to TX.

Originally Posted by f4nt4

This totally does not give adequate credit to the pt with multiple abcesses who is allergic to "some kind of antibiotic"

And then there was the ER doc who asked me if I was "allergic to any antibiotics" -- just like that, and didn't listen to anything I said after "yes"

He stepped out of the room for a prescription pad and returned with a scrip for Erythromycin.

My response? "Yep, that's the one I'm allergic to."

The look on his face was priceless -- and yes, I know it's an uncommon allergy, but hey, I'm not allergic to ANY pain meds.

I learned 3 important lessons this week:

1. do not inject heroin mixed with meth INTO YOUR PENIS because you will develop chest pain and svt. after you are converted you will rule in by enzymes

2. do not smoke WHILE SIPHONING GASOLINE WITH YOUR MOUTH
(enough said...burn center...etc)
the tech asked me how tightly to wrap the neck burns with silvadene impermeated gauze...my response, "tight enough that he can't reproduce"

3. if you are a hardcore alcoholic with a blood alcohol 4 times the legal limit and a head injury the best way to get service is to threaten everyone in the dept while demanding a head ct from the front door. as soon as the head ct is ordered the best way to assure a timely study and appropriate intervention is to elope from the dept without notifying anyone on staff before the study is done.also give us a fake name and address so we can't find you to tell you that you are at high risk for a subdural bleed.

By now, we've all learned that our patients are never to blame for what they do to themselves. At least they're finally admitting it straight-up: Yesterday I saw a patient whose T-shirt read, "I am not responsible for my actions."

I wished I'd had on a T-shirt that said, "But apparently I am."

...that jumping out of a moving vehicle going 60+ mph isn't nearly as dangerous as it seems.

I've seen not one but three patients who have completed this maneauver and come out unscathed, just a few abraisions. Maybe I should give it a try...

Originally Posted by emedpa

1. do not inject heroin mixed with meth INTO YOUR PENIS because you will develop chest pain and svt. after you are converted you will rule in by enzymes

Well, if there are three things that make you happy in life, why not combine them all together?

Originally Posted by emedpa

1. do not inject heroin mixed with meth INTO YOUR PENIS because you will develop chest pain and svt. after you are converted you will rule in by enzymes

Anyone want to translate this part for those (like me) who have no idea what it means? Thanks!

Originally Posted by SailCrazy

Anyone want to translate this part for those (like me) who have no idea what it means? Thanks!

After your cardiac arrhythmia is corrected using an electric shock we will draw blood that shows elevated cardiac enzymes, thus proving myocardial infarction.

How's that?

Originally Posted by SailCrazy

Anyone want to translate this part for those (like me) who have no idea what it means? Thanks!

SVT = Superventricular tachycardia (fast heart rate)
converted = heart rate slowed by treatment with return of "normal" heart rate
ruled in by enzymes = evidence of a heart attack by presense of specific enzymes in the blood.

The patient in question damaged his heart by taking drugs.

- H

Originally Posted by f4nt4

I actually in a (and only once) replied to a pt asking ME to tell HER why she came to the hospital sweetly replied "Hun, this is the ER, not psychic friends network"

Imagine my surprise at earning a 3 day vacation for that.......

As a general rule, the better it felt when you said it, the more trouble it's going to get you into.

Sometimes, though, its just worth it. I HATE it when I ask a patient how I can help them and they say "I don't know, you're the doctor".

Psychic friends network. I like it. That may be worth a day off.

Take care,
Jeff

Originally Posted by socuteMD

After your cardiac arrhythmia is corrected using an electric shock we will draw blood that shows elevated cardiac enzymes, thus proving myocardial infarction.

How's that?

Originally Posted by FoughtFyr

SVT = Superventricular tachycardia (fast heart rate)
converted = heart rate slowed by treatment with return of "normal" heart rate
ruled in by enzymes = evidence of a heart attack by presense of specific enzymes in the blood.

The patient in question damaged his heart by taking drugs.

- H

Thanks! I was lost after svt.

http://forums.studentdoctor.net/showthread.php?t=362755 To continue thread

Wow. In after the lock.

Anybody know why the thread got split and locked? It wasn't even that long

Was it because my last remark was so lame?

I've killed threads before, sure, but damn!


So that it does not get lost into the ether: here's the famous original thread. http://forums.studentdoctor.net/showthread.php?t=257985

It looks like they're enforcing the 1k rule now. Threads that exceed 1k are getting closed. It used to be 10k.

Originally Posted by ERMudPhud

Anybody know why the thread got split and locked? It wasn't even that long

Threads that are over 1k apparently have a disproportionate impact on server speed, and they are limiting threads to 1k in order to keep the server moving quickly.

Originally Posted by Jeff698

As a general rule, the better it felt when you said it, the more trouble it's going to get you into.

Awesome! I'm totally going to steal this and put it in my signature!

When you are a parapalegic with a severe necrotic ulcer, flys may lay eggs in your wounds, leaving you with a maggot infestation and a free trip to the ED.

Originally Posted by Miami_med

When you are a parapalegic with a severe necrotic ulcer, flys may lay eggs in your wounds, leaving you with a maggot infestation and a free trip to the ED.

Maybe this was a therapeutic intervention! Weren't maggots FDA approved to eat away the dead flesh because they don't eat the fresh? Cleans it out for you!

I dunno about the FDA, but it worked for Russell Crowe in Gladiator--that's good enough for me.