Things I Learn From My Patients

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad :)
DCGuava said:
Actually, it works just fine for me...but then again, I'm on Chrome...
Click to expand...

Dude, you're perseverating. Your link was formatted incorrectly. Period. You say you use Chrome - which may be why it forgave your wrong Google link. I would have copied it and put it here clearly for all to see - but, as I notice, you edited your post, and put a correctly formatted link in there. A very small measure of courage of your convictions would have been to leave it there, boldly and unflinchingly, stating "there it is. Suck it!".

However, in my quoted post, your dud link is still there. Stand by for that.

Here it is: http://www."https.com//www.google.com/search?q=fruit+ninja

So, you are just sloppy. If you would have said, "My mistake! Let me fix that", instead of making some lame (non)excuse, then there would have been nothing.

So, you call it snark when you get called out for putting up a functionally dead link - which, if done appropriately, is snark - sarcasm?
 
Apollyon said:
Dude, you're perseverating. Your link was formatted incorrectly. Period. You say you use Chrome - which may be why it forgave your wrong Google link. I would have copied it and put it here clearly for all to see - but, as I notice, you edited your post, and put a correctly formatted link in there. A very small measure of courage of your convictions would have been to leave it there, boldly and unflinchingly, stating "there it is. Suck it!".

However, in my quoted post, your dud link is still there. Stand by for that.

Here it is: http://www."https.com//www.google.com/search?q=fruit+ninja

So, you are just sloppy. If you would have said, "My mistake! Let me fix that", instead of making some lame (non)excuse, then there would have been nothing.

So, you call it snark when you get called out for putting up a functionally dead link - which, if done appropriately, is snark - sarcasm?
Click to expand...

:love::love::love::love::love:
 
If your wife falls down and feels numb on half of her body, make sure to have her "sleep it off" for several hours before you take her to the ED the following morning. The neurologist will tell you that her deep lacunar lenticulostriate stroke has left her paralyzed on half of her body with severe neglect, and she probably could have had full function restored had you bothered to bring her in earlier.
 
Members don't see this ad :)
It's the perfect weapon! You can shame the fruit before killing it!
 
If you have a fracture, please spend 5 minutes of my time insisting to me that there is a difference between a fracture and a broken bone.
 
Aesculapius said:
If you have a fracture, please spend 5 minutes of my time insisting to me that there is a difference between a fracture and a broken bone.
Click to expand...

"Your rib is fractured." "So it's not broken, right?" "Yes, it is broken." "But what about cracked ribs? I know for a FACT that those aren't broken." "Sir, I don't know what to tell you."

Similar exchanges are present elsewhere in this thread.

(edit for Autocorrect)
 
Last edited:
You can blame this on high school health class. I distinctly remember our teacher telling us that a fracture means that the bone is not broken thru and thru (part is still attached to itself) and a broken bone means that there are now two pieces instead of one... LOL
 
  • Like
Reactions: 1 user
Unzbuzzled said:
If your wife falls down and feels numb on half of her body, make sure to have her "sleep it off" for several hours before you take her to the ED the following morning. The neurologist will tell you that her deep lacunar lenticulostriate stroke has left her paralyzed on half of her body with severe neglect, and she probably could have had full function restored had you bothered to bring her in earlier.
Click to expand...

How could coming to the ER have "probably" restored full function in that case?

Poetic Silence said:
It's the perfect weapon! You can shame the fruit before killing it!
Click to expand...

Taken just by itself out of context I find that quote absurdly hilarious. I don't know why.

killerleaf said:
You can blame this on high school health class. I distinctly remember our teacher telling us that a fracture means that the bone is not broken thru and thru (part is still attached to itself) and a broken bone means that there are now two pieces instead of one... LOL
Click to expand...

No amount of funding can fix this.

Apollyon said:
"Your rib is fractured." "So it's not broken, right?" "Yes, it is broken." "But what about cracked ribs? I know for a FACT that those aren't broken." "Sir, I don't know what to tell you."

Similar exchanges are present elsewhere in this thread.

(edit for Autocorrect)
Click to expand...

Perhaps we can give out a Thesaurus with every sling and set of crutches.
 
docB said:
No amount of funding can fix this.

Perhaps we can give out a Thesaurus with every sling and set of crutches.
Click to expand...

I'm sure I give my PG scores a hit everytime I talk to one of these people.
"So, is it a fracture or is it broken?"
"Well, those mean the same thing, and I don't know what meaning you give each word, so I'm just going to tell you it's both."
"..."
 
Dr.McNinja said:
I'm sure I give my PG scores a hit everytime I talk to one of these people.
"So, is it a fracture or is it broken?"
"Well, those mean the same thing, and I don't know what meaning you give each word, so I'm just going to tell you it's both."
"..."
Click to expand...

lol, i'm sure that people really are thinking displaced/angulated vs. nondisplaced fx when they try to affix a difference in meaning to the two worse, but I still can never figure out which one means which to them.
 
Rendar5 said:
lol, i'm sure that people really are thinking displaced/angulated vs. nondisplaced fx when they try to affix a difference in meaning to the two worse, but I still can never figure out which one means which to them.
Click to expand...

Broke = displaced

Fracture = nondisplaced


At least that is how it works in my part of the illiterate world.
 
docB said:
How could coming to the ER have "probably" restored full function in that case?
Click to expand...

I'm only an MS1, so forgive me if I don't know all the ins and outs of stroke management yet. It's just my understanding that tPA can work wonders on thrombotic strokes if you get it onboard within a few hours. Waiting several hours to get help certainly didn't improve this patient's chances of recovery, and its astonishing that symptoms as severe as those found in a lenticulostriate stroke weren't enough to warrant a fast trip to the ED. So I misspoke by inferring she could "probably" have a full recovery, but it's not outside the realm of possibility, and her chances of regaining function would be significantly improved had she been brought in earlier.
 
Unzbuzzled said:
I'm only an MS1, so forgive me if I don't know all the ins and outs of stroke management yet. It's just my understanding that tPA can work wonders on thrombotic strokes if you get it onboard within a few hours. Waiting several hours to get help certainly didn't improve this patient's chances of recovery, and its astonishing that symptoms as severe as those found in a lenticulostriate stroke weren't enough to warrant a fast trip to the ED. So I misspoke by inferring she could "probably" have a full recovery, but it's not outside the realm of possibility, and her chances of regaining function would be significantly improved had she been brought in earlier.
Click to expand...

That may be what neurologists tell you, but tPA isn't a miracle and rarely produces such great results.
 
Rendar5 said:
That may be what neurologists tell you, but tPA isn't a miracle and rarely produces such great results.
Click to expand...

Thanks for the info Rendar5; chalk it up to naiveté. I should always remember that things in the clinic are seldom as simple as how they are presented in lecture. Probably why the residents roll their eyes when we students think we know how to manage what appears to be a simple patient case...
 
K31 said:
It must seem like a miracle to neuro--hell, some patients even improve after it.
Click to expand...

I've seen it cure a dense hemiparesis once, kill a couple other people, and do a whole lot of gobbledygook in the rest. 1 out of 6 trials showing mildly improved outcomes isn't really enough to convince me that it's a panacea.
.
 
How did it kill people? Did they use tPA in a hemorrhagic stroke case? I'm just curious- we were taught that thrombotic strokes are less devastating than hemorrhagic strokes (and other CVA types) in part because anti-clotting agents like tPA often can be effectively used to break up the clot and restore perfusion before neurological deficits occur. I didn't think it was a cure-all, but surely it has some efficacy? Or is it just a last-ditch high-risk effort to try to reverse the damage?
 
Unbuzzled: it has a significant rate of causing intracranial hemorrhage. If you really want to know about thrombolytics in stroke in detail, I suggest you check out this podcast by David Newman, which is long but will guarantee you know more about thrombolytics than anyone else in your class, and probably most residents and attendings as well... http://www.smartem.org/podcasts/smart-thrombolytics-acute-stroke

The short version that you can read if you don't want to listen: http://www.thennt.com/thrombolytics-for-stroke/
 
Aesculapius said:
Unbuzzled: it has a significant rate of causing intracranial hemorrhage. If you really want to know about thrombolytics in stroke in detail, I suggest you check out this podcast by David Newman, which is long but will guarantee you know more about thrombolytics than anyone else in your class, and probably most residents and attendings as well... http://www.smartem.org/podcasts/smart-thrombolytics-acute-stroke

The short version that you can read if you don't want to listen: http://www.thennt.com/thrombolytics-for-stroke/
Click to expand...

Thanks. I didn't realize it was such a mediocre and negligible treatment for thrombotic CVAs and TIAs. This is not at all the message I got in our Neuroscience class. It's definitely good to know though.
 
Well, it's not that it is mediocre and negligible... just that data is conflicting and it probably isn't quite all the neurologists talk it up to be.
 
In the one study that showed benefit for tpa, it helped 1/8 patients. With a 6% risk of severe bleed. Certainly not a panacea. Unfortunately, we have nothing else (besides interventional therapies, with their own risks).
 
EMapplicant2012 said:
In the one study that showed benefit for tpa, it helped 1/8 patients. With a 6% risk of severe bleed. Certainly not a panacea. Unfortunately, we have nothing else (besides interventional therapies, with their own risks).
Click to expand...

So, at the end of the day, strokes are bad, and you should try reeeeally hard not to have one.
 
Unzbuzzled said:
So, at the end of the day, strokes are bad, and you should try reeeeally hard not to have one.
Click to expand...

Or if you are going to have one...make it a really big one...preferably while you're solo through-hiking the Appalachian Trail or attempting to sail non-stop around the world twice without stopping.
 
EMapplicant2012 said:
In the one study that showed benefit for tpa, it helped 1/8 patients. With a 6% risk of severe bleed. Certainly not a panacea. Unfortunately, we have nothing else (besides interventional therapies, with their own risks).
Click to expand...

If I ever have an ischemic stroke I want my doctor to give me tpa. And if I have a big brain bleed as a result then I want them to push more tpa.
 
Doctor Bob said:
If I ever have an ischemic stroke I want my doctor to give me tpa. And if I have a big brain bleed as a result then I want them to push more tpa.
Click to expand...

This is an interesting phenomena about tPA for stroke. EP (including me) bash it routinely but we would want it and would give it to our family members. The reason though is unusual if not disturbing. We want it because we understand that it's both the only chance to do better or a quicker, cleaner ticket out. We know the risks. Patients and families just don't understand statistics. We know it's Russian roulette. It's just that we see the post stroke complications so we're relatively ok hitting the hot chamber.
 
  • Like
Reactions: 1 user
docB said:
This is an interesting phenomena about tPA for stroke. EP (including me) bash it routinely but we would want it and would give it to our family members. The reason though is unusual if not disturbing. We want it because we understand that it's both the only chance to do better or a quicker, cleaner ticket out. We know the risks. Patients and families just don't understand statistics. We know it's Russian roulette. It's just that we see the post stroke complications so we're relatively ok hitting the hot chamber.
Click to expand...

Wow. I never thought of it that way. I mean, a stoke in the internal capsule (among the most common locations) can leave you without function on half of your body along with severe aphasias, neglect, and language issues depending on the side. It was about the worst thing we saw in Neuro aside from locked-in syndrome. So it's got to be one of the hardest things to deal with for all parties- the docs, the patient, and the family. What a nightmare.
 
Unzbuzzled said:
Wow. I never thought of it that way. I mean, a stoke in the internal capsule (among the most common locations) can leave you without function on half of your body along with severe aphasias, neglect, and language issues depending on the side. It was about the worst thing we saw in Neuro aside from locked-in syndrome. So it's got to be one of the hardest things to deal with for all parties- the docs, the patient, and the family. What a nightmare.
Click to expand...

Yep. Not to get political, but things like massive CVAs, locked-in syndrome, Huntington's, ALS, and the like are the very reasons why I believe in the right to die.
 
docB said:
This is an interesting phenomena about tPA for stroke. EP (including me) bash it routinely but we would want it and would give it to our family members. The reason though is unusual if not disturbing. We want it because we understand that it's both the only chance to do better or a quicker, cleaner ticket out. We know the risks. Patients and families just don't understand statistics. We know it's Russian roulette. It's just that we see the post stroke complications so we're relatively ok hitting the hot chamber.
Click to expand...

I also always hear EM guys talk about tPA's success rate based on total NNT vs NNH. Neuro guys seem to talk about it more based on success vs time to treatment. Our neurologist always made it sound like 1 hour from stroke to tPA or less was almost a panacea, while the more universal 3 (or now, 4.5)hours to tPA that makes up the bulk of the stats is more of coin flip whether it helps more than it hurts. Do you think the data supports that proposition?
 
Perrotfish said:
I also always hear EM guys talk about tPA's success rate based on total NNT vs NNH. Neuro guys seem to talk about it more based on success vs time to treatment. Our neurologist always made it sound like 1 hour from stroke to tPA or less was almost a panacea, while the more universal 3 (or now, 4.5)hours to tPA that makes up the bulk of the stats is more of coin flip whether it helps more than it hurts. Do you think the data supports that proposition?
Click to expand...

1 hour? You'd have to be an inpatient already with a very attentive doctor/nurse. Or have your stroke in the lobby.
 
Apollyon said:
Where are you now, with posts 3177-3194 not being on topic of the thread?
Click to expand...

:laugh:

Sorry, I guess I let it slide since it was at least medically related. When the conversation steers toward "fun times with Fluffy" or "things I could easily Google myself" is when I begin to question how the topic got so sidetracked.
 
DrSnips said:
1 hour? You'd have to be an inpatient already with a very attentive doctor/nurse. Or have your stroke in the lobby.
Click to expand...
Not always, alot of hospitals have a stroke or brain attack team setup. At the hospital I work at it is common to be able to give tPA within 20-40 minutes of neurology being paged.
 
Apollyon said:
Where are you now, with posts 3177-3194 not being on topic of the thread?
Click to expand...

Ok, ok. Not that I'm taking sole credit for getting this thing off topic:D, but to appease the masses, lets get things back on track.

Don't lance your perianal abscesses with a rusty old razor blade. The wounds, being in the taintular region, will get continually infected, inflamed and irritated, and land you in the ED at 9AM on a tuesday when a whole troupe of students will be there to judge your wiping abilities.
 
In the epic battle of ped v train. The train always wins.

Also, if you name your child "yourhighness", what are the chances they come in with a gsw?
 
link2swim06 said:
Not always, alot of hospitals have a stroke or brain attack team setup. At the hospital I work at it is common to be able to give tPA within 20-40 minutes of neurology being paged.
Click to expand...

And what do you figure is the median time from symptom onset to presentation in the ED?
There's a reason why the best set-up stroke centers in the country are giving fewer than 5% of their acute CVA patients tPA.
 
DrSnips said:
1 hour? You'd have to be an inpatient already with a very attentive doctor/nurse. Or have your stroke in the lobby.
Click to expand...

Maybe. My point was that neuro always talks about tPA as though it was a wonder drug at 1 hour or less, that got less and less effective as you approach the 3 hour mark. As in:

Stroke in the lobby --> 1 hour --> tPA --> full recovery
Call EMT at symptom onset --> 2 hours --> tPA --> dramatic improvement in function
"We'll go after Judge Joe Brown!" ---> 3 hours --> tPA --> barely statistically significant

I was wondering if anyone here had seen/done truely fast tPA administration, and if it was really as dramatic an improvement as the Neuro people say it is.
 
Perrotfish said:
Maybe. My point was that neuro always talks about tPA as though it was a wonder drug at 1 hour or less, that got less and less effective as you approach the 3 hour mark. As in:

Stroke in the lobby --> 1 hour --> tPA --> full recovery
Call EMT at symptom onset --> 2 hours --> tPA --> dramatic improvement in function
"We'll go after Judge Joe Brown!" ---> 3 hours --> tPA --> barely statistically significant

I was wondering if anyone here had seen/done truely fast tPA administration, and if it was really as dramatic an improvement as the Neuro people say it is.
Click to expand...

In SC, had a guy came in right away with R sided dense hemiplegia. Stat CT shows a textbook L MCA infarct. The neuro on-call was a complete ***hole usually. This was a Sunday evening, around 9pm. However, neuro came in, and gave this pt the t-PA. It was truly incredible. The guy came to life right in front of my eyes.

There are the total scoffers here on SDN that say, bar none, when someone gets better after t-PA, it is because they were having a TIA. For this one anecdotal case, with a positive (not equivocal or negative) CT, it worked. That's enough to convince me that it isn't worthless, as some here might make you think. I mean, if it truly was, considering the risk of bleeding, then why do P&T committees nationwide still have it on formulary, while pulling droperidol? It is NOT all bad and no good, as some people here might make you think.
 
You must log in or register to reply here.
Next unread thread

Similar threads

FlaminHotER
EM Docs can learn from the NFL Players Association
Replies
18
Views
2K
thegenius
thegenius
thegenius
I wish patients knew what the ER was for
2 3 4 5
Replies
210
Views
11K
gruemd
G
H
Patients per Hour
2
Replies
50
Views
3K
LChristmas
LChristmas
BoardingDoc
Fun patients
Replies
27
Views
3K
DocEspana
DocEspana
alpinism
Hospital wants us to admit dead patients
2
Replies
84
Views
4K
DocEspana
DocEspana
Top