Things I Learn From My Patients

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If you are a type II diabetic, it is possible through noncompliance with meds to reach a blood glucose of 1780 and a pH of 6.84. You will be in such bad shape as to induce the doc to say "That kid's dying!" as you vomit all over yourself repeatedly. Miraculously, several hours later, you will be stable enough to be taken up for your lengthy ICU stay. Stupidly, your only other 2 ER visits are also for DKA. :eyebrow:

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Not from an A&E this time, I'm not a medical person but have thoroughly enjoyed this thread - my own stupidity here, though I at least had the good sense to just clean it and stop whining afterwards, instead of rolling into hospital. But I think this at least comes close to the standard of ridiculous behaviour present in this thread...

When you've had a bad day, there's nothing per se wrong with deciding you want a drink. Upon discovering that the only alcohol in the house is an unopened bottle of wine, you might think things are looking up - that's until you discover that you bought a corked bottle by accident, and don't have a corkscrew. Since the shops are shut, the obvious solution is of course to dig the cork out with your swiss army knife.
After about half an hour of work, feel free to forget that swiss army knives are hinged, and snap the blade shut with your finger between it and the body of the knife. Once you've managed to open the knife again and get your finger out, revealing the 1cm gash directly into the tip of your dominant index finger, which has split your fingernail cleanly in two, the appropriate response is "**** it, I haven't embedded a knife into my fingertip just to end up without a drink".
It is only twenty minutes later, when you've succeeded in doing exactly the same thing again, this time to your dominant thumb, that you should head over to Google and discover that all you ever had to do to get the cork out was pour hot water over the neck of the bottle. What with the two bisected fingertips, you won't even feel the scald.

Insult to injury... Don't most Swiss Army Knives come with a corkscrew?

MacGuyver would be so dissapointed.
 
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Bow hunting is great fun. You get to hunt like the legendary folks of yore who had a stick and a string and some more sharp sticks to launch. Ok, so technology has come a little way since then. Now we've got broadhead arrows with nice tapered razor blades and "bleeders". Feel free to throw those suckers in a cloth bag and then toss them on the bean bag at home after a long day of huntin'. There is nothing better for an ER doc than fishing broadhead arrows out of a toddler's butt.
 
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if you are SOCMYOB early in the morning when you are feeling "tipsy" (blood alcohol level of .289) you will randomly "get jumped" by 5 girls and earn a trip to the er as well as a consult with ortho for your spiral tim-fib fracture followed by a rod in your leg and that the girls who jumped you will only go for your legs since that is your only injury
 
Insult to injury... Don't most Swiss Army Knives come with a corkscrew?

MacGuyver would be so dissapointed.

Officer's models and some tool models do. The basic models have only a bottle opener and can opener.

Do we REALLY want drunks to have more complicated tools? They might try using the eyeglass screwdriver while the glasses are on their face, and have the wrong blade open...
 
Officer's models and some tool models do. The basic models have only a bottle opener and can opener.

Do we REALLY want drunks to have more complicated tools? They might try using the eyeglass screwdriver while the glasses are on their face, and have the wrong blade open...

Yes, but then they could use the corkscrew to remove FB's from their anus.
 
Open pocket knives are just awesome for swatting at mosquitos!

Somehow, this patient was not intoxicated.
 
Open pocket knives are just awesome for swatting at mosquitos!

Somehow, this patient was not intoxicated.


Along those lines, if you are at an historical re-enactment with bottles of homebrewed beer, they usually don't twist off. If you don't have a cap lifter, you should totally jab the lid with your dagger (the same one with which you were eating meat, stirring coffee and poking at bugs in firewood). It's highly unlikely you'll miss and stab yourself in the web of the thumb, I mean, what are the odds?
 
If you are a type II diabetic, it is possible through noncompliance with meds to reach a blood glucose of 1780 and a pH of 6.84. You will be in such bad shape as to induce the doc to say "That kid's dying!" as you vomit all over yourself repeatedly. Miraculously, several hours later, you will be stable enough to be taken up for your lengthy ICU stay. Stupidly, your only other 2 ER visits are also for DKA. :eyebrow:
Damn, and I was impressed when I hit 342 after someone mistakenly gave me a full on sugar mexican coke :scared:
 
If you are a hard drinking man with lots of swastikas tattooed all over your torso you may want to consider that you are at risk for perforating your ulcer and that the good Dr. Rosenberg will be called in to save your life resulting in an awkward situation for everyone.
 
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If you feel dehydrated and jitteryafter going camping with your buddies, by all means drink the fluids you mom gives you. When you're found hypernatremic in the ED, take as long as you need to to admit that the "fluids" you drank was actually a home-made concoction of water and a ton of table salt. You drank straight up salt water.
 
ATTENTION: "Some Guy" has made a movie...

2723986.jpg
 
Hot chili peppers up your anus can cause burning and irritation. And Icy Hot certainly isn't the ointment I'd recommend for treating said irritation.

"Icy to Dull the Pain, Hot to Relax it Away." Yeah not always.
 
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Don't stand on the highest rung of a fully-extended extension ladder and then proceed to jump up and down trying to paint the last bit of siding on the apex of your house. You may fall 30 feet into your air conditioner resulting in a severe subdural hematoma and C5 fracture, among other things.

The good news is he'll be able to paint again, just not anytime soon. And he's lost all of his extension ladder privileges.
 
LOLOLOL that is as good as a previous post where the couple uses it as lube :D
 
Hot chili peppers up your anus can cause burning and irritation. And Icy Hot certainly isn't the ointment I'd recommend for treating said irritation.

"Icy to Dull the Pain, Hot to Relax it Away." Yeah not always.

Oops, was replying to this.
 

Well aquainted with my old friend Ativan! I had an adverse effect from that med that sent me to a psych ward for a 3-day locked up visit. It was one of the most terrifying experiences I had had in my life.

Although I was required to bring all my meds to the hospital with me, and Ativan was clearly there, I was told that none of my medications could explain what I was experiencing.

At the time of the episode, I thought I had lost my mind. Since no one in the medical profession who I had seen could explain to me what happened and had asked me several times if I had taken LSD (when I knew I had not), I was fearful that someone (perhaps a friend) had given me LSD without my knowledge. You can imagine what an impact this made on my life.

Years later, I was watching a Donahue show when the guest was Ralph Nader. Another guest was describing her adverse reaction to a drug called Ativan which was exactly what happened to me, i.e., hallucinations, sleeplessness, hyperactivity, paranoia, etc. Ralph Nader was promoting his book, "Best Pills, Worse Pills".

I owe a debt of gratitude to Mr. Nader. I might never have found a logical explanation otherwise without his book.

The second episode with the same drug happened when I was hospitalized for pneumonia, I was given Ativan without my knowledge, and sure enough, the fun hallucinations began, but this time I recognized the problem, notified my doctor, who removed the med, and I returned to normal. As a side note: One of my nurses in the hospital told me Ativan did had the same effect on her.

Yes, I know, some people use drugs because they like hallucinating, but not I, tyvm! :laugh:

Love your blog!

Hope someone may benefit from this post.

honey407
 
I have over 300 hours volunteering in the ED, and I finally have something that is worth contributing to this thread...

If you are at the river with your friends, and you stumble across a pile of yellow oval pills, be sure to take one, or two... or more (pt "not sure" how many she took). Then when you start shaking and feeling sick, be sure to go to the ED at the local hospital. They will be sure to give you a nice charcoal slurry to drink. YUM!

dsoz

They walked in just as I was checking out to leave.
 
I learned that you can reliably diagnose a pseudoseizure with an IO.
People can fake a lot, but for some reason, they can't fake that IO infusion doesn't hurt.
 
I learned that you can reliably diagnose a pseudoseizure with an IO.
People can fake a lot, but for some reason, they can't fake that IO infusion doesn't hurt.

1. Had to look up what an "IO infusion" is. OMG DNW! :eek:

2. Why on Earth would someone fake a seizure? I had a real seizure once, and it was absolutely no fun. :rolleyes:
 
Open pocket knives are just awesome for swatting at mosquitos!

Somehow, this patient was not intoxicated.

Unfortunately, I can upgrade that to "machete" and "spiders".

My father has 50+ years of hunting and woods-tromping experience under his belt, the vast majority of it unremarkable. After a hurricane, he set off to the hunt club property to clear brush with a machete. At this time, the local humongous orb weaver spider population had also exploded. I'm sure you can see where this is going.
So, he felt a spider on him, went to brush it off, and forgot which hand had the machete.
Caught himself behind the ear. Luckily Air Force "stay calm under pressure" training kicked in and he was able to make it back to the van and apply a towel to try and slow the bleeding (and he was on blood thinners at the time). Managed to drive himself through rural Virginia until he reached a volunteer fire station (where he was the second machete injury of the week). Almost got a helicopter ride to the closest hospital, but they eventually went with ground transport. My mother was out at the time, so missed all the attempts to contact her and came home to her husband with a huge bandage and 17 stitches.
The following weeks led to many Van Gogh jokes, especially as my dad was the safety officer of the hunt club at the time. He also held that position the next year when he came crashing out of a tree stand (remarkably uninjured). No alcohol was involved in either incident.
I've been following this forum for several years now, keep the stories coming! :D
 
Why on Earth would someone fake a seizure? I had a real seizure once, and it was absolutely no fun. :rolleyes:

That's a very complicated question. Sometimes, as implied above it is as simple as some form of recognizable secondary gain (drugs, "holiday" from jail, etc). Sometimes there is a component of psychiatric illness. But in addition to that, there is a lot of mystery to people's assumption of the sick role. Also, its interesting that a fair portion (I believe about 30% but don't have time to search for the source literature right now) of patients with VEEG documented pseudoseizures also have well documented genuine seizures. Also, I believe there is some literature to indicate that not an insignificant portion of people with true epilepsy display pseudoseizures sometimes.
 
Sometimes to get the benzos that are typically administered Sometimes it is just to get out of jail for a while, or to get attention.

That's a very complicated question. Sometimes, as implied above it is as simple as some form of recognizable secondary gain (drugs, "holiday" from jail, etc). Sometimes there is a component of psychiatric illness. But in addition to that, there is a lot of mystery to people's assumption of the sick role. Also, its interesting that a fair portion (I believe about 30% but don't have time to search for the source literature right now) of patients with VEEG documented pseudoseizures also have well documented genuine seizures. Also, I believe there is some literature to indicate that not an insignificant portion of people with true epilepsy display pseudoseizures sometimes.

Wow. Thanks for the info! I never thought of any of those reasons, LOL. I should've realized that drugs would be a motivator, but the holiday from jail and the psych issues also make sense.
 
I understand it's frustrating when your ex-boyfriend begins dating again, but it's really no reason to stab his new girlfriend in the back, giving her a pneumothorax. It's reassuring for the victim to tell the police officer standing by that she should be locked up because when she gets out, she's going to "cut that b**ch's head straight off." It was an interesting first day at the level one trauma center.
 
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When you have no pockets in which to store your stick of pepperoni, simply place it inside of your vagina! That way, if you find yourself in the ER and they won't give you a snack, you can pull it out and take a bite. After you take that bite, go ahead and put it back up there in case you are hungry again later.
 
When you have no pockets in which to store your stick of pepperoni, simply place it inside of your vagina! That way, if you find yourself in the ER and they won't give you a snack, you can pull it out and take a bite. After you take that bite, go ahead and put it back up there in case you are hungry again later.

Treat her for PID!

Pelvic
Italian
Deli

If she's also got candidiasis, then it's:

Pizza
In
Dere

d=)

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Treat her for PID!

Pelvic
Italian
Deli

If she's also got candidiasis, then it's:

Pizza
In
Dere

d=)

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I'm afraid she may have had Pizza In Dere, and maybe even some sort of dessert--cannoli, I'm guessing. I declined to investigate, though, as the pepperoni portability problem was not her chief complaint.:scared:
 
I'm afraid she may have had Pizza In Dere, and maybe even some sort of dessert--cannoli, I'm guessing. I declined to investigate, though, as the pepperoni portability problem was not her chief complaint.:scared:

Dear lord, what *was* her complaint?

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So I've been reading this thread since about 2006, when I was fifteen. It's part of what got me into emergency medicine, oddly enough. That, and the whole saving lives thing. Anyway, after two years as a first responder at my college, I figured I'd share a few stories myself, starting with some of my own intelligent decisions.

As a 17 year old blacksmithing apprentice, forget that your teacher is left handed and you are not, try to copy what he does exactly, and pour molten metal onto your hand. It won't sting a bit. Neither will the water in the outside quench bucket, with the ice on top that your teacher has to stick a hot piece of metal through before you can put your hand in it to cool the burns at his insistence. You totally won't develop mild frostbite on top of everything else.

When you, as a freshman at your college, having injured yourself through sheer clumsiness so often that, upon discovering a trail of blood in the hall, your RA knocks on your door with near certainty that you a responsible for it, clearly midnight baked apples is a good idea. Especially when the only coring tool in your possession is a relatively dull pocket knife. Decide, because you are becoming so very familiar with the local ED anyway, that maybe you should go into emergency medicine.

If you work at a place that has several handmade benches, of different lengths, don't forget which one you're sitting, lengthways, on, when you try to lean back...onto your head. Later, when you throw up in the middle of teaching little kids the basics of archery, and can't stand light, call your friend, and ask if, instead of getting pizza tonight, he wouldn't mind terribly going to the ED. Get a large pizza on the way. Get seen really, really quickly. Start your first responder training that same week.

If you are vomiting, and have headache, and stiff neck, your only action should be to call your sibling, because a first responder in training is obviously equivalent to a long distance ED. They can totally help you when you pass out on the other end of the line, at your college halfway across the country. When they call your campus police, and have them find you, call EMS and get you to a hospital, and you finally wake up, by all means explain that you just figured since you were vomiting, you wouldn't drink any liquids for two days, and that would make it all better. It totally wouldn't turn gastroenteritis into near fatal dehydration.

When you crawl into the wrong dorm room, scaring the **** out of its occupants, leaving a trail of urine and vomit behind you, from the sidewalk outside, up the stairs, and around the corner, it is 100% vital to make it clear that the first responder's shirt is blue, to the exclusion of all other conversation, including things like the fact you are epileptic, and the seizure you promptly start having isn't as indicative of severe alcohol poisoning as it could be. It is not necessary for the shirt to actually be blue, nor is it required that this not be the first responder's first call ever.

When you have consumed large amounts of alcohol and salsa, and are nearing relieving yourself of this load, approach the RA office, at a point when the RA is on rounds and the first responder on duty is in their room (because they have the duty phone, and don't need to be in the office). Vomit, somehow, impressively, from several feet of floor, up the door, and onto several feet of ceiling. Disappear without being seen or heard.

After having been a first responder for a year, filling a coffee can with butane and lighting it, is still an excellent idea, especially when entirely sober and acting as an after school science teacher. You will get to quote the mythbusters ("am I missing an eyebrow?") and discover that after burning your bangs into non-existence, you will get many compliments on your new haircut. You will also learn that fireballs go up, because four years of blacksmithing apprenticeship did not teach you this.

Passing out in a bush is an excellent idea. Upon waking to find a fellow student, who also happens to be a first responder, passing your bush, rushing them is clearly the only solution. Upon finding that they, having developed problems in both knees (miraculously not through injury) and using a cane, are still able to out-maneuver your staggering self, try to run away, fall, and try again, repeating as necessary. When they calls campus police, run faster, and into a lamppost, then get up, rush the student again, find yourself held at bay by the business end of a cane, and fall over.
When campus police arrives, pretend you don't speak English, and start screaming the only Spanish phrase you know, as though it were a violent curse word, and not, in fact, "si, amigo". When you turn out to have four fake ID's, none of which are for people over the age of 21, deny that you are a student, despite the student ID in your wallet. When you start vomiting up pills, and blow a .31, explain that you, in addition to the bottle of vodka, have consumed Adderall, Ritalin, and Concerta, because you "needed them to study tonight". When EMS arrives to cart you off, start trying to chew on the straps, because you can obviously still escape without consequences, at this point.

When, in 2012, you are too intoxicated to sit unassisted, George W. Bush is the answer to everything. Including, but not limited to, "who is the president", "what is your name", "what is the date", and of course, "what did you have to drink tonight?"
When, later, you are in the ED, getting pumped full of fluids, wake up, remove all of your clothing, and try to make a run for the hall, stark naked. When your efforts are thwarted by the first responder who accompanied you to the hospital, and is staying up until past dawn to drive you back when you are released, be very unhappy, and hit the pregnant nurse, in your enthusiasm for the vital goal of flashing the rest of the ED. Be strapped to the bed. Pee everywhere, cursing all the while, then pass out mid-profanity.
 
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I'm new and haven't read through more than a few (hilarious) pages, so I apologize if these valuable lessons are redundant......

1. If you find yourself in the ER with your girlfriend and she needs to have a pelvic exam, take advantage of the opportunity for education-- walk to the foot of the bed while the exam is in progress and ask the doctor, "Yo, can you show me where the G-spot is at"?

2. If a slightly mentally challenged patient who presents with abdominal pain appears to have many metal objects in the stomach on xray, send that patient to the OR. Do not, however, first check to make sure those objects are not actually being stored in a fanny-pack that the patient is wearing backward....if that's the case, the surgeon won't mind notifying you most politely.

3. When you and some of the other staff are having a slow night and decide to watch GI fish a shampoo bottle out of some guy's "wazoo" with a scope, try not to be rude by laughing hysterically when the words "For External Use Only" are largely displayed on the monitor.

4. It's perfectly acceptable to catch a squirrel and give it to your four year old son as a pet. And why not go ahead and let it sleep with your kid at night--I mean, what are the chances it's going to bite him in the face?
 
I'm new and haven't read through more than a few (hilarious) pages, so I apologize if these valuable lessons are redundant......

1. If you find yourself in the ER with your girlfriend and she needs to have a pelvic exam, take advantage of the opportunity for education-- walk to the foot of the bed while the exam is in progress and ask the doctor, "Yo, can you show me where the G-spot is at"?

2. If a slightly mentally challenged patient who presents with abdominal pain appears to have many metal objects in the stomach on xray, send that patient to the OR. Do not, however, first check to make sure those objects are not actually being stored in a fanny-pack that the patient is wearing backward....if that's the case, the surgeon won't mind notifying you most politely.

3. When you and some of the other staff are having a slow night and decide to watch GI fish a shampoo bottle out of some guy's "wazoo" with a scope, try not to be rude by laughing hysterically when the words "For External Use Only" are largely displayed on the monitor.

4. It's perfectly acceptable to catch a squirrel and give it to your four year old son as a pet. And why not go ahead and let it sleep with your kid at night--I mean, what are the chances it's going to bite him in the face?

These are all excellent! :laugh:

I know I just posted about the pneumothorax, but I forgot to add this crucial detail:

If you have just been stabbed in the back by your boyfriend's ex and have sustained a pneumothorax, scream and sob uncontrollably until they expose your nether regions for the CVC into the femoral vein. Then articulate very clearly that you'd prefer to have the line placed elsewhere (I'd imagine to preserve her dignity??). Then continue to scream and sob uncontrollably followed by cursing out the entire trauma team. Really, once you have been stabbed and meticulously examined, we have gotten past the point where you need to be embarrassed about a femoral CVC.

I suppose I should take it easy on her though. She did just get stabbed...
 
If you go down on your boyfriend, and discover that his thighs are duskily cyanotic and the soles of his feet are a strange red-brown color, take a look at the clothes on the floor before you freak out and call EMS. That way, you will save yourselves a lot of embarrassment, time and money by discovering on your own that the blue is from the dye in his brand new and never washed jeans rubbing off on his skin, and that he has been walking around barefoot all day.

Haha, we've had a few of cases of what we call "blue jean cyanosis" at our ER. Always good for a laugh!


Also, here's what one of our frequent-flyer drunks said a couple of weeks ago:

PATIENT: (intoxicated) I came in because I don't have any food left at my house.
ME: Uh, you came to the ER for food? Did you drive while drinking?
PATIENT: (looks me straight in the eye and replies indignantly) No. I drank first, then I drove. Geesh.
 
Please pay attention to your kids in the pool. It's not easy to get the news that your 5 year old daughter won't be waking up ever again.

Sad day for everyone in the pit.
 
When you wake up in the middle of the night and decide you want to cook some bacon, make sure to spray Pam cooking spray not Oven cleaner on the pan. That funny taste you get isn't a new bacon recipe so don't eat 3 of the 4 strips before your mom comes down takes one bite and spats it out. That burning in your throat, esophagus, stomach and GI tract is surely not from the "hot grease."

The kid had a BMI of 32, my attending "well this is probably just the first complication of the obesity." Also, who sprays a pan before cooking bacon???
 
When you wake up in the middle of the night and decide you want to cook some bacon, make sure to spray Pam cooking spray not Oven cleaner on the pan. That funny taste you get isn't a new bacon recipe so don't eat 3 of the 4 strips before your mom comes down takes one bite and spats it out. That burning in your throat, esophagus, stomach and GI tract is surely not from the "hot grease."

The kid had a BMI of 32, my attending "well this is probably just the first complication of the obesity." Also, who sprays a pan before cooking bacon???

Oh....wow. I accidentally breathed a bit of oven cleaning spray into my mouth once as a kid, and it's a taste and shocking pain I don't think I'll ever forget. How this person managed to chew and swallow 3 oven cleaner-coated bacon strips is just beyond me.
 
Oh....wow. I accidentally breathed a bit of oven cleaning spray into my mouth once as a kid, and it's a taste and shocking pain I don't think I'll ever forget. How this person managed to chew and swallow 3 oven cleaner-coated bacon strips is just beyond me.

Bacon makes everything better... even poison. d=)

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When you think that your three kids have chicken pox, it is entirely appropriate to bring them to the emergency department on one of the busiest nights for the past three months. Every room was full (10% were open for ambulances or real emergencies), and the waiting room had enough people to fill them all again 1.5 times.

Let's just infect all sorts of people with varicella zoster virus!

I left before the kids were seen, but I bet she waited a long time to see a doctor. (They put her and the screaming kids in an unused triage room for isolation.)

dsoz
 
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Today I learned from my patient that the Lord's glorious judgement can be found in the unlikeliest of places.

Pt sharp foot pain after inversion injury. Radiology report came back:

Acute, oblique nondisplaced rapture at the base of the 5th metatarsal.

Well, I always expected the rapture to be acute, at least...

(or maybe this should have gone under, Things I Learn From My Radiologist)
 
If you decide to play fruit ninja with a real sword, please at least know how to use said sword. Otherwise you may end up in the ER with a nice stab wound to your belly.
 
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If you decide to play fruit ninja with a real sword, please at least know how to use said sword. Otherwise you may end up in the ER with a nice stab wound to your belly.

Fruit... ninja...? :confused:
 
Recently I learned that, much like children, do not leave small objects in the vicinity of elderly, demented patients, ESPECIALLY not in the near vicinity of their food. Otherwise, you might wind up with a pleasant 94 y/o in your ED who thinks that her hearing aid goes well with her deviled egg and bran muffin.

Abdominal X-ray showed said hearing aid in her proximal duodenum when she came in. No, I could not hear it beeping on abdominal auscultation.
 
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