Laws of the Emergency Department

[prolene60]

1. Your hospitalist shall order a procalcitonin to exclude any clinical presentation of infection.
2. Your neurosurgeon shall request a repeat head CT for bleed at 6 am regardless if the first one was done at 3 am or even 1 pm the day before.
3. Your patient's spouse shall always indicate the Monstrous Massive pain tolerance that he/she has.
4. All of your healthy patients with normal renal function shall be able to hold their bladder more than my mini doddle, and not give a urine sample.
5. Your patient's family member in any type of medical field shall request a Lipase AND Amylase to be performed.
6. All of your patients brought in for medical clearance for jail shall be tachycardic to at least the 120's. Also, the arresting officer shall leave the suspect no matter how heinous the crime if eval takes more than 10 minutes.
7. Your local urgent care shall instill the most absolute dangerous diagnosis in your patient's head before they arrive to your ER.
8. Any phone call to a nursing home to gather information on the patient they just dumped off shall invariably lead to a nurse that just got on shift for the first time and doesn't know the patient.
9. Your subspecialist shall only like to deal with certain parts of their specialty whether it be only certain bones for ortho and certain parts of the eye for ophthalmology. The rest shall be recommended for transfer.
10. All patients who have access to their online chart shall inquire about their slightly abnormal eosinophils when you tell them everything is fine.
11. Your patient shall huff and puff when they have to tell you why they are there because they already gave a 30 second spiel to the tech who wheeled them in.
12. Your nurse shall always comment on the color of the urine sample.
13. Your patient getting a lac repair shall always ask how many sutures you think its going to take.
14. Your triage nurse shall label any complaint in the musculoskeletal system a level 4 or 5.
15. Your hospital shall hire a lab troll that comes in once per week to secretly steal a lab specimen that never makes it to the lab however nurse swears she sent it.

Sorry for the dumb post. Just been irritable lately with some of my shifts

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[BoardingDoc]

I've posted them elsewhere in the past but apropos of your post, some of my unofficial rules of the ED are:

Luggage sign is directly correlated with homelessness and malingering.

Teddy bear sign is directly correlated with mental illness.

Number of listed allergies is inversely proportional to chance of sanity.

Vomiting gets treated with zofran. Noisy vomiting gets treated with droperidol.

Anyone who says "I have a high pain tolerance" doesn't.

Anyone arriving to the ED via ambulance is either sick enough to be admitted, or has nothing wrong with them that 2 Tylenol couldn't fix.

 

[sylvanthus]

These are gonna sound racist so bring the flames…

Old asian man comes in with chest pain and tries to be stoic, hes on the verge of death. Take that **** seriously.

Female hispanic 15 mph car crash, will have total body dolor and get a **** ton of imaging.

 

[GassYous]

These are gonna sound racist so bring the flames…

Old asian man comes in with chest pain and tries to be stoic, hes on the verge of death. Take that **** seriously.

Female hispanic 15 mph car crash, will have total body dolor and get a **** ton of imaging.

Also farmers and amish

 

[CoolDoc1729]

Lol @ medical clearance from police. Yes you have to medically clear them. No you cannot do any testing. I hate when the police get pissy because it’s going to take an hour or two to get CTs back. The last two times I stuck to my guns through the eye rolling and sighing :
1) sternal fracture
2) C2 fracture

 

[RustedFox]

(2.) and (7.) hit hard.

 

[ScepticSkeksis]

The cafeteria shall be located as far away from the ED as possible, and shall stop serving meals 30 minutes before your shift starts

The doctors lounge shall also be as far away as possible, and usually involves an elevator ride and/or multiple sets of locked doors for convenience

The Nurses shall call "Code Sepsis overhead" for anyone even slightly tachyardic.

The Charge Nurse shall force you to immediately go see any patient with mild paresthesias of indeterminate age to "see if it's a code white".

Nurses shall not be allowed to to IO lines, US-guided lines, or EJs. Because this one time......reasons.

 

[Tiger26]

This is an amazing thread--thanks for starting it. Mine are as follows:

-Nobody whose life you save will ever fill out a patient satisfaction survey

-If you ever save a kid's life, someone on the pediatric team on the inpatient service or at transfer center will find the most mundane fault with your care and amplify it as loudly as possible

-IV fluids make everyone feel better

-Droperidol was given back to emergency physicians just to keep enough of them remaining in the workforce. It was previously temporarily taken away to boost the profits for competing meds just coming to market.

-Farmers have a 99% likelihood of severe disease, often requiring critical care.

-Requiring a $5 copay upfront at the door could bankrupt us

-There are very few people where you can truly save a life (choking, STEMI, etc). Most people die no matter how great of a job you did. Most people live no matter how poor of care they receive. We make a benefit only by being in the right place at the exact right time.

-Generally, only issues that happen suddenly have a rapid fix. Things that occur slowly only have a slow fix (i.e. most of the things people come in for).

-Much of emergency medicine involves dealing with psychiatric issues manifesting as physical symptoms. At least the psych patients are upfront with it.

-Developing a script to prepare someone for their inevitable normal test results is essential to the job

-Sending someone home without a trophy of some sort (labs, imaging, turkey sandwich, prescription, sling, etc) is almost impossible to do.

-People don't understand that most things get better with time. When you tell them this, they will gaslight you with their eyes.

-A work note vending machine in the waiting room could make someone richer than Elon

-When two people or more people from the same family check-in, they have nothing that requires the ED (with the rare exception of real carbon monoxide poisoning I suppose). Like, literally nothing that requires emergency care.

-Most aeromedical transport provides little added benefit in transport times compared to ground ambulance. That said, there will almost always be a weather issue during the time you truly need it.

-Speaking of bad weather, it is the most enjoyable time to work in the ED since it keeps most people home (unless you rely on RVUs). Fog, snowstorms, ice storms, and pounding rain make us happy.

-If students were exposed to all the ED patients instead of just the interesting ones on their rotation, very few people would choose this specialty.

-Suturing was fun in med school. Now I'm excited when I can get away with skin glue or even better, a bandaid.

-No matter how extensive of a workup you've done, you'll get a complaint without listening to heart/lungs or palpating an abdomen.

-Jenny McJenerston, APNP, DNP, RN, BA, HS Diploma, Middle School Graduate, Pre-School Honors Student, APGAR 10 will send a patient every shift that will make you realize how hopeless American healthcare is becoming

-Regardless of what tests you've ordered, a psychiatric facility will find a reason to decline a transfer based on something you haven't objectively ruled out yet. Mine this week was for a guy not having a covid test within the last 12 hours (had one the day before).

-Lastly, the nicest people who have never had any bad habits are the ones you will need to tell that they have cancer.

 

[Apollyon]

There are very few people where you can truly save a life (choking, STEMI, etc). Most people die no matter how great of a job you did. Most people live no matter how poor of care they receive. We make a benefit only by being in the right place at the exact right time.

I know this one more simply and less eloquently: "No matter what you do, some people are going to die. And, no matter what you do, some people are going to live."



-Lastly, the nicest people who have never had any bad habits are the ones you will need to tell that they have cancer.

I recall, possibly, the nicest guy I've ever met, who came in for abd pain. CT shows an apple core lesion. Thank heavens, he was resected and lived.

 

[Birdstrike]

16. You will work with at least one partner who is a hardworking, unflappable machine, that one day, suddenly and spectacularly, starts questioning his entire existence, making impulsive financial decisions, takes up extreme sports, puts his band back together, leaves his wife and Emergency Medicine.

 

[The Knife & Gun Club]

- Loud/screaming people are rarely sick. Quiet patients scare me.

- If there is some unconventional way you could really help someone, rest assured an administrator who hasn’t seen a patient in 10 years made a policy against it.

- Casper the Ghost sign (sheets over head) is directly correlated with not needing to be in the ER.

 

[EMhawkeye]

- patient care gets done between nurse’s tiktok breaks

 

[Tenk]

Ct everyone for everything.