Positive Cell Phone Sign...

[Tenk]

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Well, the Idiocracy prophecy is here boys and girls, just saw my first positive cell phone sign on a STEMI. Nurse couldn’t get vitals because they were talking on the phone. Wth.

 

[TheSingularity]

I love the cell phone sign.

I document it whenever it is present.

 

[CajunMedic]

Standard part of my reassessment documentation. I sometimes will add it on to my “lazy reassessment” dot-phrase

 

[RustedFox]

Well, the Idiocracy prophecy is here boys and girls, just saw my first positive cell phone sign on a STEMI. Nurse couldn’t get vitals because she was talking on the phone. Wth.

Wowww.

just...

*The number one cause of burnout is... the patients*.

 

[Tenk]

I love the cell phone sign.

I document it whenever it is present.

I do too normally because it usually means they shouldn’t be in the ED but seemed kinda inappropriate to document here...

 

[turkeyjerky]

Yeah, I stopped believing in the cell phone sign several years ago. Modern technology is so addicting as to make the discriminatory value worthless. At this point it's like seeing a febrile IVDUer who presented with back pain and discharging them w/ a dx of 'drug seeking behavior'.

 

[WilcoWorld]

Yeah, I stopped believing in the cell phone sign several years ago. Modern technology is so addicting as to make the discriminatory value worthless. At this point it's like seeing a febrile IVDUer who presented with back pain and discharging them w/ a dx of 'drug seeking behavior'.

Really good point.

 

[Brigade4Radiant]

Yeah, I stopped believing in the cell phone sign several years ago. Modern technology is so addicting as to make the discriminatory value worthless. At this point it's like seeing a febrile IVDUer who presented with back pain and discharging them w/ a dx of 'drug seeking behavior'.

Yeah the fact that this patient had a STEMI you can’t use the cellphone sign as a reliable indicator that someone is fine.

 

[The Knife & Gun Club]

I new one I’ve picked up on is suitcase sign. If the patient shows up with a suitcase odds ratio of homelessness and trying to admitted for nonsense is >5.1

 

[GeneralVeers]

Suitcase sign is very specific indeed!

I'd add stuffed animal sign. In an adult it's 100% indicative of personality disorder.

 

[southerndoc]

I new one I’ve picked up on is suitcase sign. If the patient shows up with a suitcase odds ratio of homelessness and trying to admitted for nonsense is >5.1

I refer to it as the positive Samsonite sign. We used to joke about it when I was a medic. People would call 911 and would be standing on the sidewalk outside their residence waiting to be picked up as if we were a taxi taking them to the airport.

The positive Samsonite sign does indeed have a positive predictive value of admission.

 

[hoot504]

Sunglasses sign is far more useful. If you show up to the ER more concerned with trying to look like that dude from CSI: Miami, it's 99% predictive of a bull**** visit and a personality disorder.

 

[deleted547339]

Suitcase sign is very specific indeed!

I'd add stuffed animal sign. In an adult it's 100% indicative of personality disorder.

Yea, I responded to a Rapid Response page to see a patient convincingly seizing outside of admitting with a teddy bear. One is the more realistic pseudoseizures I’ve seen but 10/10 sure of nonepiletic due to teddy bear sign.

 

[BoardingDoc]

Some of my unofficial rules of the ED (some have been mentioned already)

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.

 

[wareagle726]

One of my big regrets in residency was not doing a prospective cell phone sign study at the trauma hospital.

I've also noticed a high correlation with flannel cat/dog/hello kitty/cartoon pants and meth. Don't have a good name for that one yet.

 

[southerndoc]

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

Oh yes. When the N:E >1 (Noise to Emesis Ratio) then they get the vitamin D (droperidol) or the vitamin H (Haldol).

 

[GeneralVeers]

How about pets in the ER? We have some semi homeless people who malinger and want to be admitted but they bring their small dogs.

Hospital policy is we can't keep the animal in hospital with them...

 

[bravotwozero]

Honestly I have never seen that happen before. The only pets I've seen there are comfort dogs that get walked around the ED by staff. Even saw one of them on a doggie stroller! A bit much to be honest...

 

[GeneralVeers]

The patients use them as a manipulation ploy because the nurses think they are "cute". Once I tell them if they get admitted the dog has to leave, they usually voluntarily go.

 

[deleted480308]

Some of my unofficial rules of the ED (some have been mentioned already)

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.

I definitely have a variation “# of allergies is inversely proportional to odds any of them are real”

“have a high pain tolerance” means you don’t.........man, that’ll preach

 

[Grade4BorBor]

Some of my unofficial rules of the ED (some have been mentioned already)

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.

Amish or Mennonite pt in the ED is more likely to have a life-threatening medical problem, especially if trauma involved.

 

[deleted480308]

Usefulness of interaction with a male patient in their 20s-30s is inversely proportional to presense of, and the amount of speaking done by, the patient’s mother

 

[Apollyon]

Amish or Mennonite pt in the ED is more likely to have a life-threatening medical problem, especially if trauma involved.

Ain't that the truth. Had a two year old Mennonite kid who Mom said had a fever and cough. THE best behaved 2 year old I'd ever seen. Pneumonia? No, better - partially collapsed R lung (10% pneumo). (Kids did just fine.)

 

[Dr Mantis Toboggan]

Ain't that the truth. Had a two year old Mennonite kid who Mom said had a fever and cough. THE best behaved 2 year old I'd ever seen. Pneumonia? No, better - partially collapsed R lung (10% pneumo). (Kids did just fine.)

words of wisdom from an old Peds ED director I worked with: “never discharge an Amish kid”

once I had one with bacterial meningitis, dad thanked me for taking care of him and asked me what he owed me, he was going to go back home and sell some land to his neighbors to pay off the bill (they do this then work the land and sell the crops to pay the neighbor back and buy back the land).

I told him don’t worry about that right now.

 

[Tenk]

Some of my unofficial rules of the ED (some have been mentioned already)

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.

I did once treat an NFL lineman whose wife said he had a high pain tolerance.

He had a high pain tolerance.

 

[Tenk]

Usefulness of interaction with a male patient in their 20s-30s is inversely proportional to presense of, and the amount of speaking done by, the patient’s mother

Omg that is so annoying. They are always like uber Karens too.

 

[The Knife & Gun Club]

How about pets in the ER? We have some semi homeless people who malinger and want to be admitted but they bring their small dogs.

Hospital policy is we can't keep the animal in hospital with them...

Lady with emotional support dog that $hits in the waiting room, presented the other day with...with a flare up of her MALIGNANT MITRAL VALVE PROLAPSE.

 

[Apollyon]

He had a high pain tolerance.

Like, 800mg ibuprofen for bone on bone osteoarthritis (nun I saw in Hawai'i), with audible crepitus? Or, open ankle fx/dislocation with 90° angulation that took only 2mg morphine (saw in residency)?

I always heard it as "people that say they have a high pain tolerance have a high pain medicine tolerance", like, "I have a high pain tolerance, so I need 4mg Dilaudid. Also, it only works on me if you push it really quickly."

If you can, without busting HIPAA, can you say what was wrong with the guy, for which he took no/little pain meds?

 

[Tenk]

Like, 800mg ibuprofen for bone on bone osteoarthritis (nun I saw in Hawai'i), with audible crepitus? Or, open ankle fx/dislocation with 90° angulation that took only 2mg morphine (saw in residency)?

I always heard it as "people that say they have a high pain tolerance have a high pain medicine tolerance", like, "I have a high pain tolerance, so I need 4mg Dilaudid. Also, it only works on me if you push it really quickly."

If you can, without busting HIPAA, can you say what was wrong with the guy, for which he took no/little pain meds?

Had a ~1 cm septic stone. I asked him his pain level cause I was genuinely curious. He’s like “mmmm a 2.”

 

[Apollyon]

Had a ~1 cm septic stone. I asked him his pain level cause I was genuinely curious. He’s like “mmmm a 2.”

Yeah, that's a high tolerance. I think it's a shame when we are surprised when normal people present to the ED.

 

[YeOleBoneWiz]

I am honestly shocked there are doubters of The Idiocracy or the Idiocalypse. Honestly Mike Judge was being generous with 500 years. I say give it 50-100.

 

[deleted547339]

Remember when there was a thread like this then some civilian came here and told us we were all terrible humans? Good times, lol.

 

[Ceke2002]

Remember when there was a thread like this then some civilian came here and told us we were all terrible humans? Good times, lol.

This thread needs more fibromyalgia for the LULZ. 😀

 

[BoardingDoc]

Remember when there was a thread like this then some civilian came here and told us we were all terrible humans? Good times, lol.

If I recall correctly, that person had stage 4 metastatic fibromyalgia.

 

[southerndoc]

If I recall correctly, that person had stage 4 metastatic fibromyalgia.

Yes, they were in palliative care.

 

[RustedFox]

Yes, they were in palliative care.

OMG, find that thread!

 

[dadaddadaBATMAN]

Suitcase sign is very specific indeed!

I'd add stuffed animal sign. In an adult it's 100% indicative of personality disorder.

Or developmental disability. Either way there’s a high chance I’m not going to recognize your decision making capacity

 

[GeneralVeers]

Or developmental disability. Either way there’s a high chance I’m not going to recognize your decision making capacity

It's always a win when these people suddenly declare their suicidality at the end of the visit.

 

[Ceke2002]

OMG, find that thread!

Anyone remember an approximate year for it? Digging through fibro threads now, but a way of narrowing down would be helpful.

 

[Arcan57]

Yeah, that's a high tolerance. I think it's a shame when we are surprised when normal people present to the ED.

Had a farmer in residency that has his combine flip on him, shattering his pelvis. He crawled 4+ hrs to get in range of a cell tower so he could call 911. Pain was a 3/10 on arrival to our trauma center. I always took it to mean that farmers are tough SOBs, but now I'm wondering if some of it was the hours he spent getting to us having redefined his pain scale...

On the other end of the spectrum, I saw a patient recently that had constant 10/10 back pain for a year. I kinda wanted to ask "So it's felt like your spine is ripping out of your body while you're on fire every second of every day for the last year?" But I was really worried my sense of empathy wouldn't survive through a yes response

 

[Apollyon]

Had a farmer in residency that has his combine flip on him, shattering his pelvis. He crawled 4+ hrs to get in range of a cell tower so he could call 911. Pain was a 3/10 on arrival to our trauma center. I always took it to mean that farmers are tough SOBs, but now I'm wondering if some of it was the hours he spent getting to us having redefined his pain scale...

On the other end of the spectrum, I saw a patient recently that had constant 10/10 back pain for a year. I kinda wanted to ask "So it's felt like your spine is ripping out of your body while you're on fire every second of every day for the last year?" But I was really worried my sense of empathy wouldn't survive through a yes response

I recall a similar farmer pt when I was a resident. This guy had fractured his left ankle - and, being a good farmer, he had a manual transmission in his pickup truck. Yes, he depressed the clutch with his broken ankle.

Oh, that reminds me of the traumatically amputated hand (note: if one end is attached to a hog, don't attach the other end to your wrist): pain level? 6-7.

 

[CajunMedic]

Had a farmer in residency that has his combine flip on him, shattering his pelvis. He crawled 4+ hrs to get in range of a cell tower so he could call 911. Pain was a 3/10 on arrival to our trauma center. I always took it to mean that farmers are tough SOBs, but now I'm wondering if some of it was the hours he spent getting to us having redefined his pain scale...

I recall a similar farmer pt when I was a resident. This guy had fractured his left ankle - and, being a good farmer, he had a manual transmission in his pickup truck. Yes, he depressed the clutch with his broken ankle.

My one and only true cardiac arrest save as a medic was one of these guys. Drives himself to the station and nonchalantly says "I've had indigestion for a couple of days, family thinks it's my heart, I'm pretty sure i'm fine" Massive ST elevation in Lead 2 and goes into V-fib 5 minutes into transport. Get ROSC, completely wakes up. Gets flown to cath lab, 3 stents, and only concern was "Do I still get my elk hunt?"

 

[southerndoc]

OMG, find that thread!

Sorry, I was just joking about the palliative care part.

 

[southerndoc]

OMG, find that thread!

pain control admissions This thread brings up good memories for gastroparesis.

 

[RustedFox]

Someone unlock that thread, please.
For teh lulz.

 

[WheezyBaby]

Honestly I have never seen that happen before. The only pets I've seen there are comfort dogs that get walked around the ED by staff. Even saw one of them on a doggie stroller! A bit much to be honest...

I had a patient bring in a dead bird in a bag once. Said it fell out of the sky and hit them then died. Wanted to show us. OK then

words of wisdom from an old Peds ED director I worked with: “never discharge an Amish kid”

once I had one with bacterial meningitis, dad thanked me for taking care of him and asked me what he owed me, he was going to go back home and sell some land to his neighbors to pay off the bill (they do this then work the land and sell the crops to pay the neighbor back and buy back the land).

I told him don’t worry about that right now.

I care for a lot of Amish. Amish kid in the ED gets extremely high pretest for badness. Between the consanguinity, community evaluation before coming in, general reluctance to come in, it's never good

 

[deleted547339]

Had a farmer in residency that has his combine flip on him, shattering his pelvis. He crawled 4+ hrs to get in range of a cell tower so he could call 911. Pain was a 3/10 on arrival to our trauma center. I always took it to mean that farmers are tough SOBs, but now I'm wondering if some of it was the hours he spent getting to us having redefined his pain scale...

On the other end of the spectrum, I saw a patient recently that had constant 10/10 back pain for a year. I kinda wanted to ask "So it's felt like your spine is ripping out of your body while you're on fire every second of every day for the last year?" But I was really worried my sense of empathy wouldn't survive through a yes response

I had a Mexican guy with an ankle injury when I was a resident. He injured it playing soccer the day before (maybe 2?). Flagged him for a hall bed. Took off his cowboy boot that went to midcalf and his tri-mal was open from prolonged skin tenting....he’d been walking on it???? And how did he put on the boots??

 

[Apollyon]

I had a Mexican guy with an ankle injury when I was a resident. He injured it playing soccer the day before (maybe 2?). Flagged him for a hall bed. Took off his cowboy boot that went to midcalf and his tri-mal was open from prolonged skin tenting....he’d been walking on it???? And how did he put on the boots??

That was a guy in SC - brick wall - literally - fell on him. Femur fx. His only question? In Spanish, "When can I go back to work?"

 

[Grade4BorBor]

I had a Mexican guy with an ankle injury when I was a resident. He injured it playing soccer the day before (maybe 2?). Flagged him for a hall bed. Took off his cowboy boot that went to midcalf and his tri-mal was open from prolonged skin tenting....he’d been walking on it???? And how did he put on the boots??

I have to wonder if he has a better prognosis than the average person with this injury, given he's walking on an open fracture. I'm not an orthopod but I think many don't regain full weight bearing status even after treatment and rehabilitation.

 

[deleted547339]

I have to wonder if he has a better prognosis than the average person with this injury, given he's walking on an open fracture. I'm not an orthopod but I think many don't regain full weight bearing status even after treatment and rehabilitation.

Yea, I pulled his boot off and saw his foot flop. Wasn’t sure if I should pick up his foot or my jaw off the floor first. He had a wooden spoon tied to the lateral aspect as a splint.