Things I Learn From My Patients

Discussion in 'Emergency Medicine' started by docB, May 2, 2003.

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  1. Forensic Chick

    Forensic Chick 10+ Year Member

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    Jan 29, 2002
    California
    I, like UTH2003, have not started MS1 yet, but I have worked in an Emergency Dept for a year now. May I add that when stealing a Rx pad to fill it out correctly when turning it into the pharmacy the following day. They realize something is fishy when you write for "1.2 pounds of Mofin" (yeah, sound it out). Also, don't try to pierce yourself with a large gauge fishing hook (especially a prince albert) or decide that the medical equipment in your room is included in your stay; you really won't be able to use that chest tube that you try to stuff into your purse or the epistaxis clamp that you think would increase your sexual adventures. I totally stopped believing in "survival of the fittest" when I started working in the ED.......
     
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  3. Scrubbs

    Scrubbs Chisellers beware! 7+ Year Member

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    NeverNeverLand
    If you don't like dialysis, just stop going... its one of those optional things, right? Also, if your body swells up with anasarca, you feel crappy, you have a Hgb of 6 and your doctors tell you that you could bleed to death b/c you're in DIC, its ok to sign out AMA if you're tired. A good night's sleep at home will make it all better!
     
    redsox93 likes this.
  4. Febrifuge

    Febrifuge Grizzled Old Newcomer 7+ Year Member

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    I am also pre-med, and yet (no offense to UTH2003) I am not making this up; I don't need to. I volunteer in an inner-city ED.

    1) Mosquito bites itch. A lot. Really, really bad. So much in fact that, what the heck, you may as well go on in to the Emergency Department.

    Did I mention they really itch? Bad?

    2) Under no circumstances should you apply calamine, or benadryl lotion, or really anything at all, to try to alleviate the itching. It's not like you can just get that kind of miracle drug at the store. Much better to just come on in.

    3) If you've been triaged, you've been to see the ED admissions folks, and then you need to wait all of 30 minutes before being able to see a doctor, well shoot, that's too long. Just tell the staff you appreciate it all the same, but you need to go.

    This patient saved the county some cash by eloping, so that earns them a tiny sliver of respect. I wonder how their insurance will like that charge for the triage, though...
     
    GroverPsychMD likes this.
  5. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

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    I've seen the mosquito bite patient too but even better I once spent a day snowboarding and forgot to wear sunscreen. I got an absolutely blistering sunburn. A coworker picked up a chart and said, "oh, K****, you should see this one." The chief complaint was sunburn. I went in and said, "Hi, I'm Dr. M*****. How can I help you?" to a patient who wasn't burned nearly as badly as I was. Without even making eye contact the sniveling, crying patient began telling me about their horrible, painful sunburn. In mid sentence they happened to look up at me, said, "Oh!" and stopped crying.
     
  6. DrQuinn

    DrQuinn My name is Neo Moderator Emeritus 10+ Year Member

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    tee-hee!
    :laugh:
     
  7. Febrifuge

    Febrifuge Grizzled Old Newcomer 7+ Year Member

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    Brilliant. Just brilliant. You, sir, get the propz. :D
     
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  8. Hayduke

    Hayduke Member 10+ Year Member

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    canyonless wasteland
    When your 15yo daughter gives precipitous delivery to a bleating, underweight infant 30 minutes after presenting to triage c "gas pains", you should run around the department loudly yelling, "I don't know what y'all did or who that baby is, but my lil' girl warn't pregnant when she come in here"
     
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  9. streetdoc

    streetdoc Senior Member 10+ Year Member

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    The Tundra
    i can't resisit sharing
    if you are going to have a leg amputated in a car accident be very sure that the neighborhood dog is not lurking in the area...they tend to take what they can get. even legs!
    what a nght...

    streetdoc
     
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  10. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    Truly cool. I wouldn't suggest this same approach with stab wounds or STDs.

    When I was a resident I had an attending who was so sick one night she was having to excuse herself during her histories to go vomit. On toward about 2am she asked me to cover everything for an hour so she could lie down. She had a nurse stick an IV in her and soaked up IV fluid for and hour and then went back to work. She would put her white coat over her IV and do her thing then go back to her desk and plug in while she charted. Crazy.
     
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  11. mikecwru

    mikecwru M.D. = Massive Debt 7+ Year Member

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    Alcohol, table saws, and flannel shirts do not mix.

    mike
     
  12. TMarkus

    TMarkus Member 7+ Year Member

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    Bellingham
    Never underestimate the power of a small laser dot on the chest
    (emitting from the cops gun) to calm down an unruly patient. It was the easiest four point restraint ever!
     
    GroverPsychMD likes this.
  13. Scrubbs

    Scrubbs Chisellers beware! 7+ Year Member

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    NeverNeverLand
    That's so West Philly!! I've heard a couple of similar stories about people giving birth and then saying, "That baby ain't mine!"
     
    emergencycat likes this.
  14. edinOH

    edinOH Can I get a work excuse? 7+ Year Member

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    On my very first shift as a resident I learned that patients wait until shift change to code. This lady had been in the ED for about 4 hours and was in the process of being admitted to the unit. Then, right as we are getting ready to leave she decides to go into vfib. I think she did it just to piss us off.
     
  15. mikecwru

    mikecwru M.D. = Massive Debt 7+ Year Member

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    ... if you're not happy with the speed of your nurses and discharge process, it's a good idea to go up to the desk every 5 minutes and ask what's taking them so long. They'll go even faster if you start throwing things and telling everyone to **** off.

    mike
     
  16. mikecwru

    mikecwru M.D. = Massive Debt 7+ Year Member

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    ... whenever you have a 30+ year old guy in the room and here's there with his mom, things cannot be good/easy.

    mike
     
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  17. DrQuinn

    DrQuinn My name is Neo Moderator Emeritus 10+ Year Member

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    When you try to steal the otoscope from the WALL UNIT, make sure to unhook the power wire that attaches the scope to the base. Having a wire run from the wall unit to your pocket isn't as smooth as you think at 11:30 PM in the ED.

    Q, DO
     
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  18. Chode

    Chode Banned Banned

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    shame. what a waste of good blow

    aspiration : tastes so nice I inhaled it twice!

    good ET tube will fix that....
    dirtballs get the med student intubation
     
  19. emedpa

    emedpa GlobalDoc 10+ Year Member

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    Taking an Away team....
    it's ok to smoke at home as long as you do it outside when the kids are home even after all 4 of them have recurrent om with multiple ent visits and surgeries and asthma requiring frequent ed visits and maintenance steroids......
     
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  20. Annette

    Annette gainfully employed Lifetime Donor 10+ Year Member

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    The Land of Lincoln
    It's ok to leave AMA to go have a cigarette while you are actively infarcting, especially if I haven't had to do the H+P yet.
     
    redsox93 likes this.
  21. EMIMG

    EMIMG Senior Member 7+ Year Member

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    When you are a recent home hospice patient due to end stage COPD, and you are on home oxygen, it is OK to go and light a cigarette and have it flash up and burn your face.

    It is then OK to have your family call EMS for you.

    Furthermore, while EMS is getting there, it is OK to go agonal and eventually code with no specific No-code instructions.

    So, it is OK for EMS to bring the patient into the hospital where the patient is PEA on the monitor (thankfully the family was there and confirmed his DNR wishes).

    Then, to top it all off, when you call the ME to report the case, and tell them that the patient is in hospice, the ME still says that they have to bring the body in becasue of the "trauma" that the guy sustained while lighting the cigarette on oxygen.
     
  22. Chode

    Chode Banned Banned

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    Jul 10, 2003
    the big rush usually occurs after Jerry Springer finishes at 2 AM.
    There is a late bus that brings in all those folks with chronic complaints, that had a very busy day.

    Jenny Jones
    ricki Lake
    Judge Joe Brown
    Judge Judy
    Oprah
    Re-runs of Fresh Prince.

    YEs, it's tough to make it in for your back pain times 5 years, when you have such a busy schedule.

    Thank God for the ill of the world that it's basically only infomercials after 2 AM. They'd never seek treatment!
     
  23. Chode

    Chode Banned Banned

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    Jul 10, 2003
    We prefer the Term AMF to AMA...


    Adios Mother fu**er!
     
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  24. m and m

    m and m Member 7+ Year Member

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    HO HO

    I liiiike it!

    Nurse, please make sure they sign the AMF form before they go.
     
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  25. 16846

    16846 Guest

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    Make sure to have your boyfriend re-insert the same 12" dildo that was taken out of your ?booty? with twice as much force this time after it was in there for a few hours and was forcibly removed by the ED personnel 2 hours ago because surely the hole is now open enough that it won't get stuck a second time...
     
  26. emdoc21

    emdoc21 Member 7+ Year Member

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    Learned from a patient last week.....

    Injecting a mixture of wine, Klonopin, and Lidocaine into your veins may seem like a cool idea at the time when you're wasted, but can leave a nasty phlebitis a few days later.
     
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  27. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    What goes with Klonopin? Red or white?
     
  28. EMRaiden

    EMRaiden Senior Member 10+ Year Member

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    I had a patient come in the other day complaining that he had had Hepatitis B so long it had turned into Hepatitis C...:laugh:
     
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  29. DOrk

    DOrk Digital Rectal Examiner 7+ Year Member

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    Pt came in w/ "contractions" q 5 min. When asked about the prominent scar on her belly she said it was from her hysterectomy
     
  30. anonymousEM

    anonymousEM Senior Member 10+ Year Member

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    Unlike most pts who frequent the county ED and "take some pills for somethin' " The daughter of my latest AMS brought in the meds she could find in the house. 2 Bags with 51 bottles and 18 different meds all mixed up and a gallon baggie with an array of brightly colored pills. As one resident said, "It's like Fruity Pebbles"
     
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  31. mamadoc

    mamadoc Old Member 7+ Year Member

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    May 17, 2002
    I've been enjoying this thread immensely and after two weeks in the ED I can add to it!

    The medical student examining you has the power to get the cops to loosen your handcuffs. Just ask her! :rolleyes:
     
  32. tRmedic21

    tRmedic21 useless... 7+ Year Member

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    Just an MS2, but 7 years as a p-med.....

    After cutting your own throat with a box knife and missing all major vessels, it is a good idea to stand outside and have a smoke while awaiting the ambulance... the crew will likely get a good laugh out of watching the smoke pour out of your nearly-transected trachea!

    Also, after inserting a toilet brush wrapped in duct tape and saran wrap into your rectum (23 y/o male) and having the handle break off (DOH!), have your mother drive you to the ED.... it always makes for good conversation in the car!

    Man I love this passtime... maybe I should look into an ED residency?
     
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  33. tRmedic21

    tRmedic21 useless... 7+ Year Member

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    If, after 83 years of living the life of an uncircumcised man, you decide to dehood yourself with a steak knife, you prolly don't wanna wait 2 days before you let someone know things aren't healing too well down there!
     
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  34. MoCookiess

    MoCookiess Hater of Biochemistry 7+ Year Member

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    Austin, TX
    I love this thread! If you just can't get enough of these stories, go find/buy Emergency, by Mark Brown... its a bunch of collected stories of EP's most memorable cases.
     
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  35. soluentgreen

    soluentgreen Junior Member 7+ Year Member

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    If you are in police custody and are brought to the ED for evaluation, do not go to the bathroom then try to escape through the ceiling, because the styrofoam ceiling will probably collapse at some point and the NYPD standing outside the bathroom door might notice your bare behind, scantiliy covered by the hospital gown, hanging out of the ceiling.
     
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  36. citygirl

    citygirl Land of Happy Cows 7+ Year Member

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    It takes three large adults to hold down one five year old with a bead up his nose so the ENT can get it out without ramming the hook into his little five year old brain (the same brain that thought sticking the bead up there was a good idea so he could gross out his sister).

    That broken hand you deliberately smashed with a hammer will get you ONE PRESCRIPTION FOR VICODIN, NO REFILLS. Do not go home and remove the cast and try to return to the ER two hours later to get more. We are busy, but we will remember you.
     
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  37. charlie brown

    charlie brown Junior Member

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    If you have an appointment with your ob/gyn in two days, but have a hot date tonight and realize that you "smell down there," come on into the ER to get that fixed, because, man, we love gynecology. That's why we went into EM.
     
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  38. citygirl

    citygirl Land of Happy Cows 7+ Year Member

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    Blue Nun.:laugh:
     
  39. emedpa

    emedpa GlobalDoc 10+ Year Member

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    Taking an Away team....
    if you have a retained fb in your(fill in an uncomfortable place here) and its been in there for 2 months, the best time to come into the e.d. to demand to have it removed is at 2 am on a saturday in the middle of summer.your triage nurse is then likely to triage them in front of everyone with an acute injury because you have" 10/10" pain.
     
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  40. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    If you're a 13 year old girl with a long arm, fiberglass cast on it's totally OK to go swimming at the beach (she didn't even try the usless bag with duct tape trick). When your dripping, sand filled cast starts to itch be sure to use a bent coat hanger to pull out all the cast padding. Since that won't work (I swear I'm not making this up) go ahead and pour salt down the cast on the assumption that it will soak up the water. Once your arm is a red, macerated mess come on down to the ED.
    Aside from the stupidity of this course of action this girl also had a weird affect so I asked if she was developmentally delayed. This thoroughly annoyed the girl and her mother but the dad said, "Well I can see why you might think that but no."
     
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  41. I, too, definitely recommend Mark Brown's Emergency! and the stories by DOs, MDs, nurses, etc are all compiled in that book! There were many times I was laughing out loud while reading some of them!
     
  42. mikecwru

    mikecwru M.D. = Massive Debt 7+ Year Member

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    If your ass is sore from lots of diarrhea, turpentine can be quite soothing to your anal sphincter.

    mike
     
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  43. RPW

    RPW 10+ Year Member

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    I just got throught reading a book by an ER doc written in the 70's it was called Breath, Little boy, Breath.

    Really a good book with lots of funny stories in it but I cant remember who the author is.
     
  44. eddieberetta

    eddieberetta 10+ Year Member

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    :laugh: :laugh: :laugh:
    That is just classic!
     
  45. Voxel

    Voxel Moderator Emeritus 7+ Year Member

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    You guys crack me up.... got any more stories?
     
  46. monkeyarms

    monkeyarms jello wrestler 7+ Year Member

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    all up in your area
    if you ever "wake up" and you are "shaking and unconscious" it probably means that you are having a seizure. if the attending physician finds this to be unlikely, simply explain that you used to be a model but now have fat fingers and that your feet feel as if someone has "blown them up with dynamite." that will certainly nail down the diagnosis, in spite of the fact that you perform all tests of neurological function with extreme vigor. if this still doesn't get you admitted, you can demand treatment for a 2 centimeter scab on your ankle and explain that you think it is "developing into AIDS."
     
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  47. Sweet Tea

    Sweet Tea Girl Next Door 10+ Year Member

    When your 97-year old mother trips and falls on the floor and doesn't say anything or really seem to move at all, you should definetly wait 5-6 days before calling EMS. If she starts to feel cold (even though she hasn't said that she's cold), just cover her with blankets and surround her with space heaters. She's probably just sleeping and will get up when she's good and ready. Nevermind the smell and the roaches.
     
  48. EMRaiden

    EMRaiden Senior Member 10+ Year Member

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    If your "privates" are irritated and itching try using some Car Wash on them... the ammonia is guaranteed to help..:confused:
     
  49. Sessamoid

    Sessamoid 1K Member 10+ Year Member

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    If you're an alcoholic and feel the craving, don't go into your grandmother's medicine cabinet that hasn't been cleaned out since before the second world war (and probably closer to the first) and drink an aromatic-smelling bottle labelled, "Oil of Wintergreen."

    He had the lowest pH I'd seen of any patient who had a pulse (or at least had one until just before they hit the ER).
     
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  50. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    I have to admit I didn't learn this one from a patient. If you're an EM intern and faced with a grueling manual disimpaction and you can't find clove oil to put inside your mask don't substitute oil of wintergreen. After a half hour of fumes I don't think I got toxic but I sure felt really strange for the rest of the shift.
     
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  51. Sessamoid

    Sessamoid 1K Member 10+ Year Member

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    LOL! Why exactly did you even have oil of wintergreen at your disposal? It would have been interesting to see what your ABG showed.
     

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