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Discussion in 'Emergency Medicine' started by docB, May 2, 2003.
Did you tell thhem it didn't really matter, because a cockroach can't go backwards anyway? It can only move forward.
If you come to the ER complaining of loss of sensation in both hands, go ahead and play gameboy enthusiastically while waiting for the labs to come back.
If you are an almost unconcious from alcohol, well dressed man with a head lac from a fight, don't p**s off the ER staff by standing up and peeing all over the ER admission area because then they will put you in restrains and the ER doc will let the nurse add some furosemide to the IV fluids. After some time the ER staff will come to your bed and watch you making your nice suit wet...
I had a restrained, supine patient that I was interviewing say "Hey man, you ain't got no boogers in your nose."
Well, thanks for noticing!
I just love this stuff!!!!!!!!!!!
I am an EMT basic student .
Does this stuff really happen ???
ever notice how narcan seems to ruin a perfectly good overdose ??????
If you're a 20 year old aspiring, but still amateur, alcoholic and you get well and truly lit and find yourself passed out on an ED bed with a full bladder, by all means stand your wobbly ass up, drop trou right in front of God and everyone and let 'er rip!
Actually, I was fairly impressed. Dude managed to get about a 45 degree arc, hit half way across the room and keep it at full stream for close to two minutes!
If you're an obnoxious, stuffed shirt executive from out of town and you and your colleague get drunk and have an MVA and are brought to the ER on spine boards with handcuffs, once we clear you and the cops cite and release you by all means make a pass as the female medicine resident. When she blows you off you should absolutely make a comment about her being a "stuck up bitch" and a "fake blond." After that same med res turns around and reads you a 2 minute riot act at the top of her lungs that is clearly audible to God and everyone in the ER and utilized the phrase "tiny penis" 12 times by all means come to me and say "You're in charge here. What are you going to do about that?"
It gives me the opportunity to say, "I going to explain to YOU that what YOU said was inappropriate and have YOU (and your tiny penis*) excorted out of the ER."
*I didn't say that part but I should have. If anyone ever invents a time machine it's main benefit to mankind will be to eliminate the angst of not thinking of the perfect come back for at least 24 hours.
After you bring your 775 lb body to the ED to w/u a foul odor from your rectum and upon examination (with one person holding up the left buttocks with all his might) a lost television remote is found abscessed inside your gluteal fold, by all means, ask if you can have it back because you were tired of changing channels with your cane and by throwing objects at the television. Really, there is no need to question just how or why the remote is there.... True story from my MS-III days......definitely propelled me into EM
***I jokingly asked my attending if he thought passing gas would change the channels. Now that would be confusing for the patient
In the vein of obnoxious drunk patients. If you are a well dressed yuppie out for a night of drinking don't get so drunk that you pass out in the back of your cab and vomit on yourself. This will result in the cab driver bringing you to the county hospital. Once you wake up don't start screaming about how you have health insurance and over a million dollars in the bank and so you don't belong with poor people, incompetent doctors, and mean ugly nurses at the county hospital. Then demand to be transferred to a nonexistant hospital in a rich part of town. Finally start demanding to know the SAT scores and names of colleges and medical schools of the med students and residents working in the ED while speculating about how much better your scores and college was. I finally told him my SAT scores (which were better even then his probably fictitious ones) and the list of ivy league schools I had spent way to much time attending. Then I took away his wallet, cell phone, and clothes and locked them up for safe keeping while sending him to detox wearing a hospital gown. He was much nicer when he came back the next day to retrieve his personal possesions.
Doesn't everyone have a foul odor coming from their rectum? Should we all go to the ER?
After you fall and hit your head on the ice while trying to dig your car out of a snow bank by all means get angry and wedge your snowbrush on the gas peddle while you dig out the rear tires and then act amazed when you get run over by your own car.
After volunteering to let a medical student perform a psych history on you, definetely threaten to "**** him up" when he greets you. When he politely asks you about your day, proceed to pull down your pants and ask him to suck it. Then, when the observing physician promptly ends the session, sweetly ask why.
1. Using a blow-torch to work on your car (near the fuel tank, of course--geniuses, every one of 'em!) is pretty much guaranteed to win you a tour of the Burn Unit, followed by a free trip to the morgue.
2. The F-150 will ALWAYS win. Don't even try it.
3. Believe it or not, there IS a difference between your 3 year-old nephew and a shooting-range target.
Don't go to work probably still drunk, bend over to pick something up while your buddy is cutting something with a circular saw so that you cut open your scalp and skull..........
If you're a psych pt who wants to go home and you've sold the psych social worker that you're a fine upstanding member of society and I'm on my way to dc you don't leap out of bed and attack the RN just prior to my arrival. You'll just wind up back on your hold in 4 points with a hip full of vitamin H.
If you don't know the temperature of your childs' fever because you "can't afford" a thermometer, perhaps you pawn one or both of the unopened packs of cigarettes in your shirt pocket and spend the 10 bucks to get one at walmart.
I learned this when I was shadowing some paramedics in rural OK.
If your family/doctor/government whatever has taken away your drivers license because you have frequent seizures and refuse to take your pheno, please use a riding lawn-mower as your primary means of transportation. Chances are, you won't seize, hit a telephone pole, burn your leg and scalp on the mower as you fall off of it, and cause a power outage in your surrounding area.
Also, if you've been to a derm, and they've frozen off various seb kars, sun spots, etc, with liquid nitrogen, by all means use liquid CO2 as a home remedy to avoid paying the doctor's bill.
I mean really, folks.
I love patients who say that the doctor's bills are too high but it's appropriate to have a Escalade and be on welfare. Luxuries are never too expensive, but saving lives is.
These are the people I see on the show Repo-Men complaining that they NEED the expensive car to get to work to pay for their kids food!
Newark NJ: the "i cant afford my kids medicine but I have a cell phone, a pack of smokes and a quarter to rub off my instant lottery ticket" Capital of the World
If you're getting older and having trouble balancing while sober, by all means get drunk and then try to ride your bike back home one-handed (the other hand needs to hold the six pack).
Threatening the ER doctor with "I'm going to leave," and "I'm going to pull this (male) foley right out," are effective ways to get things done faster.
While yelling at the top of your lungs that you are having chest pain and you need a doctor to see you immediately, it is best to quit masterbating once said doctor enters the room to evaluate you. Your doctor really doesn't want to see you do that.
This happened to me yesterday (I was the doctor, not the pt). I was never able to get a clear answer as to if his pain was exacerbated by this form of "exertion".
Along this same vein...
I got called in by my Dept Chief after a patient complained that I "didn't do anything for him". He was complaining of generalized weakness and syncope, I launched into the entire w/u including CT and Cardiac. After a few hours one of the nursing assistants went into the room to stock and found the patient being "stimulated" by his friend.
As is my usual practice, I documented a recheck note:
"Pt receiving handjob, feels much better, w/u negative, will D/C"
heh, you said vein.
That is some thorough documentation.
There's a little corner of my brain that wants all of life to be a wacky '80s sex comedy. So I'm imagining the gruff, white-haired, button-down Chief of Staff, wandering through the department at the exact moment that pt is being discharged.
"Feeling better, are we, sir?"
"Ohhh, yeah. I feel real good."
Incarceration (with guard at beside), severe chest pain, hemiparesis, and a Foley (!) should not be a impediment to masturbating while the med student tries to listen to your heart.
Did the pt. have a positive Throckmorton's sign?
OK, I'll bite. What's a Throckmorton sign?
When an XRay shows the penis pointing in the same direction as a fracture, typically hip. Not suprisingly, the sensitivity isn't all that great.
In this case, however, perhaps it means that dude's penis (with foley in place, mind you) was aimed at the poor medical student.
Also known as:
John Thomas' sign
Tom Bentley Throckmorton
Also known as the John Thomas sign. Synonym: position of the penis in relation to unilateral disease. Throckmorton's sign is a slang term used jokingly by medical students and residents. A positive "Throckmorton" sign is when the patient's penis lies to or points to the side of the body wherein lies the abnormality on a plain X-ray of the Pelvis. For example, a broken right hip with a shadow of the penis pointing to the right has a positive "throckmorten". If there is no abnormality, a jovial Radiologist might tell the referring Physician; "He's Throckmorten to the right so you might want to check over there.?
We thank Kris Rowney, Mike Michaels, George Broughton and Roger Blauvelt for information submitted.
* A. E. Baogaert:
Genital asymmetry in men. Human Reproduction, Oxford, 1997, 12: 68-72.
* R. H. Chang, F. K. Hsu, S. T. Chan, et al:
Scrotal asymmetry and handedness.
Journal of Anatomy, London, 1960, 94: 543-548.
* Merlin C. Thomas, Brett D. Lyons, Robert J. Walker:
John Thomas sign: common distraction or useful pointer?
Letter. The Medical Journal of Australia, Sydney, 1998, 169: 670
In this instance, I was wondering if the penis was deviated toward the side of the hemiparesis.
Not too specific but very sensitive apparently.
This thread is awesome! Here are a few from my pre-med ED volunteer experiences:
If you decide to show off how tough you are to your girlfriend by picking up a rattlesnake and swinging it around by its tail, remember that it does have the ability to move and can very easily bite you on the thigh. Then act all surprised when you have to be treated with anti-venom and admitted and complain that "you f--cking docs ruined my family's bbq."
If you weigh 400+ plus pounds, are diabetic, and have not taken your insulin regularly for "several years," do not be surprised when the nurses take away the two Big-Mac extra value meals that you sent your family out to get while you are being treated.
If you use heroin on a regular basis and are severely constipated, coming back to triage 6 hours after leaving with a 30 day supply of OTC laxatives and taking ALL of them already probably isn't going to help. Rolling on the floor and screaming "Give me more of them, I ain't sh!t in 2 weeks" probably won't help much either.
The level of traffic through the trauma room is inversely proportional to my need to get experience working in the trauma room.
My most recent 16 hours in there, I've had one case. The most recent 16 hours I've been working in sub-acute areas, there have been about ten.
This happens to me too!!!!!!!!!!!!!!!!!!!!! Glad I am not the only one!
If you're a 16 y/o male who comes to the ER at 3am on a Friday night c/o "spider bite on penis," try not to start crying when you find out it's actually herpes.
I gotta admit though, I did feel bad for the kid.... looked like he got hit by a train after hearing the news.
As a future physician/physician assistant, I come over to the ED as a registrar. Is it me, or have I waxed philisophical since I started about the .00000000009% of the patients coming here not being emergent?
Finger pain, toe pain, these are not emergencies.
Send me my first trauma, please
Don't stick things in your rectum. A good general rule. Should you break this rule be sure that you are not a 14 year old boy who has swiped your mom's vibrator. Once the vibrator disappears and doesn't come out for 3 days you will have to come to the ER and go for an EUA/removal. Trying to explain this string of events to your dad is significantly more akward than, say, explaining how you wrecked the car.
PS- This case was disturbing to me on many levels.
PPS- string, why don't they ever use string?
Along this same vein:
If you are 13 and feeling....experimental....Don't use the dish hose from the sink as your ambassador to rectal pleasure. If you do, the spring-loaded handle thingy will open after you shove it up past the anus, making it impossible to get out.
Furthermore, it will be difficult to explain to your step-father when he discovers you how you became 'tethered' to the sink by the dish hose.
You'll have to have it surgically removed. And I'm betting nobody will volunteer to do the dishes ever again...
Some strange things in some strange places...
Pt brought in from Psych hosp for unexplained fever. Did a KUB as he was tender in his abd. Guess what we found... a blade and a small pencil.
No he didnt swallow these. It was in his bladder. The guy had inserted it up his urethra.. Dont think about it guys...True story, I swear..
I am squeamish when I think about it........<shuddering in disbelief>
Say it ain't so......
Oh, we have a frequent urethra FB flyer. He's been in more than a dozen times, 3 of those times I've witnessed myself. One was a metal ring, the other a button, the other a number 2 pencil. He has put knives up there before. He's given himself a (I didn't know this happened) a traumatic hypospadias.
Check it out,
A related thread on the PharmD board and pretty funny too. DocB appears to have really started something here.
Yeah, we had a guy that was a frequent flier for URO and GI. He'd either (or both) jam stuff up his urethra or swallow it. He was a resident of the local max sec prison. It was sad, I'd call up URO or GI and just say Mr. X is here and they'd say I'm on my way.
Damn. I didn't leave myself any plausible deniability.
While I was on an EM away we had a guy come into the prison ward with a pencil jammed up is urethra, and this was listed as his chief complaint. When I grabbed the chart and saw this, I laughed and showed my attending. He said "Don't worry about it, that's just 'Joe', he's here all the time with that. Go examine him and then call urology." So I go to examine my patient, whose name on the chart says "Steve". I ask "Steve" if he also goes by the name "Joe". Steve laughs and says "No, Joe got out last month..." So what I'm left trying to figure out is if there is some rule at the prison that someone always has to do this. I mean, they let Joe out and now it's Steve's turn?!? WTF?!?
God, I love EM!