ER Hall of Fame

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Moonlighting in Lancaster, Texas. Woman comes in with GCS 4-5. Glucose undetectable by FS Glucometer. Formal lab says < 10.

Lady was comatose, then laughing hysterically, then screaming for 5 minutes, then comatose again. Took 5 amps of D50 and sugar reached 60 then fell again to teens. Put on a D50 drip at high rate and takes 20 minutes to keep it at 60+.

Story: Young lady "fell off bed with boyfriend" and landed on top of insulin pump which malfunctioned and kept pumping out insulin. Pump had to be removed emergently that night.

She lived but with focal neuro deficits.
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BMI ~90. Not me but my friend, in (predictably) the gastric bypass clinic.
 
I am not sure if this belongs in the hall of fame or not but I once had a guy driven up to the ED bay in cardiac arrest. I was a paramedic that had just delivered a patient so I started resuscitating him and took him into the resuscitation room of the ED. He had arrested less than a block from the hospital in the passenger side of a vehicle (thankfully) and still had rolaids in his hand for his "Indigestion". While performing compressions on this guy he opened his eyes, looked at me, and lifted his head off of the bed. Of course, I stopped compressions and stared in disbelief. He then lowered his head and closed his eyes. This guy was in a pulseless rythm the entire time. Since he had obviously kept neuro function intact after extended resuscitation (pupils still reactive throughout), we took him to the flouroscope and continued CPR while a cardiologist inserted a pacer wire in a lst ditch effort, no capture. This may have been before trancutaneous pacing, I don't recall. Anyway, we worked this guy for two hours before the Doc finally called it. Has anyone else had similar experiences? Would be interested in hearing them...

:eek:
 
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a_ditchdoc said:
I am not sure if this belongs in the hall of fame or not but I once had a guy driven up to the ED bay in cardiac arrest. I was a paramedic that had just delivered a patient so I started resuscitating him and took him into the resuscitation room of the ED. He had arrested less than a block from the hospital in the passenger side of a vehicle (thankfully) and still had rolaids in his hand for his "Indigestion". While performing compressions on this guy he opened his eyes, looked at me, and lifted his head off of the bed. Of course, I stopped compressions and stared in disbelief. He then lowered his head and closed his eyes. This guy was in a pulseless rythm the entire time. Since he had obviously kept neuro function intact after extended resuscitation (pupils still reactive throughout), we took him to the flouroscope and continued CPR while a cardiologist inserted a pacer wire in a lst ditch effort, no capture. This may have been before trancutaneous pacing, I don't recall. Anyway, we worked this guy for two hours before the Doc finally called it. Has anyone else had similar experiences? Would be interested in hearing them...

:eek:
Click to expand...
Yeah. I saw a guy once who would wake up with CPR without ROSC.
 
I've got this DKA kid in the PICU. Bicarb of 1.6, repeated twice. pCO2 of 7.1
 
aphistis said:
Gotta ask--height & weight?
Click to expand...
5'7" and 575# puts you right at a healthy 90.
 
First of all, the patient who weighed, nope, not 575, but > 850# (the scale did not read any larger!). When he died he was taken by forklift in a Uhaul to the funeral home.Sad.

Secondly, the man with acute psychosis and back pain who had never been to the doctor before. Hypercalcemic, but a Ca of 13 can be dealt with. A PSA 6746, however, does not bode well for the patient (repeated, three times). I still remember the call to urology resident (anyone else get a little "why are you bothering me" attitude from them?). I believe she asked me "what's the patients urological problem" to which I promptly answered "his PSA is 6746". Nothing else needed to be said.
 
O2 saturation of 0 on the monitor, confirmed by ABG in a guy I just intubated. Heart still beating and everything. The pO2 was <27 (undetectable) on 100% BVM. Working Dx is ARDS. BTW the pulse ox was down to 50 when I got to him. He only started to brady down as I was intubating him.
 
20y/o female with jaundice (surprising) with Tbili=71.4 and Dbili 55.7

17y/o female with cpk of 376,840 and AST 3850
 
Med list: 33 items none of which were OTC or herbal

I have seen the rare nut on 50 or 60 "meds" that were actually a variety of herbal preps but this is the first patient I'd ever seen whose docs actually thought they should be on that many prescription drugs
 
Yow. I've been the extra hands in the room, and sorted a patients' pill bottles (helpfully brought along by the medics) into groupings by prescribing physician, so I've wondered: do they all know about each other, and all the meds? (I've seen approx 25)
 
ERMudPhud said:
Med list: 33 items none of which were OTC or herbal

I have seen the rare nut on 50 or 60 "meds" that were actually a variety of herbal preps but this is the first patient I'd ever seen whose docs actually thought they should be on that many prescription drugs
Click to expand...

You beat me. I had 28 the other night at the World Famous CCF.

mike
 
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I had some time on my hands and I figured it was time to post the current leaders (or likely liars in maybe a few cases)

Alcohol-Blood 830 Jpgreer13
Alcohol-Breath(usually lower) 540 febrifuge
Na-high 221 gerickson03m
Na-low 95 Freeeedom
Glucose-high 2390 Arcan57
Glucose-low 3 SBL
Ph-low 6.10 Margaritaboy
Ph-high 7.88 pinbor1
Plts-low 0 seaglass
Cl- low beriberi
Ca-low 4.2 a little elf
Ca-high 18 Ermudphud
C02-high 318 beyond all hope
Bicarb-low 1.6 pinbor1
INR-high 92 Apollyon
%Bands-high 68 debvz
TSH-high 425 margaritaboy
Lithium 8.1 Zambezi
K-low 0.8 jjackis
K-high 13.7 emt30119
TBili 92 virion
Dbili 56 wthomp03
BUN 212 bcsmith
Cr 47.4 bccsmith
Troponin I 1100 AJM
BNP 331042 Apollyon
Cholesterol 1200 (a suspiciously round number) ham sandwich
Triglycerides 12000 ham sandwich
Mg 0.2 EMIMG
Temp-high 109 docB
Temp-low ?
WBC 430,000 beyond all hope
CPK >800,000 Scrubbs
Lipase 62,500 Apollyon
Hct high 72 Ermudphud
Hgb low 0.8 EMraiden
PSA 6746 clc17
Anion Gap 48 JLw2004
Drug screen 6 of 6 positive docb
duration of unevaluated chief complaint 39 years Apollyon
youngest smoker 5 years old emtp2pac
youngest ivda 11 years emtp2pac
Pack years smoking 420 Apollyon
BMI 90 smoke this
weight >850 pounds clc17
02sat 0% Seaglass
Blood pressure 330/180 12r34y
Corneal Foreign bodies >50 cdr50
Tooth/tattoo ration 6/23 Kev Jones
Medlist (active prescription meds) 33 Ermudphud
Pain scale 10/10 docB (and all the rest of us)
 
ERMudPhud said:
Med list: 33 items none of which were OTC or herbal

I have seen the rare nut on 50 or 60 "meds" that were actually a variety of herbal preps but this is the first patient I'd ever seen whose docs actually thought they should be on that many prescription drugs
Click to expand...

O.k., I saw 26 today. Not as impressive as yours except my patient was 16 years old. 26 meds, all prescribed by MD/DOs and all prescription drugs with the exception of ibuprofen, tylenol (both scheduled) and stool softener.

- H
 
My personal "oh sh-t" values (from 9 years of experience in EMS, lab and RT):

Glucose: High: 2240 Low: 4

PaO2 (in a patient who was sitting up and talking): 14 mmHg

PaCO2 low- 0 (head trauma patient being bagged by an overzealous paramedic; needless to say he was otherwised bagged shortly after his arrival at the hospital)

PaCO2 high- 304 mm Hg (cardiac arrest)

HCO3- high 67 low 2.1

pH- low 6.00 on a DKA case (theABG machine wouldn't read any lower) highest: 7.88 (too much NaHCO3 in the field for a hyperkalemic episode)


COHb (carboxyhemoglobin; on a live patient) 44% (according to the book I looked at, 35-40% is enough to either put you in a coma or kill you)

Methemoglobin (following accidental NTG OD): 22%

Blood alcohol level: 1.01

Hemoglobin: 2.2 g/dL (this was on an outpatient I drew as a phlebotomist....she went home and the doc had to call and tell her to find a ride back to the hospital because she was "a little anemic" (the pt's description of what the doctor told her :laugh: )

Highest Temp: 112 F (meth OD; drug dealer ate his "stash" while running from the cops; needless to say he died)

Lowest Temp (survived): 89.9 F (child accidentally locked out of the house during a snowstorm)

Drug Panel: Positive for TCA's, benzos, THC, barbiturates, cocaine, amphetamines, methamphetamines, opiates, and PCP. (9 out of 9 on the Triage panel)

High potassium: 26.7 (suicide of a nurse who shot herself full of KCl, succinylcholine and diazepam)

Heaviest patient: not sure but we had to take the bay window out of the front of his house to get him into the ambulance; oh and BTW he had maggots.
 
Bun 288 Cr 33 K 9.3 Pt. lived, ICU for 3 weeks.
 
uterine fibroid= 16x19x14 cms
 
Alcohol-Blood 830 Jpgreer13
Alcohol-Breath(usually lower) 540 febrifuge
Na-high 221 gerickson03m
Na-low 95 Freeeedom
Glucose-high 2390 Arcan57
Glucose-low 3 SBL
Ph-low 6.00 ISU_STEVE
Ph-high 7.88 pinbor1 and ISU_Steve (tie)
Plts-low 0 seaglass
Cl- low beriberi
Ca-low 4.2 a little elf
Ca-high 18 Ermudphud
C02-high 318 beyond all hope
PaCO2- 304 ISU_STEVE
Bicarb-low 1.6 pinbor1
Bicarb- High 67 ISU_Steve
INR-high 92 Apollyon
%Bands-high 68 debvz
TSH-high 425 margaritaboy
Lithium 8.1 Zambezi
K-low 0.8 jjackis
K-high 26.7 ISU_Steve
TBili 92 virion
Dbili 56 wthomp03
BUN 212 bcsmith
Cr 47.4 bccsmith
Troponin I 1100 AJM
BNP 331042 Apollyon
Cholesterol 1200 (a suspiciously round number) ham sandwich
Triglycerides 12000 ham sandwich
Mg 0.2 EMIMG
Temp-high 109 docB
Temp-low 89.9 ISU_Steve
WBC 430,000 beyond all hope
CPK >800,000 Scrubbs
Lipase 62,500 Apollyon
Hct high 72 Ermudphud
Hgb low 0.8 EMraiden
PSA 6746 clc17
Anion Gap 48 JLw2004
Drug screen 9 out of 9 positive ISU_Steve
duration of unevaluated chief complaint 39 years Apollyon
youngest smoker 5 years old emtp2pac
youngest ivda 11 years emtp2pac
Pack years smoking 420 Apollyon
BMI 90 smoke this
weight >850 pounds clc17
02sat 0% Seaglass
Blood pressure 330/180 12r34y
Corneal Foreign bodies >50 cdr50
Tooth/tattoo ration 6/23 Kev Jones
Medlist (active prescription meds) 33 Ermudphud
Pain scale 10/10 docB (and all the rest of us)
uterine fibroid= 16x19x14 cms ROJA
Carboxyhemoglobin- 44% ISU_STEVE
Methemoglobin- 22% ISU_STEVE
PaO2 (low)- 14 mm Hg ISU_STEVE
 
EtOH 687 on arrival, started having withdrawl seizures late the next day...EtOH 403.
 
Do ACCU checks count?

Last night in the ED. Pt headed upstairs to ICU, already admitted.
Brady to Asystole.

Epi,atropine, epi, Bicarb, atropine, epi, hold chest compressions... pulse.

ACCU check... 2

Thats what the little machine said.
Believe it or not.

D50 then D5 and made it to the ICU.
 
largest quantity of stool delivered by manual disimpaction=15 pounds

My wife saw the patient in the ED but the actual procedure ended up having to be done in the OR under general anesthesia.
 
ERMudPhud said:
largest quantity of stool delivered by manual disimpaction=15 pounds
Click to expand...


What did they decide to name it?

Take care,
Jeff
 
Only because it wasn't a large enough pile of s--t to be considered a member of the Bush family ;)
 
docB said:
My comment has much more to do with Edward's being a plaintiff's lawyer than anything political.
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Duly noted.....my comment had more to do with Bush being full of it as a hypocrite and a human being rather than anything political.
 
This is a story that belongs here:

http://news.yahoo.com/s/ap/20050801...2TtiBIF;_ylu=X3oDMTBiMW04NW9mBHNlYwMlJVRPUCUl

Dentures Removed From Man's Bronchial Tube

TAIPEI, Taiwan - A Taiwanese man is breathing easier after a surgeon removed a missing set of dentures from one of his bronchial tubes — three years after he lost them in a fall.


Surgeon Chen Chun-lei said the unidentified man visited his clinic several days ago complaining of shortness of breath and a high fever.

The man had no idea the missing denture was the culprit, causing a mild case of pneumonia.

"He had looked for the missing dentures for three years but they were nowhere to be found," Chen said.

Chen operated after an X-ray detected an unknown object in one of his bronchial tubes — what turned out to be the missing denture.

Chen said the 45-year-old man did not suffer serious breathing problems earlier, possibly because the lower denture of eight teeth had stuck in part of the bronchial tube but did not entirely block the passage of air.

"The patient might have needed to have part of his lung removed if the denture was not located before it caused severe damage," Chen said Monday. "He was a lucky man to find it when he did."
 
ISU_Steve said:
"He was a lucky man to find it when he did."
Click to expand...

LOL, Three years = lucky? :rolleyes:
 
I had a lipase of 0 today. I don't know what it means for this pt but I've never seen 0 before. Strange thing is that comes up as a critical value for some reason. The nurse came up to inform me of it so I told her, in a serious voice, to give the pt 500 units of lipase. She walked off in a purposeful way. I wonder what happened with that.
 
docB said:
I had a lipase of 0 today. I don't know what it means for this pt but I've never seen 0 before. Strange thing is that comes up as a critical value for some reason. The nurse came up to inform me of it so I told her, in a serious voice, to give the pt 500 units of lipase. She walked off in a purposeful way. I wonder what happened with that.
Click to expand...

"Hang up a bag of BUN, stat!" - another way to perplex the staff
 
docB said:
I had a lipase of 0 today. I don't know what it means for this pt but I've never seen 0 before. Strange thing is that comes up as a critical value for some reason. The nurse came up to inform me of it so I told her, in a serious voice, to give the pt 500 units of lipase. She walked off in a purposeful way. I wonder what happened with that.
Click to expand...


You're a bad man
 
Doesn't quite unseat the leader, but when I was a med student we had a guy come in with a BUN of around 180 and a Creatinine of 34.3. He was a 55 year old vet that had obstructive BPH and hadn't urinated in about 10 days. His wife was out of town so he didn't have anyone to take him to the hospital. He didn't think it was worth calling EMS over. His only complaints were a distended belly, nausea, and pruritis.

I don't recall what his K was, but it wasn't crazy high. I think overnight in the MICU with a Foley and fluids running his Crt was down to 17 the next day and 4 two days later.
 
Just admitted a patient the other night with a BUN of >221. Apparently, the machine stops counting at that point. Creat was only 6.2 with a K of 5.8. Came in for change of mental status. Of course, the real question is which came first, the uremia or the the wack-a-doodleness. :D
 
I didn't see any records for ammonia so I nominate my patient tonight with a stellar... DA DA DADA 302 ! Yes she's altered. Yes she's ESLD. Let me call the internist. I know he'll be proud.
 
Ferritin of 76,000 in a kid with HLH.
 
I think there's a decimal place difference here in the frozen north, but I had a patient in acute renal failure with a creatinine over 370. I'm guessing that's 37 in yankee numbers, or else I've got a REAL champ!
 
docB said:
It doesn't beat the record of Na of 221 gerickson03m but my pt with Na 179 gets a mention. Chloride was 150.
Click to expand...

Not an ED pt per se, but gotta throw in the guy on my Medicine service right now with the Na of 190.
 
NateatUC said:
Not an ED pt per se, but gotta throw in the guy on my Medicine service right now with the Na of 190.
Click to expand...
What's the story behind that one?
 
jesswise said:
I think there's a decimal place difference here in the frozen north, but I had a patient in acute renal failure with a creatinine over 370. I'm guessing that's 37 in yankee numbers, or else I've got a REAL champ!
Click to expand...

It must be hard to take care of patients if you have no clue what the lab value means. Creatinine of 370 umol/L = 4.2 mg/dL. Nowhere near to make it to the Hall of Fame.
 
INR of >999.99. Cancer patient. Came down nicely with FFP and Vitamin K.


Hemoglobin of 1.3. Extubated the other day and doing well.


Potassium 1.1 and sodium 109 in same patient. 23 year history of bulemia. QTc was almost .6!

later
 
Praetorian said:
What's the story behind that one?
Click to expand...

Honestly not really sure. Was actually the intern's pt, not mine. Elderly, demented, 24-hour care requiring guy. Not taking PO for several days, though I still don't think that'll get the ol' Na up to 190.

Family made him DNR/DNI, and he actually passed away a couple days ago.
 
docB said:
It doesn't beat the record of Na of 221 gerickson03m but my pt with Na 179 gets a mention. Chloride was 150.
Click to expand...


I had a pt in the ED a couple months ago with a Na of 190. Thankfully his sister dropped him off and left her phone number with the nurse because he wasn't making any sense. After trying to get his history, and before getting any lab values back, I called his sister. She told me "last time he got like this his sodium was messed up." . . . too bad all patients don't come with such a strong historian. :laugh:
 
All on same patient...

Na 180 (grossly lipemic so probably higher)
Glucose 1560
Serum Osmolality 447
Temp 107
CK 470,000 (peaked)

Just transferred him out of the MICU yesterday.
 
Clinic patient- magnesium 0.3
STO'd for IV magnesium replacement
recheck one week later 0.2.
Complained that she didn't like the tablets we had given her!
 
It doesn't quite beat the record for high temp, but I think they deserve an honorable mention.
Elderly lady s/p cardiac arrest now with hypoxic brain injury (brain dead) with a temp of 107.6.
20 month old with a rectal temp of 105.9, an hour after a proper dose of tylenol. He was jumping around the ER laughing, giggling, etc.
 
So last week

I had a guy with a volume contraction alkalosis, bowel obstruction, and air in the biliary tree with a GI bleed on top of it all.

His AGAP was 50
Chloride was 53
Bicarb of 46

The ICU still wanted to reject him because he was talking and not intubated.
 
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