sponch

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On rounds this morning, we were seeing this bullsh!t consult on the medicine floor for a patient with an "incarcerated" hernia (which they incidentally fed breakfast). At the end, he told us:

"I don't like those medicine doctors. I like the surgical ones better."

At which point we all lost it. Had to share.
 

opr8n

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my recent kick has been the ER doctors, examples:

#1: csalled to see a patient with an appy (atleast they got that right), but the guy said he was healthy, no problems, shouldbe ready to go very soon to the OR . . . so they guy has had throat cancer, chemo/rad/surg, had a gtube, is on coumadin for a recent [email protected]!!!!!!!! Not exactly to picture ofperfect health . . The kicker is this, the ER doc didnt order Coags on the guy, so i did and his INR was 3.9!!! Its always the surgeon who thinks abut bleeding before it happens

#2: Called o ER to see an incarcerated ventral hernia . . .
ona patient with no prior abd surgeries hmmmmm
And the ER doc get a CT scan (which showed no hernias)
I put my hands on the guy and he had a very large hard obstructing colon cancer
 

purplefish

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Still love the ED... "I need to consult you on possible DVT, gout or necrotizing fasciitis, and I will be leaving in the next few minutes"
 
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sponch

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I also love how they think that saying "I just got sign out on this patient" excuses them from having to know anything about a patient let alone actually having seen the patient.
 

Winged Scapula

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Tired, even if you're doing a GMO tour, you're still a surgeon in our eyes.:D

And 10 Vicodin for a mandible fracture? Geez, no wonder those EDs see frequent flyers for pain meds. If they actually gave them some adequate analgesia and number of pills, it might reduce the number of returnees (then again, it might increase it too! ;) ).
 

Winged Scapula

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Aw, so much love.

Now if only you'd send me those bikini shots I keep asking for. ;)
I'm working on 'shopping some clothes on the nude photos you took of me last year. I'll get them to you soon. ;)

I was in awe. Not only for the analgesics, but because everywhere I have been, you get a head CT at the drop of the hat, but apparently up there a 5min LOC doesn't warrant one.
Yeah, I didn't realize you could even get into an ED as a trauma without getting a CT of the head, let alone with a LOC.

Plus, I don't claim to be any kind of expert on trauma, ENT/OMFS, or really anything else. But only an idiot would think that a stupid mandible series is adequate to evaluate a such a blow.

And I never look at mandible films, but that day I'm staring at them, thinking "Man, that's a lot of bone overlap and I can't really make out the cortices in a lot of areas." Add that to the patient who keeps saying her chin hurts . . . lord.
I'm no expert either but a CT face with fine cuts +/- a Panorex would have been a good idea (along with more Vicodin).
 

aphistis

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I'm no expert either but a CT face with fine cuts +/- a Panorex would have been a good idea (along with more Vicodin).
Ding ding. Extra credit for knowing what a panorex even *is*, Kim. ;)

10 vicodin for a fractured mandible is ridiculous. I give twice that for a run-of-the-mill tooth extraction.
 

JackADeli

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...10 vicodin for a fractured mandible is ridiculous...
I agree.
I take at least 10 vocodin a day to palliate the soul pain I suffer from having to deal with the ED carnage and collateral damage...:scared:

Our OMF trauma studs all say to truely evaluate a mandible you need a panorex...even if you have a fine cut facial CT-scan.
 

Winged Scapula

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Ding ding. Extra credit for knowing what a panorex even *is*, Kim. ;)
Any surgery resident who spends 5+ years of trauma, especially blunt, should know that. I cannot tell you how many Panorexes (Panorexi?) I've ordered over the years.

10 vicodin for a fractured mandible is ridiculous. I give twice that for a run-of-the-mill tooth extraction.
My thoughts exactly. 10 Vicodin won't even last the day for most patients.
 

Winged Scapula

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I'm going to totally one-up you guys.

After routine knee scopes, I used to give 90 Percocet.
Dude...you're the candy man. I only give 50 for a mastectomy (which is admittedly not a particularly painful operation) and the vast majority of the time its enough.

Remind me to call you if I need a routine knee scope (then again, not...Percocet made me syncopal when I took it post-op).
 

aphistis

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I know what a Panorex is.

I know that the Dental and OMFS Clinics are the only folks who have one here.

And I also know exactly how many Saturday mornings dentists and oral surgeons work . . .

That's why I got the CT. :)
Hah. Touche!
 

aphistis

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Any surgery resident who spends 5+ years of trauma, especially blunt, should know that. I cannot tell you how many Panorexes (Panorexi?) I've ordered over the years.
Panorrhexis? :p Or, you could go with "orthopantomographs" (most popular among insecure dental school faculty who want to sound like they're ordering some major imaging study).

"Panorex" is actually the original company's trade name that has held on over time. The other, properly generic, term for the films is the much-more-easily-pluralized "panoramic."
 

Winged Scapula

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I was 100% supported by my senior residents when I did this, and my teams never took those annoying late-night calls saying, "I had surgery last week, I'm out of pain meds, and it really hurts!!"
Good point.

I like to think of myself as generous with the pain meds for cancer patients. Never under the residents or attendings who tried to limit them in that case.

Ortho generally has a different patient population, although for our trauma patients, I'd worry they were selling them if I gave them 90 Percs and they were out of them the next day. Then again, what do I care?;)



Made you woozy huh? Mental note if I ever make it to Arizona . . .

("No Dr. C, that's how the drink is supposed to taste.")

;)
:lol:
 
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