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NSAIDAllergy said:
I had a patient come in with no significant history with chest pain & a troponin >220. She was 17.
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Just out of curiosity, what made you order a trop on a 17yo with no significant history?
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atkinsje said:
Just out of curiosity, what made you order a trop on a 17yo with no significant history?
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I was rotating at a peds tertiary referral center. The presentation was chest pain radiating to left upper extremity. Labs by committee.
 
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Arcan57 said:
What did the cath show?
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It was clean. Actually, they initially did a cardiac MRI, then went to cath when the results were inconclusive (and Mom & Dad resisted the cath initially).
 
devlyyn said:
ALL at 46? Dr. Goljan, you lie! That's pretty impressive though.
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Rare but not unheard of. The downside is that ALL in kids is pretty curable, as is AML in adults. Flip those around though and things tend to not go very well.

Did I mention she's a Jehovah's Witness? Makes things a lot more complicated.
 
49 y/o male presents with chest pain and inferior STEMI. (Nice working guy, insurance, family, suburbs. Ran out of his simvastatin, metoptolol and lisinopril and "felt good" so he didn't refill them.) Multiple occlusions, needs a CABG and a valve replacement (mitral, I think). They are able to stent and open the RCA, they place a balloon pump, and he goes to the ICU on integrillin and vasopressin. (This hospital has a cath lab, but has to transfer all of their cases that need thoracic surgery.) Alert and oriented, stable vitals (considering he's on vaso and the balloon), pain free. Spends the night in the ICU waiting for a bed to open up at one of the 2 hospitals in town that can open him up. I get called the next morning to transport him. He signs his own consent for treatment.

He bradys down right before moving him and arrests. A physician rounding with his group of residents claims the patient and runs the code. Push some epi, goes into v tach, several shocks, gets tubed. The residents are bagging him at between 80 and 100 breaths per minute, and he gets 5 amps of bicarb in the first 10 minutes of the arrest. :wow: No one can tell them anything. The cath lab NP comes in for the day and almost drops her cup of coffee when she sees the gas: pH 7.91, pCO2 13, pO2 412. We try to get them to give him some amiodarone (he's been shocked at least half a dozen times) but they need to "stabilize him" first. When he is perfusing for 5 minutes consecutively, I offer to take him (and try to get him somewhere safe) but they want to TPA him. Mind you, he's bleeding around his art line and central line sites, and has been on integrillin for 16 hours. Finally his cardiologist comes in takes control and sends me on my way. The guys on vaso, levo, neo and dopamine with a crap pressure. We get him to the receiving hospital and he never makes it to the OR. :(
 
Gi upset x3 weeks. No PMD. Urgent care gave him Lomotil and started him on a PO anti-hypertensive for what he says was a BP of "240/120".

K+ 7, HCO3 11, Gap 31, BUN 159, Cr. 39.4 <- highest I've seen.
 
xaelia said:
Gi upset x3 weeks. No PMD. Urgent care gave him Lomotil and started him on a PO anti-hypertensive for what he says was a BP of "240/120".

K+ 7, HCO3 11, Gap 31, BUN 159, Cr. 39.4 <- highest I've seen.
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I'm sure his kidneys are fine. . . :shifty:
 
Ha! I think I slightly bettered this one today. Classic story for a PE. SOB s/p long transatlantic plane ride with leg swelling. Awake and talking, though shallow respirations. I STAT creatinine to get a quick CTA chest... >20.... Hmmm... recheck >20.

Labs:
Na 123
K 8
HCO3 7
Gap 32
Lactate 0.4
BUN 267 <-- by FAR the highest I've seen.
Cr 32
 
Had a pt presented with AMS. On exam she was AO2 and had minimal belly tenderness with normal vitals generally looked pretty good. We got her glucose back first and it was 2140 which is easily the highest I've seen. Then her amylase and lipase came back over 5000 and realized this was going to be nasty pancreatitis. She went to the unit and spiraled over the next few days.
 
ccfccp said:
Ha! I think I slightly bettered this one today. Classic story for a PE. SOB s/p long transatlantic plane ride with leg swelling. Awake and talking, though shallow respirations. I STAT creatinine to get a quick CTA chest... >20.... Hmmm... recheck >20.

Labs:
Na 123
K 8
HCO3 7
Gap 32
Lactate 0.4
BUN 267 <-- by FAR the highest I've seen.
Cr 32
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Definitely the worst BUN I've seen. I had one in the 180's a few months ago that I though was impressive, but that doesn't touch 267. damn.
 
erin682 said:
Definitely the worst BUN I've seen. I had one in the 180's a few months ago that I though was impressive, but that doesn't touch 267. damn.
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I think my previous high had been in the 140s. Checking up on him today, he seems to be doing better after emergent dialysis. :)
 
DocVirk said:
Sodium of 99.

Awake and talking, although dyspneic from his entire right lung being whited out.
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Got patient with a sodium of 96 yesterday... she came in because she just felt a little run down, otherwise healthy. And she's mid 40's without any other (known) medical problems.

Neph doesn't have an explanation... after a bit of a workup their current working theory is that a recent viral URI caused a transient SIADH. I've never heard of that before, but that's why I'm not a nephrologist and why I need to read a lot more.
 
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beriberi said:
Cl- 57, K <2.0 (1.8 I think)

A 8 week kid whose (granted, uneducated but well meaning) parents had been taking him to the doctor for a few weeks because "all he does is throw up and get skinnier". Formula switched several times. Doctor unconcerned that baby 1 pound below birth weight. Parents hotlined for child neglect. Kid had pyloric stenosis.
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And I sure hope the doctor faced some kind of censure for this.
 
docB said:
Seeing a drunk today who's a regular. Looked it up in the system computer that covers 4 hospitals and he was in the ED 45 times in 2007. That's just my 4 houses, doesn't count all the other hospitals in town.

ED visits in 1 year = 45
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45 visits between 4 hospitals? Bah. Happens all the time.

I have a relative whose kids might well have accomplished that. She got divorced and her ex had to pay the kids' medical bills, so she would take them to doctors and the ER all the time, just to soak him. :mad:

Highest Scr? 29. Patient lived only a few hours after admission.

Grandest multipara: G18 P14 L15. She was Amish.

Youngest mother: 12. Incest victim via stepfather.

Oldest mother: 48.
 
WilcoWorld said:
Unerringly correct! I've never met an alcoholic with any other source of income.[/sarcasm]
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I once worked at a hospital where one of the ER docs was a recovering alcoholic, and for him, hitting bottom was when he went into an ER cubical with another woman who worked in another department, and while she was giving him a BJ, she had a seizure and nearly bit it off. :eek:

He went to detox, and the woman later went on disability according to my source.
 
devlyyn said:
ALL at 46? Dr. Goljan, you lie! That's pretty impressive though.
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My grandfather died from ALL at the age of 61. This was in the 1950s; he was offered chemotherapy but declined when he was told that it had never cured anyone, and died three weeks later on comfort care only.
 
tonight my crushing chest pain patient, who said it was because her family made her take meth and cocaine....

K 10, Cr 21. pretty awesome ekg. baseline Cr a month earlier 1.3.
 
Had a homeless frequent flyer come in with a GCS of 3 a couple days ago. Tubed him (could have done it without meds since he had no gag reflex). Sent him to CT expecting to see a bleed. CT came back clean. ETOH came back at 670. A few hours later he pulled out the tube and asked for a meal tray.
 
Bump.

I had a patient last week who had no hx of renal issues who came in talking but "weak" and possible seizure.

K-9.7
Cr 22.something

EKG was impressive. Even more impressive, he had his own intrinsic rhythm back (after being externally paced) before going to dialysis.
 
PEA arrest

Hg 1.7
LDH >27,000
LA 25

Acute drug-induced hemolytic anemia secondary to ampicillin infusion. Still alive.
 
Not a lab record but a weight record. My company repeatedly transported a person who weighed 1200lbs. I'm not sure how they weighed him. And I don't even want to think about coding them
 
50 yo sedentary dude starts p90x on day 1. Day 3 has back pain. Day 4 comes to ED with brown urine.

CK 142,886.
 
I know it's not the highest (saw >70,000 on here once) but had a guy last night with a lipase of 31,000. Now that was one sick looking dude. The pancreas looked like schmoo on CT. :scared:

And DrMom: srsly? Did y'all have to use a crane to move that person to a stretcher? Would a stretcher work??
 
DrMom said:
Fortunately they got to stay in their motorized WC.
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Who made it? Hyster?
H1050HD_280x307.jpg
 
Had a patient with a BMI of 116 a couple of years ago. Female about 5'6 and 720 lbs.
 
It did occur to me to come home and tell the wifey about this case in the morning (I was working nights)... but seeing as how she loves her waffles and syrup for breakfast, I thought better of it.

Patient's K was 9.2... Cr...22.8... BUN... well, it was high.
 
Ammonia 476. A little confused, yes.

Had a Hgb of 3.2 last night - nowhere near this thread's record, but my new record. Some sort of previously undiagnosed malignancy-related issue, apparently.
 
xaelia said:
Ammonia 476. A little confused, yes.
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But you know it doesn't coordinate. I saw a guy a little off at 300, and another liver player floridly out of his mind with an ammonia of 70. If the patient was literally "a little confused", then that would be interesting (although 476 is interesting in any regard).
 
"Little confused" == moaning incomprehensibly.

I have seen an ammonia in the 400s that was mostly asymptomatic secondary to chronic subacute valproic acid toxicity.
 
Different patients:

glucose of 2190 (sodium 135, corrected 197)
creatinine 22
platelet count 1
 
V.Fib arrest 2/2 huffing Dust-Off (8 cans over the course of a couple hours)...multiple rounds of epi given prehospital...(not ideal)...When we got him VF continually was responsive to a single shock with ROSC, only to then deteriorate in <2 minutes...94 shocks over 12 hours...walked out of the hospital 11 days later with a new tattoo over his chest.
 
34yo female with excruciating abdominal pain of sudden onset. all labs come back except for lipase, which is "pending." a few hours of pestering the lab later... Lipase: 41,000
 
Arterial pH 6.62

Little old lady came in altered and talking. Got dehydrated at home. Went into ARF with hyperkalemia. Didn't survive the night. Sad case.
 
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docB said:
Arterial pH 6.62

LOL came in altered and talking. Got dehydrated at home. Went into ARF with hyperkalemia. Didn't survive the night. Sad case.
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Wow...Originally read LOL as "laughing out loud." Got to the end of the sentence and had to try again.
 
Wow, a glucose over 2000? I'm surprised he wasn't growing rock candy in his bladder from precipitated sugar.
 
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