Most ridiculous ER consult

[grumbo]

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In tribute to the "Most ridiculous question" thread that is so popular. I think a ridiculous ER consult thread would be appropritae too. I'm sure there's one out there, but we can always renew the idea.

At my facility, the insane consults all come from 2-3 providers. All of the other providers combined do not equal the number of consults from these 2-3.


Most recently: I was consulted down to the ER for exertional chest pain and diaphoresis in a 51 year old male. Sounds legit enough. However, on exam, he states he doesn't have any chest pain, no chest discomfort, no pressure, no nothing. He came to the ER because he sweats when he works out and gets tired. (I wonder why). So me thinking there's got to be more to this, do some more digging. Turns out, no RF for CAD, neg EKG, neg cardiac enzymes. So in the end, I was consulted for an over weight man who sweats when he runs and gets tired.😕 As I explain to the ER doc that we won't be admitting him, she says, "so you don't think he needs an exercise stress test?" Me: "No, he just needs exercise."

 

[grumbo]

I have to add one more.

Consulted to eval a 3 year old with respiratory distress, O2 requirment, possible croup. On arrival to ER, I find the patient listed in room 1, I look in room one, but no one's in there. I ask the nurse when the pt is at (assuming getting a chest xray or something).

nurse: "oh, well Dad decided to take the patient down to the caffeteria to get food before they close. Dr. xxxx said it was okay."

Looking around, I see a dad pushing a stroller down the hall. I ask him to come back to eval this unstable patient. As soon as he takes the kid out of the stroller, he starts running all over the ER chasing his brother.

Clearly I needed to be consulted and clearly he needed to be admited.

 

[docB]

I think a ridiculous ER consult thread would be appropritae too.

You think so? I can match every ridiculous consult story with a ridiculous consultant story. But rather than have that flame war this might be better suited to individual specialty fora than gen res.

 

[typhoonegator]

Ah, hubris. As fun as it is to tell stories, threads like this one unfortunately require the fun to be at someone else's expense. In this case, our brothers and sisters-in-arms down in the ED.

I'm a neurologist, and I've certainly had my share of emotionally challenging consults. However, one needs to remember that consults are called because someone is asking for your help. The reasons for that can take several forms, some more valid than others, but in my opinion it is never appropriate to point and laugh at someone asking for your admitted expertise and assistance.

Additionally, and again in my opinion, one should not single out the ED staff for poor consults. I've gotten just as many, or more, questionable consults from floor services as the ED. If you start pointing fingers at all of them, you're going to find yourself very lonely.

Once you have a service of your own, you suddenly realize that you can't know everything about everything, and your patients deserve the best care your facility can provide. Then *poof*, you're the one ordering your juniors to call questionable consults "just to make sure". No one is immune.

 

[grumbo]

Then doesn't have to be ER consults, but consults in general. I'm FM and I know that there are plenty of consults I've made that are equally ridiculous. Virtually no specialty is immune. The purpose is entertaining stories, no mocking or degrading a specialty in general.

 

[michaelrack]

, and your patients deserve the best care your facility can provide. .

That's a questionable assumption. A problem that a patient has had for years usually doesn't require an inpatient consultation. For example, a non-suicidal patient with chronic depression doesn't need to see a psychiatry consult attending, he needs a social worker to get him set up with a community mental health center. And you don't need to get a sleep medicine consult just because the patient's family doesn't think they can get him to go to a sleep clinic as an outpatient.
(these are both situations I dealt with back when I was in academics)

 

[AznTrojan]

when i was neurology resident.. i got called to the ER because a patient was newly aphasic.. fearing an acute stroke.. i rushed to the ER and found the patient in acute respiratory failure.. he had no neuro deficit.. but he sure as hell was dyspneic, sucking on O2 with his accessory muscles.. and of course.. he couldn't get more than a couple words together because he was so short of breath

i pretty much almost cussed out the ER director for not seeing the patient (he just got report from an EMT and consulted neurology blindly) and told his ass to order to intubate the patient and get a damn CXR.. the CXR was completely white out.. some attendings pretty much hear stroke and just consult neuro without doing anything else

 

[Winged Scapula]

Then doesn't have to be ER consults, but consults in general.

That may have been your intent, but you have titled this thread "Most Ridiculous ER Consult".

The purpose is entertaining stories, no mocking or degrading a specialty in general.

Again, that may have been your intent, but in my experience, this thread will degenerate into hurt feelings, insults and eventually be closed. SDN is a community of health care providers, mostly medical students, residents and physicians. Our field is already been torn apart by outsiders, IMHO, threads like this only encourage us to do the same to each other.

I hated ED consults as much as anyone else and I'm sure I've made a few dumb consults in my life but it doesn't help anyone to start a thread bashing other specialties. The ED is a easy target; no one likes going down there but those guys probably hate calling the consults as much as we hate getting them. I've watched them practically beg consultants to come in and see patients. That can't be a great way to spend your day.

Fun as it seems, I'm not sure this thread is good for SDN or for anyone else who reads it.

 

[smq123]

You think so? I can match every ridiculous consult story with a ridiculous consultant story. But rather than have that flame war this might be better suited to individual specialty fora than gen res.

I agree. Maybe changing this thread title to "Most ridiculous consult" would've been better. Or just not bringing it up at all.

 

[Apollyon]

Or just not bringing it up at all.

This is the infinitely better idea.

 

[typhoonegator]

That's a questionable assumption. A problem that a patient has had for years usually doesn't require an inpatient consultation. For example, a non-suicidal patient with chronic depression doesn't need to see a psychiatry consult attending, he needs a social worker to get him set up with a community mental health center. And you don't need to get a sleep medicine consult just because the patient's family doesn't think they can get him to go to a sleep clinic as an outpatient.
(these are both situations I dealt with back when I was in academics)

You're right, although I would argue that calling social work IS a consult. Nowhere in my rant did I mention calling abusive consults for the heck of it -- you have to be aware of your resources. But there are problems, like first trimester spotting or incidentally discovered subclavian steal, that I'm probably going to call for help on, even if I'm pretty sure the consulting service isn't going to do anything in-house. You can fault me for that if you want, but not everyone has perfect outpatient follow-up, and little problems can be come big in a hurry when people aren't plugged into the system in the right way.

 

[Miami_med]

Here's One I got the other day:

Stat Trauma Consult- 90+ yo male on coumadin with fall from standing at home has head trauma with "some scratches on scalp" but a negative CT scan except for some mild soft tissue swelling. Possible LOC.

I go see the patient, and I find a perfectly pleasant and lucid elderly gentleman who recounts to me in perfect detail a fall in which he lands on his sacrum and then holds himself up with his hands to avoid hitting his head. There is no head trauma. Zero. Not a scratch. It turns out that the consulting physician had simply ordered a CT and assumed that the "soft tissue swelling," noted on CT would probably be associated with head trauma and never saw the patient. Apparently possible LOC is code for, "I never spoke to him in order to ask him."

 

[Rendar5]

Is this thread really gonna stay up? If so, then we probably really should make a "most ridiculous thing a consultant ever told me" response thread in this forum too, along with a "The most ridiculous reason my PCP told me to come to the ED" thread.

Honestly, i hope this thread gets moved to a more appropriate forum. I don't really like coming into one of the forums I'm part of to find a thread making fun of the instances where my field looks dumb. Now if I decide to go to the internal medicine forum or surgery forum for some reason, sure, put this there no problem so you can gripe about whatever stresses your nerves, including other medical fields and I won't pay it another mind.

 

[Winged Scapula]

I agree with Rendar. There is no room for bashing other specialties here.

We all have our own "home" forums where we've traditionally allowed such complaints, but we should be fostering collegiality here.

Can I encourage users to ignore this thread and let it die, rather than continuing in this vein?

 

[Apollyon]

The irony is that this forum's moderator - who has been moving threads left and right - even posted in this thread, and didn't move it or change the title. And anyone who has spent any amount of time on SDN knows that someone will bump this thread with a story about a consult to the ED that that person thought was unreasonable. There is NO WAY it will end well.

 

[zenman]

Last Sunday about 0100 I carried my wife to the ER in Pattaya, Thailand with RUQ pains and consulted the ER doc who diagnosed her with Viral Gastroenteritis and gave her pain meds and cipro. I consulted myself and told my wife she probably had cholelithiasis.

I got her in to see an IM doc who did a scan and sure enough, I was correct. She sees a surgeon in a couple days.

My wife is damn sure glad I'm a nurse. 😀

 

[smq123]

Honestly, i hope this thread gets moved to a more appropriate forum. I don't really like coming into one of the forums I'm part of to find a thread making fun of the instances where my field looks dumb. Now if I decide to go to the internal medicine forum or surgery forum for some reason, sure, put this there no problem so you can gripe about whatever stresses your nerves, including other medical fields and I won't pay it another mind.

To be honest, I'm not even comfortable moving it to another forum. Just because you're in EM doesn't mean that you won't read other forums, and, in general, I don't think that this is the kind of attitude that should be propagated on SDN (i.e. "Specialty X sucks because...." or "Specialty Y doesn't know what they're doing....").

I would like to close it, but it's generally understood that, as a moderator, closing a thread is a last-ditch move.

I was waiting for the OP to come back in and have some input. If he agrees to changing the thread title, that's what I'll do.

 

[grumbo]

Uggg........ Just close the thread. There are more posts complaining about the thread than entertaining stories. Apparently I didn't realize that a story about 1-2 docs equates to the denigration of an entire specialty. Relating a story about a single nurse who has an off moment and pages you at 2AM about something inane is not an attack on all nursing. Same should apply to our own specialties. Guess not. Obviously this was not a great idea. Just close it.