Things I Learn From My Patients

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emtp6811 said:
Awesome! I'm totally going to steal this and put it in my signature!
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I just wish I'd been the first to say it.

BTW, welcome to our cult! My poor iBook died after many years of faithful service. I just got its replacement; a MacBook Pro C2Duo. Sweet!

Take care,
Jeff
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Today I learned that if a woman had sex with her boyfriend, had her period two weeks later, and then slept with her baby-daddy two more weeks later, there's still a good chance this pregnancy is from her boyfriend, and she should demand a paternity test.
 
Rbrav said:
Today I learned that if a woman had sex with her boyfriend, had her period two weeks later, and then slept with her baby-daddy two more weeks later, there's still a good chance this pregnancy is from her boyfriend, and she should demand a paternity test.
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The real tragedy is that she thinks she can get it by coming to the ER and saying she has vaginal bleeding.


Take care,
Jeff
 
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If a man breaks up with his boyfriend, then goes to a bar and picks up another guy; the resulting activities *might* result in a fractured penis...

Just as a side note, my friend and I were studying for Step II CS and was going through a case of a patient with a side complaint of ED. First Aid suggested as a workup to get a Penis Ultrasound. I have not been involved much with the workup for ED, but is this commong practice? I just try to imagine one of those young US techs putting the gel on and then trying to hold it while running the probe around looking for something...all while keeping a straight face. And I used to think checking for a hernia sucked...
 
EM_Rebuilder said:
If a man breaks up with his boyfriend, then goes to a bar and picks up another guy; the resulting activities *might* result in a fractured penis...

Just as a side note, my friend and I were studying for Step II CS and was going through a case of a patient with a side complaint of ED. First Aid suggested as a workup to get a Penis Ultrasound. I have not been involved much with the workup for ED, but is this commong practice? I just try to imagine one of those young US techs putting the gel on and then trying to hold it while running the probe around looking for something...all while keeping a straight face. And I used to think checking for a hernia sucked...
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Yeah this is right. Ultrasound.. Techs might not like it but they'll do em!
 
Jeff698 said:
The real tragedy is that she thinks she can get it by coming to the ER and saying she has vaginal bleeding.


Take care,
Jeff
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Jeff,

In my ED we have every test known to man and we love our patients so that they can just ask for it. We do bone densities, bone scans, heck we even do our own in ED HIDA scans.. :)
 
EctopicFetus said:
Jeff,

In my ED we have every test known to man and we love our patients so that they can just ask for it. We do bone densities, bone scans, heck we even do our own in ED HIDA scans.. :)
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Sweet. Since y'all are so full of love for your patients, how about we just send all of our patients wanting STAT non-emergency lab tests, imaging over to y'all? :) Lord knows, bus fair from Texas to Arizona has got to be cheaper than one big toe MRI!

Of course, I'd guess if you're anything like us, you feel every PCP in the country has already done this!

Take care,
Jeff
 
Jeff698 said:
The real tragedy is that she thinks she can get it by coming to the ER and saying she has vaginal bleeding.


Take care,
Jeff
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I like it when they come in and ask for the blood test because they don't want to wait for their urine to be hCG positive. Cuz those extra 3 days are killer.
 
Hello! I'm still a high school student, unfortunately, but I'm bound and determined to become a doctor. I also have an interesting story to contribute... about why tiny little hick-town folks should not reproduce.

Over summer vacation, a junior in my school had football practice. Well, he and his buddies got there a little early, and because the gates were locked, they decided the jump the fence (your standard, four foot chainlink fence). But when the junior jumped, but he didn't quite clear it; the top of one of the links tore through his pants and nicked his scrotum. So, after much agony, he decided - no, not to go and seek medical attention or something crazy like that - this kid had a beter idea! After all, who on MySpace wouldn't think that it was groovy to see a video of a kid getting his balls ripped up?

He jumped over again, deliberately not clearing the fence this time, while his friend recorded it using his cell phone. There was a trip to the emergency room and stitches and some other fancy stuff... and he was, indeed, the talk on MySpace for many long weeks.

Idiot.
 
From the streets....Clearly if you woke up this sunday with the stomach flu and you and your baby are vomitting, or simply you are vomitting and the baby and dad are not all are still good reasons for the entire family to make an outing to the ED. This is the new " going for a sunday drive."
 
Great thread. I'm an undergrad physiology teacher and I've been in the trenches as a CNA in a nursing home, but I've never been in an ER as staff. Very enlightening.

Anyway, here's what I learned today:

If you're a retired neurologist, you know enough about medicine that it's okay to wait 2 days to call your doctor after the drugstore blood pressure cuff gives you a reading of 186/96. In fact, resist going when the one that your cardiology nurse friend loans you reads 217/116 the next morning. It's no big deal. Really.
 
I do. In my former state, they weren't called CNAs, they were STNAs, so I changed the initials for my post because it is the more common term and screwed it up because I don't use the term that often. Dar. Fixed now.
 
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I'm not a doctor, but I've learnt a few important things during my 21 years on the planet.

One: if you're nicking drums of acid from the emergency services, make sure that what you're stealing to make meth is actually hydrochloric acid, as opposed to hydrofluoric acid. Because that doesn't end up being fun for anyone.

Two, sort of related to that: I get that you addicts might really really need your fix of meth right now, but still. It isn't a good idea to snort the stuff you're still cooking. That doesn't end up being fun for anyone, either.
 
EctopicFetus said:
Yeah this is right. Ultrasound.. Techs might not like it but they'll do em!
Click to expand...

I'm an ultrasound tech, and I can tell you that there are a lot of things we don't like, but do anyway.

See also transvaginal and transrectal U/S. Especially when there is bleeding involved.

Or scrotal ultrasounds on morbidly obese patients.

I love my job.
 
new one...

If you come to our ED and have a complaint of URI, and get pissed off waiting to be seen, by all means, call 911 for an ambulance to come to our ED to pick you up, and bring you to...(you guessed it)...OUR ED, because "the ambulance people are being seen before you". Don't be surprised if you initially get a verbal slap on the wrist after the first 9 calls to 911, and really don't be surprised when, after 18 calls to 911, they send a policeman to write you a ticket, and sit with you to prevent you from calling more.

I swear, idiocy knows no limits.
 
Probably not a good idea to chase your crack fix with 16000 mg (yup, about 26-600 mg tabs) of your "fiance's" ibuprofen. Just because your friend did it and got a really good high doesn't mean you won't feel like utter crap and get to swallow that tasty charcoal. And, by all means, let your attentive fiance sit at your bedside holding your hand while the rest of the ED staff silently snicker at your idiocy for the next 4 hours.
 
If you have uncontrolled hypertension x3 years you should probably not take a cup of cough syrup with phenylephrine in it.

Yes, I said a cup. When I asked the wife if she meant one of those little plastic cups that come with the cough syrup, she said no. A cup, like 8 ounces.

Poor bastard had an ICH that you could see up on the screen from across the ER and was already posturing.

-Mike
 
I'm in a level one trauma ED and a patient comes in with n/v/d. She hasn't been checked on for an hour or so. The clinical supervisor goes in to do something and the patient is essentially dead. The clinical supervisor calls for a crash cart and they resussitate her. Lesson is - patients that present with n/v/d could die on you.
 
RUNNEROD said:
I'm in a level one trauma ED and a patient comes in with n/v/d. She hasn't been checked on for an hour or so. The clinical supervisor goes in to do something and the patient is essentially dead. The clinical supervisor calls for a crash cart and they resussitate her. Lesson is - patients that present with n/v/d could die on you.
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Duly noted. Why here?
 
Yeah, what was the reason for the N/V/D?
 
As a student, I recently learn-ed to always go to the ED to have yourself checked out because your girlfriend has strep.
When asked if he was having symptoms, the response was "no, I feel fine". :confused:


I also learn-ed that drinking household bleach gives you some nasty blisters and isn't really the best method for killing yourself.


And I must never forget that if I can't get my mother-in-law to agree to being put in a nursing home, I should take her to the ED in hopes that the EM doc will make her go.
 
It is always a good idea to threaten the triage nurse with a call to your lawyer because you have been sitting in the waiting room for 3 hours for a pilonidal cyst you've had for the past week, telling her, "If it gets infected I'm going to sue!"
 
I also learn-ed that drinking household bleach gives you some nasty blisters and isn't really the best method for killing yourself.
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He should have gone for Draino. The district next to ours just had a suicide by drinking the stuff last night. It still amazes me the ways people decide to use in attempts to kill themselves.
 
If your child has sickle cell disease, please tell me. Please. 'Cause then I'll know to check a CBC, which will let me know that your child has a Hb of 4.2.

So what did I learn from this patient? Don't trust parents. Yeah yeah yeah, I know, I should know that already. But somehow, it always seemed to me that parents lied less...

More fool me.
 
If the cops are chasing you, your ear is not a proper place to hide your weed stash. What's worse, don't tell us that it's some random girl's phone number you stuffed in your ear to hide from your girlfriend.
 
Dr. Will said:
If the cops are chasing you, your ear is not a proper place to hide your weed stash. What's worse, don't tell us that it's some random girl's phone number you stuffed in your ear to hide from your girlfriend.
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Feeding your weed stash to your dog is not a good idea either. Apparently in high doses it can cause what can best described as an acute psychotic break in said dog, putting multiple dog bites with avulsions and arterial bleeding on your growing list of problems.
 
I just wanted to say hi and let you all know that I've spent way too much of the last few days reading this thread. You guys are awesome. And now I definitely know if I have to go the ER, to bring pizza.

I don't work in EM, but I'm a secretary in a pediatric endocrinology office and have encountered so much of the stupid just there that it's astounding. This week I learned that no matter how many times your child goes into DKA, it is possible to never recognize it.

Mom: He's been vomiting all morning. Do you think it's his diabetes?
Me: It could be, or he could have the stomach flu. Does he have any other symptoms?
Mom: Well, he's got large ketones.
Me: What's his blood sugar?
Mom: .....blood sugar?
Me: ....yes. Have you checked his blood sugar?
Mom: Should I?
Me: ..........yes.

Incidentally, it was over 500, meter couldn't read it. Since the kid was in pretty severe DKA, I sent her to you guys. You must love me forever. :love:
 
PedsEndoSec said:
I just wanted to say hi and let you all know that I've spent way too much of the last few days reading this thread. You guys are awesome. And now I definitely know if I have to go the ER, to bring pizza.

I don't work in EM, but I'm a secretary in a pediatric endocrinology office and have encountered so much of the stupid just there that it's astounding. This week I learned that no matter how many times your child goes into DKA, it is possible to never recognize it.

Mom: He's been vomiting all morning. Do you think it's his diabetes?
Me: It could be, or he could have the stomach flu. Does he have any other symptoms?
Mom: Well, he's got large ketones.
Me: What's his blood sugar?
Mom: .....blood sugar?
Me: ....yes. Have you checked his blood sugar?
Mom: Should I?
Me: ..........yes.

Incidentally, it was over 500, meter couldn't read it. Since the kid was in pretty severe DKA, I sent her to you guys. You must love me forever. :love:
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You're OK. We like those. Real emergency, instant disposition. The peds ones I hate are the infant with the tickle in the throat (I want antibiotics so he doesn't get sick) and the bacteremia work up (Pediatrician: I'm too busy to tap the kid so I want you to do it).
 
docB said:
You're OK. We like those. Real emergency, instant disposition. The peds ones I hate are the infant with the tickle in the throat (I want antibiotics so he doesn't get sick) and the bacteremia work up (Pediatrician: I'm too busy to tap the kid so I want you to do it).
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Or the parents who bring their kids down to the ER because they're getting ready to fly somewhere for vacation and want to make sure their kids sit still quietly on the plane. I was in the ER a couple weeks ago after I tried to cut a finger off while working on a splint and got to listen to a mother of three (oldest was about 6) explain to the triage nurse that her kids "have the hyper and they get all crazy" and wanted something "right quick now" to calm them down to a flight leaving later that afternoon. :laugh:

Incidentally, when you're working with thermoplastic and tin snips, please check to make sure you know where all your fingers are...preferably BEFORE you start cutting the plastic. :(
 
One thing I learned from a patient recently is to ensure that you close your zippo lighter after use...preferably before you put it in your shirt pocket. Not doing this will cause burns and casue you to be upset with us when we "ruined" your favorite shirt.
 
explain to the triage nurse that her kids "have the hyper and they get all crazy" and wanted something "right quick now" to calm them down to a flight leaving later that afternoon.
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:laugh: Benadryl, the OTHER 'mother's little helper' :laugh:
 
DropkickMurphy said:
:laugh: Benadryl, the OTHER 'mother's little helper' :laugh:
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My parents were old school.
"Shut up or you'll wish you were never born!"

Not a peep from any of us kids after that. :laugh:


I almost went to the ED yesterday because of my sore throat. If I've learned anything from patients, it's that the ED is actually a 24/7 primary care center. Payment optional.
 
I almost went to the ED yesterday because of my sore throat. If I've learned anything from patients, it's that the ED is actually a 24/7 primary care center. Payment optional.
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Exactly, especialy if you give a fake name, address and SSN. Not that I've ever done that for a broken hand.
 
Not a doctor or a health care professional, nor do I play one on TV. I got the link for Part I of this thread from a friend who knows I appreciate this kind of humor.

Here's what I learned from my husband:

If you fall out of bed in the middle of the night because a bunch of cats and a beagle got between you and your wife (that's me!) and forced you right out of the bed, don't worry about how bad your ribs hurt the next day.

In fact, you should ignore the pain for a few days (and lie to your wife about how much it hurts) until you just can't stand it anymore and have to go to the ER at 4:00 AM.

That's when you'll get the X-Ray and the CAT (hee!) scan that shows you've cracked your 8th and 9th ribs. You'll get sent home with Vicodin, Flexeril (sp?), an antibiotic, and a really pitiful disposition. And you'll spend the next three days sitting upright in a chair in the bedroom while your wife makes sure you get your meds on time while taking care of everything else around the house.

All because you were too stubborn to admit that it hurt four days ago. Maybe they could've prevented a lot of the pain if you'd only gone to the doctor sooner. :rolleyes:

Oh, and here's what I learned from an emergency vet: If an eight-week-old kitten who is underweight for her age comes into the ER in the middle of the night with a high fever, vomiting, and uncontrollable diarrhea, it's a good idea to send her home with some oral antibiotics, a pat on the head, and a notation in the chart that her "owners are overly anxious and worried".

That way when the same kitten presents in your ER less than eight hours later as "unconscious, cold, limp, EMERGENCY [underlined twice in the chart]", everything that you did wrong will be documented in her chart and you'll find yourself looking for a new line of work a mere four hours later.

True story. The kitten (who you may have guessed belongs to Kittendaddy and I) lived and is now a healthy and happy cat.

And there was a sign at the front desk when we came back to visit her that evening stating that "Dr. K is moving to California and will no longer be practicing veterinary medicine." Seriously!

I bet every single ER doc here would've taken one look at that kitten and admitted her right away - and you guys aren't even vets! ;)
 
Yesterday, I learned that sometimes patients do actually have a zebra of a diagnosis. I saw a kid with hip pain, severely limited range of motion of intermittent low grade temp after a viral URI.

Sounds like toxic synovitis, no?

Uhh... ran into the Mom and patient today in the hospital while I was picking up some meds from employee health (another story!). Mom says, "Look, there's our ER doc. Well, we got a dianosis." I say, "Great!" thinking kiddo has something like a septic hip that was drained or a simple osteo on IV antibiotics. Toxic synovitis wouldn't have kept them in the hospital for so long... Mom says, "Not so much - she has neuroblastoma." I hope my reply showed how sorry, and apologetic, I was. I hope to holy high hell that the kiddo got diagnosed from the ER after I signed her out as "toxic synovitis vs. septic joint, getting Toradol, hip films, and CBC/ESR/CRP".

I haven't had time to go chart diving, but I hope something in my work up triggered the suspicion of something worse than the usual.

So she taught me to be careful - this attending stuff is tricky. Just 'cause Mom is crazy insane neurotic doesn't mean that she's not right. She thought something was wrong and it was.

Yikes.
 
We all know that smoking with O2 is bad but today I learned that its worse with a full beard. Oh the smell
 
I haven't learned anything today. I'm inthe peds er
 
ERMudPhud said:
We all know that smoking with O2 is bad but today I learned that its worse with a full beard. Oh the smell
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The worst was a lady who was on a Venturi mask at home and decided she just HAD to have a cigarette. She pulled the mask off to one side and *FOOOM!* Next thing you know.....she's on her back in the ED gasping for air. Burned flesh, hair and melted plastic......*shudders* The smell made me nauseous. The one type of ICU I will not work in is a burn unit.
 
This week I learned that holding on to your ciggs, and your 50+ pack year history is more important than, say - having sex. I mean, c'mon! Also, having emphasema is no reason to stop something you like damnit, and so what if you are only 46 and can't hold an erection. Altho, he did want some viagra because as I mention, he can't get an erection.

Pt presented with neurologic deficits in left hand, but that's another story.
 
Kittenmommy, what were the ABx for? Did he get a pneumonia from not breathing deeply?
 
Gem134 said:
This week I learned that holding on to your ciggs, and your 50+ pack year history is more important than, say - having sex. I mean, c'mon! Also, having emphasema is no reason to stop something you like damnit, and so what if you are anly 46 and can't hold an erection. Altho, he did want some viagra because as I mention, he can't get an erection.
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I for one am always shocked when the nicotine/tar inhalers don't work as well for COPD-ers as the long-acting beta agonist and steroid inhalers do. I know my patients are usually surprised by it as well. Maybe we need to start putting nicotine in the combivent.
 
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