Things I Learn From My Patients

[Siggy]

If you are feeling light headed and have chest pain, it actually is a good idea to go to the nearest fire station instead of calling for an ambulance. That way, when you collapse after you've been there for a whole 2 minutes, at least they will still have an AED to use on you.

(note: I sat in on the radio call at the hospital with the MICN. AED had a shockable rythum and went for the gold).

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[docB]

Las Vegas is the fastest growing city in the country. A huge number of the patients I see don't have a PMD because they "just" moved here (sometime within the last year). Here are some medical tips for your move:
-Don't jus quit taking your cyclosporin because you moved away from your doctor your transplanted kidney will die. Your aunt can't give you another one.
-You can't quit dialysis just because you moved. Your kidneys won't work any better in Vegas than they did in LA.
-If you move here and run out of insulin (after 2 months) and call your doctor back in Jersey and tell him you feel bad and can't quit puking ('cause you're in DKA) he'll tell you to go to the ER. I'll tell you you're an idiot.
-If you show up in the ER because you need a new PMD and med refills I can't instantly get the records from your old PMD in Detroit, especially if you can't remember his name or phone number. Therefore, since you don't know any of your meds or history I won't either. BTW none of this would be my problem except that your BP is 260/130.
-If you have an elderly, infirm relative somewhere else and you either feel they are not getting good care or it is inconvienient for them to be where they are it is not the proper course of action to fly, drive or peddle them here and dump them in my ER so I can find them a new home.
PS- about that last one I see 3-5 of those per week now. Some are really sick. The amusing ones are the ones that are well and just require an assisted living type place because they can go home. When they get discharged it results in some amusing conversations.
Family: "Waddaya mean he can go home? I brought him in so you can find him a place."
Me: "That's not what we do. We're the ER. He's got no serious illness or emergency. You can take him home and care for him and then you can find him a place to live."
I had one guy that just turned around and walked out leaving his dad sitting in a wheelchair in the hall. I wound up having to admit him as a social.

 

[blotto geltaco]

-If you have an elderly, infirm relative somewhere else and you either feel they are not getting good care or it is inconvienient for them to be where they are it is not the proper course of action to fly, drive or peddle them here and dump them in my ER so I can find them a new home.

Also otherwise known as "pop drop". Very prevalent at any VA. Best chance for reversal is informing the family that the family won't get a monthly check any more if the pt. is placed.

 

[cdr50]

lesson # 155674:


self injecting boiling crisco into the urethra will not resolve an erectile dysfunction... no matter how many times your best friend assures you.

 

[docB]

lesson # 155674:


self injecting boiling crisco into the urethra will not resolve an erectile dysfunction... no matter how many times your best friend assures you.

It's always a good idea to insist that friends with such advice be willing to demonstrate their treatments. Unfortuately there will still be those who want to believe.

 

[spyderdoc]

lesson # 155674:


self injecting boiling crisco into the urethra will not resolve an erectile dysfunction... no matter how many times your best friend assures you.

There's one good way to remove yourself from the gene pool...(and rightfully so!)

 

[Sessamoid]

There's one good way to remove yourself from the gene pool...(and rightfully so!)

Go lemmings, go!

 

[heldicus]

lesson # 155674:


self injecting boiling crisco into the urethra will not resolve an erectile dysfunction... no matter how many times your best friend assures you.

OMG.

To borrow from Lewis Black: I thought we all had a little voice inside our heads when it comes to 'down there.' A little voice that sees you standing there in the bathroom with your pants around your ankles, with a 14g needle and some crisco on a hotplate. And that voice says "hey, maybe this isn't such a good idea."

I must ask, what are the lasting effects of a hot crisco catheterization?

 

[funkless]

OMG.

I must ask, what are the lasting effects of a hot crisco catheterization?

Moreover, what are consequences of hot crisco injection + coitus w/ girl who has a yeast infection? Hush puppies?

BLEEECH. Made myself sick.

 

[Jeff698]

Moreover, what are consequences of hot crisco injection + coitus w/ girl who has a yeast infection? Hush puppies?

Oh.

Wow.



My friend, you have reached a new level of disgustingness.





I salute you!

Take care,
Jeff

T-13 hours, 43 minutes (not that I'm counting)

 

[cdr50]

regarding:

>what are the lasting effects of a hot crisco catheterization?


while no long term studies have been completed and reported...
and the full spectrum of possible treatment outcomes has likely not yet been defined, we might look to the limited number of subjects who have participated in this treatment and examine outcomes.

our one subject reported a chief complaint of "burning with urination" eight days post hot crisco introduction.

urinary hesitance, dysuria, and penile erythema with edema were reported.

no improvement in erectile function was observed by day eight.

while long term followup is lacking, the one subject in our study was evaluated for other complaints thirteen months post urethral/crisco treatment... and dissatisfaction with an ongoing erectile dysfunction was expressed.

a complete list of long term effects are (at this time) unknown...
(subject has been lost to followup)
(thankfully!!!)
but...
it is felt that potential outcomes will likely not justify the employment of this treatment strategy.

 

[heldicus]

regarding:

>what are the lasting effects of a hot crisco catheterization?


while no long term studies have been completed and reported...
and the full spectrum of possible treatment outcomes has likely not yet been defined, we might look to the limited number of subjects who have participated in this treatment and examine outcomes.

our one subject reported a chief complaint of "burning with urination" eight days post hot crisco introduction.

urinary hesitance, dysuria, and penile erythema with edema were reported.

no improvement in erectile function was observed by day eight.

while long term followup is lacking, the one subject in our study was evaluated for other complaints thirteen months post urethral/crisco treatment... and dissatisfaction with an ongoing erectile dysfunction was expressed.

a complete list of long term effects are (at this time) unknown...
(subject has been lost to followup)
(thankfully!!!)
but...
it is felt that potential outcomes will likely not justify the employment of this treatment strategy.

That's hysterical...I've got NEJM on the line for you...

 

[docB]

but...
it is felt that potential outcomes will likely not justify the employment of this treatment strategy.

Well that's a gross rush to judgement! I say we need a huge prospective, multicenter trial to sort this out. I'll write the IRB.

 

[Sessamoid]

Even if you're in a rush to get out of the restroom, make sure you zip up carefully.

I know the scenario is well-known from Hollywood, but it was the first time I'd had to extract one of those from a patient. This one was in Hollywood too, but for real.

 

[GeneralVeers]

If you're 48 years old with multiple risk factors for heart disease and come to the county ED complaining of substernal chest pain, it's a good use of everybody's time if you sign out AMA 6 hours later because "they won't let you smoke in the hospital". If you do it, the best time is BEFORE your cardiac markers come back.

 

[cubsrule4e]

Just because the hired help outside your room isnt a "real cop" doesnt make it hurt any less when youre trying to escape and they tackle you, resulting in you taking a header through a sliding glass door.

 

[Sessamoid]

If you're a 65+ male, if you start feeling chest pain, do not try to cure these pains over a period of one week by placing hot coins in various places on your chest roughly corresponding to the location of the pain (over sternum and left chest in the direction of the left shoulder), not even if you hate doctors and hospitals.

Coining != angioplasty.

 

[v-tach]

If you're a 65+ male, if you start feeling chest pain, do not try to cure these pains over a period of one week by placing hot coins in various places on your chest roughly corresponding to the location of the pain (over sternum and left chest in the direction of the left shoulder), not even if you hate doctors and hospitals.

Coining != angioplasty.

Yikes! What ended up happening with this patient?

 

[USAF_Dentman]

Ok, this is going to sound sick..(one of my buddies who is an EM res told me this)....

This one woman was using a glass dildo and it broke off inside of her and they took it out of her piece by piece....OUCH!

 

[spyderdoc]

If you are having rough intercourse, and your partner likes to insert foriegn objects while in the act, make sure he uses a 6ft long RCA cable, folds it in half and twists it so it has the characteristics of a foley catheter. This way, he can insert it directly into your urethra. Make sure it goes most the way in so that it can roll into a ball in your bladder. After the post coital euphoria wears off, you realize that you can't remove it, so you go to the ER wearing nothing but a short skirt. So now when you do the walk of shame down the ER hallway with the connecter ends of the cable dangling between your legs, don't wonder why all these people are looking at you funny!

As for her partner, make sure you send her to the ER alone so you don't have to deal with all of the embarassment...

This is a true case from when I was a ER tech. The whole ED staff stood in a silent jaw dropping stupor around the xray box while looking at the coiled up wire in her bladder....

The urologist came in, sedated her, did a hail mary and just pulled it right out. The ED doc thought that was kinda ballsy since we were not sure if it tied itself into a knot while it was coiling up...It would be kinda like pulling a foley with the balloon still inflated. Luckily for her, it was not.

 

[MoosePilot]

If you are having rough intercourse, and your partner likes to insert foriegn objects while in the act, make sure he uses a 6ft long RCA cable, folds it in half and twists it so it has the characteristics of a foley catheter. This way, he can insert it directly into your urethra. Make sure it goes most the way in so that it can roll into a ball in your bladder. After the post coital euphoria wears off, you realize that you can't remove it, so you go to the ER wearing nothing but a short skirt. So now when you do the walk of shame down the ER hallway with the connecter ends of the cable dangling between your legs, don't wonder why all these people are looking at you funny!

As for her partner, make sure you send her to the ER alone so you don't have to deal with all of the embarassment...

This is a true case from when I was a ER tech. The whole ED staff stood in a silent jaw dropping stupor around the xray box while looking at the coiled up wire in her bladder....

The urologist came in, sedated her, did a hail mary and just pulled it right out. The ED doc thought that was kinda ballsy since we were not sure if it tied itself into a knot while it was coiling up...It would be kinda like pulling a foley with the balloon still inflated. Luckily for her, it was not.

Wow!

 

[Febrifuge]

The urologist came in, sedated her, did a hail mary and just pulled it right out. The ED doc thought that was kinda ballsy since we were not sure if it tied itself into a knot while it was coiling up...It would be kinda like pulling a foley with the balloon still inflated. Luckily for her, it was not.

Dude!

Though, if you had two views on xray, I bet you could tell if there was a knot. And I wonder... ultrasound would be helpful too, yeah? Heck, now that I think about it I bet our residents would be disappointed that Uro got to do it instead of them.

 

[spyderdoc]

Dude!

Though, if you had two views on xray, I bet you could tell if there was a knot. And I wonder... ultrasound would be helpful too, yeah? Heck, now that I think about it I bet our residents would be disappointed that Uro got to do it instead of them.

Well, that was way back when I was a tech....
Even now, I would probably still call urology to remove it...You can do a whole lotta damage if things go wrong...

 

[Sessamoid]

Yikes! What ended up happening with this patient?

Exactly what you think would happen.

 

[Febrifuge]

Well, that was way back when I was a tech....
Even now, I would probably still call urology to remove it...You can do a whole lotta damage if things go wrong...

Oh, my resident associates would call Uro, too. I'm just speculating that they'd be a little sad to give up such a crazy procedure, even if it's the right thing to do. (A couple of them drop by here from time to time, and they'll feel free to correct me if I'm wrong.)

 

[Apollyon]

Dude!

Though, if you had two views on xray, I bet you could tell if there was a knot. And I wonder... ultrasound would be helpful too, yeah? Heck, now that I think about it I bet our residents would be disappointed that Uro got to do it instead of them.

It's more likely the knot would form as it was pulled out (vs forming when going in) - so a lateral XR probably wouldn't help (but fluoro would). U/S is a good suggestion.

 

[cdr50]

re.:

>a lateral XR probably wouldn't help (but fluoro would). U/S is a good suggestion


one will find increased resistance if...
while removing a 6 ft long RCA cable from a subject's bladder...
the cable becomes knotted and the resultant knot is greater in size than the urinary bladder urethra through which it is being removed. when increased resistance is encountered, flouroscopy will allow an excellent view of the cause for increased resistance!

the trick (and challenge!) (when flouroscopy is unavailable) is to know when to pull harder...
and when to not pull harder!

 

[docB]

I really learned something on this one.

If you're an ER doc who is reducing a dislocated hip on an incontinent little old lady you should either leave the diaper on the pt or avoid putting your knee in her crotch when you kneal on the bed to pull the hip. If you don't you'll wind up with a sickly warm feeling all over your leg as you finish the reduction.

 

[ERMudPhud]

I really learned something on this one.

If you're an ER doc who is reducing a dislocated hip on an incontinent little old lady you should either leave the diaper on the pt or avoid putting your knee in her crotch when you kneal on the bed to pull the hip. If you don't you'll wind up with a sickly warm feeling all over your leg as you finish the reduction.

I tend to squat rather than kneel on the bed when reducing hips but I've lost track of the number of times little old ladies have stooled on my shoes. I've recently noticed that propofol>>>> way better than anything else when it comes to reducing hips. They are so relaxed you can pretty much lift the hip into place.

 

[ERMudPhud]

Dental pain is more important than respiratory arrest.

Our ED has bays divided into sections by curtains. Last night I was in the middle of resuscitating a respiratory arrest from an overdose. It was a horrible intubation with multiple attemps with us opening all kinds of toys from our difficult airway kit. Between each attempt we are laboriously bagging the patient back up. The bay is full of nurses, techs, RT's, docs, etc... In the middle of it all the patient from the next bed wanders over and loudly complains that she is in pain, she's been here 20 minutes, and no one has seen her yet.

 

[Apollyon]

Even though it's only a simulator grenade (meaning it has about enough explosive of 1/4 stick dynamite), after you pull the cord and throw it, if it doesn't go where you wanted it to go, don't go to pick it up. When it explodes one foot from your hand, be thankful it has only degloved the middle finger on your dominant hand.

 

[deleted6669]

Dental pain is more important than respiratory arrest.

Our ED has bays divided into sections by curtains. Last night I was in the middle of resuscitating a respiratory arrest from an overdose. It was a horrible intubation with multiple attemps with us opening all kinds of toys from our difficult airway kit. Between each attempt we are laboriously bagging the patient back up. The bay is full of nurses, techs, RT's, docs, etc... In the middle of it all the patient from the next bed wanders over and loudly complains that she is in pain, she's been here 20 minutes, and no one has seen her yet.

same thing happened to me on my last code...I'm intubating the guy and pt comes in from next room demanding meds for his exacerbation of chronic back pain......we kick him out..few minutes later I am putting in an ej, guy comes back in and tries it again....come on dude, cpr in progress, equipment all over the place, catch a clue....we were so pissed we gave him a good long "therapeutic wait" and he ended up leaving before being seen

 

[docB]

If you are one of those guys who compensates for his self esteem issues by jacking your truck 8 feet up in the air don’t let your drunk girlfriend try to get out of it on her own. She will topple out and fall on the asphalt breaking her fall with her face. Then once you come into the ER it’s best not to stand in the hallway and make a loud scene by yelling at the charge nurse because you feel you are not getting placed fast enough. The reason you shouldn’t do this is not just because it reinforces your status as an obnoxious jerk. It’s also because someone who knows you might see you being such an ass and call your wife to tell her that you’re in the ER with another woman. Once your wife shows up about 30 min later you’ll be lucky that she is asking for you at the desk. Since you are not registered in the ER the desk won’t know who you are so they’ll page out overhead for you to meet your wife in the ER waiting room. When you hear this remember to yell at your nurse and demand to know why your wife is here looking for you because as you know an ER nurse’s highest priority is to keep track of your wife and to help keep your infidelities secret. Once you realize that you are totally caught make sure you sneak out the ambulance door to avoid your wife like the coward you are.

 

[cardiotonic]

If you are one of those guys who compensates for his self esteem issues by jacking your truck 8 feet up in the air don’t let your drunk girlfriend try to get out of it on her own. She will topple out and fall on the asphalt breaking her fall with her face. Then once you come into the ER it’s best not to stand in the hallway and make a loud scene by yelling at the charge nurse because you feel you are not getting placed fast enough. The reason you shouldn’t do this is not just because it reinforces your status as an obnoxious jerk. It’s also because someone who knows you might see you being such an ass and call your wife to tell her that you’re in the ER with another woman. Once your wife shows up about 30 min later you’ll be lucky that she is asking for you at the desk. Since you are not registered in the ER the desk won’t know who you are so they’ll page out overhead for you to meet your wife in the ER waiting room. When you hear this remember to yell at your nurse and demand to know why your wife is here looking for you because as you know an ER nurse’s highest priority is to keep track of your wife and to help keep your infidelities secret. Once you realize that you are totally caught make sure you sneak out the ambulance door to avoid your wife like the coward you are.

Hello docB,

I noticed you practice emergency medicine in Las Vegas, and I just wanted to ask you a few questions. I'm going to be attending Touro University College of Osteopathic Medicine, Nevada (Henderson) in the fall, and I am strongly considering becoming an er physician. First, how do you like emergency medicine? What are the pros and cons? Secondly, what type of person do you think it takes to become a good er physician? Lastly, what do you think of emergency medicine in Las Vegas? Thanks in advance for your time.

cardiotonic
TUNV Class of 2009

 

[leviathan]

Hello docB,

I noticed you practice emergency medicine in Las Vegas, and I just wanted to ask you a few questions. I'm going to be attending Touro University College of Osteopathic Medicine, Nevada (Henderson) in the fall, and I am strongly considering becoming an er physician. First, how do you like emergency medicine? What are the pros and cons? Secondly, what type of person do you think it takes to become a good er physician? Lastly, what do you think of emergency medicine in Las Vegas? Thanks in advance for your time.

cardiotonic
TUNV Class of 2009

Cardiotonic,
If you look elsewhere on the board (eg. the FAQ), you will probably find lots of people asking the same question where docB and other EM physicians have taken the time to create a carefully thought out and insightful response. Just giving you some advice in case docB decides not to answer the same question again.

 

[docB]

Hello docB,

I noticed you practice emergency medicine in Las Vegas, and I just wanted to ask you a few questions. I'm going to be attending Touro University College of Osteopathic Medicine, Nevada (Henderson) in the fall, and I am strongly considering becoming an er physician. First, how do you like emergency medicine? What are the pros and cons? Secondly, what type of person do you think it takes to become a good er physician? Lastly, what do you think of emergency medicine in Las Vegas? Thanks in advance for your time.

cardiotonic
TUNV Class of 2009

Happy to answer but will do it in a PM.

 

[ERMudPhud]

Lessons from my last shift

1. Shooting heroin into your radial artery is bad

2. It is possible to manually disimpact yourself

3. Herbals are ineffective in treating metastatic cancer

 

[USCDiver]

Getting a bone density scan can result in 'burns' if the scanner is left over your chest too long, despite the fact that there is no clinical evidence for a burn, your skin looks entirely normal and is non-tender.
Quote of the Day: "I ain't no doctor and I ain't no nurse, but I know you wouldn't leave a torch on a cow's skin that long when you're branding her."

 

[stoic]

2. It is possible to manually disimpact yourself

i'm quite curious as to how this would be accomplished?

 

[iliacus]

If you are one of those guys who compensates for his self esteem issues by jacking your truck 8 feet up in the air don’t let your drunk girlfriend try to get out of it on her own. She will topple out and fall on the asphalt breaking her fall with her face. Then once you come into the ER it’s best not to stand in the hallway and make a loud scene by yelling at the charge nurse because you feel you are not getting placed fast enough. The reason you shouldn’t do this is not just because it reinforces your status as an obnoxious jerk. It’s also because someone who knows you might see you being such an ass and call your wife to tell her that you’re in the ER with another woman. Once your wife shows up about 30 min later you’ll be lucky that she is asking for you at the desk. Since you are not registered in the ER the desk won’t know who you are so they’ll page out overhead for you to meet your wife in the ER waiting room. When you hear this remember to yell at your nurse and demand to know why your wife is here looking for you because as you know an ER nurse’s highest priority is to keep track of your wife and to help keep your infidelities secret. Once you realize that you are totally caught make sure you sneak out the ambulance door to avoid your wife like the coward you are.

This is a classic. docB you never let us down

 

[beanbean]

Another way to get caught cheating:

While your wife is slaving away as a cocktail waitress at the local steak house, be sure to hook up with a girl at a friend's house while having a few drinks and painkillers. Since you feel you are less impaired than she, by all means offer to drive your new girl's car and head off to a bar together. Drive 65 mph head on into a stone bridge wall.....killing the girl you just hooked up with!

Scene in the trauma room: One patient DOA; one patient drunk and completely without remorse; and one really pissed off wife who showed up after hearing her loving husband was in a MVC.

The guy got 8 yrs in prison for vehicular manslaughter after a trial (no plea). Second DWI offense and received his third awaiting trial. Never took responsibility for the accident and still claims he wasn't driving. One of those "when we were thrown in the air we switched seats" excuses. Loser.

Wife divorced him.

 

[deleted6669]

if you are stealing a 20 dollar bottle of jack daniels from a liquor store and your anticipated getaway vehicle is your bicycle, make sure you look both ways before entering traffic as you will get hit by a large truck and suffer, among other injuries, a mandibular fx, a laforte 3 fx, 2 midforearm fxs, and a fx/dislocation of your ankle.....
and you will drop the bottle of j.d.

 

[doctordan]

- Spreading dog food onto your genitals is not a successful way of feeding your pets and can end in tears
- Do not do as one of my patients requiring removal of a foreign body claims to have done "I was just getting some bowling trophies down from the attic and fell from my ladder onto one of them" I didn't ask him why he was naked at the time. Or as a 17 year old requiring the same proceedure because he "swallowed" a whole carrot
- Do not let your kid but a live gerbil in their mouth however much they want to.

 

[vanelo]

if you are stealing a 20 dollar bottle of jack daniels from a liquor store and your anticipated getaway vehicle is your bicycle, make sure you look both ways before entering traffic as you will get hit by a large truck and suffer, among other injuries, a mandibular fx, a laforte 3 fx, 2 midforearm fxs, and a fx/dislocation of your ankle.....
and you will drop the bottle of j.d.

Unlucky guy to drop that bottle.

 

[IdiotBoxen]

I've not posted here in a while. I saved up the gems just for you guys...

1) 62 yo pt with breast carcinoma. Goes to see a herbalist. Suggestion, is that she sits on this shaking table to make the cancer cells dizzy, then hit them with the homeopathy to finish them off. Funnily enough, this failed to work and my good friends in surgery did a radical double mastectomy. PET indicates she has mets to the bone.

2) Dude, if you've raped your wife half to death, the best suggestion is NOT to turn up to the hospital when there are 3 police officers in the room with her, with 1 guarding the door.

3) When you come in for your well-woman exam, please remove the bag of marijuana from your vagina beforehand.

4) Don't pick up the box of latex gloves and throw it at the medical student.

5) No, why would pouring yoghurt in your vagina cause problems?

6) The messages on cigarette packs aren't kidding. They will harm your child. One patient claimed the risk was "trumped up" and not real.

Had one sad case though. 34 year old woman was 8 months pregnant, had a massive bleed in her brain. She unfortunately died, but, we delivered the female child by c-section and is safe and well with her dad.

 

[Febrifuge]

5) No, why would pouring yoghurt in your vagina cause problems?

In a strictly wilderness-medicine kind of way, mind you, wouldn't this be a half-decent temporary measure to fight a raging yeast infection?

 

[pushinepi2]

same thing happened to me on my last code...I'm intubating the guy and pt comes in from next room demanding meds for his exacerbation of chronic back pain......we kick him out..few minutes later I am putting in an ej, guy comes back in and tries it again....come on dude, cpr in progress, equipment all over the place, catch a clue....we were so pissed we gave him a good long "therapeutic wait" and he ended up leaving before being seen

Jeeeeeeeezzzzz... you really should consider taking down the sign that says, "EMERGENCY ROOM." Its very misleading. Perhaps you might consider changing the signage to read, "Have it your way." or.. "Open late."

-Push

 

[docB]

Jeeeeeeeezzzzz... you really should consider taking down the sign that says, "EMERGENCY ROOM." Its very misleading. Perhaps you might consider changing the signage to read, "Have it your way." or.. "Open late."

-Push

Ifrequently tell patients that of course they can have what ever *****ic thing it is that they want because after all we are the Burger King of medicine. I also frequently tell people when they ask for pain meds that we are like a vending machine for narcotics.

 

[aphistis]

if you are stealing a 20 dollar bottle of jack daniels from a liquor store and your anticipated getaway vehicle is your bicycle, make sure you look both ways before entering traffic as you will get hit by a large truck and suffer, among other injuries, a mandibular fx, a laforte 3 fx, 2 midforearm fxs, and a fx/dislocation of your ankle.....
and you will drop the bottle of j.d.

The OMS guys (& girls?) must've had a great time with that one. Did the LF3 trash his vision?

 

[VA Hopeful Dr]

Ifrequently tell patients that of course they can have what ever *****ic thing it is that they want because after all we are the Burger King of medicine. I also frequently tell people when they ask for pain meds that we are like a vending machine for narcotics.

Ah, but vending machines require you to put in money before they give you candy.