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A tale of two transfers...

Discussion in 'Emergency Medicine' started by DrQuinn, Apr 30, 2007.

  1. DrQuinn

    DrQuinn My name is Neo Moderator Emeritus 10+ Year Member

    Dec 6, 2000
    Just a glimpse into what I saw tonight on a baby 6 hour shift:

    One transfer, for a healthy 20 year old female with foreign body in her eye. ? of what the item was, but a small speck 6:00 to her pupil. They tried irrigation, and q-tips to "remove" the spot on her cornea.

    On slit lamp exam, I couldn't find any item whatsoever. She has no fb sensation. Weird. Fluorescein exam: she has a tiny tiny corneal abrasion 6:00 to her pupil. No seidel's sign, no ice skating rink sign. Otherwise normal exam.

    Poor little 20 year old probably had to endure a non-anesthetized q-tip debridement of her cornea where she was at. *sigh*

    Other transfer, "aneurysm that is about to blow, go to Washington Hospital Center, you could die at any minute." 64 year old helathy male complains of night sweats and weight loss x 2 months. PCP did a "pan-scan" CT chest/abd/pelvis, looking for malignancy. Ends up finding a true ascending aortic aneurysm.


    Yes, I did indeed see these patients back to back.

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  3. Painter1

    Painter1 Junior Member 7+ Year Member

    Mar 16, 2006
    Had a similar "emergent" referral from a PMD who wrote in a RX note: "eye foriegn body, needs evaluation and management"

    13yo with no foriegn body sensation, no photophobia, no eye pain, no vision changes. On exam, mild bilteral injected scleral with absolutely no foriegn body anywhere after an exhaustive exam.

    some of these pmds are something else.
  4. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

    Nov 2, 2004
    What's the "Ice skating rink" sign? I can imagine repeated abrasions from an FB under the lid resembling unZambonied ice, but I've never heard of it.
  5. DrQuinn

    DrQuinn My name is Neo Moderator Emeritus 10+ Year Member

    Dec 6, 2000
    exactly what you describe.

  6. kungfufishing

    kungfufishing Senior Member 7+ Year Member

    Mar 7, 2003
    For me personally I think the ice skating rink sign would probably be a fracture of my distal radius...
  7. Jeff698

    Jeff698 EM/EMS nerd 15+ Year Member

    Aug 11, 2000
    Salado, Texas
    proximal radius in my wife's case.

    Take care,
  8. trkd

    trkd 10+ Year Member

    Dec 23, 2002
    San Diego
    I think the "unzambonied sign" is better name... and much cooler. :thumbup:
  9. beyond all hope

    beyond all hope Senior Member 7+ Year Member

    Dec 18, 2003
    Having been on the sending and recieving end of transfers, they can be silly. A lot of times you sound like an idiot when you're trying to transfer a patient out because you're tired and you have thirteen other things going on. However, I've heard even more idiocy than I can credit for business.

    Attending ER physicians who transfer in burns. I ask them to describe the burn and they say 'It looks bad'.

    ER transfers are usually less silly than PCP transfers. The primaries can be absurd. R/o hypertension. Although I had one PMD who sent a pt in for r/o appy having done an outpt CT that was positive! I was impressed and somewhat appalled. Surgery repeated the CT, which was positive, and took him to the OR after at least 18 hours of WU between us and the PMD. Lucky it didn't rupture.

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