Guinness Book of EM Records

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So our local record for ED hold with no plan was a fellow who spent 8 weeks in the ED. He was evicted from his nursing home for antisocial behaviour (they said if you don`t like the rules, then leave and he said fine, I will and rolled out to go get coffee - did I mention the hemiplegia and wheelchair) and when I called his family doctor the doc said that since he was no longer resident in the nursing home then he wasn`t his patient any more. So I now had a hemiplegic 67 year old man with diabetes, renal failure and IHD in a wheelchair with no home. I called the medical director who promised that a solution would be found. So he was held in the ED for 8 weeks while they tried to talk any of the local docs into taking him on as a patientand tried to talk the nursing home director into acting her age. Finally the medical director admitted him to himself (he was a surgeon and hadn`t practiced in about 9 years at that point), then signed out to another family doctor, thus effectively making him her patient. I haven`t seen him since so I suppose he is back in some nursing home somewhere (or deceased). Really weird situation.
Oh, it helps to know that in our 3 hospitals family docs all manage their own patients except if they need surgery, and consult specialists as needed, so if someone comes in with no family doc we have to find someone to take them. In two of the communities where I work there is an organised rota, but in this one it is a matter of calling until you find someone having a weak moment. This usually eventually involves the medical director, as there is only so much of an emerg shift you can spend pleading with people.
Cheers,
M
 
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If there's a hospital that doesn't have a set plan for admitting unattached patients, the first think I do is get the administrator on call to take care of it. It isn't my problem that the hospital doesn't think in the future. Once I call the AOC, they can do whatever the hell they want. But 8 weeks? I'd be calling the news on day 2. That's straight bull****.
 
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Dr.McNinja said:
If there's a hospital that doesn't have a set plan for admitting unattached patients, the first think I do is get the administrator on call to take care of it. It isn't my problem that the hospital doesn't think in the future. Once I call the AOC, they can do whatever the hell they want. But 8 weeks? I'd be calling the news on day 2. That's straight bull****.
Click to expand...

Yes, it was a bit of an anomaly even for our area. I was only made aware of the length of the hold when I went back to work several weeks later and he was still there. I then followed his further career on the computer. I rarely go out there but I invariably get something like this when I do. The nurses claim that all the crazy people come in when I work, thus putting the blame for all the systemic dysfunction where it belongs, squarely on my shoulders. I think I`m back there next week some time for what I am hoping is my swan song in this particular department. Oh joy! Cheers.
M
 
gutonc said:
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.
Click to expand...

Apparently a few years ago there was a psych pt in the ED for 30 days at the hospital I am at. This was before they added a psychiatrist to the ED.
 
med2UCC said:
So our local record for ED hold with no plan was a fellow who spent 8 weeks in the ED. He was evicted from his nursing home for antisocial behaviour (they said if you don`t like the rules, then leave and he said fine, I will and rolled out to go get coffee - did I mention the hemiplegia and wheelchair) and when I called his family doctor the doc said that since he was no longer resident in the nursing home then he wasn`t his patient any more. So I now had a hemiplegic 67 year old man with diabetes, renal failure and IHD in a wheelchair with no home. I called the medical director who promised that a solution would be found. So he was held in the ED for 8 weeks while they tried to talk any of the local docs into taking him on as a patientand tried to talk the nursing home director into acting her age. Finally the medical director admitted him to himself (he was a surgeon and hadn`t practiced in about 9 years at that point), then signed out to another family doctor, thus effectively making him her patient. I haven`t seen him since so I suppose he is back in some nursing home somewhere (or deceased). Really weird situation.
Oh, it helps to know that in our 3 hospitals family docs all manage their own patients except if they need surgery, and consult specialists as needed, so if someone comes in with no family doc we have to find someone to take them. In two of the communities where I work there is an organised rota, but in this one it is a matter of calling until you find someone having a weak moment. This usually eventually involves the medical director, as there is only so much of an emerg shift you can spend pleading with people.
Cheers,
M
Click to expand...
Pretty sure that's illegal. If the family doc had a pre-existing relationship with the guy, he was his family doc for at least 30 days after the pt is "fired", including for any emergency care. AFAIK it doesn't matter why the pt was fired.
 
Raryn said:
Pretty sure that's illegal. If the family doc had a pre-existing relationship with the guy, he was his family doc for at least 30 days after the pt is "fired", including for any emergency care. AFAIK it doesn't matter why the pt was fired.
Click to expand...

Not sure that`s true in Canada. In any case, that`s what happened. And it`s one of the reasons why I`m not working there anymore. Cheers,
M
 
I know it's not a record, but I was pretty impressed when I got a full culture and finaled sensitivity on a patient still in the ED this afternoon. 50+ hours into her ED stay.

Also, there was a pH of 70.40

Kind of my new favorite typo ever.
 
LP results:
Protein>500
Glucose<2
WBC's = 16,500!
 
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 didn't check the record sheet, but we admitted the same patient 3, nearly, 4 times in the same 12 hour shift.

1) patient admitted for nasty wound infection. Patient has been seen here a lot because he is ill a lot. He is also a d*ck. These things are unrelated, sadly. So, Patient gets to floor and sees the accepting attending. Apparently they have history. He immediately AMAs.

2) he comes back to the hospital 2 hours after AMAing, because the pain killers ran out. Readmitted to same service. Sees a different resident do his H&P so he assumes its a different attending. It's not. Goes to floor. Sees attending again. Then he friggen elopes.

3) "Elopes" straight to the ED where he signs in as an ED patient again. Demands he be admitted to Surgery instead. We admit him to surgery since it is a a wound, but obviously it took some calling in of favors. Surgery accepts him but then immediately pages the MAR to request transfer to Medicine service. The MAR evaluates and transfers him back to his original team due to bounce back rules.

4) apparently the guy would sign out AMA again and return to the ED later that night just after the shift ended demanding to be treated exclusively in the ED and sent home with pills and outpatient IM follow up. No clue if he got his way on that.
 
Not my patient, but colleague of mine with status who's lactic acid was >30, corrected to less than 5 in 2 hours
 
I had a similar guy a few months back...

DocEspana said:
I didn't check the record sheet, but we admitted the same patient 3, nearly, 4 times in the same 12 hour shift.

1) patient admitted for nasty wound infection. Patient has been seen here a lot because he is ill a lot. He is also a d*ck. These things are unrelated, sadly. So, Patient gets to floor and sees the accepting attending. Apparently they have history. He immediately AMAs.

2) he comes back to the hospital 2 hours after AMAing, because the pain killers ran out. Readmitted to same service. Sees a different resident do his H&P so he assumes its a different attending. It's not. Goes to floor. Sees attending again. Then he friggen elopes.

3) "Elopes" straight to the ED where he signs in as an ED patient again. Demands he be admitted to Surgery instead. We admit him to surgery since it is a a wound, but obviously it took some calling in of favors. Surgery accepts him but then immediately pages the MAR to request transfer to Medicine service. The MAR evaluates and transfers him back to his original team due to bounce back rules.

4) apparently the guy would sign out AMA again and return to the ED later that night just after the shift ended demanding to be treated exclusively in the ED and sent home with pills and outpatient IM follow up. No clue if he got his way on that.
Click to expand...
 
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Not mine, but the "favorite note ever" of an attending I shadowed...


BMI: 99

Note: Patient's actual BMI is >100, but the computer does not allow three-digit inputs in this category.
 
sodium < 100.

beer potomania w/ reset osmostat

ended up getting a formal lab value of 90. Guy was pretty much asymptomatic other than "generalized weakness".
 
Ammonia of 297. Hx HepB, hepC. Not surprisingly, change in mental status
 
Saw a case recently. Interesting for me. Many of you had probably seen similar things before.

Acutely sick febrile patient with an ECG that had 2 different QRS complexes. Turns out she had a past heterotopic heart transplant.
 
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KLPM said:
Saw a case recently. Interesting for me. Many of you had probably seen similar things before.

Acutely sick febrile patient with an ECG that had 2 different QRS complexes. Turns out she had a past heterotopic heart transplant.
Click to expand...

I hope you saved a copy of that EKG, so you can ask for an assessment from all the med students/residents you come across.
 
Tonight I had an anion gap of 55. Glucose 1815. pH was around 7.00.
 
Perrin said:
Tonight I had an anion gap of 55. Glucose 1815. pH was around 7.00.
Click to expand...
Wow. Amazing what a tough night shift and getting the circadian rhythms out of wack can do to a fella. Geez. Hope you bounce back after a nap and some fluids.
 
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Birdstrike said:
Wow. Amazing what a tough night shift and getting the circadian rhythms out of wack can do to a fella. Geez. Hope you bounce back after a nap and some fluids.
Click to expand...

Haha.

[queue sad music]

'I worked three night shifts in a row.... and now I have the Beetus.'




82752658.jpg
 
This might win the longest in the ED award.

When I was a med student a psych pt stayed in the ED for almost 3 months because we couldn't find placement.
 
link2swim06 said:
This might win the longest in the ED award.

When I was a med student a psych pt stayed in the ED for almost 3 months because we couldn't find placement.
Click to expand...
At no point in the entire 3 months, could anyone get the guy to agree to not kill himself for long enough to get a psych appointment, at some point during his 3 months?

When he went to psych inpatient, did he stay there for three months? I seriously doubt it.

This is where some smart hospitals will arrange a contract to actually pay cash to a psych hospital for these patients' treatment. They've found it literally costs less to pay for a brief psych hold at some psych hospital, than to get roped into this money burning insanity for weeks/months on end. It sounds crazy that a hospital would do this, but some have, and have actually saved money.
 
I've got one for worst allergy ever:

Doc: "Maam, are you allergic to any medications?
Patient: "Yes. Morphine is one."
D: "And what reaction do you have to morphine?"
P: "It makes me giddy and light-headed."
D: "..."
 
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Perrin said:
Tonight I had an anion gap of 55. Glucose 1815. pH was around 7.00.
Click to expand...

Had a similar case a few months ago. Didn't end well. Did you get a lactate on this guy? Our one was 10 if memory serves me right.
 
Spinach Dip said:
I've got one for worst allergy ever:

Doc: "Maam, are you allergic to any medications?
Patient: "Yes. Morphine is one."
D: "And what reaction do you have to morphine?"
P: "It makes me giddy and light-headed."
D: "..."
Click to expand...

So you found the one patient who wasn't a drug seeker.

Anyway my example is from a medical reenactment show. A woman not only survived two point blank shots to the head but was conscious when she hit the ER doors.
/Her skull was so fractured by the bullets that it saved her from the swelling.
 
I had a guy brought in by EMS for "high sugar". Is walkie-talkie, acting totally normal, but then suddenly slumps and codes while waiting for a bed. We get pulses back, and on the way up the lab calls. pH 6.8, glucose 2100, lactate 17. K+ 5.2

He ended up having a perf'ed viscous with the worst ct belly I've ever seen. Radiologist actually dictated "abdominal catastrophe". Twice.
 
This wasn't in the ED but we had a hepC/alcoholic cirrhosis patient the other day that we pulled 11.2L off with a para. The guy weighed 150 pounds before the tap, and I had to leave before we weighed him again.
 
Record for me at least. WBC 375,0000 a few days ago. Incredible case. Long story short... kid in his 20s with CML, off his meds, who developed such severe splenic sequestration and splenomegaly that he suffered spontaneous splenic rupture and showed up with a belly full of blood.
 
17 GSW in one patient inflicted during same encounter. None requiring intervention.
 
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Hemoglobin of 1.7 in a patient that was walking around the ED. Cancer, refusing chemo/radiation. Would get blood transfusions and then sign out AMA.

Platelet count of 1. Yes, one. ITP.
 
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Arcan57 said:
17 GSW in one patient inflicted during same encounter. None requiring intervention.
Click to expand...

What a terrible shot! Guy must be shooting like the dude in grossed pointe blank with the gun angled sideways....


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EM2BE said:
Running list thanks to dropkick a while back (from first link)

Alcohol-Blood 830 Jpgreer13
Biggest abdominal aortic aneurysm- 10.5cm Desperado
Blood pressure 330/180 12r34y
BMI 111 EM2BE (although weight of >850 listed below is much higher)
Drug screen 9 out of 9 positive ISU_Steve
Glucose-low 0 LanceArmstrong
Largest stool removed by manual disimpaction- 15 lbs ERMudPhud
Medlist (active prescription meds) 33 Ermudphud
Pack years smoking 420 Apollyon
Pain scale 10/10 docB (and all the rest of us)
Tooth/tattoo ration 6/23 Kev Jones
weight >850 pounds clc17
Click to expand...

Y'all just made my morning - funniest med post since "Things I learned from my patients"
 
BoardingDoc said:
Seriously, I don't know if I feel worse for the patient or the shooter. That's just ****ing embarrassing.
Click to expand...
He helped me develop my "seasonal trends in ISS score in patients suffering from GSWs" idea. In places with actual winter, being shot during winter is actually deadlier because people can get closer to you without being obvious about hiding a gun and it's harder to run in bulky (i.e. warm) clothes. In the summer, encounters start from further away and most people that are doing the shooting have no formal training in markmanship nor do they regularly visit a gun range. This leads to an explosion of extremity and buttock wounds vs winter which tends to be thoracoabdominal. Along those lines, I'm convinced that anyone that's shot in the head (not self-inflicted or execution style) was purely luck.
 
That being said, the frequency of shootings definitely goes down in severe winter weather. Detroit gangsters are definitely fair weather gangsters. Sun's out, guns out, is definitely a thing.


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bravotwozero said:
That being said, the frequency of shootings definitely goes down in severe winter weather. Detroit gangsters are definitely fair weather gangsters. Sun's out, guns out, is definitely a thing.


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Click to expand...
Quite. Lower frequency in winter. Although it seems like their business model should be evergreen.
 
Arcan57 said:
17 GSW in one patient inflicted during same encounter. None requiring intervention.
Click to expand...
Shotgun pellets?

bravotwozero said:
That being said, the frequency of shootings definitely goes down in severe winter weather. Detroit gangsters are definitely fair weather gangsters. Sun's out, guns out, is definitely a thing.
Click to expand...

Oh yeah. 1st warm spring weekend in a major city...whatever you do, DO NOT sit on your front porch minding your own business.
 
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The White Coat Investor said:
HGB 1.8 with normal vitals. Not lab error.
Click to expand...
I just picked up a guy w/ a Hgb of 2.7...since November. He thought God would fix it so ignored the half dozen entreaties of his PCP to go to the ED, or the 3 Hem/Onc referrals he set up for him.
 
WilcoWorld said:
Oh yeah. 1st warm spring weekend in a major city...whatever you do, DO NOT sit on your front porch minding your own business.
Click to expand...

All tremble before the mighty and terrible SOPMOB
 
Had a patient with a Serum Osmolality of 378. Thought that might be at least close to the record but nope 447. That’s insane. Can’t comment on glucose since our lab maxed out at >1500
 
Buckeye1992 said:
Had a patient with a Serum Osmolality of 378. Thought that might be at least close to the record but nope 447. That’s insane. Can’t comment on glucose since our lab maxed out at >1500
Click to expand...

You bumped a 3 year old list of "EM records" for the sake of stating that you could not contribute to said list?

6C83xrt.png
 
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