Things I Learn From My Patients

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I'd imagine that the SP cath would still be a pain to set up if the patient was that obese. How did he urinate before the cath was put in?

I didn't get to stick around to see the SP cath. But he had a very large adult diaper (roughly the size of two Chux pads) on when admitted to the ED, and the poor guy had sores from it.

Aoirann said:
Jesus! I'm 420 pounds and its nowhere near that bad. How fat was this guy? Was he brought in by a team of Oompa Lumbas?

Actually, I don't know how much he weighed; our beds only weighed up to 600 pounds, and he exceeded their max. Our nurses' best guess was 700+. It took 12 of us to move him from one bed to the other.

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So... Apparently when your patient develops a new bundle branch block and goes into respiratory arrest and subsequently goes unconscious, they can still hear you.

A septic patient was a direct admit from another facility to our observation unit, and we were trying to clarify pt.'s code status because they only faxed half of her living will. I called a code during the respiratory arrest... I was bagging pt. when the code team arrived and and was unresponsive and not breathing still. Physician wanted to clarify code status and we half jokingly proceeded to tell him we didn't know. I'm still bagging... Pt. still limp, heart rate 33, pressure 55/43... Physician says "I guess we should do everything, open RSI kit." After he said that, pt.'s rhythm converts back to nsr. Pt. pushed the ambu bag off pt.'s face and said "yes doc, do everything."

Incredible, but 5 minutes after transferring to MICU pt. went into vtach and could not be converted.

Sorry for choppy grammar on this post. Using my phone.
 
One I learned from personal experience:

Apparently, CT techs like big needles. If the prep nurse takes one glance at your cephalic vein and says, "Oh yeah, we can fit an 16 in there", with a little grin on her face, the appropriate response is to RUN AWAY.
 
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When your fibromyalgia pain only responds to Actiq or sufentanil, be sure not to forget the mountain of peer review articles you prepared at home to substantiate your claim. Who needs continuing ed when pt's are so well read? :slap:
 
If for whatever reason you are feeling bored, you definitely should not unscrew the projectiles from .22 rounds and light off the powder in the casing, because eventually one WILL send shrapnel into your eye, with no Ill effects except a lacerated sclera fortunately (unfortunately?) sparing you your eyesight but earning you a visit to two trauma centers and a lot of medical bills.

Had a similar one a couple years back. 9 year old boy was upset santa brought a bb gun instead of a real gun so he improvised and shot a bb into the primer of a 20 gauge cartridge. Of course the shell fired but spun around during ignition and peppered the kids legs with hundreds of pellets. Fortunately it was birdshot and not buckshot or a slug. He learned that "next time it would be safer to take off running when I pull the trigger."
 
Had a similar one a couple years back. 9 year old boy was upset santa brought a bb gun instead of a real gun so he improvised and shot a bb into the primer of a 20 gauge cartridge. Of course the shell fired but spun around during ignition and peppered the kids legs with hundreds of pellets. Fortunately it was birdshot and not buckshot or a slug. He learned that "next time it would be safer to take off running when I pull the trigger."

I should probably not tell people how to "diesel" a pellet gun, then.

He must have been holding it. The range on pellets not secured in a barrel is measured in inches, not feet.

If you drop your reproduction katana, you should definitely reach out and grab it by the blade. You don't need all those tendons, after all.
 
I should probably not tell people how to "diesel" a pellet gun, then.

He must have been holding it. The range on pellets not secured in a barrel is measured in inches, not feet.

If you drop your reproduction katana, you should definitely reach out and grab it by the blade. You don't need all those tendons, after all.

Per the pt, the 20 gauge shell was pressed almost completely into soft ground at his feet before firing a bb into the primer. Always more fun and colorful when you put oxidation reduction rxns in a restrictive environment! :boom: Tough kid tho, I didn't see a sniffle out of him. Better than most adults, which, in my experience, is USUALLY the case with kids. Periodically I'll get a screamer. It always induces positive anticipation when a child, or the parent for that matter, sees the pleasure devices we use for lumbar punctures. :eek: After having experienced one myself when I was an undergrad, I would probably scream too. Extremely uncomfortable.

YouTube just educated me on dieseling, but it's a new one for me.

Katana juggling? Had they already graduated from chainsaw juggling?
 
Katana juggling? Had they already graduated from chainsaw juggling?

As a hobby/sideline, I forge blades and sell commercial ones. I am amazed I haven't sent anyone your way in the last 20 years. They flip blades around to show off, drop them, try to catch them, poke each other with them, run their fingers over the edges to see how sharp they are, pick them up by the razor-sharpened blade to look at the handle...

Honestly, I think triage should include, "Too stupid to reproduce" as a category.

But so far, just the one major slice...by a nuclear safety inspector...
 
Don't double up on multiple families of drugs. Even while in the ER.



Let's say you go to the ER late at night for some significant back pain. You take a clonazepam in the waiting room to relax.

Upon examination, the doctor thinks you have a slipped disk. He sends you to MRI with a little dilauded on board so you'll lay still.

When the MRI comes back, it shows some irritation but nothing serious. The doctor wants to keep you over night and do the test again in the morning. He asks you if you want a trazodone to help you sleep, as you have a prescription for it.

You will have the best night of sleep in your life, and wake up 13 hours later, when all your classes for the day are already over.
 
But so far, just the one major slice...by a nuclear safety inspector...
I know I should know better by now... but...
a nuclear safety inspector? :flame:
srsly?
:poke::diebanana:
 
I know I should know better by now... but...
a nuclear safety inspector? :flame:
srsly?
:poke::diebanana:


Yup. Friend of mine. He dropped the sword and grabbed for it. At least he wasn't being silly, it just slipped as he lifted it. But two fingers to the bone.
 
Yup. Friend of mine. He dropped the sword and grabbed for it. At least he wasn't being silly, it just slipped as he lifted it. But two fingers to the bone.
:eek::barf:
although certainly, grabbing a falling object is a reflex action, and probably :luck: many a priceless Ming vase...
you don't just 'grab' a katana; it is not a normal physical object. Katanas are supernaturally destructive things
emplllama.gif
(for something with no moving parts, or demons sealed into it :ninja:
highlanderplz.gif
), and forgetting that is quite silly considering how it's the reason you wanted it in the first place...
(on that note I wonder what proportion of ER admissions are the result of ending up on the wrong side/end of a katana :idea: :poke: :whoa::diebanana:
 
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Jesus that's a lot of emoticons. Short and sweet rule of thumb - falling knife is all blade, falling gun is all trigger. Both get to hit the ground and get scuffed up.
 
Jesus that's a lot of emoticons. Short and sweet rule of thumb - falling knife is all blade, falling gun is all trigger. Both get to hit the ground and get scuffed up.

I know nothing about guns, so: Could a gun hit the ground and fire? Because that would be bad too! :eek:
 
I know nothing about guns, so: Could a gun hit the ground and fire? Because that would be bad too! :eek:

It was a very common problem with early submachine guns that fired from an open bolt, such as the MP 40 "burp gun," the Sten gun, and the Thompson (the "Tommy Gun" of Prohibition-era gangsters). Dropped submachine guns would fire one or more bullets if they landed at the wrong angle, and they caused a lot of accidental deaths during WWII. It shouldn't be a problem with more modern firearms though, unless they are modified or damaged as sb247 said.

[/useless historical trivia]
 
It was a very common problem with early submachine guns that fired from an open bolt, such as the MP 40 "burp gun," the Sten gun, and the Thompson (the "Tommy Gun" of Prohibition-era gangsters). Dropped submachine guns would fire one or more bullets if they landed at the wrong angle, and they caused a lot of accidental deaths during WWII. It shouldn't be a problem with more modern firearms though, unless they are modified or damaged as sb247 said.

[/useless historical trivia]

Thanks - that's very interesting! I had no idea about any of that! :D
 
I have learned from my patients that one can be allergic to OTC tylenol, but IV forms and those compounded into other medications (say... oxycodone? You know, just a random example) are perfectly fine and produce no reaction whatsoever.

I also learned that it's quite possible to be allergic to generic medications, and that it's actually quite prudent in this situation to spend six hours trying every pharmacy in town until you find one that has the brand-name "Z-Pack".

Man, I don't know what I'd do without my patients, shoring up my shoddy knowledge of immunology!
 
I have learned from my patients that one can be allergic to OTC tylenol, but IV forms and those compounded into other medications (say... oxycodone? You know, just a random example) are perfectly fine and produce no reaction whatsoever.

I also learned that it's quite possible to be allergic to generic medications, and that it's actually quite prudent in this situation to spend six hours trying every pharmacy in town until you find one that has the brand-name "Z-Pack".

There are cases of true allergies to dyes only found in generic formulations, or certain strengths of a particular medication. I've run into similar complaints from pt's n the ED and I'm sure 90+% were total BS, but a colleague whose specialty is pain management relayed to me that he has a pt who has an allergy to a particular generic form of ms-contin 30 mg, but not 15 or 60 mg tablets, nor was there a problem with the branded formulation. Evidently the purple dye in the 30 mg formulation produced a moderate anaphylactic rxn. Of course this is an allergy to the dye and not "generic morphine", but I no longer immediately dismiss such claims from my pt's.

Growing up, my best buddy who suffered from asthma was particularly sensitive to tartrazine (F&D yellow #5). I'm not saying this is the case here (especially the alleged oxycodone allergy), but I believe it's plausible in certain cases.
 
There are cases of true allergies to dyes only found in generic formulations, or certain strengths of a particular medication. I've run into similar complaints from pt's n the ED and I'm sure 90+% were total BS, but a colleague whose specialty is pain management relayed to me that he has a pt who has an allergy to a particular generic form of ms-contin 30 mg, but not 15 or 60 mg tablets, nor was there a problem with the branded formulation. Evidently the purple dye in the 30 mg formulation produced a moderate anaphylactic rxn. Of course this is an allergy to the dye and not "generic morphine", but I no longer immediately dismiss such claims from my pt's.

Growing up, my best buddy who suffered from asthma was particularly sensitive to tartrazine (F&D yellow #5). I'm not saying this is the case here (especially the alleged oxycodone allergy), but I believe it's plausible in certain cases.

I'm allergic to a dye in a medication that's no longer produced (Deconamine, if you're interested). The doctor always had to write "dye-free" on the prescription.
 
There are cases of true allergies to dyes only found in generic formulations, or certain strengths of a particular medication. I've run into similar complaints from pt's n the ED and I'm sure 90+% were total BS, but a colleague whose specialty is pain management relayed to me that he has a pt who has an allergy to a particular generic form of ms-contin 30 mg, but not 15 or 60 mg tablets, nor was there a problem with the branded formulation. Evidently the purple dye in the 30 mg formulation produced a moderate anaphylactic rxn. Of course this is an allergy to the dye and not "generic morphine", but I no longer immediately dismiss such claims from my pt's.

Growing up, my best buddy who suffered from asthma was particularly sensitive to tartrazine (F&D yellow #5). I'm not saying this is the case here (especially the alleged oxycodone allergy), but I believe it's plausible in certain cases.

Huh. That's interesting. I try not to immediately jump to thinking that people are lying (hard in a field this cynical), but it's good to know when there are more things to take into account. Maybe someday I'll have a patient that will thank you for this. In the meantime, I will simply do so myself. =)
 
a *moderate* anaphylaxis? there's a phrase you don't normally expect

Anaphylaxis can be mild: itchy hives that pass without intervention, all the way to full blown shock with compromised airway etc. leading to death within minutes of exposure. Yes, perhaps moderate was poor word choice as any anaphylactic rxn is potentially life threatening. What appears to be a mild rxn can progress rapidly.
 
Anaphylaxis can be mild: itchy hives that pass without intervention, all the way to full blown shock with compromised airway etc. leading to death within minutes of exposure. Yes, perhaps moderate was poor word choice as any anaphylactic rxn is potentially life threatening. What appears to be a mild rxn can progress rapidly.
well I didn't mean it was a bad turn of the phrase - evidently there *are* mild
anaphylactic reactions, - but you say it's only prudent to classify it as mild *after* the event :luck::xf:
 
That the imprint on the pill affects potency. Overheard in the pharmacy yesterday: "On those Roxys, can I git the ones that have the M on them, instead of the V? The ones with the M work better"-gentleman dropping off questionable looking Rx's
 
If you are a 13-yo chasing your friend on bicycles (without helmets, obviously), it is probably not a good idea to follow him OFF of your tiny little culdesac and into the MAIN THOROUGHFARE at rush hour.

Remember, the first kid (who decided to go that way) will get through without a scratch. The second one (whose only sin is following the first) will get intimate with an SUV's bumper and be in the hospital a long time.



(For full disclosure, I was in the car behind said SUV. Fortunately, the kid in question saw what was coming in time and jammed on his breaks. The SUV and his front tire came within about 3 inches of contact. A lot of yelling ensued.... Kid acted like it was no big deal, so maybe you'll get to meet him sometime soon.)
 
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If you're playing ladder toss (aka teste toss) at a party and decide to throw one of the bolas high up into a tree, please attempt to climb up after it even though you are very drunk and out of shape. And it's certainly a good idea to attempt to make a gymnastic dismount by jumping down to grab a branch ten feet below you, which itself is about ten feet off the lawn. You will fall straight into the ground, audibly fracturing both arms and a wrist. You should then get up and try to laugh it off, while it is clearly evident that both of your arms are oddly bent and beginning to swell. Oh and make sure that you are also DJing this party, so that, fifteen minutes later when the pain is unbearable, your very angry girlfriend can show up, yell at you in front of all the partygoers, load up all your equipment into your van and drive you to the local urgent care clinic. Also, make sure that you are uninsured and on probation, so that all of your bases are sufficiently covered.
 
If you're playing ladder toss (aka teste toss) at a party and decide to throw one of the bolas high up into a tree, please attempt to climb up after it even though you are very drunk and out of shape. And it's certainly a good idea to attempt to make a gymnastic dismount by jumping down to grab a branch ten feet below you, which itself is about ten feet off the lawn. You will fall straight into the ground, audibly fracturing both arms and a wrist. You should then get up and try to laugh it off, while it is clearly evident that both of your arms are oddly bent and beginning to swell. Oh and make sure that you are also DJing this party, so that, fifteen minutes later when the pain is unbearable, your very angry girlfriend can show up, yell at you in front of all the partygoers, load up all your equipment into your van and drive you to the local urgent care clinic. Also, make sure that you are uninsured and on probation, so that all of your bases are sufficiently covered.

This part is usually implied.
 
All recent trips to ER have been from from the adults. Sigh.

When your purple and red dye allergic seizure prone baby momma starts seizing following shotgunning "sizzup" with you, taking her to the ER is a good idea.

However, the entire ER will not believe you are sober, if only from the drugs being all over you. While that ho may have poured it on you, that doesn't explain the purple snot running down your face.

When police arrive for your wasted butt's free ride to jail, claiming that bitch drank all your "really good sizzup" will not impress them. Stripping off your purple stained clothes doesn't either. Nor does running to the slut with sizzup coated nails and trying to get sizzup from her nails.

However, her foot taller, 150 pounds heavier husband will be so impressed, he will slam his fist into your face, then stand his foot a centimeter away from crushing certain parts while going into his "No one insults, bothers, touches or anything that she doesn't like, his wife" rant.

Can someone explain why the crazy ones are always in full force when I wind up having to go in?

And, what on earth is the appeal of sizzup as that cough syrup tastes worse than socks from teen male gym locker that were hiding for seven months smell. And I do love my Jager, so potent tastes don't bother me.

I still maintain that matte black nail polish doesn't resemble sizzup, or at least what the syrup part looks like.
 
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And, what on earth is the appeal of sizzup as that cough syrup tastes worse than socks from teen male gym locker that were hiding for seven months smell. And I do love my Jager, so potent tastes don't bother me.

I had to look up "sizzup". Urban Dictionary tell me that this is the recipe:

Promethazine w/Codeine syrup
Any fruit flavored soda
A jolly rancher

All other thoughts aside, that sounds so disgustingly sweet that I don't know how anyone could even drink it. Why both to add the soda and Jolly Rancher? Why not just drink the cough syrup and be done with it?

I know, logic. Sorry! :p

(Still totes loving your username, LOL!)
 
I had to look up "sizzup". Urban Dictionary tell me that this is the recipe:

I had a patient during residency who had slammed his hand in a door. Exam normal except for some swelling and tenderness. XR negative. At discharge, he asked for some pain meds. I told him to take some OTC meds. He said, "Nah, I'm really hurting and that stuff don't work. I need something stronger. Oh, and I can't take pills. I need the liquid stuff. Oh, and the pain meds make me sick, so I need the liquid vomiting medicine."

I paused for a minute and point blank asked him, "Are you asking me to prescribe you some syzzurp so you can make purple drank?" His GF was in the room and started laughing. I pointed to his paperwork on the table and said, "You're free to go now," and walked out of the room.
 
All other thoughts aside, that sounds so disgustingly sweet that I don't know how anyone could even drink it. Why both to add the soda and Jolly Rancher? Why not just drink the cough syrup and be done with it?

I know, logic. Sorry! :p
.....
jfb6np_th.jpg
 
Because that cough syrup is really, violently disgusting. Which I learned from a round of bronchitis when I was coughing hard enough to dislocate and crack ribs. As in it's so horrible tasting, I not only need my medication flavored like a two year old, I also had to worship Zofran and Ativan. It was really fun to get as the only flavoring that helped was grape. Not sure the pharmacist would have sold said drugs had I not been violently coughing the entire dang time. I can well assure you that 7-up regular or cherry do nothing to remove the taste from one's mouth.

I have school aged children. I know what the crap is, but I'd be a really bad addict because I don't get the fun of most drugs. Because, really, cold symptom relief pills mixed with explosive fertilizer sounds just delightful. Now there's something that rots you into a zombie lizard, yay, sign me up for that. But that probably explains why I have not yet been a patient worth mentioning.
 
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When the nurse hands you a cup and sends you to the bathroom for a sample she wants urine, not semen.

For some reason, I imagine the nurse receiving the cup as cartoon dog Droopy. The patient hands him the cup, walks away, and Droopy looks at the camera and says "Well that was uncalled for."
 
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It’s been a while since I heard this somewhere, but isn’t there a drug that causes nausea in some of those syrups to discourage abuse? I’ve always thought it was weird how people who can probably afford to go after “normal” drugs try to pass drinking cough syrup as something cool.
 
Teaching Doctors about Patients Bad Luck!

I swear to god every single thing I'm about to tell you about happened to my Family over about a 10 day period. Its Long, bare with me!

If your 3 year old Minorly Immuno Suppressed child ends up with Cat Scratch Disease, let the PCP send you home instead of Insisting on a Admit.

Do not by any means allow the 3 year old to take a 45 minute nap. Because when she wakes up, every Lymph node in her Body will be swollen to Golf ball size within minutes. This will be accompanied by a fever too high for either of your Home Thermometers to measure. (105+) Despite Motrin and Tylenol being on Board.

Now instead of Calmly calling a Ambulance, Scoop up the Child and run for the Car and Childrens ED. On your way down the side walk, step on a Random Walnut, roll your ankle off the side walk, nearly dropping the ill child and Listen as your Ankle goes Crack, Crackle, Pop!

Proceed to Drive to the ER, in a 5 Speed stick, irritating the Injured Ankle.

I at least had the Presence of mind to have her Surgeon meet us in the ED. She was admitted and had the Node in the right Axilla removed. She had a Cystic Hygroma there that was Leaking uncontrollably due to the swollen node. This was her 8th surgery!

Once she was stable, I head across the street to the Adult ED, Where I was given a funky half cast, half ace wrap monstrosity and Lectured for walking on a Fractured Fibula. A nice RN Wheeled me back across the street to the Children's Hospital, where my Phone promptly rings, and a caller Informs me that the 3 year old's 8 year old brother is in the Children's Urgent Care 30 minutes away with a Broken Arm.

Drive 30 Minutes to Sign for Care for the 8 Year, and find out that despite what the SIL has said, it is a Shattered Elbow, not a broken arm. Proceed to Follow the Ambulance back to the Main Children's Hospital where the 8 year old will spend 13 Hours in the Que for Admit for Surgery to repair the Broken "Arm". Bonus points that said child is NPO the entire time and Misses his ADHD AND BIPOLAR MEDS! This culminates in the Attending Chief of Orthopedics refusing to allow said child to be admitted to his unit after the child has a Versed reaction and tries to strangle the Anesthesiologist, and bites the security guard trying to help her.

Pray at the General Surgeons feet when he manages to swing a room, right down the hall from your 3 year old. Spend the next 5 days in the hospital with 2 children both recovering from surgery. Alternate between their rooms every 30 minutes to a hour, until you nearly Collapse from Pain and Exhaustion. Be Kicked out of the Hospital the last night with a Prescription written to sleep "12 Hours"

The Next week, Rinse and Repeat when your 7 Year old Son, is overdosed by a Know it all RN. Despite what the Prescription bottle says She will write down that he is on Tegretol, instead of Trileptal while doing admit papers. Because Oxcarbazepine is the Same as Carbamazepine. Bonus points for Severity when the RN writes down 450mg as the Dose for the Tegretol, and then Argues with you that he is on Tegretol not Trileptal. Call another nurse over and ask her to make sure the records say Trileptal, feel reassured when the Nurse lies and says it does. The next morning race for the ER after said 7 year old is given 1350mg of Tegretol over 18 hours, and is Vomiting while Unconscious. Spend 4 Days in the hospital while 7 year old sleeps off his Overdose, with a Serum level of 19.6 while on O2. On the 4th day , be discharged with the appearances of no Major Permanent Damage. 24 Hours later, said 7 year old should Collapse while Vomiting and screaming his stomach hurts.

Go back to the ER, Where the Triage nurses will tell you your regular room is ready. 7 year old has a apparently Large 1cm Fecolith blocking the entrance to his lightly swollen Appendix.Radioligist found it on a Ultra sound? Quite a feat!However , Every surgeon on duty refuses to touch him, unless the Appendix ruptures because he was just over dosed. Learn that the Overdose could have inadvertently caused the Appendix problem due to no food for 3 days, followed by non stop eating?. Be discharged home.

The next day call your Toddlers surgeon and ask him for advice on what to do, when Saintly Surgeon pulls up the 7 year olds imaging records online, he will tell you Do not walk, run for the hospital right now! You will go back to the hospital again! Be direct admitted by said Surgeon and have emergency appendectomy surgery, and a minor hernia repair ( Why not? I already was there, he says).

You get Ultra Bonus points if your Husband is away for work for 10 days in the middle of all this, and even more when the Police and DCF show up to investigate you for Truancy! Your Local Pharmacy however, now thinks you are abusing drugs because you have filled 2 Roxicet, 1 Vicodin, and 1 Ativan script all in 10 days. They will refuse to fill more than the one Roxicet, until you bring in both children with Surgical Incisions to PROVE you were actually prescribed the medications.

The only good thing to come out of it all, was some Kind soul adopted us Anonymously for Christmas that year. We opened the door to find a huge box filled with gifts for the children. Faith in Humanity Restored!
 
Teaching Doctors about Patients Bad Luck!

I swear to god every single thing I'm about to tell you about happened to my Family over about a 10 day period. Its Long, bare with me!

If your 3 year old Minorly Immuno Suppressed child ends up with Cat Scratch Disease, let the PCP send you home instead of Insisting on a Admit.

Do not by any means allow the 3 year old to take a 45 minute nap. Because when she wakes up, every Lymph node in her Body will be swollen to Golf ball size within minutes. This will be accompanied by a fever too high for either of your Home Thermometers to measure. (105+) Despite Motrin and Tylenol being on Board.

Now instead of Calmly calling a Ambulance, Scoop up the Child and run for the Car and Childrens ED. On your way down the side walk, step on a Random Walnut, roll your ankle off the side walk, nearly dropping the ill child and Listen as your Ankle goes Crack, Crackle, Pop!

Proceed to Drive to the ER, in a 5 Speed stick, irritating the Injured Ankle.

I at least had the Presence of mind to have her Surgeon meet us in the ED. She was admitted and had the Node in the right Axilla removed. She had a Cystic Hygroma there that was Leaking uncontrollably due to the swollen node. This was her 8th surgery!

Once she was stable, I head across the street to the Adult ED, Where I was given a funky half cast, half ace wrap monstrosity and Lectured for walking on a Fractured Fibula. A nice RN Wheeled me back across the street to the Children's Hospital, where my Phone promptly rings, and a caller Informs me that the 3 year old's 8 year old brother is in the Children's Urgent Care 30 minutes away with a Broken Arm.

Drive 30 Minutes to Sign for Care for the 8 Year, and find out that despite what the SIL has said, it is a Shattered Elbow, not a broken arm. Proceed to Follow the Ambulance back to the Main Children's Hospital where the 8 year old will spend 13 Hours in the Que for Admit for Surgery to repair the Broken "Arm". Bonus points that said child is NPO the entire time and Misses his ADHD AND BIPOLAR MEDS! This culminates in the Attending Chief of Orthopedics refusing to allow said child to be admitted to his unit after the child has a Versed reaction and tries to strangle the Anesthesiologist, and bites the security guard trying to help her.

Pray at the General Surgeons feet when he manages to swing a room, right down the hall from your 3 year old. Spend the next 5 days in the hospital with 2 children both recovering from surgery. Alternate between their rooms every 30 minutes to a hour, until you nearly Collapse from Pain and Exhaustion. Be Kicked out of the Hospital the last night with a Prescription written to sleep "12 Hours"

The Next week, Rinse and Repeat when your 7 Year old Son, is overdosed by a Know it all RN. Despite what the Prescription bottle says She will write down that he is on Tegretol, instead of Trileptal while doing admit papers. Because Oxcarbazepine is the Same as Carbamazepine. Bonus points for Severity when the RN writes down 450mg as the Dose for the Tegretol, and then Argues with you that he is on Tegretol not Trileptal. Call another nurse over and ask her to make sure the records say Trileptal, feel reassured when the Nurse lies and says it does. The next morning race for the ER after said 7 year old is given 1350mg of Tegretol over 18 hours, and is Vomiting while Unconscious. Spend 4 Days in the hospital while 7 year old sleeps off his Overdose, with a Serum level of 19.6 while on O2. On the 4th day , be discharged with the appearances of no Major Permanent Damage. 24 Hours later, said 7 year old should Collapse while Vomiting and screaming his stomach hurts.

Go back to the ER, Where the Triage nurses will tell you your regular room is ready. 7 year old has a apparently Large 1cm Fecolith blocking the entrance to his lightly swollen Appendix.Radioligist found it on a Ultra sound? Quite a feat!However , Every surgeon on duty refuses to touch him, unless the Appendix ruptures because he was just over dosed. Learn that the Overdose could have inadvertently caused the Appendix problem due to no food for 3 days, followed by non stop eating?. Be discharged home.

The next day call your Toddlers surgeon and ask him for advice on what to do, when Saintly Surgeon pulls up the 7 year olds imaging records online, he will tell you Do not walk, run for the hospital right now! You will go back to the hospital again! Be direct admitted by said Surgeon and have emergency appendectomy surgery, and a minor hernia repair ( Why not? I already was there, he says).

You get Ultra Bonus points if your Husband is away for work for 10 days in the middle of all this, and even more when the Police and DCF show up to investigate you for Truancy! Your Local Pharmacy however, now thinks you are abusing drugs because you have filled 2 Roxicet, 1 Vicodin, and 1 Ativan script all in 10 days. They will refuse to fill more than the one Roxicet, until you bring in both children with Surgical Incisions to PROVE you were actually prescribed the medications.

The only good thing to come out of it all, was some Kind soul adopted us Anonymously for Christmas that year. We opened the door to find a huge box filled with gifts for the children. Faith in Humanity Restored!

Holy crap.
 
Teaching Doctors about Patients Bad Luck!

I swear to god every single thing I'm about to tell you about happened to my Family over about a 10 day period. Its Long, bare with me!

I really wanted to read this because it seemed interesting but your capitalization is so strange that it literally was hurting my eyes to read this entry. Let me offer you some assistance: capitalize the first word of each sentence and anything that is a proper noun. Otherwise, you really don't need to capitalize it.
 
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If you are incarcerated and suicidal there are probably more efficient ways to kill your itself than consuming your spectacles. This will just buy you a colostomy when the pieces perforate the bowel.

Poor guy... Little did he know his new pink sock just gave other inmates more options. Yes... And welcome back sir. What may I do for ou this week? I'm sure your colostomy herpes outbreak represents shingles and not an std... (Gag).
 
Teaching Doctors about Patients Bad Luck!

I swear to god every single thing I'm about to tell you about happened to my Family over about a 10 day period. Its Long, bare with me!

If your 3 year old Minorly Immuno Suppressed child ends up with Cat Scratch Disease, let the PCP send you home instead of Insisting on a Admit.

Do not by any means allow the 3 year old to take a 45 minute nap. Because when she wakes up, every Lymph node in her Body will be swollen to Golf ball size within minutes. This will be accompanied by a fever too high for either of your Home Thermometers to measure. (105+) Despite Motrin and Tylenol being on Board.

Now instead of Calmly calling a Ambulance, Scoop up the Child and run for the Car and Childrens ED. On your way down the side walk, step on a Random Walnut, roll your ankle off the side walk, nearly dropping the ill child and Listen as your Ankle goes Crack, Crackle, Pop!

Proceed to Drive to the ER, in a 5 Speed stick, irritating the Injured Ankle.

I at least had the Presence of mind to have her Surgeon meet us in the ED. She was admitted and had the Node in the right Axilla removed. She had a Cystic Hygroma there that was Leaking uncontrollably due to the swollen node. This was her 8th surgery!

Once she was stable, I head across the street to the Adult ED, Where I was given a funky half cast, half ace wrap monstrosity and Lectured for walking on a Fractured Fibula. A nice RN Wheeled me back across the street to the Children's Hospital, where my Phone promptly rings, and a caller Informs me that the 3 year old's 8 year old brother is in the Children's Urgent Care 30 minutes away with a Broken Arm.

Drive 30 Minutes to Sign for Care for the 8 Year, and find out that despite what the SIL has said, it is a Shattered Elbow, not a broken arm. Proceed to Follow the Ambulance back to the Main Children's Hospital where the 8 year old will spend 13 Hours in the Que for Admit for Surgery to repair the Broken "Arm". Bonus points that said child is NPO the entire time and Misses his ADHD AND BIPOLAR MEDS! This culminates in the Attending Chief of Orthopedics refusing to allow said child to be admitted to his unit after the child has a Versed reaction and tries to strangle the Anesthesiologist, and bites the security guard trying to help her.

Pray at the General Surgeons feet when he manages to swing a room, right down the hall from your 3 year old. Spend the next 5 days in the hospital with 2 children both recovering from surgery. Alternate between their rooms every 30 minutes to a hour, until you nearly Collapse from Pain and Exhaustion. Be Kicked out of the Hospital the last night with a Prescription written to sleep "12 Hours"

The Next week, Rinse and Repeat when your 7 Year old Son, is overdosed by a Know it all RN. Despite what the Prescription bottle says She will write down that he is on Tegretol, instead of Trileptal while doing admit papers. Because Oxcarbazepine is the Same as Carbamazepine. Bonus points for Severity when the RN writes down 450mg as the Dose for the Tegretol, and then Argues with you that he is on Tegretol not Trileptal. Call another nurse over and ask her to make sure the records say Trileptal, feel reassured when the Nurse lies and says it does. The next morning race for the ER after said 7 year old is given 1350mg of Tegretol over 18 hours, and is Vomiting while Unconscious. Spend 4 Days in the hospital while 7 year old sleeps off his Overdose, with a Serum level of 19.6 while on O2. On the 4th day , be discharged with the appearances of no Major Permanent Damage. 24 Hours later, said 7 year old should Collapse while Vomiting and screaming his stomach hurts.

Go back to the ER, Where the Triage nurses will tell you your regular room is ready. 7 year old has a apparently Large 1cm Fecolith blocking the entrance to his lightly swollen Appendix.Radioligist found it on a Ultra sound? Quite a feat!However , Every surgeon on duty refuses to touch him, unless the Appendix ruptures because he was just over dosed. Learn that the Overdose could have inadvertently caused the Appendix problem due to no food for 3 days, followed by non stop eating?. Be discharged home.

The next day call your Toddlers surgeon and ask him for advice on what to do, when Saintly Surgeon pulls up the 7 year olds imaging records online, he will tell you Do not walk, run for the hospital right now! You will go back to the hospital again! Be direct admitted by said Surgeon and have emergency appendectomy surgery, and a minor hernia repair ( Why not? I already was there, he says).

You get Ultra Bonus points if your Husband is away for work for 10 days in the middle of all this, and even more when the Police and DCF show up to investigate you for Truancy! Your Local Pharmacy however, now thinks you are abusing drugs because you have filled 2 Roxicet, 1 Vicodin, and 1 Ativan script all in 10 days. They will refuse to fill more than the one Roxicet, until you bring in both children with Surgical Incisions to PROVE you were actually prescribed the medications.

The only good thing to come out of it all, was some Kind soul adopted us Anonymously for Christmas that year. We opened the door to find a huge box filled with gifts for the children. Faith in Humanity Restored!


Holy crap is right. I hope you got a mini vacation after that!
 
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Huh. That's interesting. I try not to immediately jump to thinking that people are lying (hard in a field this cynical), but it's good to know when there are more things to take into account. Maybe someday I'll have a patient that will thank you for this. In the meantime, I will simply do so myself. =)

Just ask the pharmacist. Red dyes are common allergies. But then hey can still do NSAID patches, different liquids have different colors etc. you can always see if the Percocet and the Tylenol have different or same dyes.... The pharmacists love this question at 2am ;). A few moments being EXTRA helpful for 1 less narcotic. I'm a grinch on slow days, safest me on faster days. Too bad the narcotic reporting sites don't list ultram, lidocaine patches, injections, and NSAID visits. "So 4 other places reed you naproxen today... ". I hate the discussion on glue allergies in the patches and need to buy a pharmacist lunch and go through my list of alternatives.

And generics may have slightly lower potency or greater, kinda chancy. As do counterfeit meds. It may be why the letter on the tab was brought up :). The hard core folk t2t ratio < 1 know more than I do sometimes. As they frequently sample items.

Ok too much preach. Story. Although I'm sure you are mad about how long it takes to be seen in the ER.... It May take longer to wait in line for 45 min at an urgent care, then get driver by ambulance to the ED for your 3 through and through abdominal gun shot wounds. I realize the nurse was nice and applied skin glue last time you cut yourself. And no, I don't think she made too much of a big deal about this. Just because the bullets came out, it's more than just 6 cuts to close. P.s. why are you smiling? He was one of the creepy Mona Lisa's... Smiled till the rectal/foley.
 
Yeah, our county is too damn broke to hang around for the mandatory 24-hour psych hold. They'll stick around for the run-of-the mill incarceritis stuff, but that's just too long for them.

Hour 24 seems like a good possibility..
 
Teaching Doctors about Patients Bad Luck!

I swear to god every single thing I'm about to tell you about happened to my Family over about a 10 day period. Its Long, bare with me!

If your 3 year old Minorly Immuno Suppressed child ends up with Cat Scratch Disease, let the PCP send you home instead of Insisting on a Admit.

Do not by any means allow the 3 year old to take a 45 minute nap. Because when she wakes up, every Lymph node in her Body will be swollen to Golf ball size within minutes. This will be accompanied by a fever too high for either of your Home Thermometers to measure. (105+) Despite Motrin and Tylenol being on Board.

Now instead of Calmly calling a Ambulance, Scoop up the Child and run for the Car and Childrens ED. On your way down the side walk, step on a Random Walnut, roll your ankle off the side walk, nearly dropping the ill child and Listen as your Ankle goes Crack, Crackle, Pop!

Proceed to Drive to the ER, in a 5 Speed stick, irritating the Injured Ankle.

I at least had the Presence of mind to have her Surgeon meet us in the ED. She was admitted and had the Node in the right Axilla removed. She had a Cystic Hygroma there that was Leaking uncontrollably due to the swollen node. This was her 8th surgery!

Once she was stable, I head across the street to the Adult ED, Where I was given a funky half cast, half ace wrap monstrosity and Lectured for walking on a Fractured Fibula. A nice RN Wheeled me back across the street to the Children's Hospital, where my Phone promptly rings, and a caller Informs me that the 3 year old's 8 year old brother is in the Children's Urgent Care 30 minutes away with a Broken Arm.

Drive 30 Minutes to Sign for Care for the 8 Year, and find out that despite what the SIL has said, it is a Shattered Elbow, not a broken arm. Proceed to Follow the Ambulance back to the Main Children's Hospital where the 8 year old will spend 13 Hours in the Que for Admit for Surgery to repair the Broken "Arm". Bonus points that said child is NPO the entire time and Misses his ADHD AND BIPOLAR MEDS! This culminates in the Attending Chief of Orthopedics refusing to allow said child to be admitted to his unit after the child has a Versed reaction and tries to strangle the Anesthesiologist, and bites the security guard trying to help her.

Pray at the General Surgeons feet when he manages to swing a room, right down the hall from your 3 year old. Spend the next 5 days in the hospital with 2 children both recovering from surgery. Alternate between their rooms every 30 minutes to a hour, until you nearly Collapse from Pain and Exhaustion. Be Kicked out of the Hospital the last night with a Prescription written to sleep "12 Hours"

The Next week, Rinse and Repeat when your 7 Year old Son, is overdosed by a Know it all RN. Despite what the Prescription bottle says She will write down that he is on Tegretol, instead of Trileptal while doing admit papers. Because Oxcarbazepine is the Same as Carbamazepine. Bonus points for Severity when the RN writes down 450mg as the Dose for the Tegretol, and then Argues with you that he is on Tegretol not Trileptal. Call another nurse over and ask her to make sure the records say Trileptal, feel reassured when the Nurse lies and says it does. The next morning race for the ER after said 7 year old is given 1350mg of Tegretol over 18 hours, and is Vomiting while Unconscious. Spend 4 Days in the hospital while 7 year old sleeps off his Overdose, with a Serum level of 19.6 while on O2. On the 4th day , be discharged with the appearances of no Major Permanent Damage. 24 Hours later, said 7 year old should Collapse while Vomiting and screaming his stomach hurts.

Go back to the ER, Where the Triage nurses will tell you your regular room is ready. 7 year old has a apparently Large 1cm Fecolith blocking the entrance to his lightly swollen Appendix.Radioligist found it on a Ultra sound? Quite a feat!However , Every surgeon on duty refuses to touch him, unless the Appendix ruptures because he was just over dosed. Learn that the Overdose could have inadvertently caused the Appendix problem due to no food for 3 days, followed by non stop eating?. Be discharged home.

The next day call your Toddlers surgeon and ask him for advice on what to do, when Saintly Surgeon pulls up the 7 year olds imaging records online, he will tell you Do not walk, run for the hospital right now! You will go back to the hospital again! Be direct admitted by said Surgeon and have emergency appendectomy surgery, and a minor hernia repair ( Why not? I already was there, he says).

You get Ultra Bonus points if your Husband is away for work for 10 days in the middle of all this, and even more when the Police and DCF show up to investigate you for Truancy! Your Local Pharmacy however, now thinks you are abusing drugs because you have filled 2 Roxicet, 1 Vicodin, and 1 Ativan script all in 10 days. They will refuse to fill more than the one Roxicet, until you bring in both children with Surgical Incisions to PROVE you were actually prescribed the medications.

The only good thing to come out of it all, was some Kind soul adopted us Anonymously for Christmas that year. We opened the door to find a huge box filled with gifts for the children. Faith in Humanity Restored!

Guh. That's horrifying. Hope everyone recovered well...
 
My turn for a rant:

The central line that took me two hours to put in was to save your A&& from encephalitis and not so that you could supplement the dilaudid we gave you 20 minutes ago with your preferred pharmaceutical combo of heroin and methamphetamine. Headache a little worse now? That tends to happen when you inject stimulants, my good friend, whether or not it included your self-prescribed pain med. Just wait till "nurse Nancy" gives the 2 mg of naloxone I just ordered and see how you feel! If you had initially been honest with me about your heroin use I would have filled you full of morphine to make you comfortable to begin with. I am not heartless. I am a doctor, and I know you're in a lot of pain. But now I have to reverse your buzz because you just loaded up on street drugs in my ED! So sorry dude, this part is gonna be rough, but you did it to yourself! And let me guess, the stigma of being an heroin addict is much worse than being a meth head?!? While I would rather not be known as either, I think you have your reasoning reversed. And don't be mad at us for finding out, we tend to notice you are self medicating when you get so trashed that you forget and leave an insulin syringe hanging from your central line while stumbling to the nurses station to tell us you're going out for a smoke. (Not happening Mr. Encephalitis!) Also when you find that insulin syringes are not compatible with the line we have in your chest, be sure to ruin it by injecting directly into the plastic tubing of the bolus. And on a side note, while your family practitioner labels your past bouts of encephalitis as idiopathic, the rest of us are relatively certain of the origin. Best of luck!

Finally some advice to addicts who find themselves sick and in need of an ED: Be honest about your drug usage. We are going to find out eventually. We are not going to call the cops, it's against the law, unless you are selling them from the trauma bay or putting your children or 100 year old mother in danger. Not only can honesty save your life but a little honesty about a subject that we know is difficult for you to talk about will go a long way with me. If you admit you're a heroin addict while your arm is hanging from a thread, I'm going to pump you full of morphine until you are comfortable. I am not going to let you go into withdrawl while you're sick. I'm not that mean. But if you deny you are an addict, you're going to get the 2.5-15mg q 4 like everyone else. But if I know you "slammed" a gram of heroin 2 hours ago then I will understand why 15mg of morphine is doing nothing for your pain. Help us help you. On the other hand if you come into my ED at 5pm on a Friday telling me your back pain is an 11 out of 10 while laughing with your buddy and playing a game on your smart phone, it doesn't matter if you admit you are an addict or Jesus Christ himself, YOU GET NOTHING in the way of narcotics.

Rant has ended and my customary smile has returned. Thanks for listening. Now, let's go put in another central line! ;)
 
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