Things I Learn From My Patients

[pushinepi2]

I can't believe that I forgot this - I hope none of you are suffering too much for my laxity -

If you spread a thick layer of Vicks Vapor Rub all over your face, it burns. Apparently, it burns reaaaaallly bad. The best treatment we have found for it so far begins with washing it off of your face. Thankfully, this is an intervention that is within the scope of a paramedic, so if you call 911 they can help

Thank God the irrigation of Vicks Vapo Rub is within our scope of practice... Just think.. all that suffering... when I could have just rinsed my patients off... rushing them to the nearest Vicks Toxicological receiving center... hoping that their face would be spared from the hours of pain.

On another note: Please try to keep the 911 number a secret. People might get the wrong idea with you posting it all over the internet!

Yet another story I've recalled. Several years ago, Charlie (names have been changed to protect the HIPAA compliant) figured out that complaining of chest pain would get you a fire rescue taxi, a hot meal, and overnight room, and lots of attention. He even remembered our paramedic shifts so that he could spread his joy and system wide misuse thoughout the county. He often told his 911 taxi drivers that, "you guys HAVE to take me because I could be having a heart attack." I spent several nights trying to cope with this determined, manipulative offender. The local SO was unwilling to help. Charlie always phoned 911 from different locations within our response area.

When arriving at the local subway only to find Charlie clutching his chest and smiling, I asked him what he really wanted. "Aww dude, its cold and I'm hungry. Besides... I COULD be having a heart attack...." I promptly went into the local subway, purchased a footlong, and offered it to Charlie.

"Duuude," he said,"if you give me that, I wont bother you for at least a week!" I immediately instructed Charlie to eat the sandwich. This story got around and eventually my medical director had a chat with me about my solution to the Charlie problem. He brought me behind closed doors, sat down, and looked rather severe.

"Ben.... you've got to remember. You cannot, repeat, you cannot... feed the beast."

Happy holidays! I'm off to Neverland! Yea!

---

Members don't see this ad.

 

[Siggy]

Happy holidays! I'm off to Neverland! Yea!

Watch out for MJ. He loves the "children."

 

[tonem]

I learned how important it is to have good buddies "to watch your back" while I was on the trauma service.

A scaffold collapsed dropping two construction workers 20-30 feet (reportedly). The "sicker" of the two arrived about 15 minutes before the other. Being the efficient trauma team we stripped and flipped him (including the mandatory ATLS rectal exam) and had him rolling out of the trauma bay to the scanner just as his buddy was coming in. As the paramedics were starting to give their report he yelled out "Hey Joe, don't let em turn you over!"

I guess you had to be there

 

[tom_jones]

I have a mission this weekend - to find out who is paying for the advertising on Univision and Spanish International between 2am and 4am, saying "Ahora - HORITA! Es el tiempo por una cita en la sala de emergencia!" (For those who don't know - "Now - RIGHT NOW! It's time for a visit to the ER!")

And, if I find out that these ads have been paid for by those two dudes, who SHOULD be minding their own business, sitting on their porch, reading the Bible, with Grandma - well, I'll be angry!

Actually I think SOME DUDE is in charge of this.

 

[Sessamoid]

Actually I think SOME DUDE is in charge of this.

My customers usually say it was "these two dudes", because if it was just "some dude" (singular) presumably my customer would have smacked him around. Only when my customers get ganged up on do they get "jumped".

I shouldn't make too much fun. The only time I've ever been mugged, it was by a "whole crapload of dudes", probably young gangsters.

 

[Sessamoid]

BTW, this thread alone has almost as many posts as the whole Dermatology Forum.

 

[Apollyon]

Drink "every thing my cousin put in front of me", so you can fall backwards, and hit your head on the aquarium, causing a scalp lac all the way through, violating the galea. Whine incessantly about "I hate needles!". Tell me how your teeth hurt, as I tap on your skull so your mother can hear it while I'm sewing you up. Sustain a linear skull fracture from your fall (with a debatable subdural) - thank your maker you're totally intact. Intact so much so that, 7 hours after your last drink, when you are clinically sober (clear speech, normal gait), you, as a 17 year old, have a BAC of 239.

 

[Apollyon]

If you are a "black belt" and your discipline is "ninjitsu", don't expect me to be impressed when you say, "what's the purpose of having a black belt, if they (two women) jump on you and pin you down?".

 

[MoosePilot]

If you are a "black belt" and your discipline is "ninjitsu", don't expect me to be impressed when you say, "what's the purpose of having a black belt, if they (two women) jump on you and pin you down?".

Ummmm.... depending on how they looked.... I don't think I'd do a very good job of "fighting" either

 

[45408]

Wow, even I've noticed that "some dude" has a tendency to knock you out cold while SOC, arguing with your girlfriend. Nasty punk.

 

[Apollyon]

Ummmm.... depending on how they looked.... I don't think I'd do a very good job of "fighting" either

More to the story - one woman is the ex-wife, the other is her daughter - he comes over and threatens to kill them. The woman's daughter says, "I'll help you out!" and slashes her wrists. Not to be outdone, he takes the knife, and slashes HIS wrist - then denies the wound was self-inflicted. Then, the above fracas ensued.

 

[USAF MD '05]

My patient' s husband taught me (I am NOT making this up) never to hang out with my brother-in-law in the back yard throwing apples into the air and slicing them out of the sky with an old samurai sword. If you do this there is a possibility that when your wife steps onto the back porch that the business end of the sword may become suddenly detached from the hilt and fly at least 10 feet through the air penetrating her left orbit and slicing cleanly through your beloved's brain.

Gotta love the ED- where else could you get paid to see this stuff??

Steve

 

[roja]

Well, I didn't see this but this has to one of best 'oh, ****' stories:

Young man with multiple suicide attempts, attempts to take pills in front of dad. Dad grabs them, tosses them, calls ems. 1 block from the ED, with dad in the ambulance, guy pulls a KNIFE out of his pants and STABS HIMSELF IN THE CHEST (in the box). Open thoracotomy saves his life and he is PISSED to hell when he wakes up.


Other favorite story (thankfully left prior to MSE):

Young woman arrives in ED by ambulance because she and her bf were about to have sex. BF called the ambulance because the girlfriend 'smelled bad down there'. Haven't quite figured out WHY she got in the ambulance.

 

[bemused]

Speaking of whining about needles, how about the young lady who has developed an right antecubital abscess, right in the middle of her newest tattoo, who asserts that she doesn't shoot up in that arm but in her left only (she's right-handed, you know; it's too hard to do injections with the nondominant hand) - who cries for a good twenty minutes because she is afraid of the local.

 

[bemused]

Actually I think SOME DUDE is in charge of this.

In the Good Old South, it is almost always Some Dude and That Other Guy, because southern men are too manly to be beat down by Some Dude alone. Sometimes, Some Dude has to bring several of his friends to successfully jump these lone innocent southern gentlemen

 

[mikecwru]

I recently had a guy drink draino and slice his throat with a knife, with a carotid injury. Unresponsive, ph of 6.8 on arrival. Walked out of the hospital alive.

mike

Well, I didn't see this but this has to one of best 'oh, ****' stories:

Young man with multiple suicide attempts, attempts to take pills in front of dad. Dad grabs them, tosses them, calls ems. 1 block from the ED, with dad in the ambulance, guy pulls a KNIFE out of his pants and STABS HIMSELF IN THE CHEST (in the box). Open thoracotomy saves his life and he is PISSED to hell when he wakes up.


Other favorite story (thankfully left prior to MSE):

Young woman arrives in ED by ambulance because she and her bf were about to have sex. BF called the ambulance because the girlfriend 'smelled bad down there'. Haven't quite figured out WHY she got in the ambulance.

 

[mikecwru]

11 years old isn't too young to be a drunk MVA on New Years. And, you might as well have a fake Visa Platinum to "impress the ladies."

mike

 

[docB]

I recently had a guy drink draino and slice his throat with a knife, with a carotid injury. Unresponsive, ph of 6.8 on arrival. Walked out of the hospital alive.

mike

I'd say the thing that you learned was not to drink Drano and cut your own throat but if the guy walked out it must be OK.

 

[mikecwru]

I'd say the thing that you learned was not to drink Drano and cut your own throat but if the guy walked out it must be OK.

We need this guy giving lessons to our suicidal ideation patientson proper methods, no more just scratching up the wrists and taking 5 percocets.

mike

 

[funkless]

I'd say the thing that you learned was not to drink Drano and cut your own throat but if the guy walked out it must be OK.

Depending on the order of events, the Drano might have leaked out.

It's just a thought...


--Funkless

 

[mikecwru]

Depending on the order of events, the Drano might have leaked out.

It's just a thought...


--Funkless

No, I think he gave it a good few seconds like he was tasting a fine wine, then decided to filet his neck. I NG'd a lot of it out.... wanted to pour it down my sink at home. I just thought this guy was interesting because he's the most f'ed up person I've seen in residency walk out with relatively little physical complications.

 

[docB]

I recently had a guy drink draino and slice his throat with a knife, with a carotid injury. Unresponsive, ph of 6.8 on arrival. Walked out of the hospital alive.

mike

When I was on my Tox rotation I got called about a pt that took a massive OD of Tylenol then stabbed herself in the abd and perfed her duodenum. The question was if they should give the NAC IV. The Tox attending at the time was a big opponent of ever giving NAC IV so he told 'em to give it PO even with the perf. The reason I bring it up is that this woman did the double whammy too and failed just like your guy. I still think it's bullets or buildings if you want to get the job done right.

 

[anonymousEM]

My worst tylenol OD had also murdered her dog then used the same knife to stab herself multiple times...chest,arms,legs (fortunately for the hepatologists, none deep)...what a mess...

 

[Sessamoid]

The Tox attending at the time was a big opponent of ever giving NAC IV so he told 'em to give it PO even with the perf. The reason I bring it up is that this woman did the double whammy too and failed just like your guy. I still think it's bullets or buildings if you want to get the job done right.

So he thought that a raging peritonitis was less dangerous than NAC IV? I'm sorry, that just sounds crazy. IV NAC has to be less dangerous than intraperitoneal NAC + GI contents/flora + hydrochloric acid. Where exactly is NAC absorbed in the GI tract anyway? I've given IV NAC twice and neither patient died from it. Both patients survived their rather large ingestions.

 

[docB]

So he thought that a raging peritonitis was less dangerous than NAC IV? I'm sorry, that just sounds crazy. IV NAC has to be less dangerous than intraperitoneal NAC + GI contents/flora + hydrochloric acid. Where exactly is NAC absorbed in the GI tract anyway? I've given IV NAC twice and neither patient died from it. Both patients survived their rather large ingestions.

I agree with you. I wouldn't have done it. His feeling is that the NAC would be absorbed by the stomach. He also felt that since NAC is not FDA approved for IV he is precluded from recommending it.

 

[leviathan]

We need this guy giving lessons to our suicidal ideation patientson proper methods, no more just scratching up the wrists and taking 5 percocets.

mike

Yeah, or what about the singer Elliot Smith? Stabbed himself in the abdomen (I think) about 5 or 6 times in a row. You gotta be pretty depressed to keep plunging the knife in over and over.

 

[mikecwru]

When I was on my Tox rotation I got called about a pt that took a massive OD of Tylenol then stabbed herself in the abd and perfed her duodenum. The question was if they should give the NAC IV. The Tox attending at the time was a big opponent of ever giving NAC IV so he told 'em to give it PO even with the perf. The reason I bring it up is that this woman did the double whammy too and failed just like your guy. I still think it's bullets or buildings if you want to get the job done right.

Actually, I had a guy that shot himself in the head and failed, but didn't succeed until several years later, he took a crossbow arrow in the mouth. I have the pictures.

mike

 

[Apollyon]

Actually, I had a guy that shot himself in the head and failed, but didn't succeed until several years later, he took a crossbow arrow in the mouth. I have the pictures.

mike

10 years ago, our fire company had an 80 year old guy who killed himself by shooting himself in the chest with a .22 - twice. Didn't finish the job the first time.

 

[cosmo]

ha! how's this for follow up in the ER. I saw this guy about 1 mos after he was discharged. Came back to the ED and told me that he was at an outside ED and d/c'd for chest pain (hmm maybe secondary to the crack). Well he BS's me and tells me that the surgeons told him to come back here because there was still a razor that in his stomach from last time that they couldn't find. So I decide to entertain him given that he did have some LUQ tenderness. Sure enought he had another razor there, after confronting him, he admits that he swallowed another razor for $50 more bucks so he could by some crack.

In the words of Rick James "Cocaine is a helluva drug"

How does swallowing a razor score more crack? Small town suburbanite here, just wondering.

 

[beanbean]

Many years ago I had an attempted suicide patient that literally was a frequent flier. We airlifted him after he jumped from a 3rd floor roof and he had one year previous been airlifted by the same service after slashing his wrists. Survived both attempts; I guess he liked flying in the helicopter.

All these patients trying so hard to kill themselves remind me of Brad in the cinematic classic, "Bachelor Party". He's the whacked-out, depressed guy that spend the whole movie trying to do himself in and finally crashes a bus into a movie theater.

 

[MoosePilot]

How does swallowing a razor score more crack? Small town suburbanite here, just wondering.

Guessing a bet. I used to hang around people that weren't far short of that

 

[Apollyon]

If you have had 3 surgeries on your neck, including a cervical fusion, and have a persistent sensory deficit in your left arm, think about this before you start jumping on a trampoline. You may flip (incompletely) and land on your head (fortunately, on the trampoline, not on the ground), and, along with your scream and your pain, you may now have a motor deficit to go with your chronic sensory problem. After several people explain to you why you are getting steroids, and will need an MRI in the morning, and as you have a rigid collar on, please, try and understand why you "can't just go outside and have a smoke, since my shoulder hurts now, but I don't feel so weak anymore".

 

[Jeff698]

Actually, I had a guy that shot himself in the head and failed, but didn't succeed until several years later, he took a crossbow arrow in the mouth. I have the pictures.

mike

Call me obsessive, but if you're gonna do it, do it right (although I'm pretty impressed with the crossbow). Maybe we should print out flyers with the following instructions:

1) Take the ENTIRE bottle of Tylenol,
2) Wash it down with bleach,
3) Jump off tall bridge over fast moving river,
4) Shoot yourself in the head with a shotgun on the way down.

That ought to do it.

 

[bemused]

Call me obsessive, but if you're gonna do it, do it right (although I'm pretty impressed with the crossbow). Maybe we should print out flyers with the following instructions:

1) Take the ENTIRE bottle of Tylenol,
2) Wash it down with bleach,
3) Jump off tall bridge over fast moving river,
4) Shoot yourself in the head with a shotgun on the way down.

That ought to do it.

And if it doesn't, it will at least earn you a post in an SDN EM thread.

 

[toofache32]

How does swallowing a razor score more crack? Small town suburbanite here, just wondering.

I might pay to see that. Maybe even give ya some crack...

 

[The White Coat Investor]

I had a very depressed older gentleman with terminal cancer who shot himself four times in the head. .22. None penetrated the calvarium....I've got the CT to prove it.

 

[MoosePilot]

I had a very depressed older gentleman with terminal cancer who shot himself four times in the head. .22. None penetrated the calvarium....I've got the CT to prove it.

Who hasn't read about these incidents? Don't suicidal people learn from others mistakes? Use a big caliber and don't aim for the skull! The head is actually pretty risky, it would suck to live through severely brain damaged but still aware.

 

[manixter]

I saw a 15 yo in labor. As part of the basic airway assessment (since she was requesting an epidural), I asked her to open her mouth. What did I see? Braces.
And--- a tongue ring. The inquiring mind might want to know WHY someone with braces would want even more metal in their mouth. The even more inquiring mind might wonder how she got it in the first place (need a note from mom if you're under 18). And, lastly, would the purported benefits of a tongue ring during fellatio be enhanced, or reduced, if one has braces?
--mir

6) Trouble brewing: orthodontic braces + fellatio

 

[manixter]

IM Rocuronium, about 1 mg/ kg should do it. Just make sure no one is around to resuscitate you.
--mir
ps Yeah, so you'll be pretty uncomfortable while you asphyxiate. But then you'll be dead.

Call me obsessive, but if you're gonna do it, do it right (although I'm pretty impressed with the crossbow). Maybe we should print out flyers with the following instructions:

1) Take the ENTIRE bottle of Tylenol,
2) Wash it down with bleach,
3) Jump off tall bridge over fast moving river,
4) Shoot yourself in the head with a shotgun on the way down.

That ought to do it.

 

[The White Coat Investor]

KCl is still a very tried and true method, although it can burn a bit IV.

 

[Apollyon]

KCl is still a very tried and true method, although it can burn a bit IV.

Hey...if it's good enough for lethal injection...

 

[funkless]

If you present with "M'ahmbroke" because you got drunk and fell, fracturing your distal humerus, beware the orthopedic consult. They'll try to trick you into consenting to surgical repair. Luckily, you're too clever to fall for that. While they're busy reading the radiographs, remove your IV and head for the door. When they try to stop you, declare loudly and repeatedly "you ain't cuttin m'ahmoff!" Negotiate for a cast instead.

--Funkless

 

[Sessamoid]

If you try to rob a store with just a bb gun, you're not likely to win a firefight against a off duty police captain carrying his service pistol who happened to be shopping there.

Same patient: If you're the kind of person who would get a tattoo of a toe tag that reads, 'D.O.A.', there's a pretty good chance that the tattoo will turn out to be prophetic.

 

[Sessamoid]

I saw a 15 yo in labor. As part of the basic airway assessment (since she was requesting an epidural), I asked her to open her mouth. What did I see? Braces.
And--- a tongue ring. The inquiring mind might want to know WHY someone with braces would want even more metal in their mouth. The even more inquiring mind might wonder how she got it in the first place (need a note from mom if you're under 18). And, lastly, would the purported benefits of a tongue ring during fellatio be enhanced, or reduced, if one has braces?
--mir

6) Trouble brewing: orthodontic braces + fellatio

I foresee even more trouble if the fellow is also sporting hardware on his genitalia. I'm still waiting for that to show up in my ER, though since I work in Hollywood maybe I won't have to wait that long.

 

[NateatUC]

Same patient: If you're the kind of person who would get a tattoo of a toe tag that reads, 'D.O.A.', there's a pretty good chance that the tattoo will turn out to be prophetic.

I dunno, seems to me that a tattoo like that should automatically equate to a tooth:tattoo ratio less than 1 (kinda like cardiovascular risk equivalents, I guess), and we all know those people NEVER die.

 

[Paws]

My worst tylenol OD had also murdered her dog then used the same knife to stab herself multiple times...chest,arms,legs (fortunately for the hepatologists, none deep)...what a mess...

Murdered her DOG!?? now, that's cruel ...

 

[aphistis]

6) Trouble brewing: orthodontic braces + fellatio

 

[deleted6669]

I foresee even more trouble if the fellow is also sporting hardware on his genitalia. I'm still waiting for that to show up in my ER, though since I work in Hollywood maybe I won't have to wait that long.

are you at queen of angels? if so say hi to mike leidner for me....we go way back......

 

[deleted6669]

10 tablets of colace is not a suicide attempt. it is a free psych admission( and a few days of diarrhea).

 

[vanelo]

If an 83-year old man arrives choking to the ER and you manage to remove the piece of meat that was blocking his airway, do leave the piece of meat in the tray so that the 17 year old drunk/stoned pt you have in the other bed can eat it.

Totally gross