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10 y/o Psych patient. Stayed in the same room in the ED for 118 hours before social work could find bed placement for the guy.

Not a lab value, but an impressive number none the less.
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ERMudPhud said:
Don't know quite why I measured it but I had a 450 yesterday. The more interesting record on this guy from my point of view was the record for fewest number of normal labs. Endstage hepatorenal with massive GIB and who knows what else. Initial labs included CBC, 7, LFT's, PT/PTT, ABG, ammonia, lactate and only his Na and Cl where normal. Everything, and I mean everything else was abnormal.
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397 - but at baseline and "Can I go home today, doc?"

VPA toxicity.
 
Does it hafta be an ED patient? Cause we had an 80% eosinophils on an HIV dermatopathy.
 
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southerndoc said:
Had a patient the other day tell me she had stage IV fibromyalgia.

Really? We're staging it now? Stage IV must be terminal. Terminal fibromyalgia. Now there's one for the record books.
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There is a joke that the IM resident clinic at our Univ Hosp is actually the end-stage fibromyalgia clinic. Funny because it's true.
 
southerndoc said:
Had a patient the other day tell me she had stage IV fibromyalgia.

Really? We're staging it now? Stage IV must be terminal. Terminal fibromyalgia. Now there's one for the record books.
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Hmm... there are some studies that suggest that people with fibromyalgia are unable to reach stage 4 of the sleep cycle (it's one of the hypotheses as to the basis for the "disease"... these are just chronically sleep deprived people). Maybe that's what the patient unknowingly meant.
 
Bumping up for two concurrent cases I had today.

Case 1: (post code) pH 6.63 with lactate of 104. Family gets the talk that I've never seen anyone survive those kinds of numbers. They look sad.

Case 2: (came in talking, sort of, but looked like death) pH 6.59, lactate >180. Family gets the same talk that the other family got, "but he was just in his doctor's office yesterday."

Bonus points for putting in an EJ and the ETT while on the phone with his PCP.


So anyway, that's my lab's lactate cutoff value. In my old ED, it would have been reported as 18, but the units here are a factor of 10. (mg/dL?)

And neither was DKA. Oh no, that would have been easy. Well, easier. Both old guys. First coded x3, then family let us let him go. Second one survived to the unit - just trying to hang on to him until his son arrives from out of town.

My partners told me not to touch anybody else for the rest of the day.
 
EM2BE said:
Saw a 475ish the other day. Guess I need to stick with it to see higher numbers.
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we've got a local drunk at my institution who comes in 3-4 times a week near intubation for drinking excessively.

She was in about a week and a half ago, got intubated for an EtOH of .552, got sent to the ICU, then extubated herself 5 hours later, left AMA, took a taxi to the bar, and came back to the ED 6 hours after that, with an EtOH of .524

This is a consistent thing for her....and it's sad, and nobody knows what to do with her.

We were actually taking bets the other day on how she'd die (likely aspiration or ruptured varix), and then she promptly arrived no more than a half hour after that hovering in the low .5's.
 
Greenbbs said:
we've got a local drunk at my institution who comes in 3-4 times a week near intubation for drinking excessively.

She was in about a week and a half ago, got intubated for an EtOH of .552, got sent to the ICU, then extubated herself 5 hours later, left AMA, took a taxi to the bar, and came back to the ED 6 hours after that, with an EtOH of .524

This is a consistent thing for her....and it's sad, and nobody knows what to do with her.

We were actually taking bets the other day on how she'd die (likely aspiration or ruptured varix), and then she promptly arrived no more than a half hour after that hovering in the low .5's.
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My first reaction was that someone should do the taxpayers a favor...but on second thought, it's good tubing practice for residents so she's an asset after all.
 
Greenbbs said:
we've got a local drunk at my institution who comes in 3-4 times a week near intubation for drinking excessively.

She was in about a week and a half ago, got intubated for an EtOH of .552, got sent to the ICU, then extubated herself 5 hours later, left AMA, took a taxi to the bar, and came back to the ED 6 hours after that, with an EtOH of .524

This is a consistent thing for her....and it's sad, and nobody knows what to do with her.

We were actually taking bets the other day on how she'd die (likely aspiration or ruptured varix), and then she promptly arrived no more than a half hour after that hovering in the low .5's.
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willow18 said:
My first reaction was that someone should do the taxpayers a favor...but on second thought, it's good tubing practice for residents so she's an asset after all.
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I always wonder where they get the money to do this.
 
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VA Hopeful Dr said:
Around here its either prostitution or some kind of government aid with the former being much more likely.
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Unerringly correct! I've never met an alcoholic with any other source of income.[/sarcasm]

I've been chided by admitting docs for intubating someone with a BAL over .600 "just because he's drunk". Sheesh
 
Case of a coworker's while on shift together last week. Lipase 51,500...not an error. Blood redrawn and lab repeated.

42 WF with epigastric pain for 48hrs. No prior h/o pancreatitis, she did however like her liquor.
 
Also an interesting case that rolled through our ED less than a month ago... 8yo M with chronic h/o nonspecific abdominal complaints going on intermittently for 5 yrs. Seen multiple times in various EDs, no conclusive dx.

Labs come back with almost 13K WBC, partner talks to mom, kid's never had a scan during any visits to EDs or PCPs. So kid gets scanned, and the result.....choledochoduodenal fistula. Now there's something you don't see every day.
 
54 yo male onset 6 hours ago of AMS and weakness. Family calls EMS when he starts breathing "really fast and deep"

pH 6.85, pCO2 40 CO2 5 (intubated)

anion gap 39

Looks like ethylene glycol ingestion -> serum osm 79 and oxalate crystals in urine

Getting emergent dialysis, fomepazole, etc
 
K of 1.5, came in because he couldn't move his arms or legs. Had been at the tanning salon the day before and had to be carried to the car because his arms weren't strong enough to use his walker. EKG was impressively ugly, and that was before he started throwing V-tach.
 
4everstudentmd said:
10 y/o Psych patient. Stayed in the same room in the ED for 118 hours before social work could find bed placement for the guy.

Not a lab value, but an impressive number none the less.
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Poor kid!!

Never had a kid stay in ED for that long (for psych anyway), but since its hard to place peds psych and they cannot hold up an ED room for days, in my hospital they now require a peds psych to go to the floor with a 1:1. If they are over 16 y.o. they will sometimes take them into adult psych.
 
Arcan57 said:
K of 1.5, came in because he couldn't move his arms or legs. Had been at the tanning salon the day before and had to be carried to the car because his arms weren't strong enough to use his walker. EKG was impressively ugly, and that was before he started throwing V-tach.
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A guy in the tanning bed? Let me guess he was a bodybuilder or something and using diuretics? I have seen men like this, but not with a K that low!!
 
southerndoc said:
Had a patient the other day tell me she had stage IV fibromyalgia.

Really? We're staging it now? Stage IV must be terminal. Terminal fibromyalgia. Now there's one for the record books.
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I'm sure they are also collecting disability checks too for this devastating disease :mad:
 
NYRN said:
A guy in the tanning bed? Let me guess he was a bodybuilder or something and using diuretics? I have seen men like this, but not with a K that low!!
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Using diuretics, yes. Body builder, no. He was on big doses of lasix to combat the third-spacing from his liver CA. He decided not to tell anyone that he wasn't taking his K.
 
Arcan57 said:
Using diuretics, yes. Body builder, no. He was on big doses of lasix to combat the third-spacing from his liver CA. He decided not to tell anyone that he wasn't taking his K.
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Good call pal.
 
4everstudentmd said:
10 y/o Psych patient. Stayed in the same room in the ED for 118 hours before social work could find bed placement for the guy.

Not a lab value, but an impressive number none the less.
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We hit 173 hours the other day. An entire week in the department. I wish we could convince our psych unit to take these.
 
Arcan57 said:
Using diuretics, yes. Body builder, no. He was on big doses of lasix to combat the third-spacing from his liver CA. He decided not to tell anyone that he wasn't taking his K.
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Lolz, and he was in a tanning bed all day? Forgive my ignorance, but was it for the same reason newborns go under bili lights?
 
Arcan57 said:
Using diuretics, yes. Body builder, no. He was on big doses of lasix to combat the third-spacing from his liver CA. He decided not to tell anyone that he wasn't taking his K.
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Damn! Did he give a reason why he didn't take his K or did he just not know that he was supposed to take it?

I think this could be a good teaching point for residents that if they are sending a pt home on lasix, they should also make sure they give an RX for K+. I have seen this overlooked many times, and then you will have patients returning to the ER like your patient did.
 
dmitrinyr said:
Good call pal.
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There's probably a study to be done about the association between tanning bed usage and medicine compliance. Although I'd think that if I owned a salon and saw someone that had to use a walker to get to the bed, I'd maybe pass on that business.
 
Troponin I on admission -> 0.55
After a trip to the cath lab, 2 rounds of CPR and 8 shocks -> 133.8

...There's not enough TroponinBind™ on earth to get that down ;)
 
is that like putting someone on a Creatinine drip?
 
Well my theory on Troponabind is that you can engineer a FAB fragment to bind any protein. For example we use Digabind to bind up Dig. We admit people for elevated troponins all the time. We could just shoot them up with Troponabind, recheck the trop which will be negative and then they can go home.
 
Sodium of 187 or 188 (can't remember exactly). Baby still awake and not seizing.

Another pt Trop 180s after cath. Developed AMI while in ED. Went straight to cath after STEMI appeared on 3rd EKG.
 
On cardio - trop s/p stemi and pci - 919 and some change
 
the original said >50, but they redrew it and got that number. I think it tops at 1000, but they can only say >50 if it's too high. Maybe you had that too?
 
Hgb 1.5
Hct 6.7

Pt's walking and talking.

Lowest anyone in the ED has ever seen.

After transfusing trauma blood pt states.."Wow, I feel so much better."
 
A junky(nasty infected trackmarks, wad of crumpled up cash, female companion dissapears into bathroom for undetermined amount of time etc. etc,) stopped me the other day when I was refueling my ambulance and wanted to know if I was "the guy that electricuted" him to save him the other day. He claims to have been in cardiac arrest with a blood sugar of 3500. I asked if he meant 350, but he was sure that it was 3500. The highest I have seen is 900. He claimed that the ER docs had never seen it that high either, is 3500 even possible?
 
EM2BE said:
On cardio - trop s/p stemi and pci - 919 and some change
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I can just hear the Cardiology resident on call responding, "Yeah, but what's his baseline?" after I called with any of those values.
 
WilcoWorld said:
I can just hear the Cardiology resident on call responding, "Yeah, but what's his baseline?" after I called with any of those values.
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The first trop was around 10. So that was definitely a bump.
 
Sodium of 99.

Awake and talking, although dyspneic from his entire right lung being whited out.
 
I had a patient come in with no significant history with chest pain & a troponin >220. She was 17.
 
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