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Discussion in 'Emergency Medicine' started by docB, May 2, 2003.
The new standard of RFB care
Baked apples anyone?
That is awesome. Reminds me of the pt i had with a dkny apple up his butt. Since it was glass the argon wouldn't have worked, but we did try the ob vacuum thing for delivering babies.
and I considered quoting that post too
only didn't think people could tell right away what it was... was half unsure myself
cannot brain today arghhhh
So why the ostomy
And how d'you get it out eventually
I forgot i posted that (note that is not the actual one retrieved). Ge got an ostomy because we never could get it out from below and in getting it out through the abdomen we largely tore up his upper rectum. It actually wouldn't come out of the pelvis until we cut into some of the tissue surrounding the rectum and had someone else shoving up fron below. In that sort of situation an ostomy lets things heal while keeping the poop away.
ohhh like that; it sounded as if he was walking around with it permanently
did he keep the apple
Nah. Haven't had anyone ask for their stuff back after.
If you are dx'd with the flu, if you have a cough/congestion a year later, you can take the Tamiflu script you never started and you will feel better briefly.....
That whole exchange killed me, but that last line!
By the third time the visiting nurse calls you for insulin orders for the patient whose blood glucose is once again 444, have her turn the glucose meter around to see if it's actually "hhh." (Actual blood glucose in ER was over 1000.)
If youre having vaginal bleeding for 3 months, make sure you show up on christmas and demand it to be fixed right away. When told you need to see a ob/gyn get very angry and then proceed to come back 3 days later under another name now with pain and get mad again that i tell you the same thing.
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In fairness, did the patient write that, or did someone transcribe it when the patient said "one to four days?"
Things learned from a patient with CC "a spider bite on my ass":
1. If normal anal play just isn't doing it for you anymore, the obvious solution to this problem is to order a fancy, exotic tarantula from a fancy, exotic tarantula seller, and then proceed to somehow coax and/or shove said arachnid into your rectum. (a more accurate CC would have been "spider bite in my ass")
2. Spiders become very upset when this happens, and they will bite you multiple times before expiring, lost somewhere in your lower bowel. No, EMS will not look for it for you. The pay grade isn't nearly high enough. Some things are best left to physicians.
3. While it is helpful to know the exact species of said spider you've "shoved up your arse because YOLO", this information is not very useful when you've waited THREE DAYS after being bitten to call the Boo-boo Bus.
4. Yes, that anal discharge is not normal. Yes, it is probably related to being bitten by the spider (....geez). No, it will not go away on its own. No, there is not something you can put on it, but thanks for noticing the "for external use only" instructions on the bug bite cream.
Guy ended up losing everything up to the transverse colon. Not sure exactly what he was going for. Sadly, all of this might've been a little easier to understand if he had irradiated the spider first. "Poop-in-a-Bag Man" is not nearly as catchy as "Spiderman".
a few others:
1. Just because a young lady is haggard looking and sleep deprived and asking for the psych hospital director by name, that does not necessarily mean she is a delusional patient that has escaped from her room. That may in fact be his wife, returning after driving cross-country for nearly 12 hours straight. You should probably page him about it before you try and take her back to the ward. Otherwise, you might pass each other in the hallway, prompting the question: "Um, what are you doing with my wife?" (I'm told that a good laugh was had by all involved.)
2. If you want to prove to your bro-dude buddy that you are tough, punching through a pane glass window with just your hand probably would've been sufficient. Heads are for "thinking things through", not "putting through things". However, afterwards, if you want to prove that you're extra tough, convince him to drunkenly punch you in your newly lacerated face. Attaboy.
3. Throwing yourself down a flight of stairs, trying to break and then boil your own arm, and then telling the nice hospital people that you did it just because you "thought it would be funny", WILL earn you a psych consult. I have no idea why either
4. Meconium is a fantastic name for your newborn son. Good to see that you're starting off on the right foot as a parent.
- When you return to the ED two days later because now you have diarrhea after starting antibiotics for a UTI, be sure to continue retelling your story as loudly as possible especially the part about "I have Ebola. My cousin is on antibiotics too and he has diarrhea and vomiting. I [email protected]#$/^ him. We have Ebola."
***It is a great idea to start a mass freak out from patients who now think they are exposed and then get upset when asked to stop making calls announcing you have Ebola. She did not have Ebola.
- Deliberately try to break a bottle against your precious head in full view of the ED waiting room then come in saying you got attacked.
- Hold your breath and play dead after the doctor says that you are cleared (can now go to jail). Keep saying "Ow [email protected]#$ stop it. I'm dead" everytime they snap you out of it.
- Come in for pain from "I almost got stabbed".
- When you and your friend cannot agree on how to best use your IV line for the drugs you have on you, be sure to get a nurse involved.
- While in for gastroenteritis, throw a fit demanding a sponge bath from "a hot nurse" because it's "my right as an American."
- Angrily and persistently insist that the transfusion would work faster if you just drank the blood
Oddly enough, I suspect there are now enough adults named Meconium that it could be a family name. There were three different kids with that name in the clinic at the hospital where I trained in the 80's, and that was just one hospital.
"At least he will retain full reproductive function."
If you enjoy playing real-life frogger, it is a bad idea to do so while fall-down drunk. Your repeated feints into traffic and back out might convince the nice 72 year old man driving the suburban at the 45 mph speed limit that you are planning to wait until he passes before you dart across the street. When you decide not to wait, the impact of your body with the front corner of the SUV will make the vehicle look like it hit a telephone pole. I doubt your skull, ribs, pelvis, etc. will look much better.
Anyone know what ever happened to docB? He hasn't been around in nearly a year and I do miss his additions to this thread that he started oh so many years ago...
I asked the same a few weeks ago. No answer about @docB
Hopefully everything is okay. I looked up his last post and it was about a subpoena for a malpractice case. Maybe related to that? Maybe his lawyer advised him to stop posting? It just seems odd for him to just up and disappear after being on the forum for so many years. He certainly made some great additions to this thread. Again, I hope all is well with him.
Yep, I'm done.
Maybe I'll teach myself how to write software or something, anything to never have to see another human being again.
That CC should be "spider bite for being an ass"... this guy's ideation processes...
well let the spider say it
Me: Hey Mr X, did you pee okay this morning?
Mr X: I dont pee, I piss *creepy stare*
O.O ****... ****... ****... ****... W-w-w-w-w-w-wh-wh-wh-wh WHY WHY!? WHY!? WHY!? WHY THE **** WOULD YOU DO THAT!? NO! NO!NONONONONONO! FOR THE LOVE OF ALMIGHTY ALLAH, NO!
While, scientifically speaking, no tarantula has venom that is a medically significant threat to a human who doesn't have an allergy, I don't think that makes much of a difference when a pair of .5" (~6.35mm) fangs plus that keep getting jammed into your guts, not to mention, if it were a species from the Americas, it would likely be kicking up utricating hairs like crazy, and in the guts, considering what they can do to the eyes, nose, throat, lungs, and mouth, it can't be a pretty picture.
And this in the month I decided to give up drinking
And the award for most memorable post of the year goes to you.
That's oddly reminescent of your username ("Pisiform") and avatar (creepy staring Stewie)
I don't mean anything by that, it's just... odd
This is what the world looks like when sober.
I think I'll take a few wet days.
Two things this time.
#1: If you see militia troopers walking your way and you're worried about being caught dealing drugs, the best thing to do isn't to avoid the business entirely, it's instead to try to stuff at least 30 tiny baggies of weed down your throat. Cue your throat being blocked 100% and 5 otherwise intimidating-looking men laughing uncontrollably as you thrash around on the ground turning blue. And after we finish performing boot assisted-heimlichs on you (because you were doing your darndest to not be easy to help), don't gripe about us being racists who take joy in beating up "proud exemplars of the negro race".
Meanwhile in Russia...
Yes, a Russian fresh out of surgery fled the hospital to go buy beer. What isn't amazing is that he fled after what looks to my philistine eyes like heavy surgery, that he's buying beer instead of vodka, or that he managed to do it. It's that it looks like the woman wearing the "GUARD" jacket is buying for him! How many of you guys would tell security to buy the poor drunk a drink now that he's got a fresh hole where his apendicitis was?
if you're a 18 year old female and your belly is getting bigger and firmer for ohh the last 9 months. its surely just your depo shots. when you start having crampy abdominal pain and wierd vaginal discharge, that pregnancy test you just took must not be accurate. you will however freak out the entire ER team when your BP is 150/90 and your heart rate is 150. we apperciate you waiting to deliver the baby until you were on l&d. As well, i was very thankful your boyfriend didnt pass out, but he was as white as a sheet.
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Is that a Sengestaken-Blakemore tube in his nose?
-If your "spud launcher" does not fire, obviously the best way to trouble-shoot this debacle is to look down the barrel. The open skull fracture did at least decompress the brain bleed, so good for him.
-Despite what your sister the nurse told you: the longer you wait out in the waiting room does not positively correlate with getting "strong pain meds".
I've been reading this thread for a while now. I'm a PhD, sister is an MD (MFM). We both spent a huge portion of our childhoods in hospitals due to various family members. My lessons:
(1) if you are screaming in pain, poop on your home couch, and still insist that we don't call an ambulance because someone else, "Might be having an emergency," while you're Simpson's yellow (chemo+gall bladder+pretty much everything going downhill), then have your husband insist on driving you to the hospital, YOU are having an emergency. Your daughters showing up 20 minutes later (after cleaning up said couch) will side with the intake nurse and your husband, and you will get treatment immediately, even if you swear it's "not that bad."
(2) if you are an 80 year old grandpa being treated by an African American nurse who used to be your employee in the '60s before she went to college, telling her to, "Get your da** n***** hands off me," is not an appropriate way to get care. You're just lucky she knew you before you flipped out and went full bore racist, and you're lucky your grandchild and wife are there to apologize.
(3) not so much ED-minded, but wanted to share re:laughing to deal with tough situations. If someone is in the end phase of terminal cancer (hours left) and wakes up thinking she is hosting a dinner party in the evening, play along. In our case, the whole family, including the oncologist, got in on it, and even the ICU nurses participated. It gave her a sense of control, which was great, and we got some (incredibly dark and depressing) laughs in the hallway (my mother getting upset with me for not having the creamed spinach done yet! It will be done...it's just in the oven...I'll go check now). She went to sleep feeling in control and passed soon after.
Thank you, both ED and otherwise, for doing everything you do and also giving us permission to laugh when things are funny, even if they're still sad. Laughter may not be the best medicine for your patients, but it can be for their families.
Okay I wasn't even in the same state as this one and I am so glad. Guy from another thread I visit teaches a shop class. So while he's describing how to use a soldering iron, a girl decides she wants to pierce her eyelid... With the Soldering iron.... And doesn't even pull the eyelid away.... The next thing he knows there is a lot of screaming and panic... He says he saw the eyeball bubble from the heat. I think even with the Trauma veterans here they've never seen anything like that.
Also from a friend of mine. Turns out when your heart is so weak from stress caused by your insane mother, you can have a BPM so low that you have a stroke at 22 because the blood starts to clot. And that you can masturbate vigriously three times and not cause your EKG to go over 50 BPM... She's got a pacemaker now and is on the list for a heart transplant. And this is after She fell down the stairs and are now parapalegic because of the brain damage from that..... It's been a rough few weeks for all of us.
Update. My friend's psychotic mother tried to kidnap her from the hospital. She came in while she was sleeping and started to pack everything up while sweet taking the nurses. She actually tried to pull out the IV. My friend woke up at that and punched her. Doctor came and got her thrown out.
You post some really weird stuff here mang
EMT Lesson from the 70s; Never EVER look away from your vic, even if you are 6’ 2” of muscle and she is a bitty 13 year old girl.
Small town FD, and I got called out to the girls home at about midnight. Radio says unknown problem, unresponsive. My partner is new. He drives. We get there and the cop says “I dunno – she’s just staring.” Mom and dad, no clues. No drugs in the house, not sick, no history. I look her over, she’s a little lethargic. All vitals seem OK, pupils are slow, lethargy is making my teeth itch, so since we are 3 minutes from the ED we do a grab and dash. I’m in back, we are being escorted by the cop – luckily. She’s on a couple liters of O2, she’s tracking me with her eyes. I reach over her to grab the mic to talk to the ER. She goes ape**** and tries to take me apart. Teeth, fists, nails, feet (feet? You’re STRAPPED DOWN. How do you DO that???) While I was reaching for her offside restraint she sinks her teeth INTO MY ARMPIT. Damn. I still have that scar. My partner is asking “Should I stop?” YES. Get on channel 2. Tell the cop to get his ass back here and help with the soft restraints!
He does. Intelligently, partner doesn’t come back to help. The cop and I get her under control and we roll. Got into the ER (they were alerted by this time) and they ask where she was hurt because she’s bloody as hell. I tell ‘em she’s not. I am. By this time she’s settled and is a scared little girl. Nurses can’t believe it. I spent 90 minutes getting cleaned up, stitched and injected with everything they could think of.
I’m guessing if this board had existed, they’d have posted this one J
If you decide to buy a industrial sized bottle of herbal sexual enhancement supplements while on vacation in Asia don't take all 150 on the first try.
Turns out you will discover the mildly hallucinogenic properties of "Black Mamba's Secret Blend".
Personal experience FTW.
I don't want to know which part of kobe they got that from
Apparently eating something with homemade hot sauce and having a beer then going to work will precipitate a trip to the ED with severe abdominal pain.
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True story from residency -- about 8pm on a 7-7 shift, 40-something HM comes rolling in out of his mind, talking about bats and alligators wearing cowboy hats, per family, was "normal" when he left for work, came home c/o HA, woke up nauseated and then started getting dizzy and now this -- ok, stroke team is a go --- but no stroke after their workup -- time marches on -- we keep trying to sedate him and keep him calm but he keeps getting ramped up -- finally, we put him in a trauma bay and he begins with the coffee ground emesis routine which turns up positive for occult blood -- beautiful --- trying to keep this guy down so we can tap him because all labs/studies are coming back normal --- can't keep him down -- finally the attending steps in and puts him down with propofol AFTER the nurses refuse to administer a propofol drip -- we get a tap which turns up clean --- call ICU to come evaluate and they wave off claiming AMS is no reason for admission to ICU ---
At about 2AM, the wife comes up and tells me that she didn't want to say anything before as the teenaged daughter was in the room but the daughter is now off to the bathroom -- she hands me a blister pack of 12 with about 4-6 tablets missing of a "Male Performance Enhancer" that our guy picked up from the 7-11 on the way to work -- downed 4 getting ready to come home from work and then dropped the other 2 when they didn't appear to have any effect.
I get on the phone to poison control and we chat -- yeah, it's got yohimbe root and a bunch of other stuff with hallucinogenic/steroid type properties ---- now ICU is interested and takes him.
Spent a week in the ICU with 3 episodes of priapism -- woke up after a week wondering what the heck had happened and walked out the door, calm, cool and collected.....
Not ED but --- yes, that substernal chest pain that gets worse when you walk up a flight of stairs, has been getting worse for 3 days and is accompanied by a "tingling" sensation in your left arm, that's absolutely from depleted CoQ10 stores from the Levaquin you were given for pneumonia 1 month ago. Yes, you absolutely got the wrong/less effective CoQ10 and if you just take enough of it, this will all go away. No, it has nothing to do with the elevated ST segments in II, III and aVF, absolutely not --- later got a report of a 90% blockage in the LAD and 80% in the circumflex ---
I really, really want to say that everyone here is making up these stories, but having worked 15 years as a 911 dispatcher, I know how true these stories are. And I've even got some advice of my own, learned from calls I've received.
If your house is infested with cockroaches, don't set off two bug bombs at 11 PM after your entire family goes to bed.
A year later, don't repeat the same mistake.
When stealing anhydrous ammonia (to make meth, naturally) with a friend, don't get into an argument with him so that he throws the anhydrous in your face.
I would mention don't smoke while on oxygen, but I've read that so many times in this thread it must be compulsory to give in to nicotine addiction while receiving oxygen and risking burns to your face.
Today I learned that if your state institutes more robust controls on prescription narcotics and the supply of oxies on the street suddenly dries up, you can use immodium instead. In fact, it works so well you actually can overdose and end up in a persistent vegetative state.
I thought the selling point of Immodium was that it's not psychoactive?
Wait, what?? I thought you'd just get really, really constipated!
One from a while back, thankfully the person involved is now in a long term treatment program and doing about a 1000 trillion times better.
If you end up being rushed into the ED with critical blood loss, after attempting to perform your own home liposuction with a kitchen knife and a vacuum cleaner, you should probably expect a nice little non negotiable stay in the psych ward once they've managed to stitch you up and run however many units of blood through you to prevent hypovolemic shock. If during your stay in the psych ward you're lucky enough to be allowed internet access, don't then proceed to pitch a fitch when none of your online support group friends are willing to come bust you out, or failing that to at least sneak in enough laxatives for you to unclog an elephant. And if you happen to then start detailing your plans to escape the ward and throw yourself off a bridge, because the Doctors, Nurses, other medical staff and all of your online support group friends are a big pile of stupid meanie heads for not catering to your desire to drop 20 pounds by like yesterday, and clearly all of this stress could have been avoided if only the ED staff had had the decency to perform emergency liposuction at the same time they were working to save your life, you really shouldn't be all that surprised when the hospital you've been admitted to starts receiving a number of concerned phone calls informing staff what's going on and telling them to check your internet history (at which point you should now be prepared to enjoy your newly upgraded, extended stay on the aforementioned psych ward).
I encountered a guy last week who likely ended up being one of your patients. You see, I drive for Uber, at night, so I meet plenty of fun characters. Let me tell you. It's like 3:50 Sunday morning. I'm about to go offline, get something to eat, and go home. Then I get a ping. I accept it, because it means money and it's likely someone wanting to go to the airport and I get a sweet surcharge for that. Nope. I get there and there's the rattiest looking long-haired heavily tattooed freakily skinny dude with long hair and a beard sitting on his porch. He staggers over to me and greets me with "Took you long enough." I welcome him aboard and notice he's holding his chest. "Are you okay, sir?" He then tells me, "I called an ambulance and for an Uber, see who get here first." "How long has this been going on." "Like a few hours -- didn't go away on its own and my wife won't stop telling me to see a doctor." I say nothing to avoid being a smartass, but I drive him to the hospital. Along the way, he starts making more pained noises and looking worse. I ask "Want me to double time it?" He nods and I step on it. Now, from my time in the militia, I can drive like a mofo if I must, so I speed up. Almost nobody else is on the road, so I step on it. I get to 60 (Speed limit is 65) and the passenger complains, "Not too fast!" I ignore him, seeing he's getting worse and worse, getting visibly more pained. So he starts screaming while we're about 15 minutes out from the hospital. I step on it for real and get there just as he's saying his arm hurts too, and he can barely breathe. I have to carry the guy into the ER myself because he can barely stand. And when he gets to the nurse, guess what he says. "I think I'm having a heart attack, but this guys' nearly killed me."
Now I know how ambulance folk feel. Hilariously, I met a former EMT on one of my fares, but I'll post that later.
A lesson from an Attending, but it has to be shared:
When writing up notes on a patient don't describe wounds or anything else that is pus-like
please describe instead as purulent
Unless is in quotes, as in the patient said it... then it's fair game. d=)
Semper Brunneis Pallium