Things I Learn From My Patients

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this one is actually something i've learned from patients. and it's not funny. i'm quite serious about it. i'm in the midwest. the very midwest. lots of cowboys. and not the kind from brokeback mountain.

anyway. don't participate in rodeos. that's what i've learned. the most horrible and most painful things i've ever seen were both the result of rodeo injuries (one quite recently, hence the post).

most horrible thing i've seen:
guy got bucked off of a bull which was then mauling and kicking the **** out of him. the bull jumped and landed right on the guys sternum with one of it's hoofs. the hoof punched right through the the sternum and ripped the right side of the heart and mediastinum apart. there was a perfect hole punched into this guys chest through his sternum. the damage was unbelievably extensive and i don't think that even if this would have happened in an OR with two cardiothoracic attendings right there that the pt would have had a shot. as it was, it was like a 15 minute transport to the hospital and the guy was long gone by the time he got to the ED. i've never seen so much blood. we met the ambulence and the back of the truck and paramedics were completely covered. the pt had lost most of his blood volume. anyway, it really sticks out in my mind as one of the worst traumatic injuries i've ever seen.

the most painful thing:
this poor guy recently defined 10/10 pain for me. he was bucked off of a horse and landed on his sacral area (this adds up to like a 8+ foot fall). he showed up and was just completely writhing in pain. he was a bad ass looking cowboy, and his was screaming and crying in pain. not whimpy crying like some people do, this was the real thing. it's that sound that just makes the hair on your neck stand up. anyway, he couldn't bear wieght or stand b/c of the pain, couldn't sit, couldn't lie on his back. the only thing he could handle was laying on stomach and even that was excruiciating. we cut off the shirt and pants and though there was no visible deformity, you could watch the muscles in his back and right thigh going through these big spasms that looked just aweful. couldn't get him in a good position for the l-spine series on plain film even after a bunch (and i mean a bunch) of demerol and robaxin (IV, not IM). anyway, we CT'ed him and he had transverse process fractures of L2, 3, 4, 5 and he had crushed his sacral hiatus as well. i don't know exactly why this was such a painful ortho injury, i'm guessing because the paraspinal muscles were still connected to the broken transverse process's (wtf is pleural for process?) and spasming so severely. anyway we ended up getting his pain undercontrol with pca dilauded, but he was snowed for several days and still extremely uncomfortable.

so yea, i learned that everyone should stay the **** away from rodeos. seriously. bad things happen which you piss much larger mammals off.
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Speaking of Rodeos i worked one a couple years back. A cowboy got bucked of and on the way down took a couple shot to the head and body from the hoofs. We roll up with backboard and all that getting ready to expose the PT to check for trauma other then the hemetoma above the eye and hoof print on the temple. I pull out my shears and well.....

Lesson learned from the rodeo clown

"If you cut one @#@$@# stitch of clothing off that cowboy son i will #$@#$#@ kill you."

Needless to say i put the shears away and have lived in fear of clowns ever since.

Oh yea cowboy woke up and waivered AMA
 
If you fall from a height and stay uncouncious for 20min don't wait a month before going to the ED for a headache or you will end up waiting a couple of hours in triage then once admitted seize and get a ETT, a scan will reveal intraventricular bleeding and you will die a few days later in the ICU with more lines in you than a mupet :scared:
 
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stoic said:
(wtf is pleural for process?)
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Just FYI...

Plural for process is processes, as in spinal processes.

(I'm the one who has to know this stuff so your reports can look so darn good!) :rolleyes:
 
When you go onto the beach to swim and fail to ask the life guard the current condition and fail to understand the meaning of colorful flags, especially the red one... don't be surprise when you get sucked out into the ocean... Yeah... go right ahead and panic... try to swim in the same straight line back onto land.. you'll become rather tired and drown and become fish food, if nobody finds your body.




http://www.nbc6.net/news/9637984/detail.html

POSTED: 8:04 am EDT August 7, 2006
UPDATED: 9:03 am EDT August 7, 2006

DANIA BEACH, Fla. -- The weekend in the water proved to be dangerous on South Florida beaches. The beautiful weather was somewhat deceiving for swimmers. "We were all having a good time," a woman who had been swimming told NBC 6.

That's until two swimmers with the Bethlehem Seventh Day Adventist Church of Pompano Beach didn't return to shore at John U. Lloyd Park.

"Everybody was getting ready to go home," one witness said. But then, she said, they noticed two swimmers were missing.

The two men were rescued but one of them died at Hollywood-Memorial Regional Hospital. Both were apparently unaware of the dangers of rip tides which were also blamed for an incident that happened minutes earlier at Lauderdale-By-The-Sea where an Iowa man drowned.

Further south in Key Biscayne, a 32-year-old man survived after falling overboard while fishing.

Rip tides warnings continue at least until the middle of this week, NBC 6 reporter Hetal Ghandi said. If you see the orange flag, it's a warning that while you can still go in the water, you need to be cautious of those dangerous rip currents.

Rip currents kill more people in Florida each year than hurricanes, lightning and tornadoes combined.


http://www.ripcurrents.noaa.gov/ for more information on rip currents
 
That's not really funny....especially given the case of the guy from Iowa. :thumbdown:
 
I wasn't trying to make it look funny... What I'm trying to point out... EDUCATE yourself before entering into the ocean.
 
Awww...I got the "lovey" smiley from FF.

Hope you and the family are doing well!
 
Anuwolf,

Your post is just plain mean. You are the one who should educate yourself. 51 pages of lighthearted stories and you don't understand the purpose of this thread? It isn't for posting news blurbs about people who died tragic deaths from natural phenomena. It's not unusual at all for people, especially those from Iowa and other inland states, not to understand the dangers of swimming in the ocean. You just wanted to gloat about something you knew that these people didn't. Grow up.
 
dwir918 said:
Anuwolf,

Your post is just plain mean. You are the one who should educate yourself. 51 pages of lighthearted stories and you don't understand the purpose of this thread? It isn't for posting news blurbs about people who died tragic deaths from natural phenomena. It's not unusual at all for people, especially those from Iowa and other inland states, not to understand the dangers of swimming in the ocean. You just wanted to gloat about something you knew that these people didn't. Grow up.
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Oh please dwir918 I've seen harsher words on this thread! If I remember clearly a member here actually avacated suicide! yes! apparently he recieved the same suicidal patient within the prior of the month and came here to poke fun about it..
 
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I think what anuwolf is missing is that we take care of these people, save their lives, and put them back together. Then we come here to vent a little. Given what we do I think we have that right. We aren't just trolling the net for tragic stories of people who die in foolish ways and then reposting them to make fun of them. As he has admitted he's a psych patient I've tried to give him the benefit of the doubt but I have to admit his postings on this thread and a few others have made me uncomfortable. Hopefully people who wander in to this thread from outside, as frequently happens, will realize he isn't one of us
 
ERMudPhud said:
I think what anuwolf is missing is that we take care of these people, save their lives, and put them back together. Then we come here to vent a little. Given what we do I think we have that right. We aren't just trolling the net for tragic stories of people who die in foolish ways and then reposting them to make fun of them. As he has admitted he's a psych patient I've tried to give him the benefit of the doubt but I have to admit his postings on this thread and a few others have made me uncomfortable. Hopefully people who wander in to this thread from outside, as frequently happens, will realize he isn't one of us
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Why is it okay for you guys to vent but I cant? Oh wait is it because I dont have a MD or DO degree? For the last time I had no attention of trying to poke fun at such traffic event. You may call me heartless but I do not have any symphony for stupid and dumb people.. If they ignore the warning signs and fail to get information regarding to the beach conditions by a life guard... I'm saving my symphony tears for those who are losing their lives in Iraq... For those who are dying from aids, Cancer,etc and for those with mental problems.

By the way I'm not a HE but a SHE... and yes I admit that I'm a psych patient... what does that have to do with this? Do you treat psych patients differently? Like if their LOWER then dogs?
 
FoughtFyr said:
What guy from Iowa?

- H
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which were also blamed for an incident that happened minutes earlier at Lauderdale-By-The-Sea where an Iowa man drowned.
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That guy from Iowa was who I am referring to.
 
and for those with mental problems.
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Ah.....well I guess there is solidarity among pysch patients.... :smuggrin:

Do you treat psych patients differently?
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Yes, when it is indicated.

Like if their LOWER then dogs?
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No, because it's harder to get lower than a Dachshund. :smuggrin: ;)

yes I admit that I'm a psych patient... what does that have to do with this?
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It's not that you're a psych patient, it's that you're an annoying psych patient.
 
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. . . . and to get back to the original thread:

Here's what I learned.

Never get out of your car to see if the person in the car in front of you is not moving because they "might have had a stroke or something" and then tap on their car window and tell them to please move. If you do this you might end up having the pleasure of experiencing a variation on the SOCMOB theme.
The person in that car will not appreciate you interrupting her cell phone conversation and she will get out of the car and jump you as you walk back to your own car. In addition to some standard blows to the head and a scuffle that leaves you on the ground unconscious, you will also sustain two stab wounds from a pair of scissors and multiple human bites to the hands and face.

To make matters worse, you will be started on HIV prophylaxis because the girl who decided to pull a Mike Tyson on you was also screaming, "I got AIDS bitch! And I hope you get it!"

Also, the story will be even more pathetic when you tell me that you came out of your brief loss of consciousness when your 8 year old grandson (who witnessed the entire incident) poured his Coke on your face to try to wake you up.
 
Dunce said:
Also, the story will be even more pathetic when you tell me that you came out of your brief loss of consciousness when your 8 year old grandson (who witnessed the entire incident) poured his Coke on your face to try to wake you up.
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:laugh: And it sucks when your hair is glued to the back board with dried coke.
 
docB said:
:laugh: And it sucks when your hair is glued to the back board with dried coke.
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We had a guy who for some reason decided to use Gorilla Glue to spike his hair. He wound up with his hand stuck to his head. Apparently his "friends" took pictures before agreeing to give him a ride to the ER.
 
Apparently, deodorant is an appropriate topical medication for a skin ulcer.

And this was just the clinic. Can't wait until I get to the ER ...
 
cc: "has been falling down a lot"

58 yo female w/ pmh significant for IDDM, htn, hyperlipidemia, and depression.

h&p/ros negative for any signs of cardiovascular disease. neuro exam normal except that pt reports daughter has repeatadly approached her to ask if she has started drinking! daughter insist mother has been acting drunk often over past few months, but pt denies drinking or any sx such as those daughter has reported.

so upon futhur discussion i get a hx of my favorite diabetic diet: one meal/day with lots of soda in between (i can't friggin' believe how often i hear this diet!). but pt swears she is still taking insulin. however, pt has figured out her insulin dose (it's been steady for years) so she decided - several months ago - that she could save money by stopping her at home blood glucose testing! long story short, her HA1c comes back as 5.0 (that's some great glycemic control) and her glucose is 44!
 
If you come to the ER with "abd pain and constipation" you should tell someone that this might be because you stuffed a can of shaving cream up your ass 2 weeks ago. If you don't say anything you'll give the X-Ray tech a real surprise.
 
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docB said:
If you come to the ER with "abd pain and constipation" you should tell someone that this might be because you stuffed a can of shaving cream up your ass 2 weeks ago. If you don't say anything you'll give the X-Ray tech a real surprise.
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Can you post that film? Please?!?

I don't have anything close. The best I can do is the case of a 3 month old who turned out having anal stenosis who had an Xray SO full of poop nobody could believe it. Not even the senior staffers used to seeing MRCP institutional bowel films. Yuck!
 
doctawife said:
Can you post that film? Please?!?

I don't have anything close. The best I can do is the case of a 3 month old who turned out having anal stenosis who had an Xray SO full of poop nobody could believe it. Not even the senior staffers used to seeing MRCP institutional bowel films. Yuck!
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Did the parents not notice that their child never had bowel movements?
 
No s**t!

BTW, I had an attending with absolutely no sense of humor and while I was working with him I got a KUB on a kiddo. When he asked me for my diagnosis I told him FOS. He really did not like that at all :D

-Mike
 
docB said:
That's not enough. Make sure you never sit outside anywhere and read the Bible.
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Pretty much you never want to go near ANY Bible. That thing is dynamite!
bunny2.jpg
 
socuteMD said:
Did the parents not notice that their child never had bowel movements?
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When I was doing a peds surgery rotation, we had a 13-year-old boy with a very distended abdomen. Turned out he had an imperforate anus. On the KUB, the rectum filled his entire abdominal cavity. I can't understand how that went unnoticed for 13 years. :(
 
If your lips are really, really dry and cracked on vacation (in Portland of all places, pretty much a desert) and you're planning to fly, definitely consider that lip balm gels are not allowed on a plane post-terrorism checks without a prescription from a physician. To deal with this requirement, be sure to call your dermatologist in New York to call in an rx for your favorite Lancome Juicy Tube lip balm (telephone message "strawberry flavor please").

When your physician says that its impossible to call with another state's license (though really not sure if that's true), ask which ER you should visit to get a state-appropriate rx. Don't be surprised with the answer "I think that would be a waste of everyone's time". Be reassured that a 5 and a half hour flight without chapstick may be safe (don't you take a break from chapstick at least that long every night?).

Has anyone else got requests like this?
 
I'm doing my senior year radiologic science externship in an outpatient clinic's x-ray department. We don't do critical trauma there, but we do get some real doozies.

Like the guy on Monday who fell off a ladder headfirst while at work, and decided to come to US instead of the ER like any sensible person would. We did a CT and an AP and lateral C-spine on him and turns out he fractured a couple of C-spine vertebrae. We all flipped our **** at this...the guy was just up and walking around like nothing was wrong...no C-collar or anything. Those fragments could've shifted out of position and he could've collapsed and died on us at any time!

A couple weeks ago, I x-rayed another ladder-diver...this guy went feet-first, though. Fractured the left fibula and the lateral malleolus, and had to have an ORIF (Open Reduction Internal Fixation...it's when they put a plate, pins or screws into a bone to hold them together). I've done his last 2 follow-up x-rays as well...makes for interesting conversation.

When I was an on-campus student in the radiologic science program, we had to do a clinical rotation at the local immediate care clinic for our patient care class. The night I did my rotation, we had a guy come in just REEKING of burninated flesh. He was a farmer and was burning his fields, and accidentally walked through a part that was already burning. I know what you're thinking: how could he miss something BURNING?! However, it's been known to happen...sometimes grass fires are really hard to see. Anyway, this guy's legs were covered in 2nd and 3rd degree burns. I don't know WTH possessed him to think, "Okay, my skin is completely blackened and I can't even feel the burning anymore. I guess I could just go to immediate care, right?" NOOOOO! We had to slather an entire tub of that burn paste all the way up his legs, gave him a shot of some narcotic that I can't remember right now, and ended up sending him to the ER anyway.

I love my job.
 
Miami_med said:
Your mother smells of elderberries
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I fart in your general direction and wave my private parts at your aunties.... :laugh:

Related to I'mLookingThru's story, I learned today that if you are hospitalized for over a month due to an emergency amputation, you should NOT become lost to follow-up, put yourself on nml diet with your PEG tube still in, and then show up to your FAMILY MEDICINE provider for a "check-up" when both your PEG site and residual leg starts getting infected and gangrenous. :eek:

And then, when your PCP tells you that you have to be emergently admitted to the hospital for all this, you should NOT go on an extended lunch break and disappear for the rest of the day (we are still looking for her :smuggrin: )...

The patient who had nearly followed up with her surgeon... who had nearly got admitted to the hospital...
 
If you are chronically on oxycodone taking your friends Talwin for your headache won't help. It will precipitate a mean withdrawl. What I don't understand is why the paramedics thought the N/V, piloerection, and tachycardia from the "Talwin overdose" would respond to Narcan! Oh well, at least its an experience the patient won't soon forget.
 
It doesn't matter if your baseline response to taking an Ambien after a couple glasses of wine involves mumbling about government conspiracies. If your boyfriend can't wake you by shouting at you or slapping you in the face, he'll call 911. If the medics can't wake you without some decent sternal noogies, and if you go immediately back into your stupor after the NP airway doesn't quite work, you're getting a ride to the ER. Sorry.

Then, if your vitals stay normal and you merely snore for a few hours, you'll be a little bewildered when you wake up in the "drunk and/or on crack and/or AMS" part of the department. The "WTF?" look on your face will be priceless, and the staff will be almost giddy that the doc can click the box for "condition resolved."

My favorite part was when the guy got his cell phone back, and called home. By then I had him propped up in bed, so he's got the gown and the pile of cheap blankets, and he's going, "hon... why am I at [gritty downtown county teaching hospital]?"
 
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26 yo male comes into the ER with 4+ pitting edema to the LE's, dyspnea, heart the size of a basketball, rhonchi and laterally displaced PMI.

Patient: (gasping for breath) Is this normal?
Me: Ah, no.
Patient: Do you think I have cancer?
Me: No.

Upon questioning I come to find out that he has used 3-4 grams of cocaine a day for the past 7-8 years.

Patient: Do you think the cocaine has anything to do with it?

Ding, ding, ding, ding.

He might be on to something there!

-Mike
 
Chronic Student said:
26 yo male comes into the ER with 4+ pitting edema to the LE's, dyspnea, heart the size of a basketball, rhonchi and laterally displaced PMI.

Patient: (gasping for breath) Is this normal?
Me: Ah, no.
Patient: Do you think I have cancer?
Me: No.

Upon questioning I come to find out that he has used 3-4 grams of cocaine a day for the past 7-8 years.

Patient: Do you think the cocaine has anything to do with it?

Ding, ding, ding, ding.

He might be on to something there!

-Mike
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3-4 grams? holy crap that's an expensive habit.
 
I got the idea that he was dealing it. I wonder if he had any money left over after what he has put up his nose.

BTW, that part was not written well. He has used for 7-8 years and is currently up to 3-4 grams/d.

-Mike
 
GoofyDoc said:
When I was doing a peds surgery rotation, we had a 13-year-old boy with a very distended abdomen. Turned out he had an imperforate anus. On the KUB, the rectum filled his entire abdominal cavity. I can't understand how that went unnoticed for 13 years. :(
Click to expand...

He probably had a fistula of some kind, maybe a really gross recto-urethral or recto-bulbar but most likely just a direct fistula to the skin from his rectum bypassing his sphincter muscles. Still, it seems unimaginable that nobody noticed anything odd.
 
Coleman said:
The next time a cockroach crawls in your ear while you are sleeping, be sure to stick your finger in your ear and plug it so it can't get out then run to the ED for us to take it out. Then, as I squirt viscous lidocaine into your ear canal, tell me how gross that feels!
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I think I just threw up a little in my mouth. :barf:
 
Sometimes when SOCMOB in the middle of MS-13 territory while drunk and underage you can get robbed. Witnesses might call the cops. Cops might call EMS. We may show up an ask what happed to your face. What wont happen is us beliving that you got stung by bee's by the pond and that it happend 20 years ago. What we will belive is that the perfectly defined shoe print was caused by a guy standing on your head as confirmed by a witness. Its also not a good idea to get rowdy in the back of my unit and call the cop a "****ing Pig". You'll get a braclets, a room to stay in and new clothes to wear but instead of them saying County Hospitol they will say County Jail on them.
 
Something i taught myself. Called dispatched as MVA w/ entrapment, supplemental said it was a dumptruck that rolled. In reality it tipped over while dumping its load on top of a gravel pile. Pt was wearing seatbelt and fell when he unbuckled it. Dispatch for ALS but downgraded to BLS.

When controlling C-spine on the side of a large gravel pile and wearing new pants make sure they arent sliding down any. When you bend down with the patient the crotch of them tend to *pop* and explode open. Thankfully i always wear boxers because of i hadnt been i may have accidently "intubated" him. I had to have another emt do my trauma assesment because i was afraid of palpating him with three limbs.

As if things couldnt get any worse i then gave my radio report to the hospitol. Just so happend that the charge nurse that picked up is close to being fired and in general is a bitch. "26 yo m that was in a dumptruck that rolled over. Pt was seatbelted and fell approx. 3-4 feet when he unbuckled. Small contusion LL back. Denies head/neck pain and LOC. No PMH. Vitals. ETA 5 minutes." The nurse radio's back and asks if IV is established. I responded with "Not at this time". She called back and the conversation went downhill quickly.

Her: Do you mean to tell me your transporting a dumptruck rollover pt BLS?
Me. Yes.
Her: Is thier an ALS provider available.
Me: This is a BLS pt.
Her: Is thier an ALS provider on the unit.
Me: He's driveing.
Her: Hold for further instructions.
Me: ETA 2 minutes.

A minute and a half goes by. She got back on. I responded that we were going to be at the hospitol in less than 30 seconds. She said in a very scalding voice "i'll meet you when you get here".

The doc and the charge nurse came up to us as we were wheeling him in and asked what happend. I said "The patient was in a dumptruck that rolledover onto its side while it was dumping its load. He fell approx. 3-4 feet inside the cab when he released his seatbelt". The doc gave the nurse a dirty look and she was very bitter while i gave the rest of my report to her.

In retrospec i probably should have said tipped over but thats no excuse for her to get snippy with me over the radio. The best part was this all happend while my boxers are clearly visible thru the foot long hole in the front of my pants.
 
Let's say that six weeks after shooting the fifteen-year-old mother of your child in the groin because the biach was cheating on you, you are jumped by her uncle while riding your bike and stabbed in the back, recieving a wound which would have killed you had it gone in a half inch to the left.

If you stand up on the pedals you'll go faster.
 
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