i saw a Pathologist on the floor today . .

[Homunculus]

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and no, not passed out from formalin exposure or anything.

so we have a neutropenic heme-onc pt (peds) who has an ANC of around, oh, ZERO who was admitted for a neutropenic fever eval and had a platelet count "<10" on her last cbc. we decide to transfuse, and after about 2cc's of platelets (a single pheresis pack) go in, she starts getting flushed, hypotensive, tachycardic and c/o chest pain. so we stop the infusion and give benadryl, solumedrol, and epi. she looks and feels better. then suddenly she has honest-to-god-about-to-shake-out-of-the-bed rigors. so we start vanc and gent.

anywho, we report this to The Blood Bank. later that day-- i swear to you this is true-- i saw a pathologist ON THE FLOOR-- and not only that, but one of his henchman residents as well!. I thought of shooting one there on the spot and mounting on my wall at home alongside the derm and optho fellows i've seen (and next to the spot reserved for "Radiologist"). But instead i let them speak.

So anyway, they're culturing the platelets, the D5 1/2NS and the cefepime that was running at the time to r/o any bugs in the platelets. Cultures we drew off the kiddo are still negative. We transfused another pack later i nteh day, premedicating with benadryl and tylenol and they ran in fine. She's getting another today. i'll let you know if anything cool comes of this. (personally i think it'd be neat, in a scientific "whoah" kinda way, if the cefepime grew some bugs. those'd be some hardass bugs.)

--your friendly neighborhood loaded for bear caveman

 

[beary]

On the peds heme-onc floor here, we always premedicate with benadryl before giving platelets. I do not know why we do this. Nor did it ever occur to me to ask.

Interesting story!

 

[yaah]

Apparently there was one contaminated bag here a few years ago (I think). I have had to go to the floor a couple of times. One of the blood bank attendings here sometimes insists on seeing patients - particularly the pheresis patients.

 

[LADoc00]

-- i swear to you this is true-- i saw a pathologist ON THE FLOOR-- and not only that, but one of his henchman residents as well!.

Dude, Im taking offense at this. Im on the floor all the time, usually bitch slapping primary care docs and their puny "henchmen".

 

[b&ierstiefel]

ha! nice.

 

[univlad]

Dude, Im taking offense at this. Im on the floor all the time, usually bitch slapping primary care docs and their puny "henchmen".

What brings you up to the floor LADoc?

 

[fedor]

What brings you up to the floor LADoc?

Free coffee and snacks, imo.

 

[bananaface]

Free coffee and snacks, imo.

wimmen?

 

[fedor]

wimmen?

No, don't think so. LADoc wouldn't know what to do if he saw one.

 

[Homunculus]

so, shocker, nothing grew out of the platelets, cefepime, IVF, or pt cultures.

bleh. 😡

back to your stream of consiousness path posts 😛

--your friendly neighborhood case study-penic caveman

 

[deschutes]

back to your stream of consiousness path posts 😛

--your friendly neighborhood case study-penic caveman

Glad to see you're still around 🙂

I've come to realize another reason I am liking path - pathologists consider a quiet in the work place a high priority for getting work done.

None of these infernal beeping machines, 14 people shuffling papers and talking all at once, pagers going off and phones ringing off the hook!

 

[yaah]

Glad to see you're still around 🙂

I've come to realize another reason I am liking path - pathologists consider a quiet in the work place a high priority for getting work done.

None of these infernal beeping machines, 14 people shuffling papers and talking all at once, pagers going off and phones ringing off the hook!

And the work area doesn't smell like ****.

 

[deschutes]

And the work area doesn't smell like ****.

You prefer xylene? So do I 😉

I can't figure out which service you are thinking of when you say this. Most services don't smell like ****.

 

[beary]

You prefer xylene? So do I 😉

I can't figure out which service you are thinking of when you say this. Most services don't smell like ****.

Services that smell like ****:
Surgery!!!
Medicine
Psych
Surg path, sometimes 😉

 

[b&ierstiefel]

Surg path, sometimes 😉

Sometimes, I question the efficacy of the bowel prep on some of the patients who have had segmental colectomies.

 

[deschutes]

Services that smell like ****:
Surgery!!!
Medicine
Psych
Surg path, sometimes 😉

Not all surgery. I told you not to do colorectal 😉

Not all medicine either.

Are you getting pelted with **** already? I mean this literally - the figurative happens all the time.

 

[b&ierstiefel]

You prefer xylene? So do I 😉

I have a confession to make...sometimes when I receive slides from the histo lab, I open up the box and take a deep whiff of the wonderful xylene. Then I start previewing some of the slides right away...after you've sniffed some xylene, you can see some really subtle findings!

 

[beary]

Are you getting pelted with **** already? I mean this literally - the figurative happens all the time.

Figuratively, yes. Literally, no, thank goodness.

The overwhelming majority of my time on psych has been spent sitting around surfing the internet. I have seen a grand total of 3 pts in two days.

Tomorrow I may bring a novel.

 

[deschutes]

The overwhelming majority of my time on psych has been spent sitting around surfing the internet. I have seen a grand total of 3 pts in two days.

Isn't it such a weird change? I remember those days.

We used to have to watch our "colleagues" interviewing on the other side of a two-way mirror (is that the right term?). Being dark and all in the watchbox, I found myself falling asleep quite a lot.

 

[fedor]

Figuratively, yes. Literally, no, thank goodness.

The overwhelming majority of my time on psych has been spent sitting around surfing the internet. I have seen a grand total of 3 pts in two days.

Tomorrow I may bring a novel.

Are you sure you aren't there as a patient?

 

[JustR]

Are you sure you aren't there as a patient?

I need some help Can I get some pathologist advice? Am I at the wrong place?

 

[beary]

Are you sure you aren't there as a patient?

Reasonably sure. 😛

 

[fedor]

I need some help Can I get some pathologist advice? Am I at the wrong place?

We're here to help

 

[yaah]

All services smell like ****. Many patients are incontinent, and the medications cause the side effect of diarrhea.

I would also add pediatrics. And pediatrics has a stranger smell, because often in these kids' rooms there are about 15 family members who haven't bathed in a week because they have been visiting the kid, and the temperature is kept too high because the kid will get chilly, and the family brings in their own food and then throw it in the trash and it starts to smell. And someone is always vomiting. Pediatrics smells.

 

[DrBloodmoney]

and no, not passed out from formalin exposure or anything.

so we have a neutropenic heme-onc pt (peds) who has an ANC of around, oh, ZERO who was admitted for a neutropenic fever eval and had a platelet count "<10" on her last cbc. we decide to transfuse, and after about 2cc's of platelets (a single pheresis pack) go in, she starts getting flushed, hypotensive, tachycardic and c/o chest pain. so we stop the infusion and give benadryl, solumedrol, and epi. she looks and feels better. then suddenly she has honest-to-god-about-to-shake-out-of-the-bed rigors. so we start vanc and gent.

anywho, we report this to The Blood Bank. later that day-- i swear to you this is true-- i saw a pathologist ON THE FLOOR-- and not only that, but one of his henchman residents as well!. I thought of shooting one there on the spot and mounting on my wall at home alongside the derm and optho fellows i've seen (and next to the spot reserved for "Radiologist"). But instead i let them speak.

So anyway, they're culturing the platelets, the D5 1/2NS and the cefepime that was running at the time to r/o any bugs in the platelets. Cultures we drew off the kiddo are still negative. We transfused another pack later i nteh day, premedicating with benadryl and tylenol and they ran in fine. She's getting another today. i'll let you know if anything cool comes of this. (personally i think it'd be neat, in a scientific "whoah" kinda way, if the cefepime grew some bugs. those'd be some hardass bugs.)

--your friendly neighborhood loaded for bear caveman

Haha Homunculus

You must have been at Reed... we actually go to the floor quite a bit for what the residents call 'harrassment rounds.' This is where the Blood bank director goes around and bugs surgeons about improper transfusion requests. So yes, I've been that exact henchman you speak of. It's a poor first year this month so that must have been who you saw.

 

[deschutes]

All services smell like ****. Many patients are incontinent, and the medications cause the side effect of diarrhea.

Hmm. I never noticed. Maybe 20+ years of public toilets in an equatorial climate inures one to these things.

I would volunteer for harassment rounds!

 

[DarksideAllstar]

Sometimes, I question the efficacy of the bowel prep on some of the patients who have had segmental colectomies.

Gotta love grossing trauma bowel.

 

[b&ierstiefel]

Gotta love grossing trauma bowel.

Haven't had to do that yet. One of my colon cancer cases did involve an ulcerative full thickness tumor that caused bowel perforation.

Where's the ink on the serosal margin here?
Well you see that piece of dung clinging on the serosa? Yeah, there's your ink. We now have a 7th color of ink...brown.

 

[yaah]

Haven't had to do that yet. One of my colon cancer cases did involve an ulcerative full thickness tumor that caused bowel perforation.

Where's the ink on the serosal margin here?
Well you see that piece of dung clinging on the serosa? Yeah, there's your ink. We now have a 7th color of ink...brown.

I had a nice esophageal cancer once like this - it was a palliative resection and the tumor was all over the margin. Person signing it out was like "What's this, ink all over tumor, where's the margin?" Me: That is the margin.