The On-Call Diaries / Blog

[TheWowEffect]

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Yay! my last call tonight ....and it's surprisingly quiet today. Got called from the ER for a dump. Refused to take him. The guy was in a real bad shape. Post MVA and CHI. Dumped by rehab center for altered mental status🙄

 

[Anasazi23]

Congrats!

And way to punt the dump!

 

[TheWowEffect]

Thanks!

Just admitted a guy who is almost catatonic. He made the evaluation all the more easy for me😉 Poor guy was also snowed by all the Zydis they gave to him in the ER.

7 more hours to go!!!

 

[Doc Samson]

Thanks!

Just admitted a guy who is almost catatonic. He made the evaluation all the more easy for me😉 Poor guy was also snowed by all the Zydis they gave to him in the ER.

7 more hours to go!!!

Nothing like giving a catatonic a neuroleptic to really lock them up for a while.

 

[DrIng]

Oh dear, I just admitted Santa! And he was in the hallway, long beard, red suit and all, kicking and screaming all the way... I think I'm on the naughty list....

 

[OldPsychDoc]

Oh dear, I just admitted Santa! And he was in the hallway, long beard, red suit and all, kicking and screaming all the way... I think I'm on the naughty list....

Great. Now what am I going to tell my kids? 😡
I suppose all that talk about elves and magic reindeer, etc. isn't going to help him out in probate court next week, is it?

 

[Hurricane]

I'm on consults. Today we got consulted for a guy for altered mental status, who was found confused and wandering around the basement of the hospital.

Then they said, "oh wait, they're taking him to the OR now, you might want to wait and see him tomorrow."

The OR? Why's he going to the OR?

"Oh his CT showed a subdural hematoma, so they're taking him down to do some burr holes."

Hm, ya think maybe the subdural hematoma has something to do with his altered mental status?

"Maybe, but the computer shows he has a history of depression, so we'd like psych to see him."

Argh! 🙄

 

[Psychintern2006]

Had a quiet night after a long time, nothing after 12.00 clock. just one ER Discharge - can I be your patient...

 

[DrLooney]

Has anyone here on-call , encountered patients who had suicidal tendencies which were ONLY recurrent when they had PMS?

I have a friend who has been otherwise stable on her antidepressants for many years but tried to overdose on sleeping pills not too long ago when her PMS related depression was too painful for her to deal with and her doctor's schedule was too busy. I told her she should have presented herself to the ER. She doesn't like to talk to her friends or family when she feels tempted to hurt herself. Her PMS is not as devastating every month but every few months it can get to the point of being debilitating.

She is aware that it is a medical problem so she's not in denial but she told me that the next time it gets as bad as it did in her last attempt, she admitted to being scared about what she will do to herself.

Is there a real scientific basis behind PMS psychosis/depression? Does hormone therapy play a role in alleviating the symptoms?

 

[Anasazi23]

Is there a real scientific basis behind PMS psychosis/depression? Does hormone therapy play a role in alleviating the symptoms?

Frequently.

http://www.psychosomaticmedicine.org/cgi/content/full/62/1/50/TBL1

Late luteal and follicular phases (essentially lowest estrogen) tend to be most related to increased incidence of attempt.

 

[Anasazi23]

Not on call anymore, but took the page as a senior from a junior resident presenting to me:

Point of advice: I'll generally tell you to admit the patient if you tell me that when you asked the woman in the ER for her recent discharge papers from a neighboring hospital from the previous week, she removes said papers from her vagina and attempts to read them.

 

[Solideliquid]

Pwned!