Guinness Book of EM Records

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Groove

Groove

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Anybody got some to report that you've personally set?

Today?

Perf'd Appy that sat in the ED for 17.5 hrs before admission while surgery ponderously went back and forth over ex-lap vs IR drain/delayed op, then would get distracted with other cases until I called again, over and over, complicated with bed request issues and stuff outside of my hands. That's a record for me.
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Blood sugar from fresh iv line of 2128.
 
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lipase: 35,000
gallstone pancreatitis
 
EtOH of 0.63, awake and asking me for taco bell
 
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dotcb said:
lipase: 35,000
gallstone pancreatitis
Click to expand...

Schizophrenic with diffuse belly pain
Lipase: 62,500
CT: Hemorrhage where her pancreas used to be
 
Lipase 42,000

Cholecystitis w/ biliary tree obstruction
 
Type I diabetic blood sugar 1419
A bit confused with a K f 6.8 and W I D E QRS.

Not good to have both schizophrenia and Type I diabetes....
 
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shopsteward said:
Linking to the Hall of Fame -

http://forums.studentdoctor.net/showthread.php?t=115359

and what is probably the most recent scoreboard on it -

http://forums.studentdoctor.net/showpost.php?p=3782163&postcount=250
Click to expand...

Running list thanks to dropkick a while back (from first link)

An updated scoreboard:
%Bands-high 68 debvz
02sat 0% Seaglass
A1C- 19.1 Wahoo
Abdominal mass- 30 x 30 x 15 cm Telemachus
Absolute Eosinophil Count- 71,000 edmadison
Alcohol-Blood 830 Jpgreer13
Alcohol-Breath(usually lower) 540 febrifuge
Ammonia- 441 medicfletch
Amylase- 37,500 jashanley
Anion Gap 50 pinbor1
Ascites fluid PMN's- 13,000 Wahoo
Bicarb- High 67 ISU_Steve
Bicarb-low 1.6 pinbor1
Biggest abdominal aortic aneurysm- 10.5cm Desperado
Blood pressure 330/180 12r34y
BMI 111 EM2BE (although weight of >850 listed below is much higher)
BNP- >5000 ("So that's what the lab's cutoff is!" dchristismi
BNP 331042 Apollyon
BUN (high) 450 LanceArmstrong
BUN (low) 0 **
C02-high 318 beyond all hope
Ca-high 18 Ermudphud
Ca-low 4.2 a little elf
Carboxyhemoglobin- 44% ISU_STEVE
Chloride (high)- 166 FoughtFyr
Chloride- (low) beriberi
Cholesterol 1200 ham sandwich
Corneal Foreign bodies >50 cdr50
CPK >800,000 Scrubbs
Cr 47.4 bccsmith
CSF RBC Count- 90 doctawife
**dchristimi's golden CSF shower notwithstanding
**Favorite, though is my friend who had an LP with more than 1,000,000 RBCs. He said he was thinking of sending it for an ABG instead of a culture.- edmadison
CSF WBC Count- 34,000 birdstrike
Dbili 56 wthomp03
Drug screen 9 out of 9 positive ISU_Steve
duration of unevaluated chief complaint 39 years Apollyon
Ethylene glycol- 452 Telemachus
Ferritin- 76,000 KidDr.
Glucose-high 2390 Arcan57
Glucose-low 0 LanceArmstrong
Hct high 79 DropkickMurphy
Hct low 6.5 Cric4U
Hgb low 0.8 EMraiden
Highest lumbar puncture opening pressure- 55 cm bobblehead
INR-high >999.99 12R34Y
K-high 26.7 ISU_Steve
K-low 0.8 jjackis
Largest stool removed by manual disimpaction- 15 lbs ERMudPhud
LDL 1200 southerndoc
Lipase (high) 71,148 wthomp03
Lipase (low) 0 docB
Lithium 8.1 Zambezi
MCV- 129 Desperado
Medlist (active prescription meds) 33 Ermudphud
Methemoglobin- 22% ISU_STEVE
Mg 0.2 EMIMG and bulgethetwine (tie)
Na-high 221 gerickson03m
Na-low 95 Freeeedom
Pack years smoking 420 Apollyon
PaCO2- 304 ISU_STEVE
Pain scale 10/10 docB (and all the rest of us)
PaO2 (low)- 14 mm Hg ISU_STEVE
Perfed Appy in ED 17.5 hrs Groove
Ph-high 7.88 pinbor1 and ISU_Steve (tie)
Ph-low 6.00 ISU_STEVE (DropkickMurphy's former screenname)
Plts-low 0 seaglass
PSA 6746 clc17
Serum Osmolality 447 WakeMedHeel
T4- undetectable Desperado
TBili 92 virion
Temp-high 109 docB, birdstrike
Temp-low 79.2 F jlw2004
Tooth/tattoo ration 6/23 Kev Jones
Triglycerides 18000 southerndoc
Troponin I 1100 AJM
TSH-high 425 margaritaboy
WBC 430,000 beyond all hope
WBC 0.0 Arcan 57 (non-cancer pt, MTX OD)
weight >850 pounds clc17
youngest IV drug abuser 11 years emtp2pac
youngest smoker 5 years old emtp2pac
youngest CVA - in utero birdstrike
 
Last edited:
Youngest with thromboembolic CVA - 11yo.
 
Lowest WBC in a patient presenting to the ED without cancer:

0.0 - accidental methotrexate overdose (taking daily rather than weekly for rheumatoid)
 
Didn't know where to put this, but figured it was along the lines of the perf'd appy in the ED for 17 hours. Kind of.


NP from MD office calls charge RN - "I'm sending you a patient, she must be seen immediately! She has a VERY RARE form of MRSA and will die in 30 days if she doesn't get treated! and she's had it for a week!!!! I want her to get Vanco immediately!!!!" The charge RN tells me so I can keep an eye out and get Vanco dosed ASAP.

Patient finally shows up. I call office to get copy of c&s of this VERY RARE MRSA.

Result:
Wound Culture - Rare Methicillin-Resistant Staph Aureus (with total run of the mill sensitivity profile)

:laugh::laugh:

Patient has been informed she has 21 days to live. Healthy non-toxic looking young woman with a resolving breast abscess. We sent her home with doxy. :idea:
 
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Apollyon said:
I think y'all are missing the intent of the OP. It wasn't for the actual "records" - it was the 17 hour wait for surgery.

As stated, for objective "record" highs and lows, there already is a thread for that.
Click to expand...

I don't really get the 17 hour perf'd appy thing. The surgeons at my hospital pretty much never operate on perf'd appendicitis. It's IV abx, pain control and delayed surgery if needed. A septic pt is really the only exception. So I didn't really get the original post...a pt can get IV abx as easily in the ED as they can on the floor so why was it a time crunch?
 
njac said:
Didn't know where to put this, but figured it was along the lines of the perf'd appy in the ED for 17 hours. Kind of.


NP from MD office calls charge RN - "I'm sending you a patient, she must be seen immediately! She has a VERY RARE form of MRSA and will die in 30 days if she doesn't get treated! and she's had it for a week!!!! I want her to get Vanco immediately!!!!" The charge RN tells me so I can keep an eye out and get Vanco dosed ASAP.

Patient finally shows up. I call office to get copy of c&s of this VERY RARE MRSA.

Result:
Wound Culture - Rare Methicillin-Resistant Staph Aureus (with total run of the mill sensitivity profile)

:laugh::laugh:

Patient has been informed she has 21 days to live. Healthy non-toxic looking young woman with a resolving breast abscess. We sent her home with doxy. :idea:
Click to expand...

Ha! Didn't hear this one... here or there?

-d

Sent from my DROID BIONIC using Tapatalk
 
Daiphon said:
Ha! Didn't hear this one... here or there?

-d

Sent from my DROID BIONIC using Tapatalk
Click to expand...

My here, your there.

Impressive, nonetheless.
 
alwaysaangel said:
I don't really get the 17 hour perf'd appy thing. The surgeons at my hospital pretty much never operate on perf'd appendicitis. It's IV abx, pain control and delayed surgery if needed. A septic pt is really the only exception. So I didn't really get the original post...a pt can get IV abx as easily in the ED as they can on the floor so why was it a time crunch?
Click to expand...

If you don't see anything wrong with someone being in the ED for 17 hrs then it's difficult to explain.

In keeping with the spirit of the thread -
most times signing out patient to oncoming doc that then signed it back out to me (non-psych) - 3 Pt was non-compliant OSA player who would refuse CPAP as soon as his CO2 came down enough to allow for cognition. His step-down bed kept being taken by other patients while he was in the process of refusing the CPAP/BiPaP, but he was too somnolent to go to the floor without it.
 
lol...these are great. I think our record for having someone sit in the ED was 46hrs. From what I remember... it was a psych case.

Alwaysaangel: Seriously? Please tell me you don't work in the ED.
 
Groove said:
lol...these are great. I think our record for having someone sit in the ED was 46hrs. From what I remember... it was a psych case.

Alwaysaangel: Seriously? Please tell me you don't work in the ED.
Click to expand...

One place I go to has a handful of people in the ED for 36-48 and more hours on a regular basis - and not just psych. Often get discharged from the ED by medicine after everything is complete. Horrible situation. Would never want to work in a similar place where this is acceptable. I know I had one pt for 3 shifts (all 12s, so 2.5-3 days in the ED).
 
EM2BE said:
One place I go to has a handful of people in the ED for 36-48 and more hours on a regular basis - and not just psych. Often get discharged from the ED by medicine after everything is complete. Horrible situation. Would never want to work in a similar place where this is acceptable. I know I had one pt for 3 shifts (all 12s, so 2.5-3 days in the ED).
Click to expand...

That's nuts. So, they admit them to obs in the ED for 2 days and then d/c? LOL. I'd blow an aneurysm.
 
Groove said:
lol...these are great. I think our record for having someone sit in the ED was 46hrs. From what I remember... it was a psych case.
Click to expand...

We had a peds psych kid crest 200 hours. Imagine more than a week of living in the ED.
 
Groove said:
That's nuts. So, they admit them to obs in the ED for 2 days and then d/c? LOL. I'd blow an aneurysm.
Click to expand...

We see this frequently, particularly with ICU patients. They are fully "admitted" and under the care of an internist (or whoever), not the EPs but they "hold" in the ED because there's no room for them upstairs. I've seen patients hold like that for days. It is not uncommon for them to have their entire hospital stay in the ED and be discharged from the same room where they started.
 
Dr.McNinja said:
We had a peds psych kid crest 200 hours. Imagine more than a week of living in the ED.
Click to expand...

When I was on my Psych rotation at Kings County I saw a kid who'd been in the Psych ED for over a week. He was almost completely non-verbal and had been just dropped off by his mom who gave fake contact info and then left...it was horrifying.
 
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docB said:
We see this frequently, particularly with ICU patients. They are fully "admitted" and under the care of an internist (or whoever), not the EPs but they "hold" in the ED because there's no room for them upstairs. I've seen patients hold like that for days. It is not uncommon for them to have their entire hospital stay in the ED and be discharged from the same room where they started.
Click to expand...

Damn. Does the hospital have the ability to go on diversion status? Does the medicine service send an ICU nurse to the ED? We're so understaffed where nursing is concerned, I can't imagine the resource utilization that kind of situation would cause, not to mention the inherent danger. Are you involved in the management at all once they're technically admitted by medicine, yet still in the ED?
 
Groove said:
Damn. Does the hospital have the ability to go on diversion status? Does the medicine service send an ICU nurse to the ED? We're so understaffed where nursing is concerned, I can't imagine the resource utilization that kind of situation would cause, not to mention the inherent danger. Are you involved in the management at all once they're technically admitted by medicine, yet still in the ED?
Click to expand...

I guess I've just gotten so used to it I don't get bothered anymore. Kind of like the daily oath of fealty to the hospital's stockholders.

We can go on divert but it's really hard and does not happen often. There are penalties to do it. It's complicated.

Once the patient is admitted I have nothing to do with them. As you can see when I say "admitted" I mean something about status, not geography. They're the responsibility of their admitting doctor.

Sometimes they send an ICU nurse down but usually it's an ER nurse which they hate. For us the biggest resource waste is that we lose a bed. We routinely use beds and chairs in the hallways.
 
Alwaysaangel: Seriously? Please tell me you don't work in the ED.
Click to expand...

We frequently board people for long periods of time in my ED. There just isnt always a bed upstairs. I guess I was just surprised it was a record... Wasn't trying to offend anyone, just didn't seem like that big of a deal for the patient to hang out in the ED for a while.
 
docB said:
I guess I've just gotten so used to it I don't get bothered anymore. Kind of like the daily oath of fealty to the hospital's stockholders.

We can go on divert but it's really hard and does not happen often. There are penalties to do it. It's complicated.

Once the patient is admitted I have nothing to do with them. As you can see when I say "admitted" I mean something about status, not geography. They're the responsibility of their admitting doctor.

Sometimes they send an ICU nurse down but usually it's an ER nurse which they hate. For us the biggest resource waste is that we lose a bed. We routinely use beds and chairs in the hallways.
Click to expand...

Hey, at least you've got a decent attitude about it. LOL, a week in the ED hallway... what a nightmare.

alwaysaangel said:
We frequently board people for long periods of time in my ED. There just isnt always a bed upstairs. I guess I was just surprised it was a record... Wasn't trying to offend anyone, just didn't seem like that big of a deal for the patient to hang out in the ED for a while.
Click to expand...

Because it's a surgical abdomen. Whether they go to the OR or get a perc drain by IR is irrelevant. Nobody with an acute abdomen that technically meets sepsis criteria (Tachy, WBC>12,000, +source) should sit in the ED for that long without admission orders or a definitive surgical plan. Too many bad things can happen in the interim and it's a needless distraction from your other sick patients that keep rolling in through the doors.
 
May be a record for WTF.
>800lbs via EMS, had to be cut out of her house by FD. Sent by PCP for an abnormal lab value.

Cr of 2.3. She was CRF, and was about her baseline per her nephrologist. Pt's reply, "Well, I have new window to look out of now."
 
In the spirit of non-clinical records here's one:

Same patient discharged 4 times in one 12 hour shift. All arrivals via EMS.

This was a homeless COPDer, frequent flier I knew in residency. Several visits a day was typical for him.
 
docB said:
In the spirit of non-clinical records here's one:

Same patient discharged 4 times in one 12 hour shift. All arrivals via EMS.

This was a homeless COPDer, frequent flier I knew in residency. Several visits a day was typical for him.
Click to expand...

I'm suprised he wasn't arrested for 911 abuse.
 
Arcan57 said:
I'm suprised he wasn't arrested for 911 abuse.
Click to expand...

We had one of those until pretty recently - but he would be found drunk at bus stops and other people called 911 for him...
 
Arcan57 said:
I'm suprised he wasn't arrested for 911 abuse.
Click to expand...

I've never actually been in an area where "911 abuse" was a real thing. It seems like it should be but the PD never seems to care. I have heard of a patient getting arrested for it once but it wasn't for medical stuff. They kept calling 911 due to a disagreement with a neighbor and the police were not going to be inconvenienced. Call 911 for an ambulance 12 times a day, that's cool. Bug the boys in blue after they tell you not to call anymore and you're toast.

Interestingly with that particular patient we did arrive at a police mediated solution eventually. Someone figured out the guy was an unregistered sex offender. So whenever he was seen by campus PD they would grab him. Took about three times before he went to jail. I wonder if he went to the jail infirmary 4 times a day.
 
I saw a pt last month on EM who called 911 for "falling" three times. Each time they came, he was sitting up in a chair drinking and refused transport. The last time, it was ED or jail...came to the ED biligerantly drunk (called 911 while in the ED)....he had a significant ST-depression, Yada Yada Yada - he had a hemoglobin of 5.5.

I was surprised.
 
docB said:
I've never actually been in an area where "911 abuse" was a real thing. It seems like it should be but the PD never seems to care. I have heard of a patient getting arrested for it once but it wasn't for medical stuff. They kept calling 911 due to a disagreement with a neighbor and the police were not going to be inconvenienced. Call 911 for an ambulance 12 times a day, that's cool. Bug the boys in blue after they tell you not to call anymore and you're toast.

Interestingly with that particular patient we did arrive at a police mediated solution eventually. Someone figured out the guy was an unregistered sex offender. So whenever he was seen by campus PD they would grab him. Took about three times before he went to jail. I wonder if he went to the jail infirmary 4 times a day.
Click to expand...

In Memphis it was a thing, the city paid to put up billboards and posters on the sides of buses about 911 abuse. I saw 2 or 3 people get arrested for it during my time there,.
 
FSU2013 said:
I saw a pt last month on EM who called 911 for "falling" three times. Each time they came, he was sitting up in a chair drinking and refused transport. The last time, it was ED or jail...came to the ED biligerantly drunk (called 911 while in the ED)....he had a significant ST-depression, Yada Yada Yada - he had a hemoglobin of 5.5.

I was surprised.
Click to expand...

Being a psychosocial sh$% show is not as protective against serious pathology as we'd like to think.
 
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Arcan57 said:
Being a psychosocial sh$% show is not as protective against serious pathology as we'd like to think.
Click to expand...

Yea, I worked with a great general surgeon on my surg rotation. He told me that if I get 1 thing out of his rotation, make sure I know that crazy people get sick too. He said he has only been burned badly 3 times in medicine - all three were nuts and he wrote them off.
 
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