Faaavorite diagnosis.

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1) Feared complaint unfounded

2) Fibromyalgia, end-stage

3) Chest pain associated with detention by law enforcement, recurrent
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glorfindel said:
1) Feared complaint unfounded

2) Fibromyalgia, end-stage

3) Chest pain associated with detention by law enforcement, recurrent
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The end stage of fibromyalgia is when you PMD is on the verge of strangling you. :laugh:
 
End stage fibromyalgia is still one step better than multi-drug resistant fibromyalgia.
 
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I still think my absolute favorite is a good DKA. I can think of no other complaint where you can take someone on the brink of death, choose the right management (even if it is algorithmic) and have them discharged within 24 hours absolutely healthy.

On the flip side, some of my least favorite are asymptomatic hypertension and hyperglycemia. The only reason they dragged their non-compliant butts into the ED is because they checked their numbers for the first time in 3 months. I just can't get over the fact that even though it's easy to treat these folks, I know that in 24 hours (or less) they're going to be right back where they started.

"Oh... your sugar is 500... maybe you should take your damn medicine."
 
StevieStud said:
PS: And layoff the 3lb bag of jellybeans
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Once, I had a trauma pt that had a finger stick around 500. One of my colleagues walks in and says "her glucose is 500 because she ate, like, a whole tray of cinnamon rolls." I thought he was just making a jab at her obesity by saying she ate some absurd amount of junk food - No. She actually admitted that just prior to arrival/trauma, she ate an entire tray of cinnamon rolls.
 
ccfccp said:
I still think my absolute favorite is a good DKA. I can think of no other complaint where you can take someone on the brink of death, choose the right management (even if it is algorithmic) and have them discharged within 24 hours absolutely healthy.

On the flip side, some of my least favorite are asymptomatic hypertension and hyperglycemia. The only reason they dragged their non-compliant butts into the ED is because they checked their numbers for the first time in 3 months. I just can't get over the fact that even though it's easy to treat these folks, I know that in 24 hours (or less) they're going to be right back where they started.

"Oh... your sugar is 500... maybe you should take your damn medicine."
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This is exactly the spirit that I was trying to capture. Thanks, CCFCCP.

On a related note: I hate doing LPs. They seem "dumb" to me. Stick the needle in their back, and keep sticking it in... until you get fluid.

An ultrasound-guided IJ, though ? ... Maaan, if you sneeze the wrong way, I'll put a US-guided IJ in you. Symphony.
 
ccfccp said:
I still think my absolute favorite is a good DKA. ."
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DKA truly freaks me out. I have a family member who was literally on death's doorstep when diagnosed with type 1 DM when I was a kid. It was a case of PMD didn't have appointments available for weeks, and parents were (overly) responsible about not using the ED (medicaidopenia).

Absolutely terrifying in retrospect.
 
New one today: Luxatio erectae.

One of the participants of a "mud run/obstacle course" thingie came in recently. Very cool guy. Very happy to be helped. I explained to him just how rare of a dislocation this was. I admit: I couldn't get him back in, but ortho did it lickety-split. Prior to reduction (and the guy's arm was still "up there"), I'm talking about the phenomenon, and what's going to happen with reduction.. etc. I look at him and say - "Any questions? - Yes, go ahead."

Guy smiles, gives the the finger, and laughs with me.
 
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EvoDevo said:
My fave diagnosis was marijuana induced hyperemesis. Heard the ERCast episode and I **** you not, I had a guy show up in my ER less than a week later who gave the perfect history. When I asked how often he smoked bud, he was "Like all day, every day, doc."

Felt like a rock star on that one.
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I also caught this shortly after learning about it from one of the podcasts (EMRAP?) The guy even came wearing a bathrobe.
 
Cerberus said:
I also caught this shortly after learning about it from one of the podcasts (EMRAP?) The guy even came wearing a bathrobe.
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We have a patient with this who we can't let use the bathroom unattended because she gets in the emergency shower and won't come out.
 
Cerberus said:
Nah, just going on about some rug that "really tied the room together"
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If anyone else here is a fellow nerd and saw "TRON:Legacy" with Bridges in it... did you get the vibe that he was very much channeling "the dude" in his new character ?
 
sorry to go off topic (or back to topic), but forgot about acute pulmonary edema. I got called a superhero by a patient's family when I rescued her from APE with a nice hefty dose of labetalol. really weird since they came in with a TIA and this happened just prior to admission.
 
Rendar5 said:
sorry to go off topic (or back to topic), but forgot about acute pulmonary edema. I got called a superhero by a patient's family when I rescued her from APE with a nice hefty dose of labetalol. really weird since they came in with a TIA and this happened just prior to admission.
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Why labetalol rather that nitro and bipap?
 
Cerberus said:
Why labetalol rather that nitro and bipap?
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It was actually a very weird case. woman had come in with TIA 3 hrs earlier (2min facial droop) with some neck pain, PMH htn, DVT on coumadin, ?COPD, no CHF, and had a new systolic murmur on exam. Had the tech do a CTA from the aortic arch up which showed an acute vertebral artery occlusion. As I'm on the phone I get a note form the nurse of BP 210/100 requesting I order the patient's nighttime BP med (toprol), then 10 minutes later I get called over from the nurse for respiratory distress and the lady's wheezing up a storm, the adult granddaughter is freaking out, the lady then vagals to a HR in the 40's that corrects itself not after she almost passes out with us getting her back to the bed. I give duonebs and swap the toprol to 20 labetalol since her pressure's climbing. took me about a minute to realize it was a cardiac wheeze, at which point I did call for bipap and tridil. Bedside echo showed no effusion (I thought i had missed a dissection). By the time the bipap and tridil arrived, the labetalol had kicked in. I'm assuming she had some sort of valvular disease that set her up for this.

One of the strangest case I 've had this year as an attending, but at least the patient and granddaughter were extremely appreciative at the end of it all.
 
RustedFox said:
If anyone else here is a fellow nerd and saw "TRON:Legacy" with Bridges in it... did you get the vibe that he was very much channeling "the dude" in his new character ?
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Yeah, a little bit. I think the intent was to show that he's attained some level of enlightenment, which is what The Dude was going for as well.

EM2BE said:
I agree they are the hidden badness. I only like when I am able to call it and be right.
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Better than not calling it, of course, but neither one of them has any treatment that will be a nice fix. Abd compartment syndrome = open abdomen, repeat takebacks = possible giant ventral hernia or loss of domain +/- an EC fistula. Yuck. I had one that was secondary to SMV thrombosis.

Btw, the SMV is more likely to thrombose. The SMA usually catches an embolus, unless they have a periostial plaque that ruptures.
 
Hmm..

Had a leaking turn to ruptured TAA while moonlighting over the weekend... not so fun.

Dx a histoplasmosis over wknd also that was kind of cool.

My one malaria 3 yrs ago was interesting. It took the fun out of it to walk in and see a banana colored young guy go "Hey doc... so I just got back from Africa on a mission trip and I think I got malaria..." Lie to me man... Lie to me. My one shot to see malaria and you damn near hand it to me on a silver platter.
 
Dakota said:
V65.5 pt with feared complaint in whom no diagnosis was made
E845.0 accident involving spacecraft injuring occupant of spacecraft
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I know it's a bit of a bump, but some lucky EM physician finally got to code this with the Spaceship 2 accident.
 
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Siggy said:
I know it's a bit of a bump, but some lucky EM physician finally got to code this with the Spaceship 2 accident.
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I know. Isn't that ****ing insane, that he ejected at Mach 1 speed, 50,000 ft above Earth and lived, neuro-intact nonetheless?

Wtf

He can have a couple mg of dilaudid for sure.
 
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Arcan57 said:
Favorite diagnosis I've never seen: erotic vomiting (it's on the list of ICD-9 codes I have to scroll through to find vomiting)

Favorite diagnosis I've actually seen: hyperkalemic periodic paralysis due to undiagnosed severe hyperthyroidism.
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Cannibinnibinoid hyperemesis shyndrome is one of my favorites too - best part is asking how many hot showers/baths they take each day...

Another favorite of mine is when you get a panicky hyperventilating hypocalcemic patient - give em a bag to breathe into and celebrate dodging a CVA/TIA workup.
 
Morgellons disease (aka Delusional Parasitosis)
 
EM4Reals said:
Morgellons disease (aka Delusional Parasitosis)
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Those patients are actually a bear to deal with... I don't mind them having the delusion about the creepy crawlies but it's often paired with the delusion that seeing me in the ED is in any way going to help them.
 
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Puss Caterpillar bites. My favorite. Definitely my favorite.
 
Saw a Trichotillomania patient today.

Hmmm very interesting.
 
Retinal detachment. I like using the ultrasound and you can really make a lasting difference in someone's life quickly. Actually, if I had the fine motor skills for tiny surgeries I should have become an opthalmologist.

E845.0 accident involving spacecraft injuring occupant of spacecraft
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Someone in California actually got to use that code this month.

http://www.bbc.com/news/world-us-canada-29857182
 
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I love the good spontaneous pneumo. Diagnosed somebody with a CRAO the other day too, felt bad for the guy but felt like a baller calling ophtho and asking them to take a look and see if they agreed. (how it works here, we have them in house and everyone consults everything eye-related)

Also I agree, shoulder dislocations are awesome. I like hips too, so long as they're not broken.
 
Priapism.

Because what could be a better conclusion to a 12-hour shift than needing to fondle an octogenarian because he took "3 or 4 viagras" so he and his wife could get it on "the way we used to."
 
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I had a pretty cool case the other day, presented as a STEMI via EMS but didn't go straight to Cath Lab because they already had patients on the tables so the Cardiologist met him in the ED. Something wasn't right about the history, 3 days of abdominal pain, now with chest pain, SOB. EMS reported normal vitals, but HR 150 and BP 70 on our monitor. Huge JVD with rales. Checked bedside US and dude has a massive pericardial effusion/tamponade. Thankfully Cards was there because I haven't done a pericardiocentesis since...ever (unless you count the ATLS dummy). We got out about a liter of bloody fluid with rapid return to normal vitals. Turned out to be malignant effusion from presumed non-small cell lung CA.
 
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I love diagnosing marijuana hyperemesis. I hate that they don't seem to get better very quickly.

I have noted that on multiple occasions my MJ hyperemesis patients have been markedly hypophosphatemic (<1.2). I now check phos on all of them.
 
Great case uscdiver

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SoCuteMD said:
I love diagnosing marijuana hyperemesis. I hate that they don't seem to get better very quickly.

I have noted that on multiple occasions my MJ hyperemesis patients have been markedly hypophosphatemic (<1.2). I now check phos on all of them.
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Try haldol. Works great.
 
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Those herpetic gingivostomatitis-es have been gratifying lately; seeing a bunch of 'em in school-aged and daycare-aged kids.

"Here's why its a virus; these lesions right here. Antibiotics will not help and may likely hurt. Here's some viscous lidocaine to get your child thru the pain; first dose here in the department - just watch 'em feel better."

Boom. Antibiotic stewardship and patient satisfaction all rolled up into one.
 
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RustedFox said:
Those herpetic gingivostomatitis-es have been gratifying lately; seeing a bunch of 'em in school-aged and daycare-aged kids.

"Here's why its a virus; these lesions right here. Antibiotics will not help and may likely hurt. Here's some viscous lidocaine to get your child thru the pain; first dose here in the department - just watch 'em feel better."

Boom. Antibiotic stewardship and patient satisfaction all rolled up into one.
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I had that when I 8 or 9. I still remember it to this day as being on of the most painful things I have went though. Just wish I would have had you as my doc, lidocaine would have been a godsend.
 
DJEMDOC said:
I had that when I 8 or 9. I still remember it to this day as being on of the most painful things I have went though. Just wish I would have had you as my doc, lidocaine would have been a godsend.
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I had it when I was a second-year med student. The pain was exquisite. Xylocaine in a syringe FTW.
 
I love a good case of crashing sepsis, maybe it's because you get to do so much "Stuff" - routine, but it's better than Dilaudopenia, STEMI or Stroke. Had a case of serotonin syndrome - pretty cool with excessive doses of tramadol. And I do love a cannabis hyperemesis syndrome - see lots where it's legal.
 
This is one of the favorites I somehow accidentally stumbled across.

E834.4OTHER FALL FROM ONE LEVEL TO ANOTHER IN WATER TRANSPORT INJURING WATER SKIER
 
THC hyperemesis is so rampant here, I'd rather just set up a hot shower tent outside the ambulance bay and save everyone involved a few hours.
 
Dane07MD said:
THC hyperemesis is so rampant here, I'd rather just set up a hot shower tent outside the ambulance bay and save everyone involved a few hours.
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THC hypermedia syndrome? That can't possibly exist. MJ is supposed to make you feel good, since it's "medicine."
 
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