Things I Learn From My Patients

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Large animal psych ward.

Large animals only? Because we have a Siamese kitten that probably belongs in a psych ward. Her name is Peanut, but we call her The Nut (for a very good reason!).

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Seriously. That thing is like having a safety deposit box and a key to the city all at the same time.

As the owner of a vagina, I swear to you that I have never put anything in there that does not belong. Tampons, husband, etc. are OK. Money, crack pipes, whatever else... no.
 
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As the owner of a vagina, I swear to you that I have never put anything in there that does not belong. Tampons, husband, etc. are OK. Money, crack pipes, whatever else... no..

I suppose some people have a much more fluid definition of "belong."
 
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I suppose some people have a much more fluid definition of "belong.".

Apparently so! I would never dream of putting money in there. I mean... what? Why would you even... Never mind. Some things are imponderable.
 
Still learning....after 10 years of marriage :).

Women aren't magpies; we're not all entranced by shiny things. Kittendaddy would do better to get me a new Apple device than something that sparkles! ;)
 
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While a good mnemonic device for Step 1, do not equate medicine names ending with the same letters as doing the same thing

No matter how much augmen-TIN you give to your husband it will not make up for you running out of dilan-TIN & he will end up in the ER @ 3 am

I mean, it seems like it should work.

Edit: Didn't see the later posts. In before discussion of intravaginal iPad ensues.

I think the weirdest thing I've seen fall out of a vagina was a plastic bag of semen.
 
Not something I learned from a patient per se but I learned, while on call last week, that if you're running to an arrest it is important to make sure you're shoes fit properly...... also learned that the laws of gravity don't respect arrest calls .... i'm an idiot
 
Not something I learned from a patient per se but I learned, while on call last week, that if you're running to an arrest it is important to make sure you're shoes fit properly...... also learned that the laws of gravity don't respect arrest calls .... i'm an idiot

That's why I tell everyone that I do NOT run - if I fall and twist an ankle, break an ankle, bonk my head, whatever - then there are now 2 victims, and, especially overnight in hospital, I am "mission critical", as I am the only doc in the joint. I do hope that you are all right!
 
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Not something I learned from a patient per se but I learned, while on call last week, that if you're running to an arrest it is important to make sure you're shoes fit properly...... also learned that the laws of gravity don't respect arrest calls .... i'm an idiot
You run to codes?

I think it's fair assessment that you can judge the amount of years post Medical School graduation by the speed at which a body moves towards a code.
 
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You run to codes?

I think it's fair assessment that you can judge the amount of years post Medical School graduation by the speed at which a body moves towards a code.


On the other hand, if you want some time off from OBGYN rotations, few things sound better than "I was running to a code when..."
 
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Turn of the snowblower before you try to manually disimpact it.
This happened to my brother when he was 16. I was 10. His screams still haunt me to this day, no exaggeration. (Fingers saved, plays a pretty good guitar, not a fan of his voice. Too late-80s romantic pop.)
 
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This happened to my brother when he was 16. I was 10. His screams still haunt me to this day, no exaggeration. (Fingers saved, plays a pretty good guitar, not a fan of his voice. Too late-80s romantic pop.)
That's horrifying...I mean the late 80s romantic pop, stuff. :spinechills:
 
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I learned that if you tell a nurse hotline that you're having the worst migraine of your life you must go to the ER now! I mean it doesn't matter if you have a history of migraine, are 23 years old. haven't had any head injuries in a decade , and can walk and talk just fine. You need to go right now!
/Didn't go. I knew you guys would waste a lot of time having to do a whole battery of tests to determine I just have a horrible headache and give me fancy versions of what I was already taking for it.
 
I learned that if you tell a nurse hotline that you're having the worst migraine of your life you must go to the ER now! I mean it doesn't matter if you have a history of migraine, are 23 years old. haven't had any head injuries in a decade , and can walk and talk just fine. You need to go right now!
/Didn't go. I knew you guys would waste a lot of time having to do a whole battery of tests to determine I just have a horrible headache and give me fancy versions of what I was already taking for it.
Except even a 23 year old with a history of migraine can have a brain bleed. If the stuff you were taking at home was working why would you have called the hotline anyway?
 
I learned that if you tell a nurse hotline that you're having the worst migraine of your life you must go to the ER now! I mean it doesn't matter if you have a history of migraine, are 23 years old. haven't had any head injuries in a decade , and can walk and talk just fine. You need to go right now!
/Didn't go. I knew you guys would waste a lot of time having to do a whole battery of tests to determine I just have a horrible headache and give me fancy versions of what I was already taking for it.
Yep -- just saw a relatively young individual the other day with a history of migraines who had a temporal AVM rupture. Acute "worst headache of life" is not something to mess around with, so their advice was warranted.
 
Yep -- just saw a relatively young individual the other day with a history of migraines who had a temporal AVM rupture. Acute "worst headache of life" is not something to mess around with, so their advice was warranted.
Agree. These nurse line will (should) never tell anyone "oh, you're fine" over the phone without an evaluation. Ever.

Stubbed toe? (1 in a million could be diabetic foot with gangrene!)

Cough? (1 in a million could be cancer!)

"Go to ER immediately."

Blame the lawyers and the broken medical malpractice system implemented by your elected representatives, not the doctors and nurses trying to survive in the system.

No one wants to be on the hook for $50 million if you're the 1 in a million.
 
Agree. These nurse line will (should) never tell anyone "oh, you're fine" over the phone without an evaluation. Ever.

Stubbed toe? (1 in a million could be diabetic foot with gangrene!)

Cough? (1 in a million could be cancer!)

"Go to ER immediately."

Blame the lawyers and the broken medical malpractice system implemented by your elected representatives, not the doctors and nurses trying to survive in the system.

No one wants to be on the hook for $50 million if you're the 1 in a million.
Sometimes they will route you to an urgent care that is covered by your plan, but yeah they aren't just going to tell you to take some aspirin and call them in the morning. Of course, if you haven't already tried and failed some aspirin (or other appropriate otc meds) why the f*ck are you calling in about it anyway?
 
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Except even a 23 year old with a history of migraine can have a brain bleed.
Of course, if you haven't already tried and failed some aspirin
uh-oh
:hurting::inpain::mask::zombie:
NOPE NOPE NOPE

I digress however...

a question that I cannot stop thinking about has been on my mind for months...
Tonight I learned yet another helpful life lesson from one of my patients. If you're on the street corner selling coke and you see the cops coming to bust you don't eat all your coke.
docB,
what did happen to Mr Got-Coke? The hero of the very first post that started this illustrious thread? You got as far as the point where he, handcuffed, proceeds to seize, vomit said coke and aspirate some - but what happened after? how did the story forwards proceed?
:oops::nailbiting::heckyeah:
 
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If you are having the worst headache of your life from a brain bleed a little aspirin isn't really going to make a big difference, while if you just have a bad migraine it might help calm it down.
maybe so, however paracetamol or ibuprofen might be better. ibuprofen was specially meant as a safer alternative to aspirin (and presumably paracetamol too)
although the risk that it's a bleed to begin with is small
 
maybe so, however paracetamol or ibuprofen might be better. ibuprofen was specially meant as a safer alternative to aspirin (and presumably paracetamol too)
although the risk that it's a bleed to begin with is small
There is a small risk of bleeding with ibuprofen as well, but for a migraine I like a cocktail of tylenol (your paracetamol), aspirin, and ibuprofen. Washed down with a caffeinated beverage if possible. I was mostly just using the aspirin based on the old stereotype of telling people "take two aspirin and call me in the morning" though.
 
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the risk of bleed with ibuprofen is lowered compared to aspirin
however, when together, ibuprofen actually inhibits aspirin's antiplatelet activity
hurray for this tetracocktail of synergy
in its honor, here's a tetraclover :luck:
 
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There is a small risk of bleeding with ibuprofen as well, but for a migraine I like a cocktail of tylenol (your paracetamol), aspirin, and ibuprofen.

I had no idea it was safe to take all that stuff together! I knew you could take tylenol and ibuprofen together, but I didn't know you could add aspirin into the mix without dying or similar. :cat:
 
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Yeah, but there's no Motrin in there. I didn't know that all four of those things played well together!.
............................................................Paracetylenol.........Asp'reen
.........................................................................................:luck:
........................................................................Coffeen........Ibuprofiin

........................................................................The Four Cornerstones
 
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............................................................Paracetylenol.........Asp'reen
.........................................................................................:luck:
........................................................................Coffeen........Ibuprofiin

........................................................................The Four Cornerstones

...of a balanced diet? :laugh:
 
There is a small risk of bleeding with ibuprofen as well, but for a migraine I like a cocktail of tylenol (your paracetamol), aspirin, and ibuprofen. Washed down with a caffeinated beverage if possible. I was mostly just using the aspirin based on the old stereotype of telling people "take two aspirin and call me in the morning" though.

No love for compazine? That's my go-to.
 
Then we are getting into the realm of prescribed things. Although i like to keep a stockpile of all kinds of meds and po reglan has helped me many a time.

Sorry - thought we were talking about what we do for patients.
 
If someone tells me they didn't try anything at home I just give a toradol shot. I get a little pi$$ed off that they didn't try anything but also know that at least it's an easy patient dispo (before birdstrike chimes in that these are easy patients who keep the checks flowing.) If they've tried something I usually use reglan in addition to toradol for ease of use as compazine requires pharmacy to send it at my shop. I may or may not add labs, serum preg, or ns bolus depending on presentation and po status. If I were to go by residency standards I would only give ibuprofen and not toradol since its analgesic effect is the same or better but I simply find that the placebo of toradol works for me. Granted, I give a spiel that indicates it is the best thing since sliced bread to those who haven't had it before and I lead with a question like "how much are you feeling better." I'm sure that plays an effect but I am okay with it. I figure if something real is there they likely wouldn't tell me it's better. I get about a 90% response rate to this that's significantly improved. If not I add an opiate. We are a dilaudid "free" ed. If asked for, I look them up on the state website. This is most of my practice. If something outside of this occurs I reevaluate if there's a concern for drug seeking vs cerebral vst aneurysm etc. I realize that toradol may exacerbate bleeding or aneurysms risk but hey we all have a risk vs benefit profile. Haha


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If someone tells me they didn't try anything at home I just give a toradol shot. I get a little pi$$ed off that they didn't try anything but also know that at least it's an easy patient dispo (before birdstrike chimes in that these are easy patients who keep the checks flowing.) If they've tried something I usually use reglan in addition to toradol for ease of use as compazine requires pharmacy to send it at my shop. I may or may not add labs, serum preg, or ns bolus depending on presentation and po status. If I were to go by residency standards I would only give ibuprofen and not toradol since its analgesic effect is the same or better but I simply find that the placebo of toradol works for me. Granted, I give a spiel that indicates it is the best thing since sliced bread to those who haven't had it before and I lead with a question like "how much are you feeling better." I'm sure that plays an effect but I am okay with it. I figure if something real is there they likely wouldn't tell me it's better. I get about a 90% response rate to this that's significantly improved. If not I add an opiate. We are a dilaudid "free" ed. If asked for, I look them up on the state website. This is most of my practice. If something outside of this occurs I reevaluate if there's a concern for drug seeking vs cerebral vst aneurysm etc. I realize that toradol may exacerbate bleeding or aneurysms risk but hey we all have a risk vs benefit profile. Haha


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They can tell me all they want that toradol and ibuprofen give the same relief, but I have had toradol work for me when ibuprofen did not so I guess put me down as one of those that placebo works well for (although if you know it is supposed to be placebo and it still works, what does that mean). Could be the antiemetic that really does the trick though since when the migraine gets really bad I would even accept a suppository version (good test if you think you have a phenergan seeker).
 
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Just to let everyone know I'm fine. And I should clarify. The medication from home took it from a 5 to a 2 on the pain scale. (After reading this thread my 10 would be I'm missing a limb or my testicles are outside of me.) It's just that before the over the counter stuff doesn't work too well for my headaches. In this case it responded rather well.
 
If someone tells me they didn't try anything at home I just give a toradol shot. I get a little pi$$ed off that they didn't try anything but also know that at least it's an easy patient dispo (before birdstrike chimes in that these are easy patients who keep the checks flowing.) If they've tried something I usually use reglan in addition to toradol for ease of use as compazine requires pharmacy to send it at my shop. I may or may not add labs, serum preg, or ns bolus depending on presentation and po status. If I were to go by residency standards I would only give ibuprofen and not toradol since its analgesic effect is the same or better but I simply find that the placebo of toradol works for me. Granted, I give a spiel that indicates it is the best thing since sliced bread to those who haven't had it before and I lead with a question like "how much are you feeling better." I'm sure that plays an effect but I am okay with it. I figure if something real is there they likely wouldn't tell me it's better. I get about a 90% response rate to this that's significantly improved. If not I add an opiate. We are a dilaudid "free" ed. If asked for, I look them up on the state website. This is most of my practice. If something outside of this occurs I reevaluate if there's a concern for drug seeking vs cerebral vst aneurysm etc. I realize that toradol may exacerbate bleeding or aneurysms risk but hey we all have a risk vs benefit profile. Haha


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:chime:
 
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Just to let everyone know I'm fine. And I should clarify. The medication from home took it from a 5 to a 2 on the pain scale. (After reading this thread my 10 would be I'm missing a limb or my testicles are outside of me.) It's just that before the over the counter stuff doesn't work too well for my headaches. In this case it responded rather well.

Your testicles are inside you? You may wanna get that checked.....
 
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They can tell me all they want that toradol and ibuprofen give the same relief, but I have had toradol work for me when ibuprofen did not so I guess put me down as one of those that placebo works well for (although if you know it is supposed to be placebo and it still works, what does that mean). Could be the antiemetic that really does the trick though since when the migraine gets really bad I would even accept a suppository version (good test if you think you have a phenergan seeker).
Toradol worked better for pain I had than ibuprofen (taken regularly and dosed correctly!). I actually went to my doctor's office and begged for a repeat dose of IM Toradol. They happily gave it to me.
 
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