Dismiss Notice
Hey Texans—join us for a DFW meetup! Click here to learn more.

Food poisoning

Discussion in 'Emergency Medicine' started by juddson, May 5, 2004.

  1. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    I think I have food poisoning. The pain in my abdoment is killing me. It's diffuse (not to one side or the other) and it feels good to burp for like 10 seconds after the burp, and then the pain comes back. I was going to wait until morning to see my doc, but I'm not sure I can make it through the night. I have no fever.

    My question is whether I will be considered one of those people all you EM people hate if I present to the ED tonight with this problem.

    I'm trying to tough it out, but I'm about ready to wake the wife and kid and go.

    Judd
     
  2. Note: SDN Members do not see this ad.

  3. Captain Kirk

    Captain Kirk New Member

    Joined:
    Apr 30, 2004
    Messages:
    3
    Likes Received:
    0
    If you have a good reason for going to the ER...by all means go. You'll be "one of those people we talk about" if you

    1) don't know why you're in the ER
    2) if you've had the problem "for 2 weeks now"
    3) if you have multiple "acute" issues

    But if you're seriously in pain, go have 'em take a look at you...take vitals and stuff. If nothings wrong...great. If something's wrong...you'll be in the right place.
     
  4. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,269
    Likes Received:
    3,676
    You will be asked, and, if you answer

    yes:
    Have you ever had this before?
    Have you seen a doctor for it?
    Did your doctor tell you what to avoid so this doesn't happen?
    Do you take medicine for this?

    or

    no:
    Did you take anything for this?
    Can you describe this pain more specifically?

    you will be seen as a tool. If you are wimpy, and your complaint of pain is out of proportion with your symptoms, you will also be seen as a tool. If you let it be known that you are an attorney, and it turns out you have nothing going on, that will also add to your tool-hood (because, although we mostly think most of you are a bag of assholes, we don't think most of you are stupid - ergo, you "should know better"). Moreover, if they then find out you are going to med school in the fall, you will reach the pinnacle.

    At the same time, I don't play doctor online (or on the telephone). If you feel you need to be seen, by all means, come be seen. If you can clearly elucidate your issue, and have tried means (if applicable) to try and alleviate it, that will be appreciated - however, if your complaint is weak, you will be waiting to be seen (and, contingent where you are, that may be a while).

    Have you vomited? Did you feel better? Blood in the vomit when you started puking (not after 4 or 5 episodes)? Dizzy/lightheaded or passed out? Chest pain/trouble breathing? Diarrhea? Blood in the diarrhea? These are all important.
     
  5. terpgirl

    terpgirl Senior Member
    7+ Year Member

    Joined:
    Mar 12, 2004
    Messages:
    144
    Likes Received:
    0
    I've had food poisioning twice in the last year... not fun. So I speak from patient experience, not as an M.D.

    I was in tears it hurt so bad... and I missed a huge graduation celebration in which I won a raffle (I never win anything!) for a television because of it. Have you tried a heating pad or the like? I wasd able to curl up in a ball and get comfortable with a heating pad... and fall asleep for a few hours. Try to find a movie you likee or something really good on TV to take your mind of the pain, and maybe an Aleve for pain--give that an hour or 2 and see if you feel better. Definately watch if you have a fever or not.

    I hate being in the ER for what I feel will e a other too. My mother busted her chin open, and didn't want to go. I refused for a while when I had a temp hitting 104 with sweating and chills.

    The ER doesn't usually close :D Try a few at home remedies to see if it helps. It would stink to go and just be told to let it pass, take some pain releavers with some ginger ale and crackers if you're remotely hungry.

    Feel etter soon!!
     
  6. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,685
    Likes Received:
    584
    Status:
    Attending Physician
    Why do you think it's food poisoning? Are you also vomiting and/or have diarrhea?

    Despite our dislike for attorneys, most of us (if not all of us), still treat attorneys, former malpractice plaintiffs, etc. as if they were our relative. We want the best for our patients.

    On another note, you might can sue the restaurant for your food poisoning (if you have it), or your wife if she cooked you a bad meal. If you cooked it yourself, then you're out of luck, unless you find a way to sue the supermarket for selling you bad food, or the manufacturer of your refrigerator for not maintaining the proper temperature (even if you left the door open -- hey, I can buy the argument that they should have put a "door ajar" alarm on the refrigerator!).

    Seriously, if you're in that much pain, you should go to the ED. Who knows what it is. It might actually be serious. It's impossible to diagnose someone over the internet.
     
  7. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,269
    Likes Received:
    3,676
    Indeed, to support southerndoc - you will NOT get substandard treatment because of your complaint or status. Even if I referred to you being a "tool", you wouldn't know that.

    What pisses me off is that I have to treat the most unappreciative, selfish, leeching elements of society as well as the people who deserve my care the most - in fact, that is why I've stated many times that the people who deserve my care the least get the best care from me - because they are the easiest people to blow off. This gives me perspective, and the patients all get treated as equals.
     
  8. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    Thanks, I'm not looking for a diagnosis over the internet. I'm just trying to gauge my "toolness potential" before I suck it up and go.

    I have no vomiting, which I feel like I should have. In fact, I have no nausia. It's pain, not nausias. That is why I am worried about it. I was wondering if it might be appenicitis.

    I had food poisoning about 10 years ago in Hilton Head and had to go to the hospital. They said it was food poisoning. In that case, I had the exact same symptoms I have now. I have tried pepto and Mylanta. Both gave me like 10 seconds of relief, and then the pain came back. Same for burping. I feel like if I could throw up I would feel better (get all that stuff out of there), but I have no nausia, and the pain is low enough that it seems in the small intestine, not the stomach.

    Thanks for all your help. I know I'm not going to die. It's just a matter of sucking up the pain until morning when I can see my family doc.

    Good lord, I would never tell anybody in the ED I was an attorney (no longer licensed, by the way) or a starting med student.

    Judd
     
  9. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    PS, I'm wondering if it is the strawberries I ate last night. I didn't wash them and everybody says I should have. I ate quite a few of them.

    judd
     
  10. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,685
    Likes Received:
    584
    Status:
    Attending Physician
    Pain can be referred, so what appears to be small intestinal pain could be your stomach or even your heart.

    It's really hard to tell without an adequate H&P.
     
  11. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    OK, well let me ask this final question:

    Forget the diagnosis. Let's assume it is food poisoning. Would you consider somebody a tool for going to the ER for it? Or is that more like a hangnail?

    Judd
     
  12. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,685
    Likes Received:
    584
    Status:
    Attending Physician
    First of all, I never consider somebody a tool for going to the ED for a legitimate concern.

    Somebody who has a sudden pain that they've never experience before... that's legitimate.

    Somebody who has had pain for 2 weeks, is a low back pain patient seeking drugs, etc., then those are usually the ones that get made fun of.
     
  13. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,269
    Likes Received:
    3,676
    Damn, Judd, you make me look like a heartless bastard! Notwithstanding the verity of that statement, if you are having enough concern, go and be seen. If you feel you can wait, then do so. If it feels just like what you had 10 years ago, let that gauge your response - whether you think things are different, or the same.

    However, abdominal pain that feels better with belching, then recurs, without nausea, vomiting, diarrhea, or fever, doesn't sound like much that I can put a finger on.

    If you are that concerned (2 hours later), by all means, go in. If it's the same, or getting worse, don't worry about an ass like me being your doc. You're more likely to get someone like southerndoc, Quinn, DocB, ERMudPhud, JPGreer, or, hell, virtually anyone else that posts on SDN.
     
  14. farrelli

    farrelli Junior Member

    Joined:
    Apr 5, 2004
    Messages:
    5
    Likes Received:
    0
    Who cares. Go to the ED already. Your pain may be as simple as food poisoning or as dangerous as a perfed ulcer. Who knows. My psychic voodoo powers only work on friday through sunday. Deal I made with the devil and all. By all means if your willing to get on a forum about emergency medicine and ask the question I think the tool likelyhood factor is a mute point. Congradulations, youve reached tooldom and havent even stepped foot in the waiting room. Now just go to the ED the worst is already over. When you look the triage nurse in her sparkling bloodshot eyes and prepare to answer her question "What prompted you to come to the ER at one in the morning instead of 7 in the morning (when the shift changes)?" Then just know that yes she thinks your a moron and yeah you are a tool. Hope this helps ease your mind.
     
  15. farrelli

    farrelli Junior Member

    Joined:
    Apr 5, 2004
    Messages:
    5
    Likes Received:
    0
    Having already hit the post button I realized two things about my previous post:

    A. I have cant spell and my grammer sucks.
    B. That my last post sounded insensitive. Hell it was insensitive. Who am I fooling. I am watching Conan O'Brian and an NBC psa announcement just aired stating we should all go above and beyond our own sense of self entitlement to not make fun of people in situations that we might find less than serious (or if they are serious to not be a jerk and make fun of them anyway) :p

    That being said; what's done is done and I cant take it back. Actually what would be the point they probibly will think you're a tool anyhow. I understand your fear in the given situation and say, yes you should go to the ED. Fear is a normal response to an abnormal situation (as is making fun of people who find themselves stuck in those said situations). So go to the ED. Thats what they are there for. As to your status of Tooldom, only time and several hundred dollars in expensive tests and the time honored hand of your venerable physician will tell. Now, isnt that the sensitive answer.
     
  16. Tas

    Tas Senior Member
    7+ Year Member

    Joined:
    Dec 22, 2003
    Messages:
    235
    Likes Received:
    1
    If you're in that much pain, GO.

    Forget what they will "think" about you. Just remember this feeling when you are treating patients.

    Now. go.
     
  17. edinOH

    edinOH Can I get a work excuse?
    7+ Year Member

    Joined:
    Nov 13, 2002
    Messages:
    768
    Likes Received:
    4
    Status:
    Attending Physician
    Are you fartin' or poopin'? Are you able to eat? Is your belly distended or feel really full?

    You may be FOS.

    Go get checked out if it is bothering you too bad.
     
  18. Febrifuge

    Febrifuge Grizzled Old Newcomer
    7+ Year Member

    Joined:
    May 7, 2003
    Messages:
    1,520
    Likes Received:
    22
    Status:
    Non-Student
    With friends like you guys, who needs enemas?
     
  19. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    Didn't mean to. Will post my full experience later. Still recovering a bit.

    Judd
     
  20. margaritaboy

    margaritaboy Senior Member
    10+ Year Member

    Joined:
    Apr 13, 2003
    Messages:
    397
    Likes Received:
    4
    Status:
    Attending Physician
    Hey! How about a freakin' update for god's sake. You can't get on this forum and claim severe abdominal pain, be called a tool by some posters, and then not give us some resolution here. We EM folks need some continuity of care and some follow up. No matter what your condition, please crawl over to the computer terminal and put us out of our misery. Give us the goods. Did you have AAA, or was it food poisioning or what? Are you 6 feet under today, or did you go to the ER?
     
  21. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,685
    Likes Received:
    584
    Status:
    Attending Physician
    And tell us if you're gonna sue your wife... we're dying to know!
     
  22. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    Ok OK. Relax. Wanted to catch the last friends. But it sucks, so I'll post here instead. What is AAA?

    I found the whole experience really interesting, and am SUPER interested in hearing what anybody on this forum has to say about it.

    Let me clear up a few things first. I posted to this forum originally because I have become sensitive to the fact that people often over-use the ED. As i said, I didn't want to be considered a tool by the ED staff when I presented myself to the ED at 2 o'clock on the morning with what would be considered the equivilant of a hangnail. So, my purpose was to find out how the ED staff would recieve me if I did go, and it turned out to be nothing at all. After all, had it turned out to be a heart-attack, then I would not have had to worry about being seen as a tool (if only).

    OK, so here is the whole story:

    I started to get some pain in my abodmen when i woke up wednesday morning. It progressively got worse all day. By 11 am, I was bloated and distended, and I had a generalized dull pain around the whole abdomen and up under the sternum. No fevor or nausea. But no desire to eat, either. I took some pepto, and had about ten seconds of relief and then the pain came back. I tried mylanta at around 9pm, and then again at around 10:30pm. At 10:30pm I tried to hit the sack, but the pain was much worse when laying down. However, when laying, the pain was NOT much worse under the sternum (which is what I would have expected had it been heartburn), but rather in the abdomen. And, as i said, I really didn't get any relief from the antacids.

    At around 11:00, I started this thread (I think - I may be off by an hour - it's hazy a bit) and hemmed and hawwed for about two hours, trying off and on to go to bed. But the pain started to interfere with my breathing - and at that point I decided to hit the ED. I got there at 2:15 am.

    In Cleveland we basically have three major hospitals. County (Metrohealth), the Cleveland Clinic and University Hospitals. There are about 12 smaller hospitals in Cleveland, but they are ALL owned by CC or UH. I went to a smaller one owned by the Cleveland Clinic near my house.

    When I got there there was nobody in the waiting room and the triage nurse took me right away. Normal temp. BP was 120 over 70 (I rock, because I'm a bit overweight). Took 10 minutes to do the insurance thing, and then I went into the waiting room. Triage nurse took me back about 5 minutes later. Went to the room and realized I was the ONLY person in the ED at this time. It has about 25 beds, and is located within the city limits of Cleveland, so this was a suprise.

    The first person to see me was a PA. Took my history and did a VERY thorough physical exam. He answered all my and my wife's questions with what appeared to be enthusiasm and knowledge. Then a nurse came in and inserted an IV in the crook of my arm. Is this a "periferal line"? Anyway, I noticed that the nurse was actually considering an area on my wrist at first, but abandoned that idea almost immedietly. I asked why he had first considered the area around the wrist. He said that he suspected that he would be back in less than two hours to take this IV out, and that had he thought I was going to be there longer than that, he would have used my wrist rather than my arm. This suggests to me that the Nurse had already (correctly, as it happens) determined that I did not have a condition that would require admission, and in fact, would not even require a stay longer than a couple of hours. Good nurse as far as I was concerned. Anyway, hooked me up to a bag, started it dripping, and left with four vials of the good stuff.

    Perhaps some of you can tell me what these four vails were for (ie, what tests were run on them).

    I waited in the room for about 20 minuted after the nurse had left and a person from X-ray came over to transport me to X-ray. This was a suprise. The last time I had had what I figured was food poisoning, i was out of town on vacation. I sucked it up for three days and finally went to the hospital on the island after my temp hit 103. There, they took blood, told me I had an infection, gave me a cocktail of something or other - which totally knocked me out for a couple of hours - and then sent me home with an anti-biotic with STRICT instructions to stay out of the sun (on Hilton Head Island at the height of summer - which i ignored, and thereafter suffered the worst skin itching in my entire life - I wanted to die). The point is, the last time I had this, I didn't get any X-rays. So, I was suprised by this.

    Now, regarding the X-rays, I am curious. Was this CYA medicine, or was it indicated because I had no fevor? Do you suppose they were ordered because they figured that they needed to do something for me because they figured that I was expecting something. I'm not making a judgement one way or the other - just asking. I'm curious.

    Anyway, they took one shot with me facing the film, away from the film, and my side to th film. They also took one with me laying on my back with the film under my back. So, four shots in all.

    Went back to the room and waited for about a half an hour. The pain got pretty bad during this period, so much so that I found myself breathing deeply to help out a bit. Most of this pain was under my sternum, but it radiated to my back as well. At that point the ER doctor came in. And said that my blood work showed "nothing", but that my X-rays showed that I was "totally full" down there. So, there was NOTHING wrong with me in the end - which was why I was so reluctant to go to the ER in the first place. My worst fear was that this was heartburn or something, and that is what it appears to have turned out to be (the doctor said "indigestion").

    Ten minutes later the nurse came in with what they called a "GI cocktail" which he said consisted of Lidocain, antacid, an anti-spasmatic and a stool softener. It contained Colase (which one is this?). I sucked it down and got no relief. The nurse told me to suck down plenty of MOM when I got home (followed by two glasses of water - you can imagine how full i felt after that, having already felt bloated when I went in). They discharged me at about 4:30 and I felt worse when I left than when I went it.

    I finally fell asleep at about 5am, and despite all the MOM and water, have not had a BM all day. Nor even the desire to have one. Strange. But, I have to say that I feel MUCH better around the abdomen but still have a lot of pain under my sternum.

    So, in the end, it turns out that nothing was wrong with me. I am a paying customer, so the hospital loves me, but I'm guess the staff does not.

    I presented all this detail because I wanted to get the opinions of the regulars here about whether what went on in the ER seemed within normal parameters. EM is a field that I am interested in, and I thought the experience was interesting, if uneventful (as I said, the last time I saw a hospital was about 10 years ago).

    As I said, I'm embarrased that i wasted the time of the ER staff. I should not have gone. But what is done is done. That said, I'm pretty satisfied with the experience and service I got. Everybody was really nice and more tolerant than I would have expected at 3 in the morning (Not that I am a demanding patient - I basically kept my mouth shut the whole time I was there).

    So, it was nothing. I'm guessing the rest of it will blow over by tomorrow morning.

    judd
     
  23. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    BTW, you would have to **** me up pretty bad for me to want to sue anybody. My wife always complains that I am more curtious to strangers than I am to my own family. For instance, when I'm in a drive-up line for the ATM machine, if there is somebody waiting behind me, I only do one transaction. My wife HATES this, and says I am entitled to spend all day at the ATM if I like no matter who is waiting behind me. I like to be curtious.

    judd
     
  24. JohnHolmes

    JohnHolmes Large Member
    10+ Year Member

    Joined:
    Dec 29, 2003
    Messages:
    3,207
    Likes Received:
    3
    judd, glad to see you are back to your posting self...

    JH :)
     
  25. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    yes, must be the stress.

    Judd
     
  26. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,269
    Likes Received:
    3,676
    I woke up Wednesday morning puking (a disconcerting occurence, if you're not drunk), and felt like hell all day...went home, and finally made the biggest, weirdest dump of my life. Spare you the details, but it was like having drunk a gallon of Go-lytely, without actually having drunk it. I did NOT feel constipated, and, therefore, wonder if I was early obstructed or pseudo/partial-obstructed. I was a new man by the evening, and didn't consider the ED; that is probably because I had better perspective.

    As for you, Judd, when the EM doc said you were "full", he meant "full of stool" (a/k/a FOS, which can also be "full of shi+"). Colace is a stool softener you take with a lot of water, and it will bulk up your stool. The x-rays were an abdominal series. The blood tests (dollars to doughnuts) were a CBC, Chem 7, liver labs (AST, ALT, and GGT if they thought you were a drinker), and belly labs (amylase, lipase). They probably didn't use all the blood, but they prefer to only draw once.

    Once you take a monster dump, I suspect you'll feel a LOT better.
     
  27. DrQuinn

    DrQuinn My name is Neo
    Moderator Emeritus 10+ Year Member

    Joined:
    Dec 6, 2000
    Messages:
    4,227
    Likes Received:
    14
    I woke up last night 'round 1 AM with some gut pain, it was like a damn atom bomb went off in my sigmoid. Rushed to the bathroom, and dropped about 12 ounces of what felt like ground beef. Followed shortly by about a can of chocolate water. Unfortauntely, I hadn't been able to grab my glasses on the way to the pot, so I didn't get to catch up on my latest issue of "Car and Driver." Ran out of toilet paper so I had to lean to get under the counter, and reloaded. All clean, and head back to bed.

    Back five minutes but this time it was just one spray of chocolate milk and some hershey squirts. Still nothing to read. But I finish up and head back to bed.

    Another five minutes pass and I'm back with about a cup of french onion soup minus the bread and cheese. Still, can't see enough to read on the BMW 540i.

    *sigh* Normally wouldn't mind a toxin-induced colonic, but this was the morning on my call day (today) so I like to load up on sleep before. Well, atleast I lost about 2# this morning.

    Hmmmmmmm, Apollyon has a episode of Hirschsprung's and delivers an 8# baby, Juddson is still waiting for lift-off, and I pepper my toilet with 10-0 buckshot. I think there's a virus on SDN going around. Hope it doesn't get ERMudPhud, Despy, or DocWagner.

    Q, DO
     
  28. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    yes, the odd thing is I've now had 1.5 doses of MOM, plenty of water chaser, and four tablespoons of Agarol. No joy yet. It's been a few days now, and things aint feelin' good down there yet.

    "gsht. . . Ah, Judd, this is Houston. . . you are. . .gsht. . .cleared for take-off."

    Judd
     
  29. Febrifuge

    Febrifuge Grizzled Old Newcomer
    7+ Year Member

    Joined:
    May 7, 2003
    Messages:
    1,520
    Likes Received:
    22
    Status:
    Non-Student
    My former roommate spoke fondly of an uncle who would emerge from the bathroom and announce, "I just took a dump that would have killed a lesser man."

    The next time my friends accuse medical people of being obsessed with disgusting details... I'll have to lie a little harder when I say no.

    But thank you all, for reinforcing my decision to go pre-med rather than nursing... someone should tell Judd all about the, um, ins and outs of manual disimpaction. Just in case.
     
  30. Seaglass

    Seaglass Quantum Member
    10+ Year Member

    Joined:
    Jul 25, 2003
    Messages:
    1,614
    Likes Received:
    6
    Status:
    Attending Physician
    peripheral line, as in located in a vein that is not part of the central circulation (a central line). Glad to hear you're ok. Don't worry, they see FOS patients in the ED all the time. When I rotated at York we seemed to get bunches of FOS kids that hadn't had a good BM in weeks. The best is when you're pressing on the belly and you can feel the s#i+ squishing around. Priceless. See what you have to look forward to?

    (to Mom) "Why isn't he on his regular bowel regimen?"

    "He doesn't like to take it."

    Now that is hardcore tool-age.

    C
     
  31. Seaglass

    Seaglass Quantum Member
    10+ Year Member

    Joined:
    Jul 25, 2003
    Messages:
    1,614
    Likes Received:
    6
    Status:
    Attending Physician
    Oh, and the abdominal series was probably because the PA thought you had a small bowel obstruction, although I don't know why unless you've had surgery.

    C
     
  32. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    is this how it works, by the way? A PA can order bowel studies on his own (or would he have suggested them with MD countersignature)? I was suprised to see a PA in the ER, by the way. He seemed very competent, though. So, I don't have any philosophical objection.

    Wondering if I would have been seen by a PA had I been complaining of chest pain or shortness of breath.

    I happen to know that at least during the day and Saturday nights (when I used to volunteer) the ER has resident staff. This is a mid-sized hospital with its own trauma center (though big ones go to County, I'm guessing) and when I was volunteering there, the ER had two residents. One was in IM, the other in Family Medicine. I fully expected to see a resident on the night I went in, but there was nobody staffing the place (that i could see) but an attending MD and the PA (and nursing staff, of course).

    Perhaps the triage nurse gives a head-up on the level of care I will likely need.

    Judd
     
  33. Seaglass

    Seaglass Quantum Member
    10+ Year Member

    Joined:
    Jul 25, 2003
    Messages:
    1,614
    Likes Received:
    6
    Status:
    Attending Physician
    Well at Baptist they have PA's that see all the same patients that the residents see, they just tend to do more low-acuity shifts (fast track) overall. It is not unusual for PA's to be seeing chest pain, sepsis, etc. in ED's.

    At some places PA's can order their own stuff without a counter-sig, at others they have to have everything signed off. I'd say the former is more often the case.

    C
     
  34. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    Really??!!!!

    I would have expected to see an MD upon arrival had I been complaining of chest pain and shortness of breath. What if I were 50? Is a PA trained to diagnose and manage heart failure?

    Judd
     
  35. ERMudPhud

    ERMudPhud Back for a visit
    10+ Year Member

    Joined:
    Feb 24, 2003
    Messages:
    1,086
    Likes Received:
    23
    Don't worry, I always wash my hands after talking to you all.

    Judd,

    We don't think people with acute complaints who have already tried OTC or home remedies are tools. Chronic complaints who suddenly decide that tonite is the night to have that wart looked at or minor acute complaints who have made no attempt at home treatment drive us crazy. However, asking the ED tech who is putting in the IV if he is putting in a "peripheral line" does have a certain toolness. :D

    A few things you should realize. In terms of abdominal pain we never really make the diagnosis of food poisoning. If the symptoms fit (transient vomiting and diarrhea) and we don't find anything else wrong then we might blame it on food poisoning but we don't have some magic lab test that tells us,"oh yeah it was the wings at Hooters" Likewise constipation. Everyone's colon is relatively full of stool on xray so if the history fits and nothing else is found we might blame the symptoms on constipation but we can't know for sure. Therefore, if you are not getting better or you are getting worse you should do like I tell all of my discharged abdominal pain patients and see your PCP or get rechecked in the ED. Sometimes on reevaluation we find something that wasn't apparent on the first visit.

    The xrays were probably also done to look for free air from a perforated ulcer, something I would certainly consider in a young, type A, with diffuse abdominal pain. The blood tubes may have been used for anything from no tests to a huge panel depending on the doc and the situation but we usually draw the whole collection to start so we only stick you once. The amount of testing and imaging probably varies a lot from doc to doc based on the clinical situation and their practice style.
     
  36. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    Oh no, I didn't ask the ED tech that. I asked you guys that. I asked him why he used the crook of my elbow rather than my wrist. And the only reason I asked the question is because I thought the wrist would hurt less and quite frankly I am no fan of needles. No toolness - plenty of wussness, though.

    Judd
     
  37. ERMudPhud

    ERMudPhud Back for a visit
    10+ Year Member

    Joined:
    Feb 24, 2003
    Messages:
    1,086
    Likes Received:
    23
    Crook of the elbow hurts less and has a higher success rate than the wrist but if you are going to be in the hospital for a long time than not being able to bend your elbow gets to be a drag
     
  38. edinOH

    edinOH Can I get a work excuse?
    7+ Year Member

    Joined:
    Nov 13, 2002
    Messages:
    768
    Likes Received:
    4
    Status:
    Attending Physician
    It is hard to say what a PA is really "trained" to do IMO. There are some excellent PAs and some really terrible ones from what I have seen. Not at all meaning to start a PA flame war here but for the most part there is pretty good uniformity of training among all EM docs. The same can't be said for PAs.

    I assume you are a relatively young guy and you mentioned your vital signs were pretty good. Plus, the triage nurses usually have a pretty good feel for who is "I don't feel so good" sick and "I think I might die in a minute" sick.

    I would imagine that if you were 50 and c/o of SOB and CP you would have recieved a cardiac work up along with investigation of your belly pain. Especially with your complaint of "epigastric" pain.

    If you haven't experienced any relief yet, I will offer one tiny bit of advice. Go to the drug store and invest in a "Fleet's Enema". The instructions should be pretty self explanatory.

    The reason I (and all the others) hesitate to offer any specific advice is because you could end up having something go terribly wrong with you someday that may or may not have anything to do with this event. Regardless, some lawyer would probably come sue our collective asses. ;)
     
  39. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    I agree 100%. I would not solicit medical advice from the internet (nor do I give specific legal advice).

    Judd
     
  40. *Wing of Zock*

    7+ Year Member

    Joined:
    Feb 9, 2004
    Messages:
    48
    Likes Received:
    0
    Come on Juddson, Don't leave us in suspense!!

    Have you birthed the brown nosed weasel yet or not??? You can't go this long without sending the Browns to the super bowl and not give us the Gory details!! What do you think this is, the surgery forum??? So go finish of that Go-Lytely, squat a grumpy, and get back to us!!!
     
  41. jpgreer13

    jpgreer13 Senior Member
    7+ Year Member

    Joined:
    Oct 1, 2002
    Messages:
    119
    Likes Received:
    2
    Funny you should all mention that. I had two people come in on my overnight shift last night complaining of food poisoning, and both were after eating at the same Chinese buffet.

    The most important question in this H & P, of course, is, "Which Chinese buffet?" Because it is vitally important that Doc Greer does not eat there.
     
  42. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    I have had very little progress in that department, and have not had much in the way of relief in the abdomen or under the sternum. Must be all the heroin, I guess. :D Will see my primary physician on monday to get this sorted out.

    Judd
     
  43. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,685
    Likes Received:
    584
    Status:
    Attending Physician
    You still haven't had a BM?

    Good grief, you get more FOS everyday!
     
  44. DrQuinn

    DrQuinn My name is Neo
    Moderator Emeritus 10+ Year Member

    Joined:
    Dec 6, 2000
    Messages:
    4,227
    Likes Received:
    14
    Time to buy Mrs. Juddson a pair of latex gloves, and to break out the Kentucky Jelly from your nightstand.

    Q, DO
     
  45. southerndoc

    southerndoc life is good
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,685
    Likes Received:
    584
    Status:
    Attending Physician
    Quinn, I thought my collection of KY Jelly in my nightstand was our little secret! I'm surprised you would reveal it to everyone on SDN!
     
  46. girlwithaknife

    7+ Year Member

    Joined:
    Nov 11, 2002
    Messages:
    67
    Likes Received:
    0
    Status:
    Resident [Any Field]
    Have you done any vomiting? Are you passing any gas from below? Your description of your symptoms earlier in the thread sounded suspicious for a distal small or large bowel obstruction, and this is probably what the ER was looking for on your abdominal films. If it is still early enough in the course of the obstruction when the films are taken, you might not yet see the characteristic gas pattern and bowel dilation that we usually rely on to diagnose bowel obstruction. Has the MOM made your pain any worse?

    If you continue to have this abdominal pain without any gas or stool passing through, or if you start vomiting green stuff, I would suggest revisiting your ER. Although a bowel obstuction usually only occurs in people with a hernia or prior abdominal surgery, or in older people at risk for colon cancer, I have seen at least two people present with SBO with no known risk factors. In each case, we never did figure out what the cause of the obstruction was, despite operating on them.
     
  47. girlwithaknife

    7+ Year Member

    Joined:
    Nov 11, 2002
    Messages:
    67
    Likes Received:
    0
    Status:
    Resident [Any Field]
    And no, returning to the ER for continued abdominal pain with no bowel movements after taking MOM does not make you a tool. Even if they still find nothing, you probably need some IV hydration if you haven't been eating/drinking well for several days.
     
  48. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    What is FOS? Remember, I'm no doc. I just play one around my friends.

    Judd
     
  49. Seaglass

    Seaglass Quantum Member
    10+ Year Member

    Joined:
    Jul 25, 2003
    Messages:
    1,614
    Likes Received:
    6
    Status:
    Attending Physician
    full of s#i+
     
  50. juddson

    juddson 3K Member
    7+ Year Member

    Joined:
    Aug 21, 2002
    Messages:
    4,049
    Likes Received:
    3
    I'm not sure I'm keen on describing all the gory details - but I finally had some "activity" this afternoon. For part of it, I was wishing for the sweet release of death. I know I'm in for an unpleasant few hours now, as I've really loaded up on the MOM and Ageral over the past few days.

    I'm not sure if I had anything as bad as an SBO. I think this was something bad I ate, which gave me huge indigestion, heartburn, etc., and now a few days later (due to the GI cocktail and all the other crap I've been taking) I'm moving it through. Part of my problem, no doubt, is that I turned to Pepto as a first resort, which, I am told, constipates you. That might have been part of the problem.

    I don't know.

    I'm going to my family doc on Monday to make sure I have this sorted and to schedule a general fitness (heart, whatever test) in anticipation of starting med school. It's time to start eating right, getting some exercise and dropping about 30 pounds. I need to start taking better care of myself. I have a new career on the way. I have a new daughter on the way, and my son is only 3 years old. So, it's time to get myself together.

    Judd
     
  51. Seaglass

    Seaglass Quantum Member
    10+ Year Member

    Joined:
    Jul 25, 2003
    Messages:
    1,614
    Likes Received:
    6
    Status:
    Attending Physician
    Incidentally, food poisoning doesn't look like this at all. Just thought I'd throw that out there.

    On the other hand, I've had something very similar to this after eating something suspicious at an "authentic" mexican restaurant.

    C
     

Share This Page