Things I Learn From My Patients

[ERMudPhud]

Maybe this only happens in Denver but we have a couple of telephone advice lines where people can ask nurses medical question. They seem to be required to go through a review of systems with every caller. No matter what problem you called about when they get to the question about chest pain just say no.


Me: "So why are you here?"

Patient: "I have no idea. I was on the phone asking the nurse a question about my medication. Next thing I know the cops and fireman are banging down my door, throwing me in a stretcher and hauling my ass down here"

Me: "Did you tell her you had chest pain"

Patient: "Well she asked me about it and I said sure I had a bit of chest pain last week..."


I think I see about one of these chest pain abductions every few months.

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[mikecwru]

Yes, we have the g**damn "Med Advice Line," in which a nurse reads a checklist. We've always joked that it could have a recording that just says "Call.....911.....proceed to the nearest ER.....enjoy a hot meal......have your narcotics for free." You don't need a person on the other line.

mike

Maybe this only happens in Denver but we have a couple of telephone advice lines where people can ask nurses medical question. They seem to be required to go through a review of systems with every caller. No matter what problem you called about when they get to the question about chest pain just say no.


Me: "So why are you here?"

Patient: "I have no idea. I was on the phone asking the nurse a question about my medication. Next thing I know the cops and fireman are banging down my door, throwing me in a stretcher and hauling my ass down here"

Me: "Did you tell her you had chest pain"

Patient: "Well she asked me about it and I said sure I had a bit of chest pain last week..."


I think I see about one of these chest pain abductions every few months.

 

[emtp2pac]

seen in a recent risk management newsletter...
don't attatch the dynamap auto bp cuff to the pts iv line. it will rapidly cause a fatal air embolus........

 

[ERMudPhud]

seen in a recent risk management newsletter...
don't attatch the dynamap auto bp cuff to the pts iv line. it will rapidly cause a fatal air embolus........

I remember one from a few years ago. Ex-nurse postop wants to go to restroom so she disconnects her IV and pneumatic stockings. When she gets back to bed she hooks them up backwards and dies. Turns out both systems at the time used luer lock connectors.

 

[roja]

it's even worse with kids.

"has little xxxxx had any health problems?"

"no"

"what's that scar on his neck? and why is he turning blue?"

"oh, he was on ECMO for awhile. . . and he has some kind of heart problem"

"why are his eyes yellow?"

"oh, he has sickle cell"



--your friendly neighborhood likes peds er in spite of the parents caveman

I hate this! I had this happen not to long ago... and 1-not being a pediatrician and 2- hating peds I told my attending I was refusing to deal with the pain in the ass mom any more..

She brought in her 3 mos old for some inane reason. Kid was kind of a 'flk' and mom was a little funny looking.. I asked mom.. any medical problems? nope. nothing. and I thought, well, she must just be a flk.

She tells the attending, oh yeah, she's a downs mosaic... had been intubated, etc etc etc...

She just didn't tell me because she wanted me to guess...

Yet another reason to HATE peds...

 

[coconut lime]

what is a luer lock?

 

[MoosePilot]

I remember one from a few years ago. Ex-nurse postop wants to go to restroom so she disconnects her IV and pneumatic stockings. When she gets back to bed she hooks them up backwards and dies. Turns out both systems at the time used luer lock connectors.

Oh, that's awful! Seems like a relatively easy mistake to make. The connectors have since been changed to be incompatible?

 

[deleted6669]

A Luer Lock Is The Twist Lock On Most Syringes(except Tb Syringes) That Keeps The Needle From Falling Off

 

[Arcan57]

Pt. with pneumothorax admitted to medicine when I was a student. He gets up to go to the bathroom which required him disconnecting his pleurovac. Gets short of breath on the pot, reattaches the pleurovac, cranks the oxygen up to 6 liters to relieve his shortness of breath. Didn't work.

 

[toofache32]

Diet or regular?

 

[Sessamoid]

That's pretty clearly a photo retouched x-ray. The shades don't match the color of the film. Plus, I doubt any old gomer with a hip prosthesis is going to spend a lot of time recreationally inserting foreign bodies into his rectum.

 

[bumblebeetuna]

drinking bleach can cure a migraine.... its best undiluted

 

[Jeff698]

Plus, I doubt any old gomer with a hip prosthesis is going to spend a lot of time recreationally inserting foreign bodies into his rectum.

Surely, you don't mean to cast doubt on the poor gentlemen's story about slipping in the shower on the Coke bottle he's been using to hold his shampoo?

Take care,
Jeff

 

[The White Coat Investor]

I don't know. My first instinct on X-rays like that is to believe them. That's not the largest object I've got an X-ray of. I'm not sure it's an old gomer....the bones don't look too thin, and I've see several patients in their 30s-40s with hip replacements. What's tipping you off to it being retouched?

 

[NYC Girl]

I LOVE THIS THREAD!!

This was a lesson learned from the wards, not from the ED, but a valuable message may be gleaned nonetheless....

If you are a 20-something admitted for diabetic ketoacidosis, weeping and screaming about the level of pain you are in, do not subsequently be seen by all floor personnel eating kit-kats in the hallway, or smoking in the lobby. Do not 1) attempt to steal nurses' personal property, 2) steal things from the med cart, or 3) set tiny fires in your room using alcohol wipes, as they will cause caregivers to dislike and mock you. Also, when you are discharged, do not attempt to change the quantity of pain meds on your script with a *different color pen*!!!!

Speaking of falsifying perscriptions, that "1 pound of mofine" story is *from one of my surgery attendings!* (unless multiple patients believe that morphine is dispensed in pound increments...) I actually quoted it to him, and he said that that was his story, that one of his patients in a VA stole his script pad and wrote "1 pound mofine".

 

[Sessamoid]

I don't know. My first instinct on X-rays like that is to believe them. That's not the largest object I've got an X-ray of. I'm not sure it's an old gomer....the bones don't look too thin, and I've see several patients in their 30s-40s with hip replacements. What's tipping you off to it being retouched?

Actually lots of little things. I've done a little photo retouching myself, and it looks pretty obvious. The color of the bottle is the biggest giveaway. The thing is pure white on the x-ray. As pure white as the hip prosthesis. Plastic doesn't look white on x-ray, in fact it's not very radioopaque at all. I've seen plastic rectal foreign bodies on x-ray, and they don't look like that.

Also, the edges of the bottle are a little bit fuzzy. You'd expect the edge of a hard object to be as sharp as the edges of other smooth, hard objects. Compare the edge of the bottle to the edge of the hip prosthesis.

The flutes on the bottle don't look like an x-ray. Those flutes would have to be hella thick to look that white compared to the rest of the bottle.

I'm pretty sure that's not even an x-ray of a soda bottle. It looks more like somebody took a photo of a soda bottle, maybe pulled out only one color layer, softened the edges with a unsharp filter or something like that, turned one of the colors into a layer, shaded it white, then overlaid it on the pelvic x-ray. My brother's an expert photo retoucher, so I've seen lots of stuff done like this, only usually much better.

 

[toofache32]

Actually lots of little things. I've done a little photo retouching myself, and it looks pretty obvious. The color of the bottle is the biggest giveaway. The thing is pure white on the x-ray. As pure white as the hip prosthesis. Plastic doesn't look white on x-ray, in fact it's not very radioopaque at all. I've seen plastic rectal foreign bodies on x-ray, and they don't look like that.

Also, the edges of the bottle are a little bit fuzzy. You'd expect the edge of a hard object to be as sharp as the edges of other smooth, hard objects. Compare the edge of the bottle to the edge of the hip prosthesis.

The flutes on the bottle don't look like an x-ray. Those flutes would have to be hella thick to look that white compared to the rest of the bottle.

I'm pretty sure that's not even an x-ray of a soda bottle. It looks more like somebody took a photo of a soda bottle, maybe pulled out only one color layer, softened the edges with a unsharp filter or something like that, turned one of the colors into a layer, shaded it white, then overlaid it on the pelvic x-ray. My brother's an expert photo retoucher, so I've seen lots of stuff done like this, only usually much better.

I got it from some website with funny pictures. I always thought it was one of the old glass coke bottles.

 

[docB]

If you are a dirtball who is abusing the system for freebies and you've decided to go with the "I'm gonna kill myself 'n I wanna dinner tray" rouse you will look like a total ***** when you try to elope after dinner and wind up in 4 points with a butt full of Haldol screaming that you didn't mean you wanted to be put on a legal hold, you just wanted dinner.

The funniest thing about this goof ball was that one of the more experienced psych malingerers was laughing his ass of at him saying "If you tolds 'em you gonna kill youself you gots to stay. If all you wants is dinner you shoulda said you gots chest pains." Then the old guy looks at me and says, "Doc, he jes don know whats what. That's all." I almost peed myself.

 

[ERMudPhud]

The funniest thing about this goof ball was that one of the more experienced psych malingerers was laughing his ass of at him saying "If you tolds 'em you gonna kill youself you gots to stay. If all you wants is dinner you shoulda said you gots chest pains." Then the old guy looks at me and says, "Doc, he jes don know whats what. That's all." I almost peed myself.

My wife once saw a patient with a whole long list of complaints. She looked him in the eye and said, "If I gave you a sandwich then what would you say" To which he replied, "Then I'd be fine"

 

[The White Coat Investor]

Actually lots of little things. I've done a little photo retouching myself, and it looks pretty obvious. The color of the bottle is the biggest giveaway. The thing is pure white on the x-ray. As pure white as the hip prosthesis. Plastic doesn't look white on x-ray, in fact it's not very radioopaque at all. I've seen plastic rectal foreign bodies on x-ray, and they don't look like that.

Also, the edges of the bottle are a little bit fuzzy. You'd expect the edge of a hard object to be as sharp as the edges of other smooth, hard objects. Compare the edge of the bottle to the edge of the hip prosthesis.

The flutes on the bottle don't look like an x-ray. Those flutes would have to be hella thick to look that white compared to the rest of the bottle.

I'm pretty sure that's not even an x-ray of a soda bottle. It looks more like somebody took a photo of a soda bottle, maybe pulled out only one color layer, softened the edges with a unsharp filter or something like that, turned one of the colors into a layer, shaded it white, then overlaid it on the pelvic x-ray. My brother's an expert photo retoucher, so I've seen lots of stuff done like this, only usually much better.

You're good.

 

[The White Coat Investor]

If you're going to stab yourself in the abdomen, don't be such a ***** when you return with a wound infection that I have use propofol just to pack the thing. And when I consent you for the sedation, don't say "If I stop breathing, don't do anything." And when I mention the possibility of death, don't ask if you can call your brother so you can change your will to include his kids...because then, I've got to call Psych.

 

[zoolander]

When you get out of Attica and are looking for a cheap high, just take your cousin's urine and sign up at the local methadone clinic. It will, however, turn out to be "a bummer" when you end up addicted and have to wake up every day at 6 am to get your "methadon."

 

[docB]

If you are an 80 yo snowbird with chronic afib and you have a PMD in Vegas and one back home in Wisconsin you may run into problems when one puts you on Coumadin and the other puts you on warfarin. Welcome to the magical land of double digit INRs.

 

[pushinepi2]

1. When purchasing a snickers bar at a local convenience store, don't pay for your food with a bag of crack.

2. Don't run from the deputy who was munching on a donut in the aisle behind you.

3. When kicking the aforementioned deputy and fleeing from the law, do not challenge the metal-tipped pack of belgian malinois dogs to a foot race. You WILL lose.

4. Try suing the sherrif's office for police brutality to recuperate some of your medical costs involved in the reconstruction and grafting of your degloved limbs.




Pushinepi2

 

[docB]

If you are a junkie brought in for heroin OD and responded to Narcan I understand your aanoyance for having your high ruined. However you should definitely NOT shoot up again in your room with some smack you had in your pocket. You will wind up intubated.

 

[funkless]

If you just can't handle prison life anymore, you should scrounge a razor blade and slice deep into your arm so that you'll bleed to death. Now, here's the key: to get the REALLY GOOD vessels, you should PRONATE your arm and slice into your extensor muscles.

--Funkless

 

[iliacus]

The best place to smoke a joint is on a 20 ft ladder. The views great and nothing beats the clean air up there. Of course try to keep your balance. You may fall and fracture your femor. If you think somebody who climbs ladders to get high would have health insurance you'd be wrong. After County USC rejects you (which as far as the health system goes is like asking the ugliest girl in school to the prom and getting turned down) bitch and scream at the clinical tech to get the nurse for more pain medication. But use charm. "Motherf****** go get my nurse" works great.

 

[margaritaboy]

The fact that Whitney Houston is not sleeping with you, methinks, is an unlikely etiology for your acute abdominal pain and diarrhea despite your very persuasive arguement.

 

[kungfufishing]

"The best place to smoke a joint is on a 20 ft ladder."


slang misinterpretation is an often overlooked cause of preventable accident and injury...

 

[MasterintuBater]

I had a seeker in the ER today who had the most interesting drug allergy I've heard yet...."I'm allergic to 2 Dilaudid, but I'm not allergic to 4"

He had also put Norvasc under his tongue to help his "nausea"

 

[funkless]

I had a seeker in the ER today who had the most interesting drug allergy I've heard yet...."I'm allergic to 2 Dilaudid, but I'm not allergic to 4"

He had also put Norvasc under his tongue to help his "nausea"

Priceless...

 

[docB]

I had a seeker in the ER today who had the most interesting drug allergy I've heard yet...."I'm allergic to 2 Dilaudid, but I'm not allergic to 4"

He had also put Norvasc under his tongue to help his "nausea"

I tell those people, "Well, we better not chance it so you get nothing."

 

[HomerSimpson]

Self-inflicted shotgun blasts to the face are easy airways. no face no teeth just a large hole to put your ett in.

 

[Annette]

I send you my humblest apologies. One of my clinic patients had a bad cold and went to the ED. She said her mouth felt like it was on fire. Seems she hadn't brushed her teeth in months and that was the cause of her discomfort. Best laugh I've had in months!

 

[HomerSimpson]

My favorite patient of all time in the ED was a patient who wanted a prescription for carmex..... why? why do you think?

 

[toofache32]

I send you my humblest apologies. One of my clinic patients had a bad cold and went to the ED. She said her mouth felt like it was on fire. Seems she hadn't brushed her teeth in months and that was the cause of her discomfort. Best laugh I've had in months!

This type of patient is the rule in my oral/maxillofacial surgery clinic. We call it a "toothbrush allergy"

 

[Seaglass]

Don't straddle an old tire as you try to see how much air it can hold - you will be blown 10 feet into the air and left with half as much scrotum as you started with.

 

[iliacus]

Denial has a new meaning for me. After getting bit by an insect that you didn't see, assume it's a brown recluse. Never mind the fact that you receive many packages and boxes from Vietnam, Thailand, and Indonesia. Be sure not to leave out your opinion that a bug could NEVER survive a trip from Vietnam to the US so it MUST be a brown recluse. Since doctors are "bad" use homeopathic treatments to heal the growing infection. Lather up golden seal and garlic all over the growing pustules and spreading cellulitus. Call your homeopathic doctor in the midwest thousands of miles away for treatment advice, all the while convincing yourself that you're waging an effective battle with garlic and vitamine E & D while three golf ball sized pustules grow out of your legs. After a nickles worth of common sense seeps into your head past the garlic, come to the clinic. However, be sure to prove to the doctors that they're wrong with all of the "information" you gleaned from hours spent on the internet while you're infection spread....Don't forget to brag about the 15 years experience you have in "herbal medicine." After all that go against the advice of 2 attending physician, 2 residents, and astonished medical student and demand a script for antibiotics and you'll be on your way.

 

[docB]

Nitroglycerine is for chest pain only. Don't take it as a gereral tonic for whatever ails you. Especially don't take it for lightheadedness.

I had an 80 yo F who had a UTI and dehydration, borderline septic. CC was weak and dizzy whenever she stands up. She started taking her sublingual nitros 2 at a time "because I thought it was my heart and it wasn't getting any better." BIBA with a BP of 65/35. Fortunately she responded to IVF.

And a bonus:
If you are BIBA on a legal hold for leaving a suicide note, taking 100 tylenol and cutting both of your wrists I am not violating your rights by forcing you to stay in the hospital. Should you try to leave my security guards will be happy to secure you to something heavy while my nurse fills your rump with sleepy meds.

 

[leviathan]

Nitroglycerine is for chest pain only. Don't take it as a gereral tonic for whatever ails you. Especially don't take it for lightheadedness.

I had an 80 yo F who had a UTI and dehydration, borderline septic. CC was weak and dizzy whenever she stands up. She started taking her sublingual nitros 2 at a time "because I thought it was my heart and it wasn't getting any better." BIBA with a BP of 65/35. Fortunately she responded to IVF.

And a bonus:
If you are BIBA on a legal hold for leaving a suicide note, taking 100 tylenol and cutting both of your wrists I am not violating your rights by forcing you to stay in the hospital. Should you try to leave my security guards will be happy to secure you to something heavy while my nurse fills your rump with sleepy meds.

Hehe, soo cruel.

 

[docB]

If you are really having the worst pain of your life (20/10) and you think you are going to die and you can't stand and you can't breathe you would probably not be able to follow me around the ER yelling loudly that you are angry that I can't have you moved to a private room with a "big TV" right now.

 

[funkless]

Nitroglycerine is for chest pain only. Don't take it as a gereral tonic for whatever ails you. Especially don't take it for lightheadedness.

I had an 80 yo F who had a UTI and dehydration, borderline septic. CC was weak and dizzy whenever she stands up. She started taking her sublingual nitros 2 at a time "because I thought it was my heart and it wasn't getting any better." BIBA with a BP of 65/35. Fortunately she responded to IVF.

And a bonus:
If you are BIBA on a legal hold for leaving a suicide note, taking 100 tylenol and cutting both of your wrists I am not violating your rights by forcing you to stay in the hospital. Should you try to leave my security guards will be happy to secure you to something heavy while my nurse fills your rump with sleepy meds.

BIBA?
Brought in by ambulance?

--Funkless

 

[docB]

BIBA?
Brought in by ambulance?

--Funkless

Yup.

Relatives include:
BIBPC = private car
BIBH = helocopter

 

[stoic]

Where is BIBP (brought in by police) in the BIBA phylogeny?

Incidently, BIBP patients are usually entertaining, I try to get in on those cases while shadowing.

Examples include:

Completely restrained HIV+ male, loaded on meth out of his brains, for a lac from breaking out a police car window. If that wasn't entertaining enough, he got the urge to vomit and deficate at the exact same time and was nice enough to let us all know before losing it. "Excuse me guys, I know ya'll are cool and just doing your jobs - not like those pigs over there - so I'm gonna warn 'ya I'm about to blow out both ends."

16 yo male brought in after wrecking his car while drunk. Do you drink? "No" (BAL 230). Do you smoke? "No." (pack of camels in shirt pocket). Do you do drugs? "nope" (half ounce of pot and various pipes in pocket).

 

[Sessamoid]

If you are really having the worst pain of your life (20/10) and you think you are going to die and you can't stand and you can't breathe you would probably not be able to follow me around the ER yelling loudly that you are angry that I can't have you moved to a private room with a "big TV" right now.

Would be even funnier if the patient was angry because he couldn't catch the latest episode of "ER".

 

[leviathan]

"Excuse me guys, I know ya'll are cool and just doing your jobs - not like those pigs over there - so I'm gonna warn 'ya I'm about to blow out both ends."

I like how you guys are "only doing your job" but not the police officers.

 

[docB]

If you feel you really need a cock ring and there are none to be found do not shove your willie through the end of a 24 mm box wrench. You see, when you finally go to the ER 48 hours later with what's left of your penis you will discover that it is very difficult to cut anything made of case hardened steel. You will wind up in the OR with a very angry urologist who will be cutting on your manhood with various tools scrounged up from the maintenance guys.

Be cheerful though, if you have given yourself enough nerve damage that you can no longer fill the Earth with your spawn you might be eligible for a Darwin award.

I wish I were making this up.

 

[IdiotBoxen]

1) Hitting the security guard with your crack pipe will not improve your situation.

2) I spent 30 minutes with this lady getting a very thorough history, for a variety of reasons. So, she's in the stirrups and I sit down on my chair. I notice a scar on her abdomen and ask her about it. "Oh, I forgot to mention my hysterectomy after they found cancer". *cries*

3) The next intern who rings me for advice on how to manage a woman's normal period will be shot. Survivors will be shot again.

4) I'm not an auto mechanic. That doesn't mean you come into the ER for a checkup before you go out shagging for the night.

5) No, young lady, being on top will not protect you from getting pregnant.

But, one patient restored my faith in human nature this week. Patient found 2 $50 notes on the floor of the change room, and gave it to me (I did give it back to the patient who later rang to claim it). She could've taken it, and nobody would have been any the wiser... Quite impressive.

 

[fuegorama]

The next intern who rings me for advice on how to manage a woman's normal period will be shot. Survivors will be shot again.

Have you considered marketing an at-home menstruation test? My partner and I toyed with this a while back and had cool, catchy names like "My Time?", or "MMM" (monthly menses monitor).

For an extra fee you could include a nifty questionaire and call it the "My Time PLUS". The card would be laminated and come with a grease pencil so you could check yes or no multiple times. Questions would include:
Are you bloated feeling?
Did you feel this way about 28 days ago?
Are you cramping?
Does fatty Mexican food and a pair of sweats sound like a good idea right now?

This way your patient (and intern) can be sure.

 

[Seaglass]

) I spent 30 minutes with this lady getting a very thorough history, for a variety of reasons. So, she's in the stirrups and I sit down on my chair. I notice a scar on her abdomen and ask her about it. "Oh, I forgot to mention my hysterectomy after they found cancer". *cries*

That's why I always ask "So, do you still have all your stuff down there?"