Adages from the ER.

[RustedFox]

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1.) If you want to complain about the use of the term "ER" and not "ED", then please - eff off.

2) Use this thread to post the best adages, advice, lessons, parables, etc - that you have heard, lived, learned, spoken... whatever.


I'll start it off, and maybe set the tone by example.

One of my senior attendings wrangled me as an intern after a situation in which I became (likely) unnecessarily angry at a situation in which I felt that "my time was being wasted".

Dr. GoodGuy said to me: "You know, RustedFox: It costs you nothing, to be kind."

Another attending looked at me one day after I was being total milquetoast and said:

"You know, RustedFox: You have to stand for something: Or you'll fall for ANYTHING."


I find myself trying to strike a balance between those two all the time. Its not easy.


Go.

 

[bravotwozero]

If you're able to watch tv, talk and text, and gobble down a bag of potato chips, perhaps a discharge is in order...


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[Daiphon]

Lack of preparation on your part does not constitute an emergency on mine.

Never underestimate the predictability of stupidity.

Semper Brunneis Pallium

 

[RustedFox]

Lack of preparation on your part does not constitute an emergency on mine.

Never underestimate the predictability of stupidity.

Semper Brunneis Pallium

 

[DeadCactus]

I find myself trying to strike a balance between those two all the time.

On the theme of balancing conflicting ideas in the ED:

1) A good plan now is better than a great plan later.

2) Don't just do something, stand there.

 

[gman33]

When someone has a seizure, step 1 is to go get a cup of coffee.

If they are still seizing when you come back, consider doing something about it.

 

[Psai]

You should go get something to eat. Don't worry, they'll still be here when you get back.

 

[Apollyon]

1. If what you are doing is working, keep doing it
2. If it is not working, stop doing it
3. If you don't know what to do, don't do anything

(Adapted from Loeb's Laws of Medicine)

 

[CliveStaples]

The patient is not dead until he/she is warm and dead.

 

[Arcan57]

Lack of preparation on your part does not constitute an emergency on mine.

Never underestimate the predictability of stupidity.

Semper Brunneis Pallium

Agree with 2nd, unfortunately EMTALA kinda invalidates the first point.

They can hurt you but they can't stop the clock.

If EVERY patient you see on a shift sucks to deal with, the problem may not be the patients. Same goes with consultants.

 

[Danbo1957]

Always assume that your patient will try to die on you before leaving the building. As an IM intern I was rotating in the ED. I gave treatment to a 55 year-old male for a laceration on the left forearm from a construction accident that required several stitches. Upon discharge, I literally watched him walk towards the ED lobby exit doors, when he suddenly stopped in mid-step and dropped to the floor like a sack of beans: SCA. No history of heart issues, and no abnormal rhythms during medical exam four hours earlier. Patient survived, but I've never forgotten that moment of terror that I felt for the first time...

 

[Zebra Hunter]

Chart as if you already have the hindsight that the patient died the day after your encounter.

 

[deleted547339]

1. GOMERS DON'T DIE.
2. GOMERS GO TO GROUND
3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
4. THE PATIENT IS THE ONE WITH THE DISEASE.
5. PLACEMENT COMES FIRST.
6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14G NEEDLE AND A GOOD STRONG ARM.
7. AGE + BUN = LASIX DOSE.
8. THEY CAN ALWAYS HURT YOU MORE.
9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
10. IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER.
11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

 

[deleted547339]

If you're able to watch tv, talk and text, and gobble down a bag of potato chips, perhaps a discharge is in order...


Sent from my iPhone using Tapatalk

I used to believe that until I had a patient with a brain abscess rupture in the ED while eating a sandwich....

 

[Apollyon]

I used to believe that until I had a patient with a brain abscess rupture in the ED while eating a sandwich....

Their brain abscess ruptured right there? Did it externalize? Like, was there grey matter pus all around? That had to stink, mightily!

 

[deleted547339]

Their brain abscess ruptured right there? Did it externalize? Like, was there grey matter pus all around? That had to stink, mightily!

Kid went from having a headache but playing to altered with focal deficit over the course of a few minutes...

Never trust kids.

 

[Apollyon]

Kid went from having a headache but playing to altered with focal deficit over the course of a few minutes...

Never trust kids.

Four groups to NEVER trust: the very old, the very young, the very drunk, and the very crazy. Every one will screw you every time (or, at least, it seems like it).

 

[deleted547339]

Four groups to NEVER trust: the very old, the very young, the very drunk, and the very crazy. Every one will screw you every time (or, at least, it seems like it).

Preach

 

[deleted245139]

Psych patients get sick too

 

[Apollyon]

Psych patients get sick too

The very crazy. I said it.

 

[Deuce Doc]

False:

I know my body.
I have a high pain tolerance.
I will follow discharge instructions.

 

[Tenk]

1.) If you want to complain about the use of the term "ER" and not "ED", then please - eff off.

2) Use this thread to post the best adages, advice, lessons, parables, etc - that you have heard, lived, learned, spoken... whatever.


I'll start it off, and maybe set the tone by example.

One of my senior attendings wrangled me as an intern after a situation in which I became (likely) unnecessarily angry at a situation in which I felt that "my time was being wasted".

Dr. GoodGuy said to me: "You know, RustedFox: It costs you nothing, to be kind."

Another attending looked at me one day after I was being total milquetoast and said:

"You know, RustedFox: You have to stand for something: Or you'll fall for ANYTHING."


I find myself trying to strike a balance between those two all the time. Its not easy.


Go.

Trying to envision who said those and I have a few good guesses I think.

 

[DocEspana]

"Our job is predicated on the existence of penises, vaginas, weapons, alcohol, and combinations of those four"

 

[gro2001]

"Our job is predicated on the existence of penises, vaginas, weapons, alcohol, and combinations of those four"

I dont know, at least 60% of my job is guaranteed by high fructose corn syrup alone...

 

[dchristismi]

I figure most of my work comes from gravity and alcohol...

 

[Vandalia]

There is nothing worse than getting in trouble for doing something you knew was wrong in the first place.

There have been plenty of times when I did something I knew was the right thing to do, knew it would cause problems, and it did. Those didn't cause me to lose a wink of sleep.

But there is nothing worse than caving, knowing it is the wrong thing to do, and still getting burned.

 

[The White Coat Investor]

60% of my income is from anxiety.

 

[em1234]

Thurman's 15 second rule:
Give every patient, no matter how trolly they may be, no matter how frequently they fly, 15 seconds of serious consideration as to whether or not they may actually be sick today.

If you find yourself spending more than 10 seconds talking yourself out of ordering a test, just order it.

Never carry the coffin alone

 

[deleted245139]

The very crazy. I said it.

Lol, yes, saw that after I posted. 100% agree w those 4. Liked the way you worded it too. The 4 horsemen of the ED.

the sickest person in the ED is the one you haven't seen yet.

 

[WilcoWorld]

The most commonly missed fracture...is the second fracture.

 

[witzelsucht]

Age > systolic BP is a poor prognostic indicator

 

[WilcoWorld]

Age > systolic BP is a poor prognostic indicator

I like this. You might want to reword it to "Age > systolic BP indicates a poor prognosis."

 

[Fox800]

If someone claims to have an allergy to an injectable antipsychotic, it means that some doctor, somewhere got so tired of their ridiculousness that they were given an injectable antipsychotic.

 

[FrustratedFamDoc]

2 from a preceptor I had in residency:

1. The enemy of good is better.
2. Sometimes medicine is the easy part.

Mine:

You can't scare stupid.

 

[gro2001]

It's better to be lucky than smart.

 

[Angry Birds]

Advice I give to medical students rotating in the ER and to junior residents:

When they hear hoofbeats, other specialties think horses instead of zebras, but we should first think hippos. What will kill the patient first and fastest? Once we've ruled that out, then we can talk about horses.

 

[Angry Birds]

The most commonly missed fracture...is the second fracture.

Good saying, but it probably isn't. It's almost certainly the night read without the radiologist.

 

[Angry Birds]

Diagnosing pregnancy by CT scan is sub-optimal. Always get a preg. And, if you are getting blood any way, then might as well get the serum hcg instead of waiting around for the urine the nurse will never get.

 

[Arcan57]

Diagnosing pregnancy by CT scan is sub-optimal. Always get a preg. And, if you are getting blood any way, then might as well get the serum hcg instead of waiting around for the urine the nurse will never get.

Bonus is that if it is positive the quant comes back instantly since they already have the number.

 

[Apollyon]

Bonus is that if it is positive the quant comes back instantly since they already have the number.

I was told they use a test just like a home test, and very specifically put the number of drops of urine or blood on it (that's a trick - you can put blood on a urine test). At least where I've been, I haven't had such a thing as you - even with a serum HCG, I still have had to wait for the quant.

 

[sum dude]

1) Squirrels eventually get run over
2) Just admit or sign out IVDA's w/ fevers/back pain/multitude of symptoms
3) nice people have highest morbidity/mortality
4) Pick your battles
5) If you're honest when admitting people life will be much easier w/ consultants (sorry, but I got a turd for you...what can ya do...have a pt here, no idea but they look bad and VS's ugly...etc)
6) Urine is inevitably the last test to come back. never wait for urine for dispo (order HCG, print out your abx, admit AMS b/4 UA when possible)
7) Buy your nurses/techs/secretaries/scribes/students/residents food every once in a while

 

[Fox800]

I was told they use a test just like a home test, and very specifically put the number of drops of urine or blood on it (that's a trick - you can put blood on a urine test). At least where I've been, I haven't had such a thing as you - even with a serum HCG, I still have had to wait for the quant.

Our lab refuses to do this. Sigh.

 

[TooMuchResearch]

1) Squirrels eventually get run over
2) Just admit or sign out IVDA's w/ fevers/back pain/multitude of symptoms
3) nice people have highest morbidity/mortality
4) Pick your battles
5) If you're honest when admitting people life will be much easier w/ consultants (sorry, but I got a turd for you...what can ya do...have a pt here, no idea but they look bad and VS's ugly...etc)
6) Urine is inevitably the last test to come back. never wait for urine for dispo (order HCG, print out your abx, admit AMS b/4 UA when possible)
7) Buy your nurses/techs/secretaries/scribes/students/residents food every once in a while

5 is a great tip for those that don't do this.

 

[n2b8me]

1. thoroughness is the enemy of speed (and vice versa)
2. F then ABCs (f is for food)
3. To my consultants: "I've got a great case for you..."
4. To my patients: "We never close, come back anytime"
5. To my EMS: "Hey, it's great to see you guys again!"
6. To my nurses: "What do you want me to order?"

 

[engineeredout]

Always pee before a procedure

 

[Fox800]

To nurses: "can you get a urine?"

90 minutes later: order straight cath. Urine magically appears.

 

[Food]

EM Chair: Look around you. Everyone is an assassin (In reference to junior residents from consulting services doing crazy ass things to patients in the ED)

Stuff I've learned thus far (take with a grain of salt):

1. Order straight caths early - you'll spend less time waiting hours to dispo a patient
2. Similar to #1, order serum beta-hcg when you're waiting for a pregnancy and the patient won't pee (don't think about how much a serum hcg costs)
3. You can totally sedate, intubate an agitated delirium/drunk/flakka/whatever in the ED, do your AMS work-up, and extubate and discharge back to jail without an admission. (one of my finest moments in residency).

 

[Food]

Diagnosing pregnancy by CT scan is sub-optimal. Always get a preg. And, if you are getting blood any way, then might as well get the serum hcg instead of waiting around for the urine the nurse will never get.

 

[Doctor J]

Squirrels get scanned.

 

[Mighty Mouse]

Nice old people who have never been to your ER before will have something terribly, terribly wrong with them.