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ER Hall of Fame

Discussion in 'Emergency Medicine' started by docB, 04.12.04.

  1. roja

    roja

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    SDN Members don't see this ad. (About Ads)
    CPK: 1,454, 952


    cc: peeing blood
    did 'alot of squats at the gym'
  2. Dr. Will

    Dr. Will

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    Damn...and I thought the CPK of greater than 600,000 was high. I even have a nice pic of the "coca cola looking" urine sitting right next to a bottle of coke. (I've been taking lots of pictures lately).

    What else...personal highs for me. Cr: 18.5 in ARF who had not peed in 1 week. Non dialysis patient.

    Massive softball size umbilical hernia containing transverse colon that has been present for over 1 year. Got a great pic of that one, too. It looked like "Quato" from Total Recall.
  3. MaxDesMer

    MaxDesMer

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    BUN=252
    27 yo obese M; hypertensive. Presented w/ N/V. "normal" mental status. Workup up by nephro, ID, Rheum. Began ruling out everything, including hantavirus, HIV, etc. Renal biopsy -> hypertensive nephropathy. Kid was from rural upstate NY and been hypertensive since he was in high school but was never treated.
  4. DocFrog

    DocFrog Junior Member

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    On my sub-I I had a guy come in, awake, respiratory distress, disoriented...blood sugar came back on fingerstick too low to measure, got official read from lab with the Chem 7, BS was 1...guy lived
  5. hazl0004

    hazl0004

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    Cr of 25.23 (BUN 153)
    I was wondering why it was taking so long for the lab to give me the results so I called down and was told they were re-running it. Turns out it was true.

    37 yo M with "32 days of vomiting and constipation," per the triage note. I must admit I went in thinking how fast can I get this guy out. Needless to say, we put in a dialysis catheter before he got admitted.
  6. mikegoal

    mikegoal rebmeM

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    Cr 41.8 BUN 230s(i think) K 8.7 without ECG changes
    guy who had been sick for weeks ended up having goodpasture's
  7. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    Rectal Temp 109.4!

    Patient apparently (pt wasn't talking obviously) took a pretty big benzo OD and then passed out outside in June in Vegas. Patient wasn't in the sun (no sunburn) but ambient temp was ~111. Pt found to be in rhabdo, ATN, hyperkalemia, etc. Came in with a heart rate of 170 and BP 60/p.

    Of note cooling went really well with IVF via a Level 1 infuser (heater off of course), ice packs, wet sheets, fans, cooling blanket and bladder irrigation. Temp was 101 within about 45 min and HR down to 110 and BP up over 100.

    The initial temp of 109.4 was in the ED after the patient had 1 L of cool NS enroute during her 15 transport in an airconditioned ambulance. I'd love to know what it was on scene.
  8. Chronic Student

    Chronic Student So Fresh, So Clean

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    I did a consult yesterday on a head bleed. He was found down on the asphalt and they estimated 10-15 minutes down at most.

    He had second degree burns on his legs and back. Curiously enough this was through a heavy workshirt and jeans.

    That means the ground was pretty hot, right?
  9. Spaceman Spiff

    Spaceman Spiff

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    This one's kind of rude... during my Sub-I, a man came who was "jumped by 5 guys in a van" who "shoved something up my butt", the patient reported. On x-ray there was a large vibrator impacted in his rectum. You could see the circuits and batteries and all, clear as day. Apparently this gentleman had a prior history of losing items up his rectum according to records. He was the toast of the ED for the rest of the shift.

    I wish I had printed that one out to add to my growing collection of swallowed objects, gruesome compound fractures, are other interesting x-rays! :D
  10. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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  11. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    This thread has higher, but I'm throwing this out there because of the mystery aspect.

    Blood glucose >1400, lab can't do higher. 20 of insulin didn't touch it (we gave that working from a meter which maxes out at 600). A1C 14.7 Surprisingly, anion gap was only about 18.

    Also had a BP of 270/120... lady was perfectly coherent. This is the 5th time we'd seen her and it was never lower than 220/100.

    This was just in a day with family medicine, but I figured it fit better here than the FM forum.
  12. Rendar5

    Rendar5

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    PT>200,INR>20 (both maxed out lab values), AST/ALT in low 20,000s.

    Now that was fulminant liver failure.
  13. aphistis

    aphistis Moderator Emeritus

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  14. emedpa

    emedpa GlobalDoc2B2015

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    highest INR I have seen(around 10 yrs ago)=41
    didn't do well....coumadin is a fairly effective drug with which to kill oneself....
  15. Rendar5

    Rendar5

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    lol, dedicated lab to wait that long to see the blood clot =)
  16. Kodak1138

    Kodak1138 Watching from Afar

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    :eek: Wow
  17. LanceArmstrong

    LanceArmstrong Level X Elite User

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    had this abg today: pH 6.707/ co2 38/o2 129/hco3 5
    -about 15 minutes before flat line...
    ...lactate 9.8
  18. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Hmph...anywhere I've ever been cuts off the pH at "less than 6.8" - I wish they knew there's a competition going on!
  19. coldcoldworld

    coldcoldworld Chief Resident

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    Had a pH of 6.66 once that, as predicted by the ominous numbers, did very poorly.
  20. WilcoWorld

    WilcoWorld Senior Member

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    I think your bicarb value is missing a decimal point...
  21. Rendar5

    Rendar5

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    HCO3- of 0.5?!
  22. fab4fan

    fab4fan TiredRetiredRN Gold Donor

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    :laugh:

    I feel really terrible for laughing at that, honest I do!
  23. GoBuckeyes913

    GoBuckeyes913 Intoxicating

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    Na 108 (Glucose was 1100 though)....unfortunately on my uncle, came to ED c/o SOB, up walking and coherent, but looked sick. Coded 12 hours later. Poopy shift. :(

    BNP 31,182.... CHF exac, lasix worked wonders. too bad EF was <10%
  24. malingering

    malingering

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    I saw this patient twice in 2 weeks. First Glucose was 1600. Second was 2400.
  25. DocVirk

    DocVirk Surviving Residency

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    Must have been the discharge instructions...
  26. njac

    njac Senior Member

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    I didn't know there were any machines that bothered to register over 1200 or so... That's ridiculous.
  27. malingering

    malingering

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    ours reads that high, with the electrolyte set...I specifically told her to start using her insulin, and to cease smoking crack, but I suppose that didn't take.
  28. Interpolfanclub

    Interpolfanclub

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    BUN 269
    Cr 35
    K 7.5
    Bicarb 3
    AG 55
    pH 7.1
    One week of being unable to pee, and breathing fast. Tubed later, dialyzed.
  29. Pharmavixen

    Pharmavixen foxy pharmacist

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    Serum ferritin = 15,000

    The patient is the previously healthy 75 yo father of a friend, who brought her dad's lab report to the bar for me to look at. Next morning she took her dad to hospital, where the ER docs said they'd never seen anything like it.

    On Dec. 23rd, he was found to have extensive melanoma, and is now in palliative.
  30. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    A1c of 26 in an uncontrolled (obviously) diabetic vet.
  31. ZincFingers

    ZincFingers HI EVERYONE!!1!

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    Lactate 20.9

    Pt is clinically doing well and is off his pressors

    Update: incredibly, a day later is still in the land of the living and off his pressors; BP doing fine. Still on A/C vent of course. Looks like they took off his bicarb drip.
    Last edited: 02.15.09
  32. eventualeventer

    eventualeventer Bird Nerd C/O 2015

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    I hope you'll let me play, even though I work with horses (pre-vet, vet tech type).

    Personal "bests":

    High PCV:
    Saw a horse a couple weeks ago that came in with a PCV 78% on machine, >80% hand spun. HR=100 -- normal for an adult horse is 30-45. C/O colic symptoms, moderate amount of reflux with NGT. Went to sx (can't use CT/MRI except on limbs in horses) -- nothing found except ugly looking colon. After 6L plasma and 50L fluids the PCV was down to 48%. He lived about a week; when they euthanized him and opened him up, his entire colon was necrotic.

    Low PCV: 10% Horse was on fluids and bleeding for about 6 days post-sx due to long-term NSAID's. It's not common to store whole blood or pRBC's in horses -- you have to do a crossmatch and bleed a donor horse on the spot, making it impractical to just pour blood in. The horse got about 50L of blood during that week and slowly stopped oozing.

    Low HCO3 -- saw a foal with diarrhea of unknown origin with a bicarb of 5, K+ < 2.0 (machine wouldn't read lower). Took several days to get his electrolyte status stable, but he made it (kicked several people for the effort, too).
  33. devlyyn

    devlyyn

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    Had a patient come in the other day with an Hgb of 0.3 and Hct of 0.6. Thats a new record for me.
  34. dchristismi

    dchristismi Gin and Tonic

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    35 yo F with h/o CP c/o abdominal distention/pain.

    Dx: FOS.

    Ct findings: Rectum: 21 cm in diameter. Colon fine per rads, which made it more of a "toxic megarectum." Looked 8 months pregnant. Was one of the most impressive scans I've ever seen. Called her PCP, said that I the standard "enemas until clear" protocol wasn't going to cut it.


    And had an honorable mention of PCO2 173 last night. Mostly obtunded, nursing home said her sats were "low." Maybe it was the guppy breathing that tipped them off. She was DNR/DNI, so we let her keep strolling towards the light.
  35. WakeMedHeel

    WakeMedHeel Senior Member

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    :eek:

    I've seen a Hct of 7...and that was plenty low.
  36. Drawing Dead

    Drawing Dead

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    Hope you had a med student for the manual disempaction! :idea::laugh:
  37. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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  38. Stitch

    Stitch Jedi Ninja Wizard Moderator

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  39. DoctorMedic

    DoctorMedic

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    would love to say wow, that is shocking, but nothing surprises me anymore...ppl suck
  40. dchristismi

    dchristismi Gin and Tonic

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    Update:

    I had her on Bipap, mostly because we figured we had to do "something."

    She woke up a couple hours later after ventilating off most of that CO2. I heard about it a few weeks later when she came back to the ED again.
  41. Kubed

    Kubed Mostly Harmless

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    Following up on a microcytic anemia with some iron studies.

    Ferritin 0.3

    ... First time I've ever had one reported with a decimal.
  42. Kubed

    Kubed Mostly Harmless

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    Most money found on homeless pt: $ 3200 in cash and tickets.

    I'm sure DocB and GeneralVeers can beat me on this one
  43. beanbean

    beanbean 1K Member

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    We often have a little of that "Vegas cash" here in Connecticut. i have had a couple of elderly people who have rolled in carrying a few thousand dollars. Where were they prior to arrival? Foxwoods or Mohegan Sun. Kinda sucks to hit it big at the casino and then crash your car driving home.
  44. EM2BE

    EM2BE Elf

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  45. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    One of the most impressive ODs I've seen in a while.

    Pt took 220 TylenolPMs based on the bottles and the 30 leftover pills. They were 500/25s so that's 110 grams of APAP and 5.5 grams of benadryl.

    Initial APAP was 414.

    Four hour APAP was 274.

    Pt was severely altered, agitated, tachycardic on presentation. Intubated and put on diprivan and versed so never seized.
  46. Arcan57

    Arcan57 Junior Member

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    I wonder what the APAP would have been without the huge dose of anticholinergic. In residency I had a Chinese take-out driver (who only spoke Mandarin) involved in an MVC carrying >$12k. We had to get his boss to translate, and I am certain the first couple of minutes of their conversation had nothing to do with the driver's medical history.


    Also, yesterday we broke our record for most strippers in the ED because of psychiatric problems at one time. Two.
  47. med2UCC

    med2UCC Relentlessly Optimistic

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    When I was a medical student in Ireland I saw a woman in clinic who had a total cholesterol of 120 mmol/L. She had some kind of pregnancy induced dyslipidaemia that they were treating with fish oils (because she was pregnant). They had managed to get it down to 25mmol/L as of the end of the pregnancy. I'm not sure what that is in mg/dL - if the conversion factor in Pepid is correct it comes to 4633.20mg/dL initially, coming down to 965.25, which seems a little high. Mind you, a normal cholesterol in mmol/L is around 5...
  48. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Thank you for that mmol translation, because, you're right, it doesn't compute (which is ironic when the unit to which we are accustomed here is mg/dL!).

    Cholesterol that high should have made her blood look like a milkshake!
  49. med2UCC

    med2UCC Relentlessly Optimistic

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    I didn't get to see her blood, but I would imagine it was pretty gross looking indeed. This was her second pregnancy and on the first she only :)laugh:) went up to 80 or so. After the child was delivered she went back to her baseline, which was pretty low as I recall, somewhere around 3.5 for total cholesterol. Last I heard the consultant cardiologist was trying to get a paper out of her. Cheers,
    M
  50. Praziquantel86

    Praziquantel86 Moderator Emeritus

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    Acute pancreatitis case...TG were over 14,000 at an outside hospital.

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