What "cool" diseases have you seen on rotations?

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Sparda29

Sparda29

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I haven't seen any of the cool stuff on my Internal Med rotation. I was rather annoyed that 95% of the patients on my floor were like 70 years old or older, I was expecting to see a lot more younger patients there.

I mean, the coolest thing I saw was this middle aged Russian dude who was going through alcohol withdrawal at the same time as being high on PCP. On top of the 9 people who were needed to restrain this guy, all the sedatives/hypnotics we were giving him would not knock him out. At one point, we were about to give him Ativan. Nurse said "nightie night" as she was about to inject him. This guy goes in a Russian accent "I KNOW WHAT NIGHTIE NIGHT MEANS YOU MOTHER****ER! I'm gonna kill you.!"

They were finally able to knock him out using a Propofol drip.
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Not on a rotation but as a practicing pharmacist, there was a state trooper who came down with an unknown virus. He literally turned completely gold... He was in ICU in coma for several days. The last option was IVIG... and his fellow troopers went to a major medical center to pick it up. This was during a major IVIG shortage. I arranged the pick up.

The troopers were doing over 100mph all the way to pick it up as they brought it in a record time.

The patient recovered 100%. To this date, we have no idea what it was.
 
Cool stuff seems to happen when tumors make the body do weird stuff. Like a pancreatic cancer that caused a patient to go through an insulin drip every 2 hours and still have blood sugars in the 500's.
 
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I once worked in a city that had a large Central American population, mostly because they had several big slaughterhouses. We once had a man present with symptoms of a brain tumor, and an MRI revealed that he had a worm in his brain! :eek: It was right on the surface, so the worm was removed and we located some exotic anthelminthic, which was shipped to us via air on a weekend, and he was discharged within a week.

He admitted that if he was hungry, he would sometimes pick bits of meat up off the assembly line and eat them.

I later worked at a clinic pharmacy in another city that had several thousand Bosnian refugees, and the men ALWAYS had Peyronie's syndrome, having been tortured. It's caused by scar tissue in the penile erectile tissue, and can be extremely painful, in addition to making sex difficult or impossible. It's also fairly common in senior citizens, but almost unheard of in young men unless he's suffered some kind of trauma to that area. We knew this because the prescriptions came with their charts, so we could see their co-morbid conditions.
 
ethyl said:
Cool stuff seems to happen when tumors make the body do weird stuff. Like a pancreatic cancer that caused a patient to go through an insulin drip every 2 hours and still have blood sugars in the 500's.
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Was the patient also moribund? It is not unusual for the blood sugar to skyrocket in the final hours of life, even if the patient has no known diabetic or pancreatic disorder.
 
Nothing that exciting. Saw a guy with guillain barre who was slowly recovering. Saw a man with hepatic failure circle the drain for a week and then was gone. Not really exciting but gruesome and kind a fascinating. A Depakote overdose that was reversed with L-carnitine.
 
no interesting diseases, but I do remember a couple of times in which I was making my med deliveries to the ICU that I noticed armed security or police officers sitting outside a patients room....
 
npage148 said:
Nothing that exciting. Saw a guy with guillain barre who was slowly recovering. Saw a man with hepatic failure circle the drain for a week and then was gone. Not really exciting but gruesome and kind a fascinating. A Depakote overdose that was reversed with L-carnitine.
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I actually had guillain barre when I was a kid..
 
Filler said:
no interesting diseases, but I do remember a couple of times in which I was making my med deliveries to the ICU that I noticed armed security or police officers sitting outside a patients room....
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Yes, if a prisoner is admitted, that's what they do.

I did one rotation in a solid organ and bone marrow transplantation unit, and there was a patient who clearly fooled them in the psychiatric evaluation; he rejected his kidney because he deliberately threw up all his meds. :mad:
 
Nocardia nova necrotizing pneumonia with a spontaneous pneumothorax, that was interesting. Disseminated adenovirus, invasive Parvovirus B19, rocky mountain spotted fever, hemophagocytic lymphohistiocytosis, C. diff bacteremia...

I've seen some good stuff I guess.
 
Naegleria fowlerii encephalitis/meningitis in a 7 year old who jumped in a lake and inhaled some water on the way in. Healthy to dead in 7 days...:(
 
Purpura fulminans in an 8 yr old who ended up having to get all her limbs amputated...heartbreaking
 
VBAC in a woman with spina bifida and exstrophy of the bladder, which was why she had the first c-section to begin with.
 
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It's been a while, but I worked as a go-fer at a pharmacy after high school and saw a husband and wife come in to get some sort of exotic eye drops made. They shared contact solution and caught something, both lost almost all of their eye sight. The craziest thing was that they had to put the drops in every half hour continuously for a few days. To this day, I'm super careful about contacts. My girlfriend gets annoyed when she can't borrow my solution.
 
Well, saw some scabies once which was kinda cool I guess. Impetigo also.

Saw an enlarged scrotum - that was pretty crazy. Decubitus ulcers as well, same patient. Poor guy.

I guess those are the most outside the norm stuff I have seen.
 
How about the strangest lab results you've ever seen?

Highest serum creatinine: 29. Patient died the same day.

Highest blood sugar: Don't recall the exact number, but >2,000.

Not a lab, but the grandest multipara I've seen in a chart was G18 P14 L15. The patient was Amish.

Youngest mother: 12. Incest victim.

Oldest mother: 48.
 
Filler said:
no interesting diseases, but I do remember a couple of times in which I was making my med deliveries to the ICU that I noticed armed security or police officers sitting outside a patients room....
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I see 'em all the time at my hospital, but that's what happens when you're the designated hospital for the county jail. Have you ever had to share an elevator with a dude in a striped jumpsuit, with chains around his hands and feet, and a few teardrop tattoos? Awkward...
 
rph3664 said:
How about the strangest lab results you've ever seen?

Highest serum creatinine: 29. Patient died the same day.

Highest blood sugar: Don't recall the exact number, but >2,000.

Not a lab, but the grandest multipara I've seen in a chart was G18 P14 L15. The patient was Amish.

Youngest mother: 12. Incest victim.

Oldest mother: 48.
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There's a thread in the EM forums dedicated to this...shocking stuff in there.

But: Ferritin 550,000...the aforementioned HLH case.
 
rph3664 said:
How about the strangest lab results you've ever seen?

Highest serum creatinine: 29. Patient died the same day.

Highest blood sugar: Don't recall the exact number, but >2,000.

Not a lab, but the grandest multipara I've seen in a chart was G18 P14 L15. The patient was Amish.

Youngest mother: 12. Incest victim.

Oldest mother: 48.
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I'm pretty sure our fattest mother was a 200-kilo 20 y/o in our CCU. She didn't make it, but I think the baby did.
 
rph3664 said:
How about the strangest lab results you've ever seen?
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serum K 18

pt was on a vent, had an IABP with bp 40/30 and was paced with no capture for 24 hours before the docs declared him dead and turned everything off; I think he had already begun to decompose because I have never seen K anywhere that high in a living person
 
Stevens-Johnson Syndrome in a 12 year old whose parents pushed the doctor for an antibiotic rx after a viral URI (I believe it was SMX-TMP). The poor kid was in absolute agony and was in the Peds ICU for weeks.

Rhabdo in a 40ish alcoholic who was admitted for EtOH-withdrawal seizures. He was so out of it and sedated that he gave no signs of muscle pain. It wasn't until the attending suggested to one of the residents that they get a CK that it was caught - his level was over 48,000.
 
AbbyNormal said:
serum K 18

pt was on a vent, had an IABP with bp 40/30 and was paced with no capture for 24 hours before the docs declared him dead and turned everything off; I think he had already begun to decompose because I have never seen K anywhere that high in a living person
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Blood glucose levels often skyrocket in the final hours of life. Maybe they always do, but I'm talking about someone who was being monitored. It will rise at 100 units or more an hour no matter how much insulin you pump into them.

ETA: Yeah, I know I already said that earlier in this thread. I noticed the duplication when I checked the thread out a third time.
 
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Moxxie said:
Stevens-Johnson Syndrome in a 12 year old whose parents pushed the doctor for an antibiotic rx after a viral URI (I believe it was SMX-TMP). The poor kid was in absolute agony and was in the Peds ICU for weeks.
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I had that when I was 8 as a reaction to penicillin. It's actually the reason I want to be a pharmacist. I was in the ICU for two weeks (only the last few days of which I remember- thanks, morphine!) and was nearly airlifted to the Shriner's burn unit in Cinncinati. They didn't because the docs weren't sure I would make it through the night.
 
Praziquantel86 said:
There's a thread in the EM forums dedicated to this...shocking stuff in there.

But: Ferritin 550,000...the aforementioned HLH case.
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I found that thread last night, and read the whole thing! You're right, some really weird stuff in there.
 
Wegener's Granulomatosis or hemachromatosis with a MELD score of 48 or maybe an IV drug abuser who had a 5cm vegetation on his mitral valve. just a couple of things i saw on my MICU rotation in a large academic teaching hospital in the twin cities (minnesota)
 
A Haitian patient in my hospital had what was believed to be a parasite in her leg, which required an amputation. The leg was the size of a large tree trunk.

When I was a medical technologist on rotation in the micro lab, I encountered a sample from a 15 year old with Leukemia who developed a disseminated Fusarium species infection. Sadly, the patient died a few days later. My micro class in pharmacy school didn't even cover Fusarium species.
 
lauradiddle said:
I see 'em all the time at my hospital, but that's what happens when you're the designated hospital for the county jail. Have you ever had to share an elevator with a dude in a striped jumpsuit, with chains around his hands and feet, and a few teardrop tattoos? Awkward...
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Haha, no I've never had that...pleasure yet. The only interesting elevator situations that I've had usually tend to deal with EMT's trying to be wise cracks

EMT: "So, ya got any good stuff in that cart or just antibiotics?"

Me: "Nah, just vanco IV's..hehe"

mind you there is a giant orange box with the words NARCOTICS right there in front of them
 
lauradiddle said:
I'm pretty sure our fattest mother was a 200-kilo 20 y/o in our CCU. She didn't make it, but I think the baby did.
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How do people like that find anyone to have sex with them? :confused:
 
lauradiddle said:
I see 'em all the time at my hospital, but that's what happens when you're the designated hospital for the county jail. Have you ever had to share an elevator with a dude in a striped jumpsuit, with chains around his hands and feet, and a few teardrop tattoos? Awkward...
Click to expand...

The hospital where I worked when I was in school was the place where they took people from the state prison, and I once saw a man in an orange jumpsuit with all kinds of chains and shackles, and there must have been a dozen huge state troopers surrounding him.

At my last job, we would sometimes get people from a minimum-security facility in a nearby town, and one time, they were discharging someone who needed a few doses of an antibiotic to tide him over until the dispensary opened in the morning. Our IT person, who was well versed in IT but not health care, had the WEIRDEST look on her face. The idea that we had prisoners in the facility just never occurred to her.

Another time, there were bulletins on TV to BOLO for a murder suspect. Several days later, he was in the adult psych unit, and tech who processed his order freaked out! She wanted to call the police to let them know where he was, and we told her that the psych unit was trained to deal with this. It turned out he had been taken to jail, and attempted suicide, which happens a lot.
 
Moyamoya is pretty cool, I've followed patients with that before

Right now I am in the neurosurgical ICU so I see subarachnoid hemorrhages pretty routinely as well as subdurals, intracranial hemorrhages.

I heard of a patient who had a Hx + migraines and was having sinusitis complicated with HA with photophobia, N/V, and generalized malaise. PCP gave a triptan + steroid nasal spray. A few days later she was found unresponsive in her own urine. Turns out with the help of that nasal spray she wore through her frontal sinus and had a brain abscess. She expired a few days later after being brain dead. They removed large portions of her skull to accomidate the swelling but her ICPs remained extremely elevated. Sad for sure.
 
I once prepared medicinal leeches for a patient with a reattached body part (I never found out exactly what) when I was in school. It was a weekend, and I was the only person in the pharmacy who was willing to do it. It really wasn't a big deal; I put on shoulder-length gloves, extricated the leeches from a water tank with a small fish net, and placed them in an ointment jar full of the tank water.

My roommate, a film major, didn't believe me. :eyebrow: So, I got one of the extra blank pre-printed labels and took it home and showed it to her.

In the past few years, two fairly prominent local citizens have died from the same rare type of colon cancer. This type usually presents as multiple brain mets, and it did with both men, neither of whom had experienced any kind of bowel problems. It also does not respond to chemotherapy or radiation, and in both cases, they died within a matter of weeks. :(
 
rxlea said:
Cdiff GI bleed has got to be one of the worst smells on the planet.
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I work at a nursing home, and the smells here are horrendous. The pharmacy is fine since we're isolated in the basement. But some of the patient floors just smell disgusting. One time I got off the elevator, took one step out and went back into the elevator to go back to the pharmacy to get a mask to wear. I do not know how the **** patients and their families tolerate the smell.

If a patient ****s the bed, the first priority of the staff on the floor should be clean it up, dispose of the soiled sheets, get a smell control team in there ASAP. Med pass can wait.

I don't know why they can't have those electronic fragrance dispersers to make it smell better.
 
Sparda29, do you work at some kind of large state facility? Very few nursing homes have their own pharmacy, unless it's such a place, or is a nursing home attached to a hospital.

Aides do most of the cleanup work, and cannot pass meds unless they have had a special med aide course, and many nursing homes don't recognize med aides. Nurses don't like it either, because the CNAs really aren't trained adequately to do a med pass.
 
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rph3664 said:
Sparda29, do you work at some kind of large state facility? Very few nursing homes have their own pharmacy, unless it's such a place, or is a nursing home attached to a hospital.

Aides do most of the cleanup work, and cannot pass meds unless they have had a special med aide course, and many nursing homes don't recognize med aides. Nurses don't like it either, because the CRNAs really aren't trained adequately to do a med pass.
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It's in the same complex as a major hospital here on Long Island. 2 floors dedicated to short term rehab and sub-acute care, 4 floors for the nursing home, 527 beds. On site hemodialysis, etc.
 
Sparda29 said:
Yeah, I think the other guy meant to say the CNAs or the LPNs do the dirty work.
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I'm pretty sure that's what they meant. It's just one letter off, but a HUGE difference. :laugh:
 
Seen a bunch of crazy stuff

Mucormycosis/Septic shock

Necrotizing fasciitis/septic shock

Disseminated TB and septic shock, and another patient with TB meningitis/septic shock

C.diff w/toxic megacolon

Multiple myasthenic crisis cases

Takotsubo's cardiomyopathy

Diltiazem overdose treated with high-dose insulin continuous infusion

Seroquel-induced neuroleptic malignant syndrome

Phenelzine overdose

Tons of ICH, status epilepticus, SAH, and neurological trauma in the neuro ICU.
 
GreyFox2002 said:
Seen a bunch of crazy stuff

Mucormycosis/Septic shock

Necrotizing fasciitis/septic shock

Disseminated TB and septic shock, and another patient with TB meningitis/septic shock

C.diff w/toxic megacolon

Multiple myasthenic crisis cases

Takotsubo's cardiomyopathy

Diltiazem overdose treated with high-dose insulin continuous infusion

Seroquel-induced neuroleptic malignant syndrome

Phenelzine overdose

Tons of ICH, status epilepticus, SAH, and neurological trauma in the neuro ICU.
Click to expand...


Damn. Where are you doing your rotations? lol. :eek:
 
GreyFox2002 said:
Seen a bunch of crazy stuff

Mucormycosis/Septic shock

Necrotizing fasciitis/septic shock

Disseminated TB and septic shock, and another patient with TB meningitis/septic shock

C.diff w/toxic megacolon

Multiple myasthenic crisis cases

Takotsubo's cardiomyopathy

Diltiazem overdose treated with high-dose insulin continuous infusion

Seroquel-induced neuroleptic malignant syndrome

Phenelzine overdose

Tons of ICH, status epilepticus, SAH, and neurological trauma in the neuro ICU.
Click to expand...

Not that I've seen all of these, but this list made me realize that things seem less cool and more normal with experience. That's sad.
 
atpsynthase said:
Damn. Where are you doing your rotations? lol. :eek:
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I did all of my rotations (minus my community) at a level 1 trauma center in downtown Detroit. A lot of them were in the ICU environment (MICU/Neuro ICU/Surgical-Trauma ICU. Nuff' said :)
 
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