ER Hall of Fame

[Jeff698]

I had what looked like a typical tertiary care patient tonight (LOTS of medical problems with no ED diagnosis in sight) who had one of the most abnormal hemoglobins I've seen in a long time:

14.0.

Seriously, for this population, doesn't that make him abnormal?

Take care,
Jeff

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[docB]

I had what looked like a typical tertiary care patient tonight (LOTS of medical problems with no ED diagnosis in sight) who had one of the most abnormal hemoglobins I've seen in a long time:

14.0.

Seriously, for this population, doesn't that make him abnormal?

Take care,
Jeff

When I was a really green med student in North Philly I thought one of my patients who had a hemoglobin of 15 was polycythemic. They weren't. They were really dehydrated. No one in Philly has a "normal" hemoglobin.

 

[vtucci]

I had a diabetic today with a HA1C of 16.6. He claims that he eats lollipops everyday

I saw a HA1C of 19. Pt had three toes amputated and a wicked case of osteomyelitis- she'll probably lose her foot below the ankle. The PA summed the case up as "uncontrolled diabetic- OBVIOUSLY".

 

[gutonc]

Except for maybe the NICU/Peds..

68 y/o guy.. yellow like my urine.. Total Bili 25.9... YEP TWENTY FIVE POINT NINE...

Most people I spoke to guessed something like 12.. YOWZA!

I work in a liver transplant center so I'm used to the yellow folks. I haven't had a 25.9 yet but I've had 3 this month >22 and I pronounced a guy on cross-cover the other night whose last Bili prior to going to comfort care (3d prior to his death) was 24. I imagine if we'd checked it on the day of death it would have topped 26.

 

[kronickm]

I work in an apheresis unit in the hosp. most of the numbers I have seen are like those posted earlier (WBC in the high 300s, chol around 1000) I remember this one case though a relatively young black lady (20s-early 30s). I cannot for the life of me remember what her disease process was, needed a platelet reduction with a platelet count of around 1,200!!!

Usually a unit of apheresis platelets looks like plasma with a little bit of shimmer to it, this looked like a yellow lava lamp.

 

[dmunorse]

Saw an 84 yo female pt today c/o a little abdominal discomfort. We noticed her sats were at 78% on O2...ABGs confirmed it.

Her d-dimer was 100. Haven't seen that before.

Unfortunately we couldn't do a CT d/t her Cr of 1.9. She'll get a V/Q scan tomorrow.

 

[ForbiddenComma]

Not really a "lab" value, but I had a urine dipstick with the glucose box more purple than the darkest purple color on the side of the vial that holds the strips. Translates into glc > 1500

35ish came to the student-run clinic with URI symptoms. I could smell that sticky sweet smell right when I walked in (and she's type 2 keep in mind). She mentioned how she "ran out" of her insulin because she couldn't afford it.

Fourth-year med student (serving as the "resident") actually refused to let me do a finger stick. She said, "She came in with a URI, so that's what we're going to treat."

The only reason why I got my UA was because I begged and pleaded, and the pt had to go to the bathroom anyway (no surprise there I guess). My suggestion that she be admitted, naturally, was seen as too ridiculous to even merit a response.

The only thing the attending doc said about this to the pt was, "You should really try to get your sugar a little lower."

 

[carrigallen]

Troponin - 904 - s/p peri-cath MI.

Potassium - 1.6. alcoholic malnutrition, syncope.

Sodium - 105. SIADH 2/2 Porphyria, seizing.

MCV - 45. Iron defiency + beta thallessemia.

BMI - 88. aka jabba the hut, each pannus had its own decub.

CPK - 450,000. jumped off four-story building, brainstems absent.

 

[Rbrav]

How did I go for so long without knowing about this thread?

My first week in the hospital as a third year, we got consulted on a woman with her third episode of rhabdomyolysis. Her CPK? Around 1,100,000. The lab ran it twice. You know it's going to be a good day when the attending's jaw drops. If I'd known what I was doing, I would have taken a peek at her urine and her BUN/Cr. I do remember hearing her kidneys were just fine, though.

 

[DogFaceMedic]

A1C of 14 in a 16yo M who feels "good". The kid looked older than me. Not as high as other A1Cs posted, but it is frustrating to see parents allow this to happen. You can survive some Hall of Fame electrolyte abnormalities, but this kid is done and isn't out of high school yet.

 

[dmitrinyr]

A1C of 14 in a 16yo M who feels "good". The kid looked older than me. Not as high as other A1Cs posted, but it is frustrating to see parents allow this to happen. You can survive some Hall of Fame electrolyte abnormalities, but this kid is done and isn't out of high school yet.

I had a similar pt while on my psych rotation in 3rd year. Pt was 18 y/o with DM and bilateral diabetic neuropathy on his heels and feet. When asked he states, "yeah, I always take my insulin!" (yeah, of course you do). It is very frustrating to see pts allow themselves to get to such an irreversible point, especially being so young. We didn't do an A1C on him but I'm sure it wasn't anywhere close to 7%.

 

[GoofyDoc]

I work in a liver transplant center so I'm used to the yellow folks. I haven't had a 25.9 yet but I've had 3 this month >22 and I pronounced a guy on cross-cover the other night whose last Bili prior to going to comfort care (3d prior to his death) was 24. I imagine if we'd checked it on the day of death it would have topped 26.

Intruding here from IM. I had a patient not too long ago with a bili of 56 (transfusion rxn). He did end up surviving. Bili's stayed up for about a week before starting to trend down.

 

[gutonc]

On a guy w/ a very floppy heart, dyspnea and chest pain...>35K, after they diluted it 1:10 and it still went off the scale. The lab called to ask if we needed it more precisely quantified and I decided that 350K was probably a close enough guesstimate.... I checked in on him today and dude diuresed 6L w/ 60mg of IV lasix x1 and is now satting 98% on RA.

In general I hate the BNP b/c it always seems to come back 500 or so on folks who you can't decide if they're dyspnea is CHF or COPD...clearly not an issue in this guy.

 

[gutonc]

I was covering in the MICU yesterday and assumed care of a guy w/ acute liver failure of unclear etiology (EMS report said "found hugging a pole and unresponsive"), neg tox screen, HCV/HBV +ve, denies ingestions.

Admission AST was 16,600, ALT was 9800, INR 14.

 

[docB]

Echocardiogram EF 5%.

Cardiologist came over and personally repeated the echo. End stage alcoholic cardiomyopathy. I think he would have started clotting up except his liver was fried too.

 

[dchristismi]

Tylenol Level = 392.

Now THAT's a suicide attempt.
None of this wimpy "I took 10 tylenols" crap. This guy took, as best we could tell, somewhere between 500-900 500mg tabs. And half of them were the Tylenol PM version, so he had the anticholinergic stuff too...

 

[gutonc]

Echocardiogram EF 5%.

Cardiologist came over and personally repeated the echo. End stage alcoholic cardiomyopathy. I think he would have started clotting up except his liver was fried too.

I admitted this guy a few weeks ago, not alcoholic CM but EF of 5% after 3d of diuresis (probably 1% on admit) w/ spontaneous echo contrast formation and an atrial mural thrombus the size of your fist. Survived to discharge but probably won't make it to his next admit.

 

[BADMD]

Tylenol Level = 392.

Now THAT's a suicide attempt.
None of this wimpy "I took 10 tylenols" crap. This guy took, as best we could tell, somewhere between 500-900 500mg tabs. And half of them were the Tylenol PM version, so he had the anticholinergic stuff too...

How many hours post ingestion was that, out of curiousity? And please tell me you didn't put him on the Acetadote protocol...

 

[madtowngirl]

platelets 1,985,000 in a post splenectomy pt. No tx because neurosurg was taking him to OR for spinal fusion and didn't want him to bleed.

 

[deuist]

Over the previous two days I cared for a woman with HTLV-induced lymphoma with a calcium of 16.7. She was already receiving steroids so we loaded her up on calcitonin. This morning, her Ca was 13.4. In addition, her anion gap was 41. Because she failed previous attempts at treating the cancer, her oncologist ceased all measures and decided to take the comfort route.

 

[overthebars]

I had a similar pt while on my psych rotation in 3rd year. Pt was 18 y/o with DM and bilateral diabetic neuropathy on his heels and feet. When asked he states, "yeah, I always take my insulin!" (yeah, of course you do). It is very frustrating to see pts allow themselves to get to such an irreversible point, especially being so young. We didn't do an A1C on him but I'm sure it wasn't anywhere close to 7%.

Came with respiratory distress and fever --> massive empyema that ultimately required decortication. None of the residents believed the A1c until I showed it to them. Her other values going back years were not much different.

I think we need another abstract post to show the running highs and lows. I'm way too lazy.

 

[bulgethetwine]

6.6 cm... and that was the smallest dimension

9.2 x 7 x 6.6 cm.

With only moderate hydro....

Even the urologist was impressed, and I woke him up to tell him about it.

 

[spyderdoc]

Had a guy with a phosphorus level of 18.3 today. He is ESRD on HD and somehow managed to skip HD for 3 weeks. His K was 7.6 (nice wide complex junctional bradycardia on his ECG). His anion gap was 22.

 

[deleted6669]

18 mm right renal stone without hematuria in a 65 yr old very pale, very hypertensive guy in agony despite lots of dilaudid. really thought it was a AAA. so did the vascular surgeon. we were both surprised to get the ct result.....

 

[coldcoldworld]

Had a very "fluffy" patient that I admitted to obs last night who was on 450 units of regular insulin a day. Actually got called on her b/c her med rec had her on U-500 concentrated insulin and pharmacy wanted me to write an order to switch her over b/c they don't carry U-500.

 

[gutonc]

Not an ER record but I saw a woman (BMI in the 18 range) w/ metastatic breast cancer in clinic a few months ago who was (relatively) functional on a total dose of MS-contin of 4g daily, plus she went through 3 x 300ml bottles of Roxanol per week for her PRN dosing.

 

[Greenbbs]

Except for maybe the NICU/Peds..

68 y/o guy.. yellow like my urine.. Total Bili 25.9... YEP TWENTY FIVE POINT NINE...

Most people I spoke to guessed something like 12.. YOWZA!

we had a guy a couple weeks ago...had pretty bad cirrhosis and was on the transplant list, and had a tbili of 28.8.....never saw one that high.

we also had a lady with familial hypertriglyceridemia who came in with pancreatitis and had a triglyceride level of upwards of 20,000 (the highest our lab machines can read), and that was after 2 dilutions. her blood came out milky red.

 

[GoofyDoc]

WBC of 112,000 in a patient with an intraabdominal infection (no leukemia hx). Returned to normal after appropriate intervention.

 

[lasek]

dont know if these are records. but thought i'd mention it

during surgery rotation

1: 12 cm ruptured AAA. patient survived surgery, was still in ICU 4 week later. dont know what happened to him after that


2: CC: i'm orange
total bili somewhere around 35, direct around 15 (dont remmeber exact numbers)
had pancreatic CA, had whipples procedure, signed out AMA from ICU on post op day 3.

 

[kbrown]

44 y.o. F brought in by EMS from church for HA and vomiting, found to be hypertensive SBP 270's. CT with huge bleed. Art line placed...BP 317/174. Didn't know that was possible. Maybe not a record, but a darn good reason for a headache.

 

[Chronic Student]

Had a patient that we operated on who went into laryngospasm when extubated. Shortly thereafter his BP and pulse faded away. Started CPR and he got lots of epi.

We got his heart started again and the BP read 341/210. I honestly did not know that a BP could go that high and the patient could live.

We got him stabalized and immediately took him to the scanner. No bleed. He was in the ICU for a few days and was eventually D/C'd to home.

He has suffered no apparent ill effects.

-Mike

 

[BADMD]

Got a patient yesterday who had AST and ALT > 9000. INR was 20. Ammonia was only 120.

My collegue had a patient with a serum ethylene glycol of 2....2 g/dL. The guy drank more than a liter of ethylene glycol.

 

[Wackie]

30 something y/o M presents actively seizing

Glucose 1326
pH 7.7

 

[doctawife]

Probably not a record, but I had a 17 year old girl who managed to pretty much voluntarily hyperventilate herself to a pH of 7.68.

If yer gonna had a psuedoseizure, I guess you might as well do it right.

 

[roja]

I beat my lowest Hgb.


New record 1.4

 

[coldcoldworld]

ESRD missed dialysis yesterday....

Potassium of 9.5. Came in with a nice junctional brady with longs runs of asystole. Nice....

 

[docB]

Seeing a drunk today who's a regular. Looked it up in the system computer that covers 4 hospitals and he was in the ED 45 times in 2007. That's just my 4 houses, doesn't count all the other hospitals in town.

ED visits in 1 year = 45

 

[Dr. Dukes]

ED visits in 1 year = 45

I bet if he put his mind to it he could hit 52...

 

[pseudoknot]

Seeing a drunk today who's a regular. Looked it up in the system computer that covers 4 hospitals and he was in the ED 45 times in 2007. That's just my 4 houses, doesn't count all the other hospitals in town.

ED visits in 1 year = 45

45 visits in one year? Please.

Three years, a thousand visits: a case study of the ultimate frequent flyer.
Ann Emerg Med. 2001 Jul;38(1):87-9.

 

[roja]

No kidding. We have people who regularly go over thier 99 visits (we have EMSTAT which tracks # visits) in several months. We had one guy, literally showed up 2-3 times a day between our two hospitals.

 

[ccfccp]

Ok... I did overnight last night and there was a guy that came in at the very end of the shift. I read most of this post and think it's a global record for Cl, but these are all personal records for me:

Na: 112
K: 1.8
Cl: 50


He was not "all there" but he wasn't seizing and could follow commands and answer questions. I'm not sure what happened, but I'll be interested to see during my next shift.

 

[aphistis]

A1C of 14 in a 16yo M who feels "good". The kid looked older than me. Not as high as other A1Cs posted, but it is frustrating to see parents allow this to happen. You can survive some Hall of Fame electrolyte abnormalities, but this kid is done and isn't out of high school yet.

Not EM, but I've seen 15.3 at my VA hospital. Guy told me he takes his meds exactly as prescribed.

 

[BADMD]

Had a guy tonight with altered mental status. Sodium of 200. He was, amazingly, not obtunded. The family brought him in because he wasn't acting right.

 

[gutonc]

Not EM, but I've seen 15.3 at my VA hospital. Guy told me he takes his meds exactly as prescribed.

I picked up a guy the other day admitted w/ CBG of 900. A1c came back the next AM @ >18. I never new (until then) how high the machine could read. Off his meds for 2 months while traveling around Mexico (but he kept taking his simvastatin at least).

 

[Wackie]

Seeing a drunk today who's a regular. Looked it up in the system computer that covers 4 hospitals and he was in the ED 45 times in 2007. That's just my 4 houses, doesn't count all the other hospitals in town.

ED visits in 1 year = 45

We have one who averages over 1 visit per week just with one ED, knows all of the doctors by name. They go to other hospitals too.

We have a newbie frequent flyer who's working on such a status starting last Sept.

On both of these patients I can probably save an HPI and just copy it into the new encounter because the story is always the exact same thing.

 

[deleted109597]

All time great on the new trauma text page system.

Trauma Alert-Pedestrian vs Train, body not yet found.



They never found the body, but they did find pieces. Not sure why they felt like waking me up for that one.

 

[kbrown]

PaCO2 on ABG 160

Man came in talking to EMS, not really talkative by the time he got to my resusc bay. Drew an ABG for academic purposes while drawing up sedative and paralytic. Tubed'em. 10 min later check ABG...PaCO2, 160. pH 6.8 or something like that.

 

[roja]

CPK: 1,454, 952


cc: peeing blood
did 'alot of squats at the gym'

 

[Dr. Will]

CPK: 1,454, 952


cc: peeing blood
did 'alot of squats at the gym'

Damn...and I thought the CPK of greater than 600,000 was high. I even have a nice pic of the "coca cola looking" urine sitting right next to a bottle of coke. (I've been taking lots of pictures lately).

What else...personal highs for me. Cr: 18.5 in ARF who had not peed in 1 week. Non dialysis patient.

Massive softball size umbilical hernia containing transverse colon that has been present for over 1 year. Got a great pic of that one, too. It looked like "Quato" from Total Recall.

 

[MaxDesMer]

BUN=252
27 yo obese M; hypertensive. Presented w/ N/V. "normal" mental status. Workup up by nephro, ID, Rheum. Began ruling out everything, including hantavirus, HIV, etc. Renal biopsy -> hypertensive nephropathy. Kid was from rural upstate NY and been hypertensive since he was in high school but was never treated.