Rules of the Emergency Department

[Doctor Bob]

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1. Be nice to the techs, they have the needles. Be nice to the nurses, they have the drugs. Be nice to the doctors, they decide which to give you.

2. Don't be a total jackass because then everyone will hate you and turn a deaf ear when you start berating the staff when your dilaudid high runs out. Don't be the super nice patient that everyone loves, because then you'll turn out to have some incurable disease. It always happens to the really nice patients.

3. Avoid hyperbole. Odds are whatever you're talking about is not as amazing as you think. "I keep having... (pause for dramatic effect)... the... (widen your eyes to add extra emphasis)... BIGGEST stools you have (throw head back in self-disbelief) ever seen." You'd be surprised. I have seen some pretty big stools, and you don't look in nearly enough distress to be having the biggest of them all.

4. Don't stand in your doorway. It doesn't get you seen any faster.

5. You probably don't have as high a pain tolerance as you think. The people who truly have high pain tolerances often just sit there quietly and don't say much, then give us a strained "yea, I thought as much" when we tell them that their femur is busted into 5+ pieces.


Please feel free to add your own.

 

[diphenyl]

6) When someone is on their 15th visit for chest pain in the past month and states their pain is 25 out of 10 I should be allowed to kill them.

7) If you answer your cell phone while I am examining you and you aren't saying your last goodbyes to your wife and children I should be allowed in the word's of Dr cox be allowed to put it on vibrate and shove is so far down your throat it makes you take a tinkle every time it goes off.

8) You are not having 10/10 abdominal pain if when I get to your bed you are text messaging

9) you loose all credibility in my mind when you tell me that the only pain med that works for you starts with a "d"

10) If at anytime you say "well I looked it up online and I think I have insert here exotic medical condition you can only really get if you fornicate with the animal its named for" I should be allowed to respond "well if you already know what you have why do you need me?"

11) If you have a tramp stamp regardless of what you symptoms are you are here for an STD related complaint

12) nobody is allergic to tylenol, motrin, benydryl, morphine, fentanyl, ASA, and saline

13) Don't pretend that you just decided to get your vaginal discharge that you have had for two weeks "taken care of" tonight at 3 am. You are here cus you can't get your boyfriend to touch you.

14) 99% of pt's with vaginal bleeding do not need to be seen by a doctor

15) If your 35 and come to my ER for vaginal bleeding/ pelvic cramping which seems to re occur every month aaround the same day, I should be allowed to sew up your vagina cus that kind of stupid needs to be contained

16) If your symptoms have been going on for two months, you have a PMD, and you look at me confused when asked if you have seen them about this, you should start shaking you head cus my kid has been looking for a good rattle

 

[theacks1]

8) You are not having 10/10 abdominal pain if when I get to your bed you are text messaging

Addendum: If you fit the above while being five months pregnant, I claim the right to have a lengthy discussion with your OB/GYN concerning the merits of complete natural childbirth.

 

[Speed Racer]

17) If the length of time you bitch about waiting without being seen is X, then the true amount of time you have been waiting is 1/3X and the amount of time it will delay me getting off my ass will be X+2 and my nurses will make you wait X^2. Therefore your time spent in the ED will be X^2 + 1/3X + 2.

18) The answer to "Who is your primary doctor?" is not, "Well, you are"

19) Yes he probably is cheating on you.

20) No herbal tea will not help you drop 30lbs and lower your 200/111 BP

21) No your monster of a child can not have a CT Brain for a bump he got 4 hours ago, unless you piss me off, in which case he gets a thyroid CT.

22) Yes it will leave a scar, and you will still be ugly.

23) No I don't have it "In your records".

24) It is pronounced "Tests" not "Test-es-es"

25) I really speak perfect Spanish, but now I am not going to just because you pissed me off.

26) The method of drug delivery here is based on how painful you make my life. Pleasant = PO, Slightly annoying = IV meds, Ex-girlfriend annoying = IM, Billy Mays and a Teletubby had offspring and it is you = rectal suppository

I could keep going.......

 

[WilcoWorld]

27) The greater amount of hypertrophic muscle tissue, tattooing, bad language, violent behavior or, in short, young 20's maleness you have, the more likely you are to be comically terrified of needles.

 

[docmartin252]

17) If the length of time you bitch about waiting without being seen is X, then the true amount of time you have been waiting is 1/3X and the amount of time it will delay me getting off my ass will be X+2 and my nurses will make you wait X^2. Therefore your time spent in the ED will be X^2 + 1/3X + 2.

It's unfortunate that these patients didn't make it all the way to algebra I to be able to understand that equation.

18) The answer to "Who is your primary doctor?" is not, "Well, you are"

A patient that willingly tells the truth? I don't believe it


28) If you're coming in for foot pain, and uhhh....oh yeah some chest pain too, sorry you get to go to the ER and not sent to the front of the line in express care because for some reason you think chest pain is a trump card.

29) No you can not come in just to get a "work note," we're not in high school anymore

30) If you are flopping around like a prize winning tuna and I ask you if you are ok and you tell me you're having a seizure...you're not, and don't get irate with me when I tell you such.

31) Just because you tell us you have a temp or high blood pressure does not mean that you in fact do. Sorry but the devices used to determine vital signs are much more reliable than you.

 

[Stitch]

31) Just because you tell us you have a temp or high blood pressure does not mean that you in fact do. Sorry but the devices used to determine vital signs are much more reliable than you.

But normally I 'run low,' so 99 really IS a fever for me!

 

[GeneralVeers]

But normally I 'run low,' so 99 really IS a fever for me!

"Doc, she felt WARM so I gave her some Tylenol!"

 

[Tiger26]

The tattoo:teeth ratio is directly correlated with number of past ED visits and with the likelihood of overall survival

 

[Doctor Bob]

33. Please know the names of your medications. "It's the little white pill doc" is not sufficient. They are all little white pills.

 

[Speed Racer]

It's unfortunate that these patients didn't make it all the way to algebra I to be able to understand that equation.

Actually I got it wrong as well. It should be X^2 + 4/3X + 2. Now to solve the quadratic.

 

[KidDr]

34. If your child vomited once and is now running around the room eating cheetos, he is not "severely dehydrated"

 

[Arcan57]

35. If you've had every advanced imaging and endoscopic test possible and every removable abdominal/pelvic organ schwacked out and you still come into the ED with your chronic abdominal pain after having refused to take the meds prescribed by you pain specialist, I have no desire to listen to you whine about how I don't care about finding the cause of your abdominal pain.

WHAT PART OF CHRONIC PAIN DON'T YOU UNDERSTAND?

Thanks and have a good night.

 

[diphenyl]

36. If in your PMH is the "end stage fibromyalgia" you might be quite correct although its not the disease that will kill you it's frustrated ER staff that listens to you that will.

37. Cockroaches won't die. No matter how many times they are shot/ stabbed, they always live. The rare innocent bystander will always die no matter where they are shot or how minor their injuries may seem.

38. The good dye young, and pricks live to be 110. this is why I make sure to cuss out the paperboy, it's like taking vitamins.

39. The middle aged guy with the small amount of resolved chest pain that only came in because his wife forced him will always be having a STEMI. No person that comes in and wants to be seen for chest pain will have a MI.

 

[KidDr]

36. If in your PMH is the "end stage fibromyalgia" you might be quite correct although its not the disease that will kill you it's frustrated ER staff that listens to you that will.

oh. my. are there actual doctors out there who are giving patients this diagnosis?? or are people making this up?

 

[gutonc]

38. The good dye young, and pricks live to be 110. this is why I make sure to cuss out the paperboy, it's like taking vitamins.

The corollary to this in my business (oncology) is "kick a puppy every day, it keeps the cancer away."

 

[docmartin252]

33. Please know the names of your medications. "It's the little white pill doc" is not sufficient. They are all little white pills.

I saw this in another thread:
Doctor: "Mr. Smith, what medication are you taking for your seizures?"
Mr. Smith: "I'm taking those peanutbutter balls my doctor prescribed."

Translation: "those peanutbutter balls" = phenobarbital

 

[Seaglass]

I have definitely seen end stage FM, as well as multi-drug resistant FM.

 

[cattail]

Rule:

If you are a female checking in with severe chronic abdominal pain, that has been worked up by multiple specialists, and you have spermatazoa in your UA, you can not demand admission for narcotic pain control.

 

[chimichanga]

34. If your child vomited once and is now running around the room eating cheetos, he is not "severely dehydrated"

Circumoral Cheetosis IS an actual diagnosis...🙂

 

[diphenyl]

41. If you have more than 5 allergies listed more than likely you not allergic to anything.

42. an allergy to benydryl is the funniest thing ever

43. No body is allergic to saline

44. If any condition has been going on for 2 months and your not knocking on death's door, its not an emergency

45. the next mother who brings her and her 3 children in by ambulance at 3 am to "get tested for the pig flu" is getting an enema with a suture tray and getting shoved into the MRI

 

[EM2BE]

I have actually seen an anaphylactic reaction to benadryl. Not so funny at the moment, but laughable after. Good thing epi was around.

 

[gutonc]

41. If you have more than 5 allergies listed more than likely you not allergic to anything.

No but you have now definitively diagnosed a personality disorder.

Gutonc's rules of allergies:
- Allergies to 3 or more antibiotics OR
- Allergies to 3 or more narcotics (except that one that starts with D) OR
- Allergies to 5 or more drugs/things (Tape and Normal Saline count as 2 and 200 each respectively)

A positive result in any of the above has a high specificity and sensitivity for a raging, untreatable Axis II disorder.

 

[bad virus]

9) you loose all credibility in my mind when you tell me that the only pain med that works for you starts with a "d"

Out of shear curiosity . . . Three months ago, a truck ran me and ma poor stumpjumper over and the ambulance deemed it fit that I had to go to the ER. Nurse gave me what she said was 4mg of Morphine IV, and literally within 10 seconds I chunked everything I had in my stomach all over her.

WTF was that and why did it happen?

Well they patched me up real good and sent me home with 30 pills of oxycodone 10 mg and told me to take one and pass out whenever needed. Well, everytime I took one, within 30 minutes to an hour, I would start chunking everything outa my stomach and I even think I was chunking stuff outa my illeum and cecum (not that bad, but bad). I know they are both opiates but what is the response I am having called. Since I am Frequent flyer card carrying member at our ER, and this seems to happen everytime (I think I have sprayed quite a few nurses before), what should I tell the staff?

 

[Jeff698]

Since I am Frequent flyer card carrying member at our ER, and this seems to happen everytime (I think I have sprayed quite a few nurses before), what should I tell the staff?

It's an allergy. You're deathly allergic to any and all forms of analgesia. Nothing can be done for you in the Emergency Department.

Your PCP, on the other hand, has a wide range of options available for your treatment. I'd recommend seeing them and avoiding the ED.

On second thought, you may be deathly allergic to the ED. Bummer.

Take care,
Jeff

 

[bad virus]

It's an allergy. You're deathly allergic to any and all forms of analgesia. Nothing can be done for you in the Emergency Department.

Your PCP, on the other hand, has a wide range of options available for your treatment. I'd recommend seeing them and avoiding the ED.

On second thought, you may be deathly allergic to the ED. Bummer.

Take care,
Jeff

Thanks Jeff,

I just learned something new from you. I had no idea's allergies can cause vomitting (seriously thanks). Regarding the PCP, I can't really go to them in the middle of the night after I break my humerus rock climbing at night. They always have that on their answering machine (those bastards). Thanks for the tip though, next time (I'm already planning it) I will tell them no analgesia please. Oh and thanks for responding to the other post, I will be sure to use that line.

Take care,

(BTW, you stole my signature, I have been using take care, since I was twelveteen).

 

[Rendar5]

No but you have now definitively diagnosed a personality disorder.

Gutonc's rules of allergies:
- Allergies to 3 or more antibiotics OR
- Allergies to 3 or more narcotics (except that one that starts with D) OR
- Allergies to 5 or more drugs/things (Tape and Normal Saline count as 2 and 200 each respectively)

A positive result in any of the above has a high specificity and sensitivity for a raging, untreatable Axis II disorder.

...umm antibiotic allergies? wtf. we give em out like candy, having multiple antibiotic allergies is not something special (i've got 4 supposedly, don't like to think of myself as being in the loony bin). Now keep the other 2 rules and that's hilarious 🙂

 

[Rendar5]

Thanks Jeff,

I just learned something new from you. I had no idea's allergies can cause vomitting (seriously thanks). Regarding the PCP, I can't really go to them in the middle of the night after I break my humerus rock climbing at night. They always have that on their answering machine (those bastards). Thanks for the tip though, next time (I'm already planning it) I will tell them no analgesia please. Oh and thanks for responding to the other post, I will be sure to use that line.

Take care,

(BTW, you stole my signature, I have been using take care, since I was twelveteen).

vomiting in response to an ingestion can signify an allergy, but that's not the norm. Urticaria, angioedema are more the norm. I think he's just saying to call it an allergy so you're not given it (exactly what seekers do when they say they have an allergy to all pain meds except for the ones that begin with a D). Nausea and vomiting are known side effects to opiates.

 

[bad virus]

vomiting in response to an ingestion can signify an allergy, but that's not the norm. Urticaria, angioedema are more the norm. I think he's just saying to call it an allergy so you're not given it (exactly what seekers do when they say they have an allergy to all pain meds except for the ones that begin with a D). Nausea and vomiting are known side effects to opiates.

Well don't I feel stupid now. Thanks for clarifying. On a side note, no joke I just got tagged on my bike by a car right infront of the ER. It's awsome having that med student badge, I walked in, got all my cuts cleaned out by a nurse and sutured all in less than 30 minutes. On the bad note, my front and rear LED's got smashed and my rear tire is gone.

Also, I think I broke my scaphoid, but didn't have enough time to wait for an X-ray. It looks like it changed color from normal to almost blu and black right now and I can only type with my other hand. I can also see it almost pulsate. The nurse called it a foosh (new accronym to me). It got way worst in just 3 hours, I think I am gonna go in tomorrow to get it X-rayed if it gets any worst.

 

[EM2BE]

Well don't I feel stupid now. Thanks for clarifying. On a side note, no joke I just got tagged on my bike by a car right infront of the ER. It's awsome having that med student badge, I walked in, got all my cuts cleaned out by a nurse and sutured all in less than 30 minutes. On the bad note, my front and rear LED's got smashed and my rear tire is gone.

Also, I think I broke my scaphoid, but didn't have enough time to wait for an X-ray. It looks like it changed color from normal to almost blu and black right now and I can only type with my other hand. I can also see it almost pulsate. The nurse called it a foosh (new accronym to me). It got way worst in just 3 hours, I think I am gonna go in tomorrow to get it X-rayed if it gets any worst.

Are you really a med student?

 

[bad virus]

Are you really a med student?

Sadly . . . yes, but I've only been one for a month and a half. Don't know much about anything other than what we covered so far.

Was the insult required? Everyone starts somewhere . . .

 

[killerleaf]

No but you have now definitively diagnosed a personality disorder.

Gutonc's rules of allergies:
- Allergies to 3 or more antibiotics OR
- Allergies to 3 or more narcotics (except that one that starts with D) OR
- Allergies to 5 or more drugs/things (Tape and Normal Saline count as 2 and 200 each respectively)

A positive result in any of the above has a high specificity and sensitivity for a raging, untreatable Axis II disorder.

Actually, my step-daughter has had documented severe allergic reactions to all but one antibiotic...she was a child at the time, but is still very cautious. (just turned 31. pretty cool, after 33 surgeries, and times when they did not think she might not live, she is doing awesome now!) something about remembering not being able to breath is pretty scary--and she does not have a personality disorder...

just might want to reconsider documented medical history for the first one!!

 

[EM2BE]

Sadly . . . yes, but I've only been one for a month and a half. Don't know much about anything other than what we covered so far.

Was the insult required? Everyone starts somewhere . . .

Wasn't meaning it as an insult. Haven't seen you post and we have lots of intruders pretending to be something they are not. It also almost appeared you were asking for advice which is why you didn't get a serious answer at first. One of the first few things you should learn is allergy vs side effect of medications. Will help you lots in the future.

 

[docmartin252]

45. the next mother who brings her and her 3 children in by ambulance at 3 am to "get tested for the pig flu" is getting an enema with a suture tray and getting shoved into the MRI

😆 haven't heard that one yet.....but I like it!

 

[njac]

from the pharmacist - I don't consider n/v with opiates an "allergy" - that is what we call a side effect. Tell them it makes you barfy and you can get something to make you less barfy before it.

 

[Arcan57]

It's not priapism if you have to masturbate to keep it tumescent.

 

[kungfufishing]

maybe he was just trying hard to reduce the swelling.

 

[WilcoWorld]

I have actually seen an anaphylactic reaction to benadryl. Not so funny at the moment, but laughable after. Good thing epi was around.

How are you certain the anaphylaxis was due to Benadryl? I assume the person took the Benadryl to treat something else, which raises suspicion.

 

[DoctorMedic]

Well don't I feel stupid now. Thanks for clarifying. On a side note, no joke I just got tagged on my bike by a car right infront of the ER. It's awsome having that med student badge, I walked in, got all my cuts cleaned out by a nurse and sutured all in less than 30 minutes. On the bad note, my front and rear LED's got smashed and my rear tire is gone.

Also, I think I broke my scaphoid, but didn't have enough time to wait for an X-ray. It looks like it changed color from normal to almost blu and black right now and I can only type with my other hand. I can also see it almost pulsate. The nurse called it a foosh (new accronym to me). It got way worst in just 3 hours, I think I am gonna go in tomorrow to get it X-rayed if it gets any worst.

from a second sem med student watch out for bone necrosis. potential complication with scaphoid injuries due to it's blood supply. also being that is the base of the anatomical snuff box watch for radial artery damage too 😛

in light of the thread
The more you complain the less I care.

 

[TrumpetDoc]

As the "tint" on the glasses increases, the probability of having the Dx of FM at least sometime in life approaches 100%

 

[diphenyl]

If a patient has a GSW to the groin he is stupid. IT means he either had the gun in his waistband and it went of inadvertently or he was dumb enough to piss off the wrong female.

 

[EM2BE]

How are you certain the anaphylaxis was due to Benadryl? I assume the person took the Benadryl to treat something else, which raises suspicion.

Just itching. No rash. Reason the connection was made, plus the timing after it was given.

 

[Arcan57]

As the "tint" on the glasses increases, the probability of having the Dx of FM at least sometime in life approaches 100%

I hate when someone comes in with the non-street legal tint and they don't have headache or blindness. It always feels like I'm waiting for the other shoe to drop. Like someone with an hand covered in bloody bandages that's chief complaint is fatigue or dysuria.

 

[NEATOMD]

Rule:

If you are a female checking in with severe chronic abdominal pain, that has been worked up by multiple specialists, and you have spermatazoa in your UA, you can not demand admission for narcotic pain control.

Don't you know about the very specialized form of post-coital migraine which specifically affects the abdominal region of the sensory humunculus? Only narcotic PCA's are effective, and often require benzos for added efficacy. Oh and DHE therapy never works so don't even try it. 😛