"Things I learn" & "Medicine Sucks" discussion thread

[FATrain]

I usually pretend to be a typical person just wanting to help and do not announce my medical training unless there's some sort of chaos for this reason.
"Why didn't you do anything?"
I'd feel like asking, "Why didn't *you* do anything?" But it was probably traumatic for the bystander and maybe they're trying to work it all out in their head.

Interestingly, as a first aider and first aid trainer, we teach and are taught that in the UK the ones who are medically trained are the LEAST likely to provide first aid assistance while out in the street. Coz they are the ones who can be sued. Lowly little first aiders like me are operating under the Good Samaritan Act (not actual legislation, but does provide common sense in the legal arena) and so cannot be sued for being nice.

Don't have any more funny stories at the moment - training has been quiet recently...

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[Snow Dax]

I'm not a doctor, just a friend of a patient, but after my experience tonight I felt compelled to post this:

If you're looking to put your leftover prescription painkiller to recreational use, and can't find a medical reference to determine a safe dosage, Yahoo! Answers will work just as well.

Thanks to all you hard-working ER folks, particularly the ones who put up with my friend tonight. I owe you one.

 

[Kittenmommy]

I really want to make a manscaping joke here about trimming the hedges but I'll let you come up with your own.

Yeah, when I read "trim the hedges", I immediately thought of this:

[YOUTUBE]http://www.youtube.com/watch?v=MvFSgXpyhoM[/YOUTUBE]

 

[Kittenmommy]

And upon being escorted to the waiting room by security, by all means threaten to sue, when you have egregiously violated other peoples' privacy, and assaulted someone else to boot. That's gonna win you some major awesome points.

Can't you have people kicked out for behaving like that? I mean, it's an ER, not a free-for-all!

 

[fragthecullen]

Edit: doesn't belong here.

 

[Kittenmommy]

It was just Urgent Care, and security escorted Mom out after all that.

And, I was the patient in the blood pressure cuff. Little Precious helped me get up off the floor, and ripped the cuff off me, he was so embarrassed by his godawful mother!

I was entertaining thoughts of homicide concerning his mother. I can just imagine what HE was thinking!

That poor kid probably spends a lot of time being embarrassed by his mom.

 

[Katydid]

That poor kid probably spends a lot of time being embarrassed by his mom.

I'm sure he does. My kid, upon hearing about that story, said, "I think I know him...."

I said, "If I ever act like his mother? Take me out back and SHOOT me."

I would never, ever want to be *that* woman, you know?

 

[Kittenmommy]

I'm sure he does. My kid, upon hearing about that story, said, "I think I know him...."

I said, "If I ever act like his mother? Take me out back and SHOOT me."

I would never, ever want to be *that* woman, you know?

Oh, I know. I mean, I can understand going all "Mama Bear" to get help for your sick kid, but she seriously overreacted to what sounds like a pretty minor situation. I bet she's a real Drama Queen in her everyday life.

 

[PsyDGrrrl]

The crazy thing is that a short while later another patient presented with the tops of all his fingers cut off too. His story? He had been driving home and saw this guy using his mower to trim his hedge and thought it was a great idea.
Honestly, you can't make this stuff up.

That cracked me the f*** up.

 

[Kittenmommy]

I posted something similar a while back... except it was YooHoo substituting for formula resulting in dehydration so severe the bambino was on the PICU by the time I (SW) got the consult request.

OK, maybe I'm crazy, but... Yoo Hoo is a liquid, right? Ignoring for the moment its total lack of nutritional benefits, wouldn't it still keep a person hydrated? I mean, it's liquid! I would think the kid would've been extremely malnourished, but not dehydrated.

Found this today on FMyLife.com:

"Today, I tried to wash my cat in the shower, naked myself as it seemed convenient. He disapproved, proceeding to scratch my manparts and nicking a vein. I just got back from the hospital with a blood infection, swollen manparts, and an 8" needle hole in my butt where I had to get antibiotics."

This man obviously has never tried to wash a cat before! I can only imagine what the ER docs were thinking when he came in...

I have washed many cats in my day (hmm, that sounds kind of... odd, doesn't it?) and let me tell you, the shower is not the place to do it!

 

[jbar]

OK, maybe I'm crazy, but... Yoo Hoo is a liquid, right? Ignoring for the moment its total lack of nutritional benefits, wouldn't it still keep a person hydrated? I mean, it's liquid! I would think the kid would've been extremely malnourished, but not dehydrated.

By that logic coke is a liquid, as is wine and is sea water. You ever try to rehydrate drinking one of those? If the liquid has a higher salt content than the body it will pull water into the gut and increase dehydration.

 

[Kittenmommy]

By that logic coke is a liquid, as is wine and is sea water. You ever try to rehydrate drinking one of those? If the liquid has a higher salt content than the body it will pull water into the gut and increase dehydration.

Aaaahh, I see. Thanks!

 

[FATrain]

Originally Posted by Kittenmommy;
OK, maybe I'm crazy, but... Yoo Hoo is a liquid, right? Ignoring for the moment its total lack of nutritional benefits, wouldn't it still keep a person hydrated? I mean, it's liquid! I would think the kid would've been extremely malnourished, but not dehydrated.

By that logic coke is a liquid, as is wine and is sea water. You ever try to rehydrate drinking one of those? If the liquid has a higher salt content than the body it will pull water into the gut and increase dehydration.

Oh thank god for that!
For a minute there I was getting it confused with UHU GLUE!

Sometimes I worry that I spend too much time reading these threads - I end up overly cautious and paranoid that I could end up as one of your examples!

 

[Katydid]

Oh, I know. I mean, I can understand going all "Mama Bear" to get help for your sick kid, but she seriously overreacted to what sounds like a pretty minor situation. I bet she's a real Drama Queen in her everyday life.

Hey, if my kid's life were being threatened by someone wielding a knife or some such, I'd be Mama Bear in a heartbeat. That person would be a smear of film on the floor by the time I was done stomping them.

On the other hand, the last time I had my kid in Urgent Care because she had pink eye (the scourge of the elementary set...pink eye is EVIL), we sat and waited patiently, even though she was miserable, and we waited our turn. I explained to her the concept of triage (she was in fifth grade then), and she understood that very well.

No, that woman was a total Draaaahmaaah Queen. I'm sure she creates draaaaahmaaaah where there's none to create. If she were half as creative in finding solutions to her problems, she'd live a fairly problem free life.

 

[Katydid]

Found this today on FMyLife.com:

"Today, I tried to wash my cat in the shower, naked myself as it seemed convenient. He disapproved, proceeding to scratch my manparts and nicking a vein. I just got back from the hospital with a blood infection, swollen manparts, and an 8" needle hole in my butt where I had to get antibiotics."

This man obviously has never tried to wash a cat before! I can only imagine what the ER docs were thinking when he came in...

I've washed cats before, but only with a towel wrapped around the cat, seeing as how I like the skin on my body to remain attached.

I have to wonder if this dude is just plain stupid, or if he was high when he attempted to wash the cat in the shower, while naked, with manparts conveniently dangling within reach of said cat. That's just insanity personified!

 

[Elynor]

I noticed on youtube that a lot of people are popping cysts/abscesses/whatever on their own.... (friends showed it to me, and were amazed when i didnt gag..)



Have you guys ever had to deal with idiots that screwed it up because they didnt wear gloves/do it proper (aka go to the doctor)?

Yeesh.

 

[Kittenmommy]

3. Always remember to remove the zucchini you have taped to your inner thigh confused before winding up unconscious in the ER. Otherwise, the medical professionals will be quite surprised when they have to cut off your pants.

Ahem.

[YOUTUBE]http://www.youtube.com/watch?v=sjXkOplqrWo[/YOUTUBE]

 

[Katydid]

It is okay to be transported by EMS to the hospital for a mosquito bite.

Of course it is. You could have some exotic tropical disease.

Besides, it's not like the EMTs have anything better to do, right? They just sit around, drinking coffee, waiting for someone to call.

Right?

Oh wait.....

 

[SomeArtStudent]

Ahem.

[YOUTUBE]sjXkOplqrWo[/YOUTUBE]

Nice.
Another valuable life lesson. Mimicking the characters from Spinal Tap = bad idea.

 

[Kittenmommy]

Nice.
Another valuable life lesson. Mimicking the characters from Spinal Tap = bad idea.

I would think that would be basic common sense, no?

 

[Kittenmommy]

That it's not a good idea to attempt to rob a pawn shop that also sells guns. Who knew?

I believe that that falls under this trope. Warning: Link goest to TV Tropes, the biggest time sink on the 'net. You have been warned!

 

[SomeArtStudent]

I would think that would be basic common sense, no?

Haha, you would think. Not all people possess basic common sense, however, as is all too clear from some of the stories related in this thread...

 

[Kittenmommy]

Haha, you would think. Not all people possess basic common sense, however, as is all too clear from some of the stories related in this thread...

I know, I know. I keep forgetting!

 

[Toohotinvegas33]

By that logic coke is a liquid, as is wine and is sea water. You ever try to rehydrate drinking one of those? If the liquid has a higher salt content than the body it will pull water into the gut and increase dehydration.

Not to play IM attending here, but I thought the process was more along the lines of your body being limited in the concentration of Sodium in the urine, So in other worlds, you can take in a concentrated solution (water + sodium), but it was take you twice as much H20 to excrete the sodium to maintain and electrolyte balance.

 

[Tigerz_Fan]

Not to play IM attending here, but I thought the process was more along the lines of your body being limited in the concentration of Sodium in the urine, So in other worlds, you can take in a concentrated solution (water + sodium), but it was take you twice as much H20 to excrete the sodium to maintain and electrolyte balance.

jbar is right. Think of it like water goes where the highest concentration of solute is. Whereever salt is, water follows.

That is why we do not recemmend sugary or salty drinks for fluid replacement in diarrhea.

 

[howelljolly]

jbar is right. Think of it like water goes where the highest concentration of solute is. Whereever salt is, water follows.

That is why we do not recemmend sugary or salty drinks for fluid replacement in diarrhea.

Both the osmols and the osmolarity (i.e. amount and concentration), in and out, make a difference. And then you have to factor in the maximal concentrating ability of the kidneys and obligatory urine production.... so, sea water and suchlike will make things worse. Beyond that, I dont know what im talking about.

 

[Tigerz_Fan]

Both the osmols and the osmolarity (i.e. amount and concentration), in and out, make a difference. And then you have to factor in the maximal concentrating ability of the kidneys and obligatory urine production.... so, sea water and suchlike will make things worse. Beyond that, I dont know what im talking about.

Agreed, I was just presenting it in a simplistic manner.

Anyway, onward with the stories:

That is it really not a good idea to grill inside your living room when it is raining outside.

 

[rhan101277]

Of course it is. You could have some exotic tropical disease.

Besides, it's not like the EMTs have anything better to do, right? They just sit around, drinking coffee, waiting for someone to call.

Right?

Oh wait.....

It would be nice if the agencies, physicians etc. that control our protocols, would change them to let paramedics treat and release certain minor issues such as this. Also things like abrasions, small cuts etc. Once someone calls us we have to take them to the hospital unless they sign a refusal form, no matter how silly. If we don't we can get sued for abandonment and mal-practice.

Some people just like to not have to wait in the waiting room. ER physicians should make them go to triage though.

 

[Noroomforlogic]

jbar is right. Think of it like water goes where the highest concentration of solute is. Whereever salt is, water follows.

That is why we do not recemmend sugary or salty drinks for fluid replacement in diarrhea.

?? Salt and glucose are actively transported out of the gut, concentration gradient be damned. The problem with drinking salt water is that your kidneys can only concentrate urine so much. It is a problem with excretion of the salt load, not that the water just sits in your intestines.

Oral rehydration solutions have both salt and sugar in them precisely because they assist with the absorption of water through the gut.

 

[Kittenmommy]

Oral rehydration solutions have both salt and sugar in them precisely because they assist with the absorption of water through the gut.

Like Gatorade! When I was a kid, I could never figure out why it tasted so... odd. Now I know it's probably because of the sugar/salt thing.

 

[Tigerz_Fan]

?? Salt and glucose are actively transported out of the gut, concentration gradient be damned. The problem with drinking salt water is that your kidneys can only concentrate urine so much. It is a problem with excretion of the salt load, not that the water just sits in your intestines.

Oral rehydration solutions have both salt and sugar in them precisely because they assist with the absorption of water through the gut.

I am referring strictly to the cause and effect of sugary and salty substances on diarrhea. Nothing else.

Leave the kidneys out of the equation for a moment. Depending on the amount of intake, not all of the solutes may get absorbed into the bloodstream from the gut. Therefore the concentration of solute will be slightly higher in the intestinal lumen. As a result, water is displaced into the gut, and increases the diarrhea.

Oral electrolyte solutions like Pedialyte for example, are not as salty, and are slightly better balanced than Gatorade. They are meant for conditions such as diarrhea.

It is not something that happens all the time, but happens sometimes. I was taught this by a GI attending and also remember it from peds in med school. I have seen them recommend these dietary restrictions (so to speak) to patients with chronic diarrhea due to various reasons. Generally, we have recommended that they avoid sugary sodas or juices. The same applies with acute diarrhea.

 

[carcass]

Hi! Not a doctor, nor a medical student, but an engineer. Very funny thread!

I thought I'd chime in on the issue of salt balance and the mechanisms behind salt dehydration.

In my chemical engineering education and my early career I studied and worked with artificial membranes. There are two issues here--the transport of salts from the stomach to the bloodstream, and second, transport across the boundary between the bloodstream and the kidneys. Both can be modeled as transport across a membrane.

The overall mass balance takes into account the transport across both membranes. The limiting transport in the system can be considered to be the kidney, however, the two interact by definition.

Osmosis happens to satisfy the physical law that systems tend to a minimum energy state. Any solution has an "Gibbs free energy of solution" that is minimized at zero concentration. It is directly analogous to the concept of gravitational or electrical potential energy. Osmosis occurs when the Gibbs free energies of two liquids separated by a membrane are unequal.

In a situation where the person starts out at normal hydration and begins drinking salt water, some salt will transport across into the blood. This will of course increase the load on the kidneys, which will use more water to remove salt from the bloodstream. As the blood salt concentration rises, the kidneys will require more and more water. Obviously this will eventually exhaust the body's supply of less salty water and the concentration on both sides of the kidney membranes will reach an equilibrium. This might be considered kidney failure(?) I'm sure there are plenty of other medial consequences of this condition.

In a situation where the person is at normal hydration and begins drinking pure, saltless water, salts will begin transporting back across the stomach membrane to minimize the free energy of solution. This is an equally dangerous condition, as salts that are required for muscle action and neural activity are drawn out of the blood. I think that in extreme cases this can cause paralysis and eventual death due to reduction of function in the central nervous system and metabolism of sugars in the muscles, especially that big important one?

 

[Toohotinvegas33]

Oral electrolyte solutions like Pedialyte for example, are not as salty, and are slightly better balanced than Gatorade. They are meant for conditions such as diarrhea.

.

Your homework for tonight is to go chug some pedialyte.

 

[Tigerz_Fan]

Your homework for tonight is to go chug some pedialyte.

Funny, I have tasted it, and always tought that Gatorade was more salty. I've also compared the labels.

Anyway, like I said, I was taught this from other attendings. They very well could be wrong..........

 

[SoCuteMD]

I am referring strictly to the cause and effect of sugary and salty substances on diarrhea. Nothing else.

Leave the kidneys out of the equation for a moment. Depending on the amount of intake, not all of the solutes may get absorbed into the bloodstream from the gut. Therefore the concentration of solute will be slightly higher in the intestinal lumen. As a result, water is displaced into the gut, and increases the diarrhea.

Oral electrolyte solutions like Pedialyte for example, are not as salty, and are slightly better balanced than Gatorade. They are meant for conditions such as diarrhea.

It is not something that happens all the time, but happens sometimes. I was taught this by a GI attending and also remember it from peds in med school. I have seen them recommend these dietary restrictions (so to speak) to patients with chronic diarrhea due to various reasons. Generally, we have recommended that they avoid sugary sodas or juices. The same applies with acute diarrhea.

Um, I'm going to pipe in here and say that you should probably review GI physiology and sodium/water transport. While it's true that overly sugary drinks can be harmful, some glucose is absolutely necessary for absorption.

Pedialyte is actually MORE salty than Gatorade. Gatorade has far too much sugar and creates too much of an osmotic load in the colon.

 

[Kittenmommy]

Pedialyte is actually MORE salty than Gatorade. Gatorade has far too much sugar and creates too much of an osmotic load in the colon.

My parents always gave me Gatorade when I was a kid, likely because Pedialyte hadn't been invented yet (yes, old poster is old). The only flavor options back then were Green and Orange. The Green was only slightly less revolting, IMO.

Does anyone else remember Gator Gum? It also came in Green and Orange, and yes, it was just as awful as it sounds.

 

[Kittenmommy]

Apparently it's a bad idea to smoke while using oxygen.

Who knew??

Anyone with common sense who watches Grey's Anatomy, in which that one patient blew himself up doing that.

 

[NateintheED]

Apparently dopplers to listen to your baby's heartbeat are available to the general public on Amazon, and at a reasonable price.

Pt (21 y/o G1 at 12 weeks): The heart beat has been in the 130's, but sometimes over 200 on the doppler.
Me: Where did you get a doppler?
Pt: My husband bought it on Amazon!

Does anyone think this is a good idea? Sounds more like a setup for an ED frequent flyer to me.

 

[Tigerz_Fan]

Apparently dopplers to listen to your baby's heartbeat are available to the general public on Amazon, and at a reasonable price.

Pt (21 y/o G1 at 12 weeks): The heart beat has been in the 130's, but sometimes over 200 on the doppler.
Me: Where did you get a doppler?
Pt: My husband bought it on Amazon!

Does anyone think this is a good idea? Sounds more like a setup for an ED frequent flyer to me.

I'm at 24 weeks, and we have had a doppler since 12 weeks. The instruction booklet states on the first line that it is not to be used as a diagnostic tool. I do not think the general public should have access to it. However, like you said, it is a set up for frequent flyers. Because as we all know, and as this thread proves, unforunately the public does not always have logical reason.

 

[DrMom]

Apparently dopplers to listen to your baby's heartbeat are available to the general public on Amazon, and at a reasonable price.

Pt (21 y/o G1 at 12 weeks): The heart beat has been in the 130's, but sometimes over 200 on the doppler.
Me: Where did you get a doppler?
Pt: My husband bought it on Amazon!

Does anyone think this is a good idea? Sounds more like a setup for an ED frequent flyer to me.

I recently had a pt with one of these. She was early in pregnancy (something like 6 weeks) and was having bleeding. She was reassured because they could hear the "baby's" heart beat. She was quite shocked to learn that there no longer was a baby & she'd been listening to her own heartbeat.

 

[Dwindlin]

Apparently dopplers to listen to your baby's heartbeat are available to the general public on Amazon, and at a reasonable price.

Pt (21 y/o G1 at 12 weeks): The heart beat has been in the 130's, but sometimes over 200 on the doppler.
Me: Where did you get a doppler?
Pt: My husband bought it on Amazon!

Does anyone think this is a good idea? Sounds more like a setup for an ED frequent flyer to me.

I hadn't heard you could buy these on amazon, so I went looking. This was my favorite...

http://www.amazon.com/Mabis-MABIS-F...ef=sr_1_9?ie=UTF8&s=hpc&qid=1253119587&sr=8-9

 

[Kittenmommy]

I recently had a pt with one of these. She was early in pregnancy (something like 6 weeks) and was having bleeding. She was reassured because they could hear the "baby's" heart beat. She was quite shocked to learn that there no longer was a baby & she'd been listening to her own heartbeat.

OMG. That is heartbreaking. That poor couple.

I hadn't heard you could buy these on amazon, so I went looking. This was my favorite...

http://www.amazon.com/Mabis-MABIS-F...ef=sr_1_9?ie=UTF8&s=hpc&qid=1253119587&sr=8-9

When our cat Kenny was diagnosed with Feline HCM, the vet told us to monitor his heart rate every day and e mail him. Well, finding a pulse on a cat is tough if you don't know what you're doing, so I bought a stethoscope.

Things I learned from this experience:

1. If you have a happy kitty, it's impossible to hear anything over the purring.

2. After a very short time, the cat will lose patience with being held still and go into "Kitteh Want Down RIGHT NAO!" mode.

I'm still not sure we ever got any kind of an accurate heart rate.

tl;dr: Medical stuff is hard if you don't know what you're doing.

 

[Kittenmommy]

I thought the folks here would appreciate this.

There's a discussion on StupidFree_Drama called "stupid/hilarious/horrifying injuries". Highlights include near death from ingrown hair (MRSA was involved) and someone who accidentally made Kool-Aid with bleach instead of water (and then drank it).

But the best worst one has to be the chick who accidentally cut her clitoris open while masturbating.

Enjoy!

Edited again because OMG leeches behind the eyeball (story #4).

 

[RepairTech]

I just wanna say:

I'm a noobeee and THIS thread is excellent and the reason I joined this site.

I'm a wannabee EMT (that means at this time not even finished my First Responder class yet) now but I am serious about learning EMS.

I'm wondering, do you ever get patients who have been self-treating with what I call "herbs and spices" much to the detriment of their health? I have very strong opinions on allopathic vs. non-allopathic medicine myself and I"m sure you've all had patients who tried to treat say, a heart attack with St. John's Wort so let's hear 'em.

 

[Tigerz_Fan]

Hey guys,

I just found this website:

http://www.ertards.com/

 

[Kittenmommy]

Hey guys,

I just found this website:

http://www.ertards.com/

It appears to be from the creators of/a hommage to FML. Same basic layout and everything.

 

[CancerEscapee]

As per the left, not in the field other than as a <strike>victim</strike> patient. I waited until I read all 59 pages to sign up and post.

This isn't really funny, but it is educational for ED folks, though I'll tell it from the patient perspective.

Even though the triage nurse put the red allergy band on your wrist and even though about eight people have checked your chart already and verified that your allergy is the very-easy-to-avoid allergy to a specific kind of steri-strip it doesn't mean that when health-care-professional #9 happens to be the one putting in your IV she won't go ahead and try to secure it to your skin with said specific kind of steri-strip. Luckily for me I am use to being on the look-out for it and it was off me within 45 seconds. I still got a blister that scarred. And by the way? Health care professional #9 is probably lucky that I didn't catch her name, since I have made something of a practice of showing that scar to subsequent placers of IVs.

moving on from the ED to upstairs...

For nurses of admitted post-surgical patients... once you've finally gotten the pain under control it might not be a good idea to cut the pain meds in half to see if that works as well. It doesn't and it can take hours to get the pain back under control. This can actually equal an extra day's stay in the hospital, no matter how much the patient wants to go home.

Oh, and when the patient has developed a blood clot (separate hospital stay, but same as the ER visit from above) from her passport (port in the arm instead of the chest, for chemo) that will necessitate her being on warfarin for 3-5 months, the best way to introduce her to the concept is by popping a video in her hospital room TV about the drug that talks all about how it's a life-time medication... again, before she's even heard of it. Hysterical crying might ensue. Then be sure that nobody but nobody refers the patient to a specialist so that when the INR pops up to 8 (three months later) and the patient again gets hysterical it takes about a week to actually get said specialist and patient in the same room (where said specialist was PISSSSSSED (not at me)).

and into the infusion clinic:

If you're a nurse passing by another nurse who is having a b*tch of a time placing an IV in a patient, don't mention that she's the best around at it... this does NOT reassure the patient.

****

All that said, while my own hospital stays and emergency room visits for myself have been fraught with f*ck-ups, I still have a tremendous respect for EM folks. Y'all really are on the front lines, work horrific hours -- often with horrific people -- and see horrific things. Venting here instead of going postal is, I think, a great thing and I've been very amused reading all this stuff. Keep up the good work and keep your chins (collectively, not calling anyone fat lmao) up!

 

[spyderdoc]

*

 

[Hamhock]

Some of the side discussions and posts from the patient perspective are changing the intended focus of the thread. The EM mods have discussed this and consequently we are going to move the posts which are not in line with the thread's original intent to this seperate thread. We hope everyone enjoys both threads going forward.

That's a great idea.
hh

 

[CancerEscapee]

fair enough