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pinbor1 said:
...The ICU still wanted to reject him because he was talking and not intubated.
Anything to avoid getting turfed on, right?

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toofache32 said:
Anything to avoid getting turfed on, right?

Man I was about to lose it. I don't know what sort of picture they painted to their attending. Must have been leaving a number of things out of the presentation.
 
New record (at least that I've seen)......HCT 79. Note: this was after 2 liters of saline for the extreme dehydration that patient presented with. Coded shortly after arriving in the ER, but his labs (drawn before he coded) came back about 5 minutes after they pronounced him.

Some of the highlights were:
HCT 79
K 7.2
pH 7.01
Na 192
Gluc 34

The cops are investigating his daughter who was allegedly taking care of him. I hope she rots in jail for what is one of the most clear cut cases of neglect I have ever seen in over 8 years of being involved in health care
 
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Very well known drunk to ed via ems, mumbling, no purposeful mov't, etc.

?ETOH=210? We all know he can handle 210 better than this. :confused:

Daughter comes in and says "Dad ran out of vodka and drank some wintergreen FLAVORED rubbing alcohol." :scared:

I don't think that's in there for flavor lady. :laugh:
 
Amylase 37,500

Pt with metastatic adenoCA of the parotid gland.
 
O.k., maybe not a record for everyone but...

Bladder temp 30.1 C (which gives me the low temp survived record here), amylase 1968, lipase 1330, glucose 664, pH <6.8 (as low as the iStat will go). And he walked out of the hospital four days later.

:eek:

- H
 
My temp on a patient who survived was 85 degrees (rectal temp) (29.4 C). Came in septic and very altered. No osborne waves on EKG though.
 
I think I may beat the low temp survivor: 80F (27C). Initially no osbornes but developed them at about 85-86 degrees of warming. Our ICU screen person wanted a a CT scan (h/o sz and had recieved 2 of ativan). I looked at here like she was whacko (did she see the bear hugger and the warming water blanket, monitor and crash cart all next to the patient). "she isn't stable enough to go. she's hypothermic" AC: Well she's warm now. ME: She is 85 degrees. that's still hypothermia. You want to disconnect her fromthe warmers, drag here upstairs, let her sit in the CT area where she will get COLDER. Oh, not to mention she could still get cardiac arrythmias and DIE??


Needless to say, she did not get a CT while she was in the ED. She got it much later when she was warm.
 
I'll never forget a pt admitted to Lucile Packard: 14 y/o f, 4'11", 35 kg, emaciated, lethargic, 60/40, p 36 weak, resp 12 shallow, rectal core temp 29C (84F), elev ST and flat t waves, depressed CNS, coded 4 hrs later - unrecoverable.
:(
 
I quickly looked through the thread and didn't see it. I'm sure some of you have seen higher:

CSF WBC count: 1290 in tube 4.

Post-op meningitis in an ENT patient.
 
Magnesium: 0.2

Thought he was having a TIA with dysarthria and confusion. Turned out he had been vomiting from Altace for weeks. I gave more Mag to him than I've given to all others combined.
 
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How about patient weights? Admitted a little old lady last night, about average height for a 75 yo, but weighing in at a whopping 58 lbs.

Almost no muscle mass, and actually got paged by the floor nurse saying that she can't give teh subQ heparin for DVT prophylaxis becase the pt HAS NO SUBQ!

On the other end of the spectrum, had a pt brought in in full arrest who easily weighed 600lbs. They had to put him on a tarp on the FLOOR of the rig, and it easily took 6-8 firefighters to haul him out. Obviously couldn't put him on a standard stretcher, so had to put him on a hospital bed in the trauma bay.
 
I think I have the record on both ends of the temperature spectrum --

Low -- guy that medics brought in a few weeks ago mumbling, found down outside -- rectal temp 79.2. He was coherent enough to curse at us for inserting the rectal probe. Baer Hugger, warm foley (which he also curse over) and warm NG fluids brought him up nicely and he left the ICU the next day.

High -- 16 y/o kid intubated for asthma in the PICU. Few days into it developed hyperthermia to 107.9 and stayed there for hours despite packing him in ice, cold water lavage to every available body cavity. Finally came down to a relatively benign 104 with dantrolene. All cultures (including some funky viral ones) came back negative as did the subsequent head CT. Amazing thing is the kid survived it neurologically intact.
 
jlw2004 said:
I think I have the record on both ends of the temperature spectrum --

Low -- guy that medics brought in a few weeks ago mumbling, found down outside -- rectal temp 79.2. He was coherent enough to curse at us for inserting the rectal probe. Baer Hugger, warm foley (which he also curse over) and warm NG fluids brought him up nicely and he left the ICU the next day.

High -- 16 y/o kid intubated for asthma in the PICU. Few days into it developed hyperthermia to 107.9 and stayed there for hours despite packing him in ice, cold water lavage to every available body cavity. Finally came down to a relatively benign 104 with dantrolene. All cultures (including some funky viral ones) came back negative as did the subsequent head CT. Amazing thing is the kid survived it neurologically intact.
So did you all ever figure what the cause of the fever was?
 
PCO2 152 in a walking talking only slightly drowsy patient.... couldn't believe it... would have guessed his PCO2 was around 50 from his clinical presentation.
 
Praetorian said:
So did you all ever figure what the cause of the fever was?

That was the most frustrating part. No! Makes me realize how much we DON'T know.
 
Lipase 71148

Pt had gallstones and was dc'd from another ER about 2 hours before coming in with a dx of gastritis. :eek:
 
docB said:
Honorable mention to my guy who coded out back of the 7-11. pH 6.51. Trop is 8. Still alive right now. Max pressors but still alive.

ETOH level?
 
I tapped a 17 day old today with fussiness, fever and a bulging fontanelle.

The CSF white count was 12,463. RBC's were 90.

The serum white count was 8.3; no left shift. Go figure.
 
65 yo Vet. Comes in complaining of SOB. Gee doc I breathe but it just doesn't seem to do anything for me. CBC=> Hgb 1.8 Hct 6.5. Troponin 3.0. Hmmmm. Well ya might be short of breath because the occasional RBC that stops by to pick-up/drop-off oxygen just isn't enough. By the way...is it a bad sign when the number of packs of cigarettes you smoke per day is higher than your hemoglobin? :eek:
 
in a DM with lethargy, pallor that was obviously used to hypoglycemia
glu on handheld glucometer <30...stat bmp...glu 0

in a guy with CRF of uknown etiology...came i nautious, dizzy, confused
BUN 450, Cr 130...2 days later Bun around 120, Cr 13 - thanks doc feel much better
 
Not impressive but I have seen this quiet a few times...BUN 0
 
48yo obese double amputee w/PMH DM, HTN c/o SOB
Denies any heart problems.

BNP > 5000

So that's what our lab's cutoff is.
 
On the nurse's triage sheet:

PMH:

MI x12
(among other DVT's, PE's and a Greenfield Filter)
 
Abdominal mass -- 30 X 30 X 15 cm (final path report -- ovarian serous cystadenoma)

Ethylene glycol -- 452
 
doctawife said:
I tapped a 17 day old today with fussiness, fever and a bulging fontanelle.

The CSF white count was 12,463. RBC's were 90.

The serum white count was 8.3; no left shift. Go figure.

Yeah, it's 'cuz all his whites were in his head!
 
One for the list:

Absolute Eosinophil Count 71,000. @ yo with Toxocara Migrans (skin parasite). Had been eating dirt (PICA) due to an all milk diet.

Honorable Mentions:
Many kids with ANCs of 0 undergoing chemo. Lowest PLT was 2 in a kid with ITP. Also had the pleasure of seeing a kid with T-cell and B-cell counts of 0 (SCID) -- not my best day. I've also had a OP of 55 on an LP in a teenager with likely pseudotumor. Favorite, though is my friend who had and LP with more than 1,000,000 RBCs. He said he was thinking of sending it for and ABG instead of a culture.
 
edmadison said:
I've also had a OP of 55 on an LP in a teenager with likely pseudotumor.

I had a 13 yo f with pseudo tumor, OP not measured because the CSF literally bubbled out the end of the mannometer.
 
Squad51 said:
I had a 13 yo f with pseudo tumor, OP not measured because the CSF literally bubbled out the end of the mannometer.


...and I was just coming here to post about an LP I did last night, ironically...

48 yo M c/o HA, subjective fever, HIV+, developed AMS as I watched. Thorough skin, stylet out, advanced another centimeter, and FFFFFSSSSSHHHH!! I got sprayed with high-velocity CSF. Popped my finger over the geyer, plugged in the manometer and it shot out the top.

Working dx is cryptococcal meningitis.

Always wear a facemask when LPing, kiddos. Damn glad I was. I did have to go change scrubs, though. Eew. :laugh:
 
Sorority girl at frat party now in the ED with ETOH level of 401, GCS of 3.
 
Seaglass said:
Sorority girl at frat party now in the ED with ETOH level of 401, GCS of 3.

Fill in the clueless med student. What is 401?? The only ones I know start with decimals!

I actually understand the significance of GCS=3.
 
socuteMD said:
Fill in the clueless med student. What is 401?? The only ones I know start with decimals!

I actually understand the significance of GCS=3.


401 in medicalese = 0.401 in legalese. it has to do with the unit of measure--i can't remember for sure, but I think we use mg/dL; i don't know what the cops use.
 
Hawkeye Kid said:
401 in medicalese = 0.401 in legalese. it has to do with the unit of measure--i can't remember for sure, but I think we use mg/dL; i don't know what the cops use.
Cops use straight percentages.
 
Seaglass said:
Sorority girl at frat party now in the ED with ETOH level of 401, GCS of 3.

I got this one beat. I saw a guy a few years back as an EMT who also had a GCS of 3, but his EtOH was 580 :eek: :eek: Of course, he probably had developed way more tolerance than that sorority girl.
 
Thought these ones were pretty impressive, all from the past week or so. I'm on internal medicine this month, so these aren't typical EM labs, but nonetheless...

Patient 1: CD4: 0 (New HIV/AIDS diagnosis)
Patient 2: A1C: 19.1
Patient 3: Ascites fluid, 13,000 PMNs (riproaring SBP)
 
Swear to god, last night had a chronic CHFer saying she had increased PND/orthopnea and SOB x 3 days. Said "I feel a little fuzzy headed". O2 sat with perfect waveform- 50%. Before that, I would have sworn it would be impossible to be walking and mentating. A neb and some Vitamin O brought her to 95%. Pinked right up!
 
One of the last ABG's I did was on a guy who the ER doc goes "There is no way that pulse ox is correct" *points* The monitor was reading 62%. This is in a patient, like yours, that was sitting up and talking. His ABG came back at 58%. I walked back in with the results and told the doc, "You were right. That wasn't correct. It was even lower than you thought". The guy also had a hemoglobin of 23.
 
An updated scoreboard:
Alcohol-Blood 830 Jpgreer13
Alcohol-Breath(usually lower) 540 febrifuge
Na-high 221 gerickson03m
Na-low 95 Freeeedom
T4- undetectable Desperado
MCV- 129 Desperado
Glucose-high 2390 Arcan57
Glucose-low 0 LanceArmstrong
Ph-low 6.00 ISU_STEVE (DropkickMurphy’s former screenname)
Ph-high 7.88 pinbor1 and ISU_Steve (tie)
Plts-low 0 seaglass
Chloride- (low) beriberi
Chloride (high)- 166 FoughtFyr
Ca-low 4.2 a little elf
Ca-high 18 Ermudphud
C02-high 318 beyond all hope
PaCO2- 304 ISU_STEVE
Bicarb-low 1.6 pinbor1
Bicarb- High 67 ISU_Steve
INR-high >999.99 12R34Y
%Bands-high 68 debvz
TSH-high 425 margaritaboy
Lithium 8.1 Zambezi
K-low 0.8 jjackis
K-high 26.7 ISU_Steve
TBili 92 virion
Dbili 56 wthomp03
BUN (high) 450 LanceArmstrong
BUN (low) 0 **
Cr 47.4 bccsmith
Troponin I 1100 AJM
BNP 331042 Apollyon
Cholesterol 1200 ham sandwich
Triglycerides 12000 ham sandwich
Mg 0.2 EMIMG and bulgethetwine (tie)
Temp-high 109 docB
Temp-low 79.2 F jlw2004
WBC 430,000 beyond all hope
CPK >800,000 Scrubbs
Lipase (high) 71,148 wthomp03
Lipase (low) 0 docB
Hct high 79 DropkickMurphy
Hct low 6.5 Cric4U
Hgb low 0.8 EMraiden
PSA 6746 clc17
Anion Gap 50 pinbor1
Drug screen 9 out of 9 positive ISU_Steve
Serum Osmolality 447 WakeMedHeel
duration of unevaluated chief complaint 39 years Apollyon
youngest smoker 5 years old emtp2pac
youngest IV drug abuser 11 years emtp2pac
Pack years smoking 420 Apollyon
BMI 90 smoke this
weight >850 pounds clc17
02sat 0% Seaglass
Blood pressure 330/180 12r34y
Corneal Foreign bodies >50 cdr50
Tooth/tattoo ration 6/23 Kev Jones
Medlist (active prescription meds) 33 Ermudphud
Pain scale 10/10 docB (and all the rest of us)
Abdominal mass- 30 x 30 x 15 cm Telemachus
Carboxyhemoglobin- 44% ISU_STEVE
Methemoglobin- 22% ISU_STEVE
PaO2 (low)- 14 mm Hg ISU_STEVE
Largest stool removed by manual disimpaction- 15 lbs ERMudPhud
Ammonia- 302 docB
Ferritin- 76,000 KidDr.
Amylase- 37,500 jashanley
CSF WBC Count- 12,463 doctawife
CSF RBC Count- 90 doctawife
**Favorite, though is my friend who had an LP with more than 1,000,000 RBCs. He said he was thinking of sending it for an ABG instead of a culture.- edmadison
Highest lumbar puncture opening pressure- 55 cm bobblehead
**dchristimi’s golden CSF shower notwithstanding :smuggrin:
BNP- >5000 (“So that’s what the lab’s cutoff is!” dchristismi
Ethylene glycol- 452 Telemachus
Absolute Eosinophil Count- 71,000 edmadison
Biggest abdominal aortic aneurysm- 10.5cm Desperado
A1C- 19.1 Wahoo
Ascites fluid PMN’s- 13,000 Wahoo
 
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