Why is EM so dumb when it comes to surgery

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gerickson03m

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I'v just finished my first year of surgery, My service has been on staff call for the last 3 weeks. We get from 3-15 consults from the ER every day. The theme is that every person with abd pain gets a CT (even if the dx is so plain ie pt with low abd pain, all labs normal, no BM for 2 weeks) and a surgery consult. :meanie: This week 78% of the ER's dx was plain wrong, I even got a call for a STAT consult! for abd pain, 3rd Year ER resident said it was bowel Ishemia, why? lactate 2.6, I went down and patient was sitting up sucking on a candy, ya, thats ishemia!! This year the program directors are making the ER residents to 3 months of Gen surg so at least they can Dx constipation correctly.
 
You know what I really hate? When the guy in the lumber department at Home Depot can't explain to me how to use the propane grills to make a Beer Can Chicken. It's like, it's the same store, yo. The fool just asks me, "so, what sort of wood did you need me to cut for you today?" and "what prompted you to come to the lumberyard today?"

What a jackass! I mean, am I out of line to expect the guy to know how to use the stuff his own store sells? I thought he earned that orange vest. He doesn't know if you use rosemary or cumin on the chicken, or even how much of the beer you leave in the can. Flippin' amateur.
 
I like beer can chicken, but it doesn't seem to be as great as everyone makes it out to be.
 
Constipation? The most commonly paid out malpractice lawsuit in surgical cases is misdiagnosed appendicitis. You know the most common misdiagnosis? That's right, "constipation". I almost never discharge a patient with the diagnosis "constipation". If something bad happens, you're gonna get crucified.

And ya know, maybe they make mistakes because they're in training? I suppose you've never made a mistake in your own field before, much less someone else's.

Wanna hear about a stupid surgeon story? I know you do. I pull in a third year surgery resident to show him a bedside ultrasound which demonstrates an obvious AAA. I even show him the leak with color doppler. He insists on getting an "official" ultrasound, which takes too long for my liking. Guy dies on the table after the ultrasound tech's eyes went big as she imaged an 18 cm leaking AAA, and they finally get him to OR. Would he have died anyway? Maybe, but his chances would have been better if he had gone immediately to OR.

Point is, everybody makes mistakes. Boneheaded mistakes get made by all specialties, and especially so in residency because that's where the most inexperienced doctors are. The lessons learned for us is that it's pointless to rail on other specialties for mistakes, because you'll make them as well. The lesson for patients is not to get sick in July.

Last question: What am I doing responding to such an obvious troll?
 
You just fed the troll, now you gotta burp him.

mike


Sessamoid said:
Constipation? The most commonly paid out malpractice lawsuit in surgical cases is misdiagnosed appendicitis. You know the most common misdiagnosis? That's right, "constipation". I almost never discharge a patient with the diagnosis "constipation". If something bad happens, you're gonna get crucified.

And ya know, maybe they make mistakes because they're in training? I suppose you've never made a mistake in your own field before, much less someone else's.

Wanna hear about a stupid surgeon story? I know you do. I pull in a third year surgery resident to show him a bedside ultrasound which demonstrates an obvious AAA. I even show him the leak with color doppler. He insists on getting an "official" ultrasound, which takes too long for my liking. Guy dies on the table after the ultrasound tech's eyes went big as she imaged an 18 cm leaking AAA, and they finally get him to OR. Would he have died anyway? Maybe, but his chances would have been better if he had gone immediately to OR.

Point is, everybody makes mistakes. Boneheaded mistakes get made by all specialties, and especially so in residency because that's where the most inexperienced doctors are. The lessons learned for us is that it's pointless to rail on other specialties for mistakes, because you'll make them as well. The lesson for patients is not to get sick in July.

Last question: What am I doing responding to such an obvious troll?
 
How about the obvious appy I had last night.
28 yo male, nausea, anorexia and RLQ pain with point tenderness right over McBurney's point. Oh and his WBC count was 16.
Called surgery, said I have an appy for you.......
Surgery came to evaluate. I don't think this is an appy, it could be IBD. Please get CT of abdomen.........3 hours later......CT reading.....appendicitis.
Could have saved the patient $3000.00 for CT and radiology reading. Patient had no insurance and I was trying to avoid the CT, especially in such an obvious case.
 
I've never tried beer can chicken. I've heard it is good though.

I've always thought Oil can Turkey would be fun.

Shove a big Foster's up the ass of a turkey and bake on the grill for a few hours.

Might try it this weekend.

Have to agree on the fried turkey. Had one this year from some little local hole in the wall with some great cajun seasoning. Best ever.
 
The thing with beer can chicken is that the chicken has to be small so that it cooks through without drying out. I've had good luck with 4-ish pound birds. If you tried it on a turkey I would think that you would have a half burned/half raw turkey. Let me know how it turns out.

I'll never try it though - turkey makes me constipated.

C
 
Wow, dude. You're a miracle worker. You brought this thread back from the dead! 🙂
 
I'm gonna vote for beer and frito pie. Now that's good eatin. 😀
 
The trick is to use Peanut Oil. It has a much higher temperature at which it burns so it won't catch on fire even if your are a ******* and drop a half frozen turkey into hot oil. I have done many turkeys over the past few years and the trick is to slooooooowly lower it in so the oil doesn't boil over. Just my 2 cents, and by the way I can't stand when surgeons think they know everything. Had a trauma surgeon tell me he didn't believe that I listend to heart sounds on a guy with A-Fib. Why you might ask. He said you don't hear S1S2 with A-Fib. I couldn't believe he said that. It made me rethink everything I knew about the heart and even call a cardiologist to be sure. What a *******.


EMRaiden said:
Q-- be careful with your Turkey Fryer, they can end a good night quickly, as the video from UL demonstrates.

http://www.ul.com/consumers/turkeys.html

http://www.ul.com/turkeyfryers/fryer.mpg

-EMRaiden
 
sigep628 said:
The trick is to use Peanut Oil. It has a much higher temperature at which it burns so it won't catch on fire even if your are a ******* and drop a half frozen turkey into hot oil. I have done many turkeys over the past few years and the trick is to slooooooowly lower it in so the oil doesn't boil over. Just my 2 cents, and by the way I can't stand when surgeons think they know everything. Had a trauma surgeon tell me he didn't believe that I listend to heart sounds on a guy with A-Fib. Why you might ask. He said you don't hear S1S2 with A-Fib. I couldn't believe he said that. It made me rethink everything I knew about the heart and even call a cardiologist to be sure. What a *******.

Maybe he meant vFib 😀

Or maybe he meant one of the gallops(I honestly cant remember if it is S3 or S4) which you shouldn't be able to hear in a-fib. I thinks it is S4 but then again who could hear a gallop in a busy trauma bay.

Next time have more faith in yourself and don't bother asking the cardiologist.
 
The key is to brine the turkey before roasting. Covering with aluminum foil while cooking will help retain some of the juices, as will allowing the bird to rest and the juices to redistribute before carving. It may not therefore be necessary to burn down the deck to get a turkey worth eating.

(www.foodtv.com)
Good Eats Roast Turkey
Recipe courtesy Alton Brown
Show:* Good Eats
Episode:* Romancing the Bird (A Good Eats Thanksgiving)

1 (14 to 16 pound) frozen young turkey
For the brine:
1 cup kosher salt
1/2 cup light brown sugar
1 gallon vegetable stock
1 tablespoon black peppercorns
1/2 tablespoon allspice berries
1/2 tablespoon candied ginger
1 gallon iced water
For the aromatics:
1 red apple, sliced
1/2 onion, sliced
1 cinnamon stick
1 cup water
4 sprigs rosemary
6 leaves sage
Canola oil

Combine all brine ingredients, except ice water, in a stockpot, and bring to a boil. Stir to dissolve solids, then remove from heat, cool to room temperature, and refrigerate until thoroughly chilled.
Early on the day of cooking, (or late the night before) combine the brine and ice water in a clean 5-gallon bucket. Place thawed turkey breast side down in brine, cover, and refrigerate or set in cool area (like a basement) for 6 hours. Turn turkey over once, half way through brining.
A few minutes before roasting, heat oven to 500 degrees. Combine the apple, onion, cinnamon stick, and cup of water in a microwave safe dish and microwave on high for 5 minutes.
Remove bird from brine and rinse inside and out with cold water. Discard brine.
Place bird on roasting rack inside wide, low pan and pat dry with paper towels. Add steeped aromatics to cavity along with rosemary and sage. Tuck back wings and coat whole bird liberally with canola (or other neutral) oil.
Roast on lowest level of the oven at 500 degrees F. for 30 minutes. Remove from oven and cover breast with double layer of aluminum foil, insert probe thermometer into thickest part of the breast and return to oven, reducing temperature to 350 degrees F. Set thermometer alarm (if available) to 161 degrees. A 14 to 16 pound bird should require a total of 2 to 2 1/2 hours of roasting. Let turkey rest, loosely covered for 15 minutes before carving.

ERMudPhud said:
Maybe he meant vFib 😀

Or maybe he meant one of the gallops(I honestly cant remember if it is S3 or S4) which you shouldn't be able to hear in a-fib. I thinks it is S4 but then again who could hear a gallop in a busy trauma bay.

Next time have more faith in yourself and don't bother asking the cardiologist.

S4 is caused when the atrial kick forces blood against a stiff ventricular wall at high velocity. It should be absent in someone with A-fib. S3 occurs during rapid ventricular filling and will therefore still be present despite a-fib.

And do I recall correctly that mesenteric ischemia causes postprandial pain, and the patient is therefore able to eat pain-free only to pay for it later? Would not this patient therefore be able to eat in the ED without return of symptoms for some period of time? Perhaps just long enough for the all-knowing surgery intern to do his 5 second H&P before pronouncing the patient cured?


'zilla
 
Fried turkey v. roast turkey= Landslide victory for fried. Agree with sigep use peanut oil and lower the turkey in as slow as your girly muscles will allow. Also throw in a whole peeled onion just after lowering bird to cause less scorching of the skin.

As for surgeons condescending know it all attitudes. I have a great and timely tale for you. Today in surgical clinic we had a pt. come in who said he was seen in the ER over the weekend for a GSW to his back and then sent home. Pt. didn't want to talk about how he got shot but said the ER docs told him he was fine and just had to come to the clinic today to get the bullet out. We pulled up the CT and saw the bullet lodged posterior to the transverse process of T6, The surgeons I was with blew a gasket "How could anyone be so stupid to send a GSW to the back home from the ED" I don't care if the bullet is not in the canal or the abdomen what about concussive force etc. etc. etc. I remained an impartial observer as is my job as an MSIV. Surgical resident gets paged for an ED consult and surgeon attending says "come on we will go have this ED doc's license for lunch" (I managed to keep my mouth shut though it was growing harder) The more he talks on the walk to the ED the more he gets full of himself and how he is going to save the world from a menace of an ED doc. He asks the first ED doc he sees if Doc X who treated the pt. is on and sure enough he is. He finds out where he is and we all go and wait for Doc X to finish with the pt. he is examining. Then in the middle of the hall this surgeon starts letting him have it. In front of me and another med student, 2 surgical residents, this guys pt. and half of the ED. UGLY! And then. The ED doc. Calmly puts up a hand to silence him and says I remember that patient, hold on, let me just get his chart. He comes back in about 5 minutes with the patients chart which clearly documented the pt. left AMA and refused all treatment after CT scan as he needed to "go take care of something important" the documentation of risk was immaculate and the surgeon went ghostly white for a moment. His response...... Oh I see............(long pause) Well the pt. didn't tell me he signed out AMA he said YOU told him he could go. Make sure in the future your patients understand that just because you tell them the CT scan looks good they aren't out of the woods yet. The ED doc reached and took the chart back and said "Good day doctors." and walked away. I loved it. By far the most interesting day of my surgery rotation yet.
 
drkp said:
Pt. didn't want to talk about how he got shot but said the ER docs told him ...

Another case of Two Dudes Syndrome.

"I was just minding my own business when these TWO DUDES walked up and shot me for no reason whatsoever."

Forget drug rehab or gang resistance education. If we could just catch those elusive two dudes, we would end violent crime as we know it.
 
Anyone feel that the old 'turduckin' is more than just a novelty dish for thanksgiving?
 
roja said:
Anyone feel that the old 'turduckin' is more than just a novelty dish for thanksgiving?
I don't know about this turduckin', beer can any-fowl or baked bird...but tofurkey has dominated among my carnivorous friends' holidays going on 5 years.
 
roja said:
Anyone feel that the old 'turduckin' is more than just a novelty dish for thanksgiving?


What is turduckin? Crouching down to avoid being hit when the fit is flying towards the shan?
 
Frito pie.....Makes me think of Doritos. Mmmmmm Doritos. Now I'm gonna stop on my way home and pick up a bag....I just hope those two dudes aren't at the 7-11 when I go there....They seem to really like those 7-11's...
 
Ah, I see a common error. Believing what patients tell you other doctors told them.

I've had many years experience being yelled at by all manner of physicians and nurses for doing whatever terrible thing a patient might have included in his excuse for doing something stupid or embarassing. There are always two sides to a story. It might be a good idea to get both of them before rushing to judgement.

Take care,
Jeff < a fried turkey virgin
 
roja said:
Frito pie is truly southern cuisine. I mention it here and people are like huh?

Nothing brings back memories of high school football games like Frito Pie. Yum!

Take care,
Jeff
 
A buddy of mine actually cooked up a turducken once, and it was fine eatin.

I got kind of hooked on the frito pie in middle school, and now I dont like it so much. However, on the topic of southern cuisine I must mention how much I love barbecue - the noun, not the verb.
 
Turducken looks TASTY!

And Frito pie? A woman after my own heart. Right up there with Moon pies, Spam and sweet taters 😍

Barbeque...I love pig.

And oysters cooked on a sliding door stolen from the local dumpster.

And REAL sweet tea.

{{tearing up from the wonderful memories}}
 
I don'tn drink sweet tea. However I do miss luzianne iced tea and sun tea. What thye try and pass off as iced tea here is horrid!

I miss texas BBQ. *sigh*
 
How the &$@# do you fit a chicken AND a duck inside a turkey? Do they go one inside the other like those little russian wooden dolls, or do they cram side by side? I'm not saying I've ever stuck my head in there, but it's a pretty tight space. And it's hard to breathe.


'zilla
 
they are all deboned. 🙂


At least that's what I hear.
 
- I now know what a 'turducken' is. Sounds interesting enough that I might actually order one (if I ever have to feed 20 people).

- I know that surgery resident !! He is now a third year, but at the end of his internship I overheard him giving the same speech.
 
bemused said:
Right up there with Moon pies, Spam and sweet taters 😍

Don't forget Dr. Pepper! Or, for that matter, Big Red.

BBQ, many, ya just gotta love good BBQ. Ever been in a really, really good BBQ place and gone in the back? There's gotta be 40-50 years of yummy carcinogens on the walls. Now THAT'S good eatin'!

Take care,
Jeff
 
*sigh* yes. Pit BBQ is the best.


I miss shiner bock as well.
 
roja said:
*sigh* yes. Pit BBQ is the best.


I miss shiner bock as well.
A new bar just opened 2 blocks from me that has Shiner Bock... on tap. Damn, I love living in Venice!
 
Another tip I picked up for fried turkey that you have reminded me of (we fried alot of birds during basic sciences) 1)Allow favorite light beer to warm to room temp (Shiner Bock works GREAT!!!) mix one part warm beer, one part melted butter, and a heap of allspice to approx. 50-75ccs and inject bird liberally about 1/2 hour before frying bird.
 
roja said:
Anyone feel that the old 'turduckin' is more than just a novelty dish for thanksgiving?

Years ago I went to Paul Prudhomme's restaurant in NYC for New Years and had turduckin and I have to say it was pretty damn good and I would definitely have it again even if it wasn't thanksgiving.

In answer to Doczilla, they do go inside each other like nested russian dolls but you are only using the deboned breasts.

:clap: :clap: :clap: to febrifuge for hijacking this thread from the start. I propose a beer-can-chicken award for the most creative hijacking of similar threads in the future.
 
kungfufishing said:
A buddy of mine actually cooked up a turducken once, and it was fine eatin.

I got kind of hooked on the frito pie in middle school, and now I dont like it so much. However, on the topic of southern cuisine I must mention how much I love barbecue - the noun, not the verb.

i thought it was a bit overcooked, but yes, it was some good eats.

frito pie is nice. luckily it's a love it or hate it thing mith most people, so i was always able to trade some junk-jello or oatmeal-raisin-nut-whatever else cookie for it at school. like chili day or burrito day, i always left the cafeteria full on frito-pie day 😍

i love me some 'cue as well. it's just so damned hard to come by in the DC area. 🙁

--your friendly neighborhood misses his comfort food caveman
 
Homunculus said:
i love me some 'cue as well. it's just so damned hard to come by in the DC area. 🙁

--your friendly neighborhood misses his comfort food caveman

Come up to Bmore for the day we got pit bbq all over the place
 
Sessamoid said:
A new bar just opened 2 blocks from me that has Shiner Bock... on tap. Damn, I love living in Venice!



you enjoy torturing me?
 
roja said:
you enjoy torturing me?
Absolutely! Did I mention that the Venice Cantina is literally steps from Venice Beach? 🙂
 
Sessamoid said:
Absolutely! Did I mention that the Venice Cantina is literally steps from Venice Beach? 🙂

OK Sess, after my string of shifts is done, we got to get there so I can try this mysterious beer..... I've never had this one....I, personally, am a Guinness fan...This started during residency at Richter's Bar in New Haven, where we would order their awesome wings along with Guinness by the yard (or half yard for lightweights like myself!).....
 
Shiner Bock is darker than American mass market beers, much lighter than Guinness or any of the true stouts. For stouts, I find Guinness to be a bit blunt. There's a fantastic stout called Rasputin which blows away Guinness, both in taste and in alcohol content. Rasputin's 8.9%, while Guinness draught is only 4.0%.
 
The only Guinness I'll drink is when I'm doing an Irish Car Bomb. Well worth the headaches.

Has anyone tried "Delirium Tremens?" My PD told me about it (he's Irish, after all), and I tell ya, it is probably the best beer I've ever had.

Blue Moon with an orange in it is pretty good too.

Q (back from Vacationing in Breckenridge, CO)
 
I just had DT on Friday. It smells like an IPA without the fruit taste. IMO it was an average beer. I did like Old Bastard Scotch ALE very very good. Also I enjoy Abita TurboDog and Old Speckled Hen. Those are some fine beers.
 
Sessamoid said:
There's a fantastic stout called Rasputin which blows away Guinness, both in taste and in alcohol content. Rasputin's 8.9%, while Guinness draught is only 4.0%.
I thought I was the only one. Old Rasputin is incredible!
 
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