This place is getting boring, post something good.

[thegenius]

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Yea there needs to be a revision of EMTALA that in real medical or surgical emergencies, like REAL ones like the one above, they get auto launched to the closest center and they deal with it.

And what is this BS that people trained in the problem at hand refuse to treat the patient saying it's too complicated?

More BS

I had a Urologist once try to not come in for penis trauma. "I don't do penis trauma" he quips. I mean WHAT THE FUUUKKK who is supposed to fix a penis then?

 

[Apollyon]

That aorto-enteric fistula had to be incomplete or something else - maybe a turd blocking it? I say that, because, my residency director told us of a case she saw in residency, which was an AE fistula, and the pt exsanguinated in less than 10 seconds, right out the butt.

 

[VA Hopeful Dr]

And what is this BS that people trained in the problem at hand refuse to treat the patient saying it's too complicated?

More BS

I had a Urologist once try to not come in for penis trauma. "I don't do penis trauma" he quips. I mean WHAT THE FUUUKKK who is supposed to fix a penis then?

The system I worked for just got hit with an EMTALA fine for a vascular surgeon who refused to fix a carotid hematoma from a recent endarterectomy because the surgeon who did the procedure originally was at another hospital.

Didn't help that he refused to even come into the hospital and examine the patient, this was all over the phone between him and the ED doctor.

 

[Boatswain2PA]

You heard me.

Started on the "hybrid" ATLS renewal course.

The videos are worse than the early 1990s Red Cross CPR videos.

$1K to watch videos and learn about how important trauma prevention is, how there are new acronyms (XABCDE, MIST, RICE, etc), and how important communication is.

Have surgeons gone soft? Is the world upside down??

 

[RustedFox]

Started on the "hybrid" ATLS renewal course.

The videos are worse than the early 1990s Red Cross CPR videos.

$1K to watch videos and learn about how important trauma prevention is, how there are new acronyms (XABCDE, MIST, RICE, etc), and how important communication is.

Have surgeons gone soft? Is the world upside down??

Haven't renewed my ATLS since residency.

Only reason I renew ACLS is because the brass tell us: "we get a big insurance discount if you're all certified".

I don't really believe them.

Follow the money. Squeeze the juice.

 

[CajunMedic]

Continuing the trend of "you'll hear about this in medical school or residency, but its rare in real life"

78 M checks in for "swelling to eye." Figure it's the usual Chalazion/Stye/cellulitis, etc. Walk in the room and the patient has a HUGE angry, red, indurated area to the medial side of the right eyebrow that extends up the forehead and down the side of the nose. Developed over 24 hours. Has a history of of endoscopic sinus surgery, chronic sinusitis, and is seen at state university medical center 3 hrs up the road by ENT. Little tachycardic, temp 99.7. Order basic labs, CT head, and CT facial bones. CT's come back with what I suspected: Pott's Puffy Tumor. His right frontal sinusitis and eroded through to the subcutaneous tissue and formed an abscess. Start the transfer process to go up the road. "We'll accept him ED to ED, but we're on diversion. We evaluate diversion every 3 hours and we'll call when we get a bed." I go off-duty at 0100, and sign out to the overnight doc. I came back on the next day at 1500 and he's still there. Got a bed about 10AM, but no transport. Finally, a BLS crew from middle of nowhere picks him up.

Followed up today. They confirmed the diagnosis and took him to the OR a couple of hours ago for endoscopic I&D. Gonna grab an intern or a PGY-2 and see if we can get it published.

 

[DocEspana]

Not specifically emergency medicine related, but I think you guys would appreciate this more than most other sections of this website would

Down here in Miami there is a hospital system called Larkin. I hesitate to refer to it as a hospital system, but I don't know what else to call it. It's three very small hospitals that all seem to be built extremely close to pockets of nursing homes. I don't know where exactly the name Larkin came from, but they are privately owned hospitals that are owned and ran by the doctor who provides all the medical care at the nursing home. Obviously the structure was set up prior to the ACA, as this would be illegal after the ACA. You can immediately see what the game is here. What's a little terrifying is that Larkin has some residencies at their hospitals, which absolutely should never be having residents.

Somehow, despite living down here for close to a decade, I missed the fact that there is also a Larkin University. It basically pumps out bad nurses and medical techs.

Well, they just announced that they intend to open a medical school at the same campus that they teach the nurses and the techs at. And I'm certain this is going to be a big hit in the larger medical student community when they roll in for an interview and see that the medical school is located in a strip mall between pawn shop and car parts Warehouse it faces directly towards the number one strip club in America.

For those strip club aficionados reading, it's directly in front of tootsies, which used to be a BJ's wholesale club, but is now the first or second biggest strip club in America and is consistently rated the number one strip club in America. Personally, I think this would be the only compelling argument for this medical school. Quick access to after school entertainment

 

[maxxor]

https://www.miamiherald.com/news/health-care/article314973823.html

This is on the first page of google results. Sounds like the crazy house of god outpatient chapter. #justmiamithings

 

[Mount Asclepius]

Hate to be brutally honest, but people don’t plan for morbidity and mortality subconsciously hoping the system just deals with it for them when the inevitable happens. We need to do better with aging in this country. This isn’t a new concept. Every ED and Hospital struggles with this. It’s not necessarily fraud. That being said, it seems there may be a little smoke here.

 

[BoardingDoc]

Hate to be brutally honest, but people don’t plan for morbidity and mortality subconsciously hoping the system just deals with it for them when the inevitable happens. We need to do better with aging in this country. This isn’t a new concept. Every ED and Hospital struggles with this. It’s not necessarily fraud. That being said, it seems there may be a little smoke here.

Agree. This place seems like a hellhole. That said, I can't count how many times I sent indigent patients to a local SNF that wasn't much better. Not because I wanted to send them there, but because it was literally the only place that would take them and the family "just can't handle it anymore."

 

[HemeOncHopeful19]

Not specifically emergency medicine related, but I think you guys would appreciate this more than most other sections of this website would

Down here in Miami there is a hospital system called Larkin. I hesitate to refer to it as a hospital system, but I don't know what else to call it. It's three very small hospitals that all seem to be built extremely close to pockets of nursing homes. I don't know where exactly the name Larkin came from, but they are privately owned hospitals that are owned and ran by the doctor who provides all the medical care at the nursing home. Obviously the structure was set up prior to the ACA, as this would be illegal after the ACA. You can immediately see what the game is here. What's a little terrifying is that Larkin has some residencies at their hospitals, which absolutely should never be having residents.

Somehow, despite living down here for close to a decade, I missed the fact that there is also a Larkin University. It basically pumps out bad nurses and medical techs.

Well, they just announced that they intend to open a medical school at the same campus that they teach the nurses and the techs at. And I'm certain this is going to be a big hit in the larger medical student community when they roll in for an interview and see that the medical school is located in a strip mall between pawn shop and car parts Warehouse it faces directly towards the number one strip club in America.

For those strip club aficionados reading, it's directly in front of tootsies, which used to be a BJ's wholesale club, but is now the first or second biggest strip club in America and is consistently rated the number one strip club in America. Personally, I think this would be the only compelling argument for this medical school. Quick access to after school entertainment

Is this some sort of lowkey/astroturfing strip club advertisement 🤔

 

[DocEspana]

Is this some sort of lowkey/astroturfing strip club advertisement 🤔

The wings are famous enough that Drake raps about them.

 

[gutonc]

Is this some sort of lowkey/astroturfing strip club advertisement 🤔

Totally unrelated, but there is a locally famous strip club near me, also renowned (maybe not in Drake raps, but that might also be a plus) for it's food, that recently went up for sale as the owner died. My brother-in-law (and our respective spouses) gave serious consideration to making an offer on the place.

We backed out because all 4 of us have FT jobs and couldn't envision the extra work needed to run the place.

 

[Apollyon]

Totally unrelated, but there is a locally famous strip club near me, also renowned (maybe not in Drake raps, but that might also be a plus) for it's food, that recently went up for sale as the owner died. My brother-in-law (and our respective spouses) gave serious consideration to making an offer on the place.

We backed out because all 4 of us have FT jobs and couldn't envision the extra work needed to run the place.

The only only of which I know (never went there) is the one in Vegas with the steakhouse that overlooks the floor, so, you can chow down while perusing your dancers. I mean, I want to go, just have yet to make it

 

[CajunMedic]

For those strip club aficionados reading, it's directly in front of tootsies, which used to be a BJ's wholesale club, but is now the first or second biggest strip club in America and is consistently rated the number one strip club in America. Personally, I think this would be the only compelling argument for this medical school. Quick access to after school entertainment

Before the State of Louisiana made the decision to shut down their hospitals and privatize the ones they didn't tear down, we had Club Dancers. It was essentially in the ED parking lot of Earl K. Long Medical Center in Baton Rouge. The club came before the hospital. Notorious for dancers with PICC lines. Depending on who was working triage, they'd call over there to look for patients before declaring them LWBS.

 

[DocEspana]

The only only of which I know (never went there) is the one in Vegas with the steakhouse that overlooks the floor, so, you can chow down while perusing your dancers. I mean, I want to go, just have yet to make it

Without looking it up, was it sapphire? I lived above the original sapphire (in Manhattan) and that was the design of sapphire in NYC and I know there are 2 or 3 of them now

 

[Apollyon]

I don't recall. I haven't looked at it for over 2 years now

 

[Pinner Doc]

What is it with hospitals and strip clubs? I did residency in Salt Lake. One of our level 1 trauma centers was across the street from a club called Southern Exposure.

I respect a ski themed strip club title.

 

[Apollyon]

What is it with hospitals and strip clubs? I did residency in Salt Lake. One of our level 1 trauma centers was across the street from a club called Southern Exposure.

I respect a ski themed strip club title.

There's one across the street from the hospital in Wahiawa on O'ahu. (Or, at least, was, when I lived there.)

 

[DocEspana]

What is it with hospitals and strip clubs? I did residency in Salt Lake. One of our level 1 trauma centers was across the street from a club called Southern Exposure.

I respect a ski themed strip club title.

Both have robust night shift employees?

 

[Powdermonkey]

Before the State of Louisiana made the decision to shut down their hospitals and privatize the ones they didn't tear down, we had Club Dancers. It was essentially in the ED parking lot of Earl K. Long Medical Center in Baton Rouge. The club came before the hospital. Notorious for dancers with PICC lines. Depending on who was working triage, they'd call over there to look for patients before declaring them LWBS.

When I interviewed there for residency way back when, there was urban legend that one of the strippers was seen regularly for stoma STI treatment. Usually from going out back with her in her van. Yep. Let that marinate just a little. Just a thin chain link fence away from the trauma entrance. It was kind of epic.

You're welcome.

 

[Boatswain2PA]

Start the transfer process to go up the road. "We'll accept him ED to ED, but we're on diversion. We evaluate diversion every 3 hours and we'll call when we get a bed." I go off-duty at 0100, and sign out to the overnight doc. I came back on the next day at 1500 and he's still there. Got a bed about 10AM, but no transport.

I have started occasionally having EMTALA class with patients/families in situations like this. Most recent was a kid with an appy on weekend. Tertiary center with in-house "Pediatric Hospital" 1 hr away closed to transfer. Other tertiary center in same city will sometimes do peds...but surgeon that weekend didn't. Options were wait for "pediatric hospital" to open up, or transfer 3.5 hours away.

After extensive d/w parents regarding situation, their unwillingness to travel 3.5 hours, and a review of EMTALA preventing me from transferring them, they elected to leave AMA and drive directly to the Pediatric Hospital ED. We sent images and notes over.

 

[Boatswain2PA]

I read and replied to Cajun's post....then read the diversion into strip clubs & hospitals....a conversation that only could be had between EM folks.

Triage calling over to the stripper pole before declaring pt LWBS.......that's awesome.

 

[eyeeye_captain]

I’ve never had the pleasure (ha) of a strip club by the hospital, but my most memorable experience was in Atlanta. Years ago I went down for a sporting event and my friend is from there, so he says hey, let’s go to the Clermont Lounge, it’s a great dive bar with a little nudity. Cool.

Get there and it’s in the basement of a boarded up hotel. Line out the door with almost everyone smoking, cash only, no lights except for neon. DJ playing oldies with a dance floor. Ok, all good.

What was neglected to be mentioned was that it’s billed as where dancers go to die. Literally every one of those fine ladies had Medicare and/or AARP, but they brought the energy despite the arthritis. Darn good time even if my eyeballs got a little singed.

Google says they renovated the hotel above it into a luxury place but the lounge lives on. Must be quite the contrast.