1.5 pks cigarettes/day starting at age 5
next pt: ivda since age 11....( where does a 5th grader score heroin?)
next pt: ivda since age 11....( where does a 5th grader score heroin?)
Smoke This said:I do have another lab value that would be hard to beat--BNP of 5311. CHF pt who went on a drug, alcohol, and food binge and came in dyspneic despite feeling a CHF exacerbation "coming on" and taking three 80mg tabs of lasix all at once in an attempt to head it off.
Smoke This said:I do have another lab value that would be hard to beat--BNP of 5311. CHF pt who went on a drug, alcohol, and food binge and came in dyspneic despite feeling a CHF exacerbation "coming on" and taking three 80mg tabs of lasix all at once in an attempt to head it off.
Apollyon said:The highest BNP I ever saw was ~14,000 (14612, I believe). This was a year ago, when I didn't know a damn thing about it - the patient just looked like a bad (but not critical) CHF'er.
anonymousEM said:ETOH 225...in a 2 year old. Daddy shouldn't have left his gin 'n juice on the portch in a bottle!
Apollyon said:Honorable mention from the SICU (at the VA, of course):
420 pack/year smoking history - a carton of butts a day, for 42+ years.
docB said:Trop 600 and 4 mm of ST elevation in a totally silent MI. Pt had absolutely no CP or SOB. Her CC was trouble speaking. She looked great when I admitted her yesterday but then went into pulm edema in the ICU and I just got back from tubing her.
docB said:I can't believe we don't have a hall of fame thread for extreme lab values. Highest and lowest potassium, pH and the like. I'll start by nominating my patient for today who is walking and talking with a blood alcohol of ....
710 Hooray! He has been training like an Olympic athlete for many years to achieve this level of greatness. what a stallion!
ETOH = 710
QuinnNSU said:CPK took FIVE hours to get back for whatever reason
Q
jdpharmd? said:Weight: 362 (Kilograms)
CC: SOB
anonymousEM said:ETOH 225...in a 2 year old. Daddy shouldn't have left his gin 'n juice on the portch in a bottle!
USCDiver said:Meant to post this one last month when I was on Neuro consult service. Called by nephrology to see ESRD on dialysis with other problems who was "unresponsive". Had been walking and talking on admission a week ago. I go in to evaluate, she's staring into space, coarse breath sounds, heart beating, but that's about it. I go to look at her labs... FSBS 53 and 51 the last two mornings respectively. I ask the nurse "Did she get a finger stick this morning?" Her reply, with a dirty look, "No, she's not diabetic."
So I says to her, I says "Why don't you get a finger stick and page me with the results"
20 minutes later, I'm seeing another patient, the pager goes off, it's the nurse, "Blood sugar is.... 5"
"Why don't you give her an amp of D50 and set up a drip and recheck in an hour."
She didn't wake up at all.... FSBS now 73. I think to myself, "hmm, that ain't good, but that ain't it"
Kicker is, I go back to round on the patient with the attending in the afternoon. Walk in the room, she's staring off into space as before, but there's no more coarse breath sounds. And no heart sounds. Son is in the room and says "She kind of stiffened up about 5 minutes ago"
The other funny thing is that the nephrologist called about half an hour after I initially saw the patient and told the nurse to get a finger stick because "it'd be embarrassing to call the neurologist if it was just hypoglycemia"fuegorama said:
God that's awful. I hope there's one less chair full at that nursing station.
Holy Crap!southerndoc said:Blood sugar: 1630
HamSandwich said:"doc, I have some bumps on my knees and elbows that hurt"
TC 1,200
TG 12,000
ERMudPhud said:Never had time to post at work before but just had HCT of 72. Go to love smokers who live at 12,000 feet
Tas said:I'm not a doctor, i work for ems - but I wondered if anyone has had a blood glucose under 7 (he lived)?
docB said:I'll phrase this like a TILFMP post because there is a moral here. If your stomach hurts and you're puking blood don't treat it with ever increasing doses of aspirin and xanax. You'll wind up with a bicarb of 6 and an anion gap of 37.
ERMudPhud said:You could treat it instead like one of my patients with ever increasing doses of ibuprofen and baking soda. Eventually giving yourself a bicarb of 44 and a venous ph >7.7 with tetany from hypocalcemia and all sorts of other electrolyte problems. We actually joked that aspirin might have been a better choice than ibuprofen since the metabolic acidosis of aspirin and metabolic alkalosis from the massive bicarb overdose might have cancelled each other out.
I've pretty much given up asking about that useless 1 to 10 pain scale. There are only two intensities of pain in the ER: 10/10 or none.docB said:I had a patient today with pain that was a 10. Wow! The worst pain a person could ever have! This guy had injured his ankle somehow. He wasn't sure how because he was pretty drunk. In fact he was asleep. Every time I'd wake him up he'd sort of half open his eyes and slur that he needed narcotics. His pain? Always a 10/10. Amazing.
Sessamoid said:I've pretty much given up asking about that useless 1 to 10 pain scale. There are only two intensities of pain in the ER: 10/10 or none.
KevJones said:How about a tooth to tattoo ratio of 6:23? Some of the artwork blended together, but he was certain that he had 23 separate pieces of work. Only two of the teeth were actually ajacent to each other.
ERMudPhud said:Give me a month and I'm pretty sure I can find someone with no teeth left and at least one tattoo, thus setting an unbeatable ratio.
At some point it must be easier to forego the blood alcohol level and just do a blood blood level and assume the rest is etOH.rdennisjr said:Not to break into the tooth:tattoo ratio discussion, but I was very excited last night to see a young man with an ETOH of 625. He really did breath much better after being snorkled.....that's the high mark any of us had seen for ETOH.
Dennis