Things I Learn From My Patients

[deleted6669]

You forgot light bulbs.

and rainbird popup sprinklers while gardening in broad daylight in the nude....
it was a great film, we could actually read "rainbird" in raised relief on the side.....

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[dmitrinyr]

I have to honestly say I've never heard that one before, but I love it!

Now I should get out in the world more to learn more medical terminology.

We always used "hi-five", "3 letter", etc. to refer to pts with HIV while on rounds in the ED. I have to say that unless you know what it means, you will be clueless the first time you hear it and wonder what it is you're missing.

 

[Drawing Dead]

Must be a NY/NJ thing because my friend told me about that when he was going to Siena (Near Albany). I didn't ever hear it in a medical realm until when I did my first EM rotation in the Bronx.

Another less commonly used HIV euphomism (sp?, I can't spell) is House in Vegas, which I have heard more from EMTs than docs.

Also, just found out today that "Some Dude" has made it here to the BX. Apparently, (sp?) he is stabbing people while they are praying in church, and moving so quickly, his victims can not get a good look at him.

 

[docB]

I have also learned that if you are a malingerer and have the high-five, the medical student drawing your blood and placing an IV will not appreciate it when you pull the IV cath out and wildly flail your arm around, dousing the bed, walls, curtain, and yes the medical student with said infected blood.

I used to hear Hi 5 all the time but I think it's a back east thing.

The point about not wanting to give Viagra to an HIV patient is an interesting one. I suppose that ethically you could go either way. It's wrong to give it as they'll likely endanger others vs. it's wrong to deny it as they can take precautions or be in a monogamous relationship. You ought to make this into a seperate thread on the topics in healthcare board.

 

[SoCuteMD]

We always used "hi-five", "3 letter", etc. to refer to pts with HIV while on rounds in the ED. I have to say that unless you know what it means, you will be clueless the first time you hear it and wonder what it is you're missing.

"viremic" "448" "CD4 count is ____"

 

[SoCuteMD]

Must be a NY/NJ thing because my friend told me about that when he was going to Siena (Near Albany). I didn't ever hear it in a medical realm until when I did my first EM rotation in the Bronx.

Another less commonly used HIV euphomism (sp?, I can't spell) is House in Vegas, which I have heard more from EMTs than docs.

Also, just found out today that "Some Dude" has made it here to the BX. Apparently, (sp?) he is stabbing people while they are praying in church, and moving so quickly, his victims can not get a good look at him.

Dude, "Some Dude" was essentially BORN in the Bronx!!!! The BX is FULL of "some dudes."

 

[medivac]

I have learned that the best time to climb up into a tree to trim branches with a chain saw is well after sunset

And after you have consumed about a case of beer.

Also it is helpful if you are blind in one eye.

You know....you just can't make this **** up.

 

[deleted6669]

I have learned that the best time to climb up into a tree to trim branches with a chain saw is well after sunset

And after you have consumed about a case of beer.

Also it is helpful if you are blind in one eye.

You know....you just can't make this **** up.

have seen this myself several times...also the best way to cut through a stubborn branch is to jump up and down on it while cutting with said chainsaw, thinking you will be able to hold onto another branch to stop yourself from falling on your chainsaw.....

 

[Katydid]

Today's fun in Urgent Care....oh, it was great.

I learned that it's perfectly fine to start screaming that the little girl who needed stitches for the laceration on her forehead was seen before you. Even though you were at Urgent Care because "well, I think I might have a cold, I've been sniffling all day."

That was certainly fun to watch. This jerk didn't appreciate it when I told him, "This child has a HEAD. INJURY. We're all waiting, she's been triaged first. You really need to get a grip."

The nurse who took my vitals and set me up in an exam room told me, in that *God, I really hate my job right now* voice, "The doctor SHOULD be with you soon, but I can't promise anything." She was stunned when I shrugged and told her, "Hey, I can wait. An ear infection can get bumped down on the triage list, I saw that poor little girl who came in crying. I can wait, I've got a book." She said, "I wish everyone was as patient as you!"

And for the record? Not just an ear infection. BOTH ears are infected, not just the right ear. I'm not digging on this at all. But, I'm still on this side of the grass, and I didn't have to have stitches in my forehead. And when I left? The jerk who was yelling about the poor little girl who needed stitches was STILL waiting in the waiting room. Guess he didn't learn that if you're not exactly up there on the triage list, AND, if you piss off the people who do triage, you're gonna be waiting a loooooong time.

 

[racerx]

Today's fun in Urgent Care....oh, it was great.

I learned that it's perfectly fine to start screaming that the little girl who needed stitches for the laceration on her forehead was seen before you. Even though you were at Urgent Care because "well, I think I might have a cold, I've been sniffling all day."

That was certainly fun to watch. This jerk didn't appreciate it when I told him, "This child has a HEAD. INJURY. We're all waiting, she's been triaged first. You really need to get a grip."

The nurse who took my vitals and set me up in an exam room told me, in that *God, I really hate my job right now* voice, "The doctor SHOULD be with you soon, but I can't promise anything." She was stunned when I shrugged and told her, "Hey, I can wait. An ear infection can get bumped down on the triage list, I saw that poor little girl who came in crying. I can wait, I've got a book." She said, "I wish everyone was as patient as you!"

And for the record? Not just an ear infection. BOTH ears are infected, not just the right ear. I'm not digging on this at all. But, I'm still on this side of the grass, and I didn't have to have stitches in my forehead. And when I left? The jerk who was yelling about the poor little girl who needed stitches was STILL waiting in the waiting room. Guess he didn't learn that if you're not exactly up there on the triage list, AND, if you piss off the people who do triage, you're gonna be waiting a loooooong time.

If there's any justice in the world, he's still sitting there. . .waiting.

 

[Cardinals]

Hello everyone

I've been reading this thread for quite a while, thought I'd join up and post a few stories of my own.

Anyway, on to the things that I've learned as a volunteer and student.

Don't insert a screwdriver into your rectum. If you do, don't try to convince the ER staff you sat on it. No one will believe you but they will enjoy showing off your x-ray to pre-meds like me who will enjoy laughing about the incident.

If you want to leave the ER, threatening to kill the person in the room with you probably isn't the best way to do it.

Don't clean your chimney with gasoline and sandpaper.

One that I heard from a classmate-If you're reading the Bible, and you come to the passage in which Jesus says "If your hand causes you to sin, cut it off", don't interpret this passage literally. Furthermore, don't believe that it is your penis that is causing you to sin.

 

[Katydid]

If there's any justice in the world, he's still sitting there. . .waiting.

Oh, I am hoping there is justice, and he's still waiting. Like I said, I was there for three hours, and when I was leaving, he was STILL waiting. I hope he waited all damn night. And was told to go home because Urgent Care hours were over....or transferred to the facility 40 minutes away.....

 

[ForbiddenComma]

I learned a sad lesson last week.

Being a healthy, mid-30s drug-seeking malingerer, one with a documented history at the hospital and one who actually asks for fentanyl by name because mere vicodin doesn't "touch" the pain, does not make you immune from actual medical problems.

Assuming if your EKG and cardiac markers come back normal, and if for medicolegal reasons they do an echo to rule out an MI from your "chest pain"... it is not entirely outside the bounds of possibility that it comes back with an EF of 20%.

(the thing is, I still think his "chest pain" was made-up. there was no evidence of ischemia/angina, his CP was the same whether lying sitting or walking, and his later cath came back clean. imagine you come in just to score some narcs and leave with a dx of CHF 2* to viral cardiomyopathy... harsh toke dude.)

 

[Depakote]

I learned a sad lesson last week.

Being a healthy, mid-30s drug-seeking malingerer, one with a documented history at the hospital and one who actually asks for fentanyl by name because mere vicodin doesn't "touch" the pain, does not make you immune from actual medical problems.

Assuming if your EKG and cardiac markers come back normal, and if for medicolegal reasons they do an echo to rule out an MI from your "chest pain"... it is not entirely outside the bounds of possibility that it comes back with an EF of 20%.

(the thing is, I still think his "chest pain" was made-up. there was no evidence of ischemia/angina, his CP was the same whether lying sitting or walking, and his later cath came back clean. imagine you come in just to score some narcs and leave with a dx of CHF 2* to viral cardiomyopathy... harsh toke dude.)

damn.

 

[racerx]

damn.

Do they have any info of this patient being a current drug abuser? If so, I would imagine getting a spot on the transplant list may be tricky.

 

[nonesuchgirl]

Not from EM, but pediatric allergy:

If you're a 15yo boy who just has to go to McDonald's with your friends and eat there, even though you're bat**** allergic to it (IDK what- milk, maybe?)- it's a great idea to go into the lav and give yourself your epi-pen before you eat.

It's not like you'll get home, ring the door bell, and go into anaphylaxis so your parents are doing cpr in the driveway while they wait for ems.

Oh, wait....

 

[Depakote]

Not from EM, but pediatric allergy:

If you're a 15yo boy who just has to go to McDonald's with your friends and eat there, even though you're bat**** allergic to it (IDK what- milk, maybe?)- it's a great idea to go into the lav and give yourself your epi-pen before you eat.

It's not like you'll get home, ring the door bell, and go into anaphylaxis so your parents are doing cpr in the driveway while they wait for ems.

Oh, wait....

Beef allergy? (know someone with that)
Does McDonalds use peanut oil for their friers?
*shrug*

 

[Drawing Dead]

Dude, "Some Dude" was essentially BORN in the Bronx!!!! The BX is FULL of "some dudes."

Believe me, I know. Just last I heard he was down south.

In case you guys didn't know, just because you are in 4 point restraints, and those ER pigs won't give you water when you're thirsty, don't fret. If you are of the male gender, you can easily work your gown up, over your waist, and arc your urine stream into your mouth. (Did not witness it, but was informed that this happened at shift change from another student) Kinda tops the foley-in-mouth guy a few pages back.

 

[SugPlum]

In case you guys didn't know, just because you are in 4 point restraints, and those ER pigs won't give you water when you're thirsty, don't fret. If you are of the male gender, you can easily work your gown up, over your waist, and arc your urine stream into your mouth. (Did not witness it, but was informed that this happened at shift change from another student) Kinda tops the foley-in-mouth guy a few pages back.

Sounds like asking for chemical restraints...vitamin H.

 

[Chronic Student]

Don't forget the Narcan!

 

[roja]

When you are completely hammered, its great to strip naked, grab a bunch of surgilube and rub it all over your body.

 

[ForbiddenComma]

Do they have any info of this patient being a current drug abuser? If so, I would imagine getting a spot on the transplant list may be tricky.

No hx of street drug abuse or HepC, but yeah, he does have a written record for seeking. One of the gruff old-school attendings actually yelled at him the last time.

Not sure if just liking fentanyl a bit too much should disqualify someone from getting a transplant... but what do I know...

 

[napster]

I'm in Long Island and have never head of high five.

 

[Chronic Student]

When you are completely hammered, its great to strip naked, grab a bunch of surgilube and rub it all over your body.

So much for HIPPA.

I asked you not to tell anyone about my indiscretion!

 

[racerx]

When you are completely hammered, its great to strip naked, grab a bunch of surgilube and rub it all over your body.

How did you dare show up for your shift the next day?


J/K

 

[AuDie]

Beef allergy? (know someone with that)
Does McDonalds use peanut oil for their friers?
*shrug*

pretty sure they use regular vegetable oil these days...at least they did when I worked there (worst 2.5 years of my life btw)

anyways, keep these stories coming! it took me weeks to get through all the posts and now I'm addicted. I have a newfound appreciation and respect for the people working in EM. Keep up the good work!

 

[deleted109597]

We always used "hi-five", "3 letter", etc. to refer to pts with HIV while on rounds in the ED. I have to say that unless you know what it means, you will be clueless the first time you hear it and wonder what it is you're missing.

I know of one hospital that calls it Ryan White. Seems a little crude, but effective. The board gets a RW next to the name. Nobody but the staff knows what it means though.

 

[MSHell]

Not from EM, but pediatric allergy:

If you're a 15yo boy who just has to go to McDonald's with your friends and eat there, even though you're bat**** allergic to it (IDK what- milk, maybe?)- it's a great idea to go into the lav and give yourself your epi-pen before you eat.

It's not like you'll get home, ring the door bell, and go into anaphylaxis so your parents are doing cpr in the driveway while they wait for ems.

Oh, wait....

Sesame allergy?

 

[Drawing Dead]

I'm in Long Island and have never head of high five.

Well, that explains it. White bread LI is quite a different demographic than the Bronx. You at Good Sam? Pass it around to your collegues, it'll probably catch on.

I like the RW one. High five I guess could be easy for someone not intended to know about it to figure out (although, HIPAA rules and all, I think EVERYONE within earshot should know, for safety reasons).

 

[Febrifuge]

although, HIPAA rules and all, I think EVERYONE within earshot should know, for safety reasons

Ehh. I guess. One time in my tech days, I was told to go collect a guy's urine sample. I went in, said hi, retrieved it from the bedside table where he had helpfully left it, came back to the RN station, and then set about labelling the sample. As I sealed the bag up, took off my gloves, and check it in on the computer, one of the nurses said gravely, "you should know, he's HIV positive."

I said I appreciated knowing that, and I would be sure not to drink this urine.

It's not that I don't take infection risk seriously; it's that universal precautions are universal for a reason.

 

[Drawing Dead]

Touche

P.S. HIV transmission from urine? Am I learning something here? Thought that was kinda low risk transmission (even if you did drink it).

 

[Cardinals]

Here's one I found on another website

A guy gets drunk, has some bees flying around him. Decides the best way to get rid of them is using his revolver. Shoots himself in the hand.

http://wrta.com/artman/publish/article_8908.shtml

 

[Chronic Student]

Touche

P.S. HIV transmission from urine? Am I learning something here? Thought that was kinda low risk transmission (even if you did drink it).

I think he was being sarcastic.

 

[SoCuteMD]

Well, that explains it. White bread LI is quite a different demographic than the Bronx. You at Good Sam? Pass it around to your collegues, it'll probably catch on.

I like the RW one. High five I guess could be easy for someone not intended to know about it to figure out (although, HIPAA rules and all, I think EVERYONE within earshot should know, for safety reasons).

I hear you can't get HIV from being within earshot of a patient with the disease. Could be just a rumor, but you never know.

 

[Febrifuge]

Touche

P.S. HIV transmission from urine? Am I learning something here? Thought that was kinda low risk transmission (even if you did drink it).

Indeed; that's why I thought it was worth a comment at the time. That, and the RN and I gave each other crap on a regular basis.

 

[roja]

So much for HIPPA.

I asked you not to tell anyone about my indiscretion!

Hey, *I* didn't use your name.



And regarding the High 5, we use this all the time.

 

[nymbarra]

Touche

P.S. HIV transmission from urine? Am I learning something here? Thought that was kinda low risk transmission (even if you did drink it).

Speaking of which...

Has anyone heard of someone injecting urine? I can imagine an IVDU thinking that he can get one more fix off of his urine metabolites...

What happens if that occurs?

 

[Kensey]

Has anyone heard of someone injecting urine? I can imagine an IVDU thinking that he can get one more fix off of his urine metabolites...

What happens if that occurs?

I'm not a doctor, but sometimes I watch House on TV, and since a search for "intravenous urine" on PubMed turns up nothing promising, I'll toss a guess in the ring.

Assuming an otherwise medically- (though probably not psychologically-, if IV urine is the issue...) healthy individual, we're basically talking about waste products filtered out of the blood suddenly being reintroduced in concentrated form back into the blood, so I would think the immediate presentation would mimic kidney failure and the treatment might involve dialysis. The interesting cases might be ones where some sort of asymptomatic chronic toxin exposure results in more concentrated levels of the toxin in the urine, which then cause acute effects when the urine is injected.

If, on the other hand, the individual has some sort of infection in their bladder, we have now mainlined the nasties directly into the circulatory system, where they will dutifully circulate. Presentation would mimic kidney failure as before, but with possible added complications looking like a systemic bacterial or yeast infection. I imagine the latter case would be all kinds of mysterious "fun" to diagnose and then treat, but the former might be the more immediately threatening, especially if something took hold in the heart or brain.

 

[Orthonut]

Beef allergy? (know someone with that)
Does McDonalds use peanut oil for their friers?
*shrug*

They used to...

Perhaps an allergy to something in the bun? I know someone who isn't gluten intolerant but does get nice lovely welts and dyspnoea if she eats wheat.

 

[NurseMom]

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

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

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

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

Well, try this one.

http://www.metro.co.uk/weird/article.html?in_article_id=76540&in_page_id=2

 

[NurseMom]

It's a good idea to hold a box of unlit sparklers in one hand and a lit one in the other.

Good thing there was a bird bath nearby to put the fire out.

(my husband did this. great guy. not so bright. )

 

[da8s0859q]

It's a good idea to hold a box of unlit sparklers in one hand and a lit one in the other.

Good thing there was a bird bath nearby to put the fire out.

(my husband did this. great guy. not so bright. )

Best part of the post.

 

[NurseMom]

It's a running theme. I just had another near-syncope-so-I-took-my-husband's-nitro-and-turned-it-into-a-full-blown-hypotensive-episode-with-runs-of-sustained-V-tach pt yesterday. Too many people have a really poor understanding of their meds and I don't know that it's their PMD's fault. They have no interest in knowing about their meds. How many time have you asked someone what their meds are and been told "my wife knows that" or "I don't know. It's in my records." Lots of people just view nitro as "heart pills" and take them whenever they feel sick because it might be their heart. I've seen pts that do that with dig, coumadin, diltiazem and crack. You just can't win.

went to visit a friend in the CCU that has a laundry list of heart problems. She had been there longer than expected d/t low b/p's. So, as I'm walking in her monitor is beeping and they are hollering in the speaker 'are you okay??' I say yes (because I see it's just a lead that's hanging) and proceed to reattach the lead. At that time I notice a patch on her.

Yeah, it's what you think.

I take a look at the IV bag. Yep. Nitro.

"Mo, did they put a nitro patch on you in the ER?" (this lady is older and leagally blind)

"Uh, I don't know, honey."

I call the nurse.

Needless to say when they got that little oversight corrected her b/p came up and they d/c her home.

Maybe there should be a Things I've learned from Other Medical Professionals" Thread?

 

[NurseMom]

Yes, and that would be, "Don't give any advice to your child on anything...ever!"

Similarly to the daugther, "Don't receive any advice from your mother on anything...ever!"

And the movie "Carrie" comes to mind....

Poor girl.

 

[NurseMom]

If you are a patient who comes into my ED with a penis fracture realize NO ONE believes your story that you did it simply while trying to pee. And yes they really are going to have to do "nasty things" like degloving for the urologist to be able to repair it so you will be able to use it again. And yes you do do have to listen to the explanation by the urologist... it's called informed consent.

OMG.

 

[EM2BE]

Don't try to prevent your friend from getting raped by a guy she met on myspace. If you do, while you are getting treated in the ED, she will take your car and go have sex with him willingly.

 

[Depakote]

OMG.

ok, think I just ruled-out a career in urology.

 

[I heart EM]

I'm not sure how I matched in EM without ever coming accross this thread, but I lost an entire day in here. Here's a few from my ED:

1. If you are an inmate who self-mutillates, and you have given yourself fifteen cuts to the fascia with the broken off edge of a plastic spoon (b/c you aren't allowed metal anymore, or even plastic knives-Hgb 6.4 btw), please do not complain to the MS4 sewing you up that "Jeezus, it hurts!" when she has exceeded your maximum mg/kg dose of lidocaine already and still has 5 lacerations yet to go. Also, do not reappear on the board on her next shift two days later with an abdominal wound 3 mm away from peritoneum. If after she sews you up this time, you promise never to cut on your belly again since that "hurt like a mo****f****," do not show up in the ED a third time that week with an identical wound parallel to the last one she closed.

2. If you are dumb enough to fornicate in the woods without a blanket and end up with the worst case of poison ivy imaginable, covering all aspects of your normally clothing-covered areas, do not be shocked when I want to examine said areas. Also, do not bring your 21 year old self to the Children's ED. Also, do not be horrified that the attending and I are female. Do take your steroid burst.

3. If you must self-pleasure with something porcelain, and it breaks and transects your urethra, you should probably drive yourself to a hospital where you are not related to one of the surgical residents.

 

[SoCuteMD]

3. If you must self-pleasure with something porcelain, and it breaks and transects your urethra, you should probably drive yourself to a hospital where you are not related to one of the surgical residents.

Best....post...EVAR

 

[Perrin]

I'm on L&D nights currently. I had a 37 y/o G10P5 @ 39.6 come in with active labor. I go for the HPI and she tells me that she went to see "Iron Man" with her husband around 7pm when the contractions started. For the first hour cxns were about q6-7m, then after *spoiler* happened it changed to q3-4m. After the movie ended, she and hubby drove 2 hours to Ob recieving.

Me, being spoiled by the 3 page IM notes (and it was 3am), wrote down precisely what she said. My resident read over it and said, "What the hell is this, an L&D accept or a fcuking movie review?!?!"