Things I Learn From My Patients

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(all the disclaimers about exothermic reactions, etc., apply, of course :laughy

it will be aqueous solution

although I remember now that the buzzsaw thing is from the book Emergency and not from here
they used water cooling too

Things I learn:

When asked if you have ever had heart problems there is no need to mention the AMI and cardiac arrest you had two weeks ago. It's more fun for me to discover it on my own.

'I didn't think that was the sort of heart problem you meant.'

Originally Posted by CajunMedic

There you go, there's your research project for your residency!

This sounds much more interesting than my current project at the VA. Gonna have a chat with my attending.

Originally Posted by JustSpeechless

Things I learn:

When asked if you have ever had heart problems there is no need to mention the AMI and cardiac arrest you had two weeks ago. It's more fun for me to discover it on my own.

'I didn't think that was the sort of heart problem you meant.'

We had a patient with a CC of angina who declared he never had any surgical procedures done, but chest xray revealed a stent. He claimed he didn't know about it being done, and I actually believe him.

ok i looked it up and thiocyanate and oxalate are too irritating for this
however i found a paper on corrosion and this sentence in it:
'Thiosulfate and chloride clearly have a synergistic effect in inducing localized corrosion.'
also i have found that acid has a synergistic effect both with chloride and thiosulfate
so salt, sodium thiosulfate and (some) citric acid would do it
BUT
do not think things have finally become sensible
for I have saved the maddest for last
if a (small) metal object were scratched in many laces with a file and immersed in acid (an EDTA compound would accelerate this), the nascent hydrogen would diffuse into the scratches and combine into molecules inside the metal, forming tiny bubbles with [b][i]huge[i][b] pressure. you can guess what has been recorded to happen next...

Originally Posted by Unzbuzzled

This sounds much more interesting than my current project at the VA. Gonna have a chat with my attending.



We had a patient with a CC of angina who declared he never had any surgical procedures done, but chest xray revealed a stent. He claimed he didn't know about it being done, and I actually believe him.

You work in a VA hospital? Were you on the HPSP or something for school? I just signed on in the AF. What's it like working in a VA hospital I wonder?

Originally Posted by dudeliness

You work in a VA hospital? Were you on the HPSP or something for school? I just signed on in the AF. What's it like working in a VA hospital I wonder?

Military physicians do not cover VA hospitals. They are covered by civilian docs. How much do you know about the contract you just signed? Did you leam about GMO tours? The military match?

Originally Posted by Perrotfish

Military physicians do not cover VA hospitals. They are covered by civilian docs. How much do you know about the contract you just signed? Did you leam about GMO tours? The military match?

There are some dual VA-military hospitals - at least there used to be. I know Nellis AFB (NV) used to be one, I am not sure if it still is.

Originally Posted by Perrotfish

Military physicians do not cover VA hospitals. They are covered by civilian docs. How much do you know about the contract you just signed? Did you leam about GMO tours? The military match?

Apparently I know less than I should

Seriously, it is a bit surprising to learn that military docs don't work in VA hospitals, although I guess that does make sense since there aren't oodles of active duty docs...

Originally Posted by dudeliness

Apparently I know less than I should

Seriously, it is a bit surprising to learn that military docs don't work in VA hospitals, although I guess that does make sense since there aren't oodles of active duty docs...

hope you weren't betting on doing your residency in a VA hospital. I thought that was an option, and was considering applying for HPSP, but my army HPSP bf informs me it is not an option. So he has only like 6 programs to choose from, only 3 of which are somewhere I would not hate living

Dept of Veterans' Affairs is not part of DoD.

I learned from the VA that even though my lung damage happened in the Middle East, and my Flight Surgeon provided a letter stating sand and dust as the reason, it is a "pre-existing condition" as I'd previously been to the VA for an upper respiratory infection.

This is great

Originally Posted by dudeliness

You work in a VA hospital? Were you on the HPSP or something for school? I just signed on in the AF. What's it like working in a VA hospital I wonder?

Yeah I work at the FHCC in North Chicago, which is right next to chicago med. I'm just a student research fellow there for the summer, and I don't have any military experience. But it is right next to the Great Lakes Navy base, so all the recruiters are always trying to get us to join the Navy to pay back our loans haha.

Interestingly, my mentor at the VA was a ship's doctor during the Gulf War, and they made him the lone medical officer on his ship before he even finished his internal medicine residency. Imagine being the only doctor on a ship, heading to war, without ever really being in charge of your own patients before. I don't know if that's how they do things now, but I can imagine it was a real steep learning curve at the time. Yikes!

Originally Posted by Unzbuzzled

Imagine being the only doctor on a ship, heading to war, without ever really being in charge of your own patients before. I don't know if that's how they do things now, but I can imagine it was a real steep learning curve at the time. Yikes!

Yep, still is.

yes, a garder snake can fit in your urethra.

Originally Posted by austin4ski

yes, a garder snake can fit in your urethra.

Yeowch!

Not ER, but still a highly informational case where I was "lucky" enough to be an observer.

When you are a male going in for a simple, outpatient procedure involving your upper thigh, please empty your bladder completely and fully before being wheeled into the procedure room. Otherwise, this might happen....



Patient is brought in and prepped. Has opted for a light, conscious sedation with plenty of lidocaine. He is hooked to an IV at a high flow rate and given versed and fentanyl premedication. For some reason, the surgeon is delayed (discussing another case with a resident or something...) Anyway, just after the surgeon comes in, the patient asks for a foley.

You all know where this is going. But it's the details that make it sooooo much better.

Patient is asked how bad he needs to go. He says something non-committal. Surgeon says a foley is not indicated at this time. Procedure begins.

Procedure goes on for a half-hour or so, then the patient again asks for a foley. Nurse grabs a urinal and tried to get a response. However, the patient explains that he has a case of urinary retention and, being a second year med student, insists he knows a little bit about what he's talking about. Apparently some part of this goes over everyone's heads, because they leave the urinal nearby but do nothing more at that point.

Then two things happen at once. The surgeon asks for the urinal to be moved further from the surgical field, and the nurses switch shifts. In the confusion, somehow the urinal gets lost and the incoming nurse has no idea that the patient has complained of urinary retention while simultaneously claiming to know a little bit about said condition.

New nurse goes to assess the patient and finds him more responsive and oriented than she had anticipated. Patient asks her for a foley, as she is a new face and might say yes. Nurse says "the chance of UTI are very high," as rationale for denying the request. Someone else mentions "He's asked that twice already."

Apparently the new nurse diagnoses the patient with excessive nervousness or tension. She prepares a little bit more versed and fentanyl and tells the patient he's going to get a "little bit more medicine." Patient says "Okay."

The amount she gives is a tad more than was strictly needed. As a result, around two minutes later, the patient becomes incredibly and abruptly disinhibited as his urethral sphincter relaxes and releases a vast amount of pressurized renal filtrate. In the ensuing controlled chaos, the surgical site and surgeon get splashed. Also, the urinal can't be easily found, which results in a large amount of renal filtrate being absorbed by towels, sterile drapes, and running onto the floor. The chaos results in the patient giggling uncontrollably as if he's been given a large dose of opiates (...oh, wait... he has).

The surgeon has to leave the room to scrub up again. As he leaves, he barks orders to everyone in view. By the time he returns, the mess is cleaned up, all the sterile dressings have been changed, the patient is out cold, and there is a foley in place to prevent any of this from happening again. The rest of the procedure goes by swiftly and smoothly, with virtually no talking between anyone in the room. The surgeon is obviously frustrated, and he has enough clout that no one wants to risk annoying him more.





The lesson? Empty your bladder before your procedure, otherwise you may wake up and find yourself in recovery, with a foley in place, and more dope onboard than you ever anticipated.

...Oh, and a surgeon who doesn't want to speak with you for extended periods of time.

...And... you may be the joke of the ward for the next couple days.

Originally Posted by Dr Peper

The lesson? Empty your bladder before your procedure, otherwise you may wake up and find yourself in recovery, with a foley in place, and more dope onboard than you ever anticipated.

...Oh, and a surgeon who doesn't want to speak with you for extended periods of time.

...And... you may be the joke of the ward for the next couple days.

OK, you know what? He should have peed first, yes. But the real stupid here (IMO) comes from everyone in the OR who ignored his multiple requests for the catheter and ignored him when he said he's a med student and knew what he was talking about. Seriously, they're supposed to be medical professionals... what did they expect would happen at that point?

PS. And it sucks that they're making a joke out of the patient when all this could have been avoided if they'd just paid attention and done their damn jobs.

I just finished reading this whole thread and it is AWESOME.


I haven't shadowed in the ER yet, but my mom was an ER nurse for a while, and this is her favorite story:

If you are a teenage boy experimenting with fireworks, do not empty the gunpowder from a dozen fireworks and try to mix it in your mother's blender. But if you do decide to do that, don't hold the lid down with your other hand and stand right over it. This will result in the traumatic amputation of several fingers, burned and skinned forearms, glass shrapnel in your face, and a couple of badly scratched corneas as a start. You will spend months in rehab and never be able to use your left hand again.

Originally Posted by Dr Peper

Not ER, but still a highly informational case where I was "lucky" enough to be an observer.

When you are a male going in for a simple, outpatient procedure involving your upper thigh, please empty your bladder completely and fully before being wheeled into the procedure room. Otherwise, this might happen....



Patient is brought in and prepped. Has opted for a light, conscious sedation with plenty of lidocaine. He is hooked to an IV at a high flow rate and given versed and fentanyl premedication. For some reason, the surgeon is delayed (discussing another case with a resident or something...) Anyway, just after the surgeon comes in, the patient asks for a foley.

You all know where this is going. But it's the details that make it sooooo much better.

Patient is asked how bad he needs to go. He says something non-committal. Surgeon says a foley is not indicated at this time. Procedure begins.

Procedure goes on for a half-hour or so, then the patient again asks for a foley. Nurse grabs a urinal and tried to get a response. However, the patient explains that he has a case of urinary retention and, being a second year med student, insists he knows a little bit about what he's talking about. Apparently some part of this goes over everyone's heads, because they leave the urinal nearby but do nothing more at that point.

Then two things happen at once. The surgeon asks for the urinal to be moved further from the surgical field, and the nurses switch shifts. In the confusion, somehow the urinal gets lost and the incoming nurse has no idea that the patient has complained of urinary retention while simultaneously claiming to know a little bit about said condition.

New nurse goes to assess the patient and finds him more responsive and oriented than she had anticipated. Patient asks her for a foley, as she is a new face and might say yes. Nurse says "the chance of UTI are very high," as rationale for denying the request. Someone else mentions "He's asked that twice already."

Apparently the new nurse diagnoses the patient with excessive nervousness or tension. She prepares a little bit more versed and fentanyl and tells the patient he's going to get a "little bit more medicine." Patient says "Okay."

The amount she gives is a tad more than was strictly needed. As a result, around two minutes later, the patient becomes incredibly and abruptly disinhibited as his urethral sphincter relaxes and releases a vast amount of pressurized renal filtrate. In the ensuing controlled chaos, the surgical site and surgeon get splashed. Also, the urinal can't be easily found, which results in a large amount of renal filtrate being absorbed by towels, sterile drapes, and running onto the floor. The chaos results in the patient giggling uncontrollably as if he's been given a large dose of opiates (...oh, wait... he has).

The surgeon has to leave the room to scrub up again. As he leaves, he barks orders to everyone in view. By the time he returns, the mess is cleaned up, all the sterile dressings have been changed, the patient is out cold, and there is a foley in place to prevent any of this from happening again. The rest of the procedure goes by swiftly and smoothly, with virtually no talking between anyone in the room. The surgeon is obviously frustrated, and he has enough clout that no one wants to risk annoying him more.





The lesson? Empty your bladder before your procedure, otherwise you may wake up and find yourself in recovery, with a foley in place, and more dope onboard than you ever anticipated.

...Oh, and a surgeon who doesn't want to speak with you for extended periods of time.

...And... you may be the joke of the ward for the next couple days.

You know it's about to go down when the patient asks FOR a Foley. Can honestly say I've never had anyone actually request one.

Originally Posted by Kittenmommy

OK, you know what? He should have peed first, yes. But the real stupid here (IMO) comes from everyone in the OR who ignored his multiple requests for the catheter and ignored him when he said he's a med student and knew what he was talking about. Seriously, they're supposed to be medical professionals... what did they expect would happen at that point?

PS. And it sucks that they're making a joke out of the patient when all this could have been avoided if they'd just paid attention and done their damn jobs.

Not to defend their actions, but all too often such requests are a byproduct of low dose narcotics so they tend to get ignored if nobody believes the request to be valid

I was told I requested my tire to be blown up.... which might have been related the flat I had the week before.

Originally Posted by StevieStud

Not to defend their actions, but all too often such requests are a byproduct of low dose narcotics so they tend to get ignored if nobody believes the request to be valid

I was told I requested my tire to be blown up.... which might have been related the flat I had the week before.

OK, yeah. But it still sucks that they made him into a joke on the floor when it was seriously their own fault.

Originally Posted by Kittenmommy

OK, yeah. But it still sucks that they made him into a joke on the floor when it was seriously their own fault.

It's nothing personal- sometimes a joke can lighten the mood in the department. I'm sure those who were there found it pretty humorous, and there's nothing to be embarrassed about from the patient's perspective. Sometimes you gotta squeeze every laugh you can out of the humorous situations because it dilutes out some of the bad energy when things get tough. As long as everyone is being a good sport, I think it's ok.