Things I Learn From My Patients

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Im a pc helpdesk tech by day and volunteer emt-b by night. Basicly my life is nothing by problem solving. This thread is awesome. Im going to add a story or two... bad spelling and all.

Before taking 2 bottles of oxycodone squeeze yourself into your dirtiest spandex pants, stained t shirt and naturally yellowed sports bra. Then waddle out to your standard cab ranger and wedge yourself behind the wheel. After you've done your best to immitate a sardine drive to a newly created road and call your ex boyfriend and tell him your going to kill yourself. This makes life intresting for everyone involved.

On the plus side i now know i can lift 300+ pounds.

I had a emt student ride along that day. She was still in high school. I had her cut the clothes off but she kept the sports bra on. After we dropped the woman off i asked her why she did that. Her response was " I didnt think anybody wanted to see that.". She going to do great in EM.

Originally Posted by BKN

What I learned from my patients back in the 70's was to fear the Big Black Guy that was terrorizing the East Coast:

The guys is, unfortunately, still roaming around.

I recieved a call early one morning for a sick/injured person, "unknown problem, needs an ambulance." I arrived to a rural home to find a 40ish year old white guy lying on the floor of his living room. He looked baaaad. I asked his wife what happened to him as I started examining him, noting to myself two bullet wounds, one each in his chest and abdoman. Wife: "He called me from a pay phone. I went to pick him up and this is how I found him. He said he had been kidnapped" I'm not very comfortable wihth the environment so I load this guy really quickly and start care as the police arrive. The guy is still concious with a a crap pressure, tachy, and tension pneumo...so lines/decompression etc....on the way to the hospital. I note that the two bullet wounds appear to be in different stages of healing. One wound is fresh and the other, the abdominal wound, looks quite a bit older with dark crusty blood around it. He also seemed very dry for a guy with acute bleeding. Me: "What happened?" Him (struggling): "I was kidnapped ...by some... big black guy. I tried to escape... and he... shot me." Me: "You are really sick, we are going to do everything we can for you, but you need to know I might be the last person you get to tell the real story to...last chance." Him: (pause) "Yeah...it was...some black guy."


I kind of thought that he was involved in drugs and some deal probably went bad. But, I was wrong. His disgruntled wife shot him the previous night in the stomach in an effort to kill him. She waited patiently...all night long...no luck...the guy just laid there moaning. She finally got up the nerve to shoot him again the next morning. Still no luck, but he's looking like he might die any time now. So, she calls a friend to help her move the body into the grave she had already dug out back. The friend, feeling in a bit of a pinch, calls 911 and tells them "Someone needs an ambulance!"

So, I have learned a lot in my years of EMS:

1) If someone says they have had "two beers", they are lying. (No relation to the story by the way, just the most commonly heard lie)

2) If some white guy ever tells me it was "Some black guy(s)", even if I witnessed the beating myself, I will be skeptical.

3) That I am not stoic, macho, or loyal to my significant others. I am entirely certain I would have been screaming with my last breath "That bitch shot me.......it was her...twice...tell the police..."

I've learned that alot of women develop trouble breathing shortly after they have a fight or break up with thier boyfriend. I call this Hysterical Female Syndrome or HFS for short.

I'll bet you do real well with the ladies

-Mike

Originally Posted by JaySin

I've learned that alot of women develop trouble breathing shortly after they have a fight or break up with thier boyfriend. I call this Hysterical Female Syndrome or HFS for short.

In one of the REALLY old St. John Ambulance first aid training books (from the early 1900's) it talks about Hysteria. It says something about it usually being noted in young females. One of the treatments is to slap her across the face!

Originally Posted by tiger_lily

In one of the REALLY old St. John Ambulance first aid training books (from the early 1900's) it talks about Hysteria. It says something about it usually being noted in young females. One of the treatments is to slap her across the face!

That's nearly as offensive as "status hispanicus"

In regards to the above, as one of the pulmonologists I used to work with (he's Cuban and the one who introduced me to the above name for this "condition") was fond of saying: "Never forget you can't spell 'Hispanic' without panic".

Originally Posted by tiger_lily

In one of the REALLY old St. John Ambulance first aid training books (from the early 1900's) it talks about Hysteria. It says something about it usually being noted in young females. One of the treatments is to slap her across the face!

We stopped doing it because we can't bill for it anymore.

But every doc has stories about it working, like a precordial thump . . .

mike

Originally Posted by mikecwru

We stopped doing it because we can't bill for it anymore.

But every doc has stories about it working, like a precordial thump . . .

mike

I find the a punch to the solar plexus works equally well in either condition, and actually has more clinical effect than a standard precordial thump. Especially if you follow through with WWE style flying elbow to the throat once they are down (in the case of hysterical pt). This step may be omitted if ROSC is obtained in the cardiac arrest patient.

Originally Posted by tiger_lily

In one of the REALLY old St. John Ambulance first aid training books (from the early 1900's) it talks about Hysteria. It says something about it usually being noted in young females. One of the treatments is to slap her across the face!

Considering the origins of the hysteria diagnosis, I'm not really surprised.

Where can I find a dr that treats hysteria like that?

Originally Posted by Dianyla

Considering the origins of the hysteria diagnosis, I'm not really surprised.

I'll treat hysteria like that.

Originally Posted by doctawife

Chief complaint. Docs are supposed to put the chief complaint in the words of the patient, eg. 'my back hurts' etc... but that stops sometime after the third year in med school. Everything pretty much gets shortened to some kinda medical slang - RADE (reactive airway disease exascerbation) or CP (chest pain) and so on.

In some places, the nurses write the chief complaint, and they do stick to the patient's own words. Which is when the fun ensues!

Had to laugh out loud yesterday. Out of the thousands of chief complaints I've transcribed in ER reports, I finally came across the most original: The attending dictates the patient's chief complaint was "Go to Hell".

Yes, he ended up with a free ride over to the local funny farm in 4-point restraints.

Originally Posted by DropkickMurphy

I'll treat hysteria like that.

Originally Posted by Level_II_Trauma

Had to laugh out loud yesterday. Out of the thousands of chief complaints I've transcribed in ER reports, I finally came across the most original: The attending dictates the patient's chief complaint was "Go to Hell".

Yes, he ended up with a free ride over to the local funny farm in 4-point restraints.

I got written up once for vulgarity in an EMS run report when I charted the patient's chief complaint as "Let me go you f--king pig! I don't know nothing about those motherf--kin' drugs!"/Cardiac arrest due to drug ingestion

Originally Posted by HIANMI

PM me and we'll schedule an appointment

Originally Posted by DropkickMurphy

I got written up once for vulgarity in an EMS run report when I charted the patient's chief complaint as "Let me go you f--king pig! I don't know nothing about those motherf--kin' drugs!"/Cardiac arrest due to drug ingestion

I don't know about EMS run sheets (reports) but I do know if it's a direct quote from the patient, it is acceptable to repeat the exact content of what was said in your medical report. Sometimes it's the only way to get an accurate description of the patient's demeanor and abusive behavior towards the staff and can legally validate why a patient is restrained, either physically or chemically...or both!

Just gotta work around those open-door county hospitals long enough and you stop being conservative about how you document patient behavior!

Originally Posted by Chronic Student

I'll bet you do real well with the ladies

-Mike

Im sorry that i dont have that much sypathy for a pt. thats CC is a direct result of her crying. Maybe next time i'll have a cry with them. Or maybe i would cry after one of the following...

A. While driving 70mph in a 10,000 pound vehical thru red lights and traffic i or another driver wrecks and is hurt or even killed.

B. While im attending to little miss lonely girl someone has a real emergency and suffers because it takes to long for another unit get to them and help.

Originally Posted by DropkickMurphy

I'll treat hysteria like that.

But who would charge who?

Originally Posted by DropkickMurphy

PM me and we'll schedule an appointment

What health insurance do you accept? I'd like to schedule for an appointment

Originally Posted by JaySin

But who would charge who?

How about pro bono work...with the assurance no one involved will get sued for something stupid.

PM me then LOL.....as Hianmi said....pro bono

Originally Posted by Level_II_Trauma

I don't know about EMS run sheets (reports) but I do know if it's a direct quote from the patient, it is acceptable to repeat the exact content of what was said in your medical report. Sometimes it's the only way to get an accurate description of the patient's demeanor and abusive behavior towards the staff and can legally validate why a patient is restrained, either physically or chemically...or both!

Just gotta work around those open-door county hospitals long enough and you stop being conservative about how you document patient behavior!

I'm not conservative at all about it. It was the new RN who got all uppity about how I charted. Our medical director told her to shut up.

Originally Posted by DropkickMurphy

I'm not conservative at all about it. It was the new RN who got all uppity about how I charted. Our medical director told her to shut up.

Didn't mean to imply you personally were being conservative, just in the general sense. Obviously, you weren't conservative at all in that you didn't hesitate not to censor your report. I can relate regarding the "new" RNs reaction, a lot of them seem to think they know all aspects of medicine, including the business/liability aspects. Some of them don't have a clue regarding the fact that, if you get your ass hauled into court over a particular case like this, you don't want to have to "ad lib" what the 5150, or meth-psychotic (or just the ******* patient), was screaming at the staff. You want to have it down on paper, in black and white, right in front of you, and the best way to do that is to document exactly what happened at the time it happened.

Right on for your medical director. He/she knows their stuff!

I have learned that a 5 year old child with bilat. Femur Fx's can be loaded in the car since the cost vs. his health condition is much more important. The incident:

a few years ago while doing volunteer ski patrol we had a 5 year old kid with bilat. femur fractures and had been knocked unconscious. His parents were and insisting there was no way we were going to load him into the air ambulance because he didn't have the money for the bill. Of course parent's didn't get their wish on that one. Ironic that the child was on a state funded medical type program (not insurance), but they were at a ski resort on rental equipment which surely cost them $76+ per person, perhaps a little less for the little guy on an advanced slope beyond his abilities, and the cost of the gas to drive approx. 180 miles to the aforementioned ski resort. Parent's also were worried that the state medical wouldn't pay for the bills because they were skiing in another state.

Originally Posted by BTTiger

a few years ago while doing volunteer ski patrol we had a 5 year old kid with bilat. femur fractures and had been knocked unconscious. His parents were and insisting there was no way we were going to load him into the air ambulance because he didn't have the money for the bill. Of course parent's didn't get their wish on that one. Ironic that the child was on a state funded medical type program (not insurance), but they were at a ski resort on rental equipment which surely cost them $76+ per person, perhaps a little less for the little guy on an advanced slope beyond his abilities, and the cost of the gas to drive approx. 180 miles to the aforementioned ski resort. Parent's also were worried that the state medical wouldn't pay for the bills because they were skiing in another state.

Well, the only thing that would make the story acceptable is IF the family went skiing on one of those 'buy a tank of gas and ski for free' deals that northeastern gas stations did in the mid-1990s.

I got my hubbie hooked on snowboarding courtesy of Shell 'round about 1996.

Originally Posted by BTTiger

I have learned that a 5 year old child with bilat. Femur Fx's can be loaded in the car since the cost vs. his health condition is much more important. The incident:

a few years ago while doing volunteer ski patrol we had a 5 year old kid with bilat. femur fractures and had been knocked unconscious. His parents were and insisting there was no way we were going to load him into the air ambulance because he didn't have the money for the bill. Of course parent's didn't get their wish on that one. Ironic that the child was on a state funded medical type program (not insurance), but they were at a ski resort on rental equipment which surely cost them $76+ per person, perhaps a little less for the little guy on an advanced slope beyond his abilities, and the cost of the gas to drive approx. 180 miles to the aforementioned ski resort. Parent's also were worried that the state medical wouldn't pay for the bills because they were skiing in another state.

it's not an uncommon concern for parents to have. also, some medschool parents are able to get their kids on medicaid because they make under the allowable income-- so not everyone on medicaid may fit what you've seen before. either way i don't begrudge low income families a family vacation. for all you know they may have saved all year for it.

i understand your venting, but try not to be *that* jaded already, lol.

--your friendly neighborhood pediatric caveman

Originally Posted by Homunculus

it's not an uncommon concern for parents to have. also, some medschool parents are able to get their kids on medicaid because they make under the allowable income-- so not everyone on medicaid may fit what you've seen before. either way i don't begrudge low income families a family vacation. for all you know they may have saved all year for it.

i understand your venting, but try not to be *that* jaded already, lol.

--your friendly neighborhood pediatric caveman

What? No witty signature sign-off this time, my anatomically disproportionate friend?

If your female loved one is prone to grand mal seizures, do not, i repeat do not engage in oral sex

Thanks for that mental image.

Would you like mustard and sauerkraut with that ma'am?

-Mike

I'm not a doc but I did learn something from a casual friend of mine...


When you start off your day at 6AM to travel on buses and walking outside most of the day and haven't had anything to drink on a very hot day... you're prune to suffer from severe dehydration. YOU MUST drink Lots of fluids! Take a few bottle of waters with you when traveling.

Originally Posted by Anuwolf

I'm not a doc but I did learn something from a casual friend of mine...


When you start off your day at 6AM to travel on buses and walking outside most of the day and haven't had anything to drink on a very hot day... you're prune to suffer from severe dehydration. YOU MUST drink Lots of fluids! Take a few bottle of waters with you when traveling.

Really? Who woulda thunk it!!

Originally Posted by Anuwolf

I'm not a doc but I did learn something from a casual friend of mine...


When you start off your day at 6AM to travel on buses and walking outside most of the day and haven't had anything to drink on a very hot day... you're prune to suffer from severe dehydration. YOU MUST drink Lots of fluids! Take a few bottle of waters with you when traveling.

This thread has gone downhill. I was waiting for the punchline, something to show how idiotic the patient was but I have to confess that I, myself, have been dehydrated and even suffered heat exhaustion on more than one occasion.

"Some dude stole my water bottle while I was standing on the corner minding my own business."

I think the problem with this thread is that nobody has any good stories.

I did ask one of my patients if she had black stools to which she replied, "No, but my boyfriend has a brown couch."

don't try to get "high" off of anything containing tylenol with your 15 year old girlfriends at a sleepover. you will just end up very very sick and get to drink a lot of charcoal, leaving you looking quite hot with that charcoal mustache.

Originally Posted by joanofarc0907

don't try to get "high" off of anything containing tylenol with your 15 year old girlfriends at a sleepover. you will just end up very very sick and get to drink a lot of charcoal, leaving you looking quite hot with that charcoal mustache.

You have to love stupid teenagers

Originally Posted by Anuwolf

you're prune to suffer from severe dehydration. YOU MUST drink Lots of fluids!

That is one of the funniest typos I've seen though.

A couple...
Do not jump feet first from a second story. Bilateral calcaneal fractures, bilateral femur fractures, and a stable pelvis fracture do not make depression better.

On OB, a patient comes in with severe von Willebrand's disease. As in, <1% activity, or a better way to put it, her hematologist showed up before the MFM who was to deliver her. During a prior delivery she was bleeding out her eyeballs and almost died. So for this one, after getting recombinant factors, and sewing up an actively bleeding labial lac while the first 2 of 4 units of blood are going in, she asks, "Can I go outside and smoke a cigarette?" When told she was receiving blood products, she said, "I can take the blood outside with me, just put it on that rolling pole."

Bilateral calcaneal fractures

Ah, the whorehouse fracture.

It is never smart to go swimming when drunk...and it's really not a smart move to dive into the end that's only 4 feet deep.

Originally Posted by DropkickMurphy

Ah, the whorehouse fracture.

Explain.

Originally Posted by indo

Explain.

I'm guessing it comes from jumping out the whorehouse window to avoid being caught.

Originally Posted by IbnSina

I'm guessing it comes from jumping out the whorehouse window to avoid being caught.

I follows the same lines as the rule that if you have bullet holes in your butt but not in your pants don't even bother trying to make up some bogus story.

Or, if you're gonna tell us that you got that tamponade from "falling on a knife," you need to think of an explanation for the second stab wound, because we MIGHT ask how it got there. Gotta love trauma surg at the county hospital

If you're going to strap on a parachute and jump out of a plane, its a good diea to aim for the landing zone. 150-foot trees are difficult to climb. Oh, and you WILL be incessantly mocked by your buddies once we get you down. Jumper was completely uninjured, by the way.

if you google "whorehouse fracture" you only get 1 meaningless result. I think that guy made it up.

Originally Posted by IbnSina

I'm guessing it comes from jumping out the whorehouse window to avoid being caught.

At least that's what I was told by an orthopedic surgeon once when he was showing me an x-ray of a guy with calcaneal fx.

Originally Posted by docB

That is one of the funniest typos I've seen though.

I'm glad you've enjoyed my typo

So tell me do you like Prunes?

Originally Posted by DropkickMurphy

At least that's what I was told by an orthopedic surgeon once when he was showing me an x-ray of a guy with calcaneal fx.

Whether it was made up or not. Its catchy and I understood it right off the bat.

Somebody has to make this stuff up so we can have new pimp questions!

-mike

Concur with above. It made perfect sense to me.

Just like a "Janitor's fracture" is any fracture so obvious that it can be spotted from ten feet away, by someone with no medical training whatsoever, who merely glances at the radiograph while emptying the trash bin.

If your a 15 yo confused little Emo kid it is probably not the best idea to snort ambien right before your mom comes in to kiss you goodnight. But if you do please don't be suprised when she calls an ambulance because she found you passed out of the floor. Also don't be suprised that the medic taking you to the hospital really doesn't care that you where trying to find the proper dosage that would give you a trip much like mushrooms but not make you pass out and forget the last 12 hours. But be aware that said medic and hospital staff will be highly amused as you look under your hospital bed for the motor that is holding you up, and lastly understand that from this day forward you will be knowen as Ambien boy