MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Fingers And Tubes In Every Orifice' source. Thu, 06 Nov 2008 02:27:45 +0100 http://fingersandtubesineveryorifice.blogspot.com/2008/10/positve-3-stooges-sign.html Tune in for more...NYUK NYUK NYUK NYUK(Oh, I'm updating my link lists. If you want me to link you up. Shoot me an email.) (Source: Fingers And Tubes In Every Orifice) Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=1894967 Tue, 21 Oct 2008 23:31:00 +0100 1894967 http://fingersandtubesineveryorifice.blogspot.com/2008/10/get-some.html Too good not to pass along. (Source: Fingers And Tubes In Every Orifice) Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=1886384 Fri, 17 Oct 2008 14:59:00 +0100 1886384 http://fingersandtubesineveryorifice.blogspot.com/2008/10/fixing-our-broken-health-care-system.html Not too long ago Medblog Addict asked me this question in an interview:"One of the presidential candidates has asked you for some advice on how to improve the nation's health care system. What do you tell them?"I thought my answer was pretty decent so I'm reposting it here:The health care crisis facing our country is akin to a festering butt pus in dire need of incision and drainage. Like butt pus, it’s well covered up so no one else can see, but it sure hell is a huge pain in the ass! My long rant on the subject can be seen here: Slippery Slope to Socialized Health CareTo summarize, we have a real national crisis at hand and it seems that none of our politicians know how or even care to solve. When over 47 million Americans do not have health insurance, we have a big problem. When a per... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=1879873 Wed, 15 Oct 2008 19:50:00 +0100 1879873 http://fingersandtubesineveryorifice.blogspot.com/2007/06/blissful-ignorance.html Hey all! Blogging to ya from a remote tropical place where the sands are sugary white, the wind blows hard, and those little drinks with the colorful umbrellas never stop flowing. Being unemployed have never felt so relaxing. Truly this windsurfer's paradise. It's so awesome pulling off a duck jibe on a 65 liter board and a 4.0 sail. Rippin' it every day, man! The wind here is just unbelievable, steady and hard, while the water stay calm without the chops. But on the south side though, the waves breaks hard off the reefs. Oh man, perfect for wave sailing and surfing! Just visited the local ER, too, and they're hiring! Sweet! Tempting, but I haven't made a decision after the interview.The internet connection here is slow and spotty.I just checked Technorati and discovered that there's a hea... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=675598 Tue, 12 Jun 2007 23:43:00 +0100 675598 http://fingersandtubesineveryorifice.blogspot.com/2007/05/calling.html My 8 y/o nephew interviewed me the other day as part of his homework assignment for school. He asked me the ultimate question, "Why did you become a doctor?" I didn't want to disappoint an impressionable child with the truth, so I gave him the usual inspirational answers about wanting to make a difference, helping people, saving lives, etc... But the truth is, I didn't know what else to do at the time so I went to med school.My application to med school was impeccable, I must brag. I was the total package, clawed my way out of the housing projects of Crack City to become valedictorian of my high school, graduated summa cum laude from a top tier engineering school of a prestigious university with internship experience through several internationally recognized companies. Even won a couple o... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=638027 Wed, 23 May 2007 17:43:00 +0100 638027 http://fingersandtubesineveryorifice.blogspot.com/2007/05/insurance.html cc: "I think I'm pregnant again"HPI: 22 y/o sexually active WF LMP "last month" c/o possible pregnancy. Denies pain. Denies vag. bleeding. Have not performed home pregnancy test.ROS: 9 points ROS o/w neg.PMHx: nonePSHx: nonePOB/GynHx: G4P4Ao, all NSVD w/o complications, no STI'sPE: WDWN, AAOx4, NAD, ambulatory, drinking bottle of Sunkist soda.HEENT: NCAT, EOMI, PERRLA, nonictericNeck: No LAD/mass/JVD/thyroidmegallyCV: RRR, no m/r/gChest: CTAB no crackles/r/r/wAbd: +BS, soft NT/ND, No HSM/masses. unable to palpate fundal ht.GU/Pelvic: deferred since patient denies pain, VB or d/cBack: No MT, no CVATExt: 2+pulses throughout, no c/c/eSkin: warm, dry, no obvious rashesNeuro: grossly intact, no lateralizing signs, nonataxic gait.Assessment: Young female requesting pregnancy test. LMP last month... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=631581 Wed, 16 May 2007 18:47:00 +0100 631581 http://fingersandtubesineveryorifice.blogspot.com/2007/05/another-quote-of-night.html From the same charge nurse to hysterical patient with a stuffy nose whose chief complaint was "I can't breathe" -"Ma'am, if you can talk, you can breathe...Ma'am, just calm down...Ma'am that hole in your mouth is bigger than the two holes in your nose! If you can talk, you can breathe!"Crushing logic, isn't it?!! (Source: Fingers And Tubes In Every Orifice) Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=612101 Wed, 16 May 2007 03:26:00 +0100 612101 http://fingersandtubesineveryorifice.blogspot.com/2007/05/quote-of-night.html Direct to you from last night's shift, wicked words of wisdom from Crack City ER's charge nurse to belligerent patient after polite attempts at diffusing a situation failed:"Sir, as a nurse, I will clean your ass, I will wipe your ass, I will stick my fingers and tubes up your ass, BUT, I will NOT go so low as to kiss your ass. And rest assuredly, if you continue to piss me off, I will not hesitate to kick your ass! Now plant your ass down or I will take your temperature with my boot!" (Source: Fingers And Tubes In Every Orifice) Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=602435 Sun, 13 May 2007 19:30:00 +0100 602435 http://fingersandtubesineveryorifice.blogspot.com/2007/05/dereliction-of-duty.html It's May. My last month at Crack City so I'll try to blog as much as I can before figuring out my next move.On some nights I'm just so sick and tired, so fed up with it all that I just wanna scream and ask, "AM I THE ONLY ONE WHO GIVES A SHIT AROUND HERE?"Case in point, father of this 7 y/o little boy brings him into the ED last night reporting that his mother's boyfriend had beatened him black and blue with a belt, to which the mother did not deny. The couple had been divorced for a little over a year. On physical exam, the little boy had indeedly not been spared the rod at all. His buttocks and back were ecchymotic, black and blue with scattered scabbed marks from numerous whippings and beatings. It was unbelievable. Sort of reminded me of a scene out of the TV mini-series Roots where Le... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=592135 Sat, 05 May 2007 16:00:00 +0100 592135 http://fingersandtubesineveryorifice.blogspot.com/2007/05/tricks-of-trade.html Our friendly blogosphere urologist Dr. Keagirl over at Urostream had this nice thing to say about us ER folks when she got called in to help with a difficult foley on a trauma patient. Grunt Doc thanked her for coming in on behalf of all of us ER guys.One thing that has always puzzled me is...well here's the comment I left on her post with a little picture at the end:Ditto, what Grunt Doc said.I find that most urologists are very "ER friendly" and accomodating.One of these days, I'm gonna have bribe one of them to show me some tricks of their trade in placing difficult foleys. Or at least get one drunk enough to reveal their secrets! Most of the time, the nurses have tried, at least over a dozen time with different size catheters. Then I get a crack at it with numerous attempts using diffe... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=589238 Fri, 04 May 2007 14:09:00 +0100 589238 http://fingersandtubesineveryorifice.blogspot.com/2007/05/toothache.html "Hey Liz, could ya bring back the lady with the toothache?" I asked the triage nurse over the phone."Which one? There are several of them out here.""The 68 years old one. Oh, please put her in Room 5 instead of the ENT room.""Why, you know her?""Nah. Just a hunch.""She told me she's been having the same toothache for 2 weeks. Room 5? You sure?""Yeah, Room 5.""Okay...the other people who came in before her will be very mad..."BOOYAH! Tombstones!"How'd you know?" Liz asked."How many 68 years old li'l lady have you seen coming to the ER in the middle of the night for a toothache?" I answered."None," she replied.Bingo! It was really a matter of knowing about the generation gap and using it to your advantage that made all the difference.As an aside, I hate it when people with toothaches come to... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=583542 Tue, 01 May 2007 21:35:00 +0100 583542 http://fingersandtubesineveryorifice.blogspot.com/2007/04/logic.html Drug seeking patient with chronic toothache returned to the ED claiming that someone had stolen his Lortab prescription generously written to him during the previous shift by one of our more easily persuaded/fooled physician in the group. I quickly looked in his halitotic mouth. Rotten molars worn down to the nubbins."I left it right there on the counter and someone stole it!" he claimed."Did they steal your Penicillin prescription, too?" I played along."No. I still got it right here.""That's so terrible!" I empathized. "Some people, stealing other people's prescription like that, un-buh-lievable!""Yeah, can you give me another prescription?" he asked"Why certainly! I'll write ya somethin' that they won't steal!" I answered accomodatingly and whipped out the prescription pad.Rx: Motrin, 80... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=576977 Sat, 28 Apr 2007 14:19:00 +0100 576977 http://fingersandtubesineveryorifice.blogspot.com/2007/04/whars-bullit.html First the xrays, as usual. More later. No peeking by clicking on the xray. I'm too lazy to change the name of the file. (Source: Fingers And Tubes In Every Orifice) Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=569658 Wed, 25 Apr 2007 15:10:00 +0100 569658 http://fingersandtubesineveryorifice.blogspot.com/2007/04/gripe-day-2007.html I've got nothing witty or whimsical to post so might as well do a Gripe Day filler.For this year Gripe Day, I've decided to be a little more selective and weed out all the potty mouth comments undeserving of any response. And there were lots of them, too. Here are the chosen few that I've considered "best of breed."This one in response to my post about the time I saved a patient's life with noninvasive BIPAP after she was inappropriately placed on a DNR order by her primary care doc:"My poor precious Mother has CHF and has had Bi-pap twice in the last 5 weeks. We have DNR’s but just added not to use the Bi Pap in the future….She is miserable.She has 15 % ejection fraction or less…she can barely walk, is severely depressed, having panic attacks nightly, the entire journey has been a n... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=568145 Tue, 24 Apr 2007 19:25:00 +0100 568145 http://fingersandtubesineveryorifice.blogspot.com/2007/04/one-question-iq-test.html Here's a one-question IQ Test to help you decide how you should spend the rest of your day.....(I turned my computer off)There is a mute who wants to buy a toothbrush.By imitating the action of brushing one's teeth, he successfully expresses himself to the shopkeeper and the purchase is done. Now, if there is a blind man who wishes to buy a pair of sunglasses,how should he express himself?Think about it first before scrolling down for the answer...Oh, enjoy the following pics.No cheating now! Don't scroll down until you really think about it!Got the answer yet?Cute Frogs, huh?Look carefully at the following picture. There's more in it than meets the eye.Look more carefully at the above picture. You'll discover more new things and images in it every time you look at it. You might even disco... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=556892 Fri, 20 Apr 2007 04:33:00 +0100 556892 http://fingersandtubesineveryorifice.blogspot.com/2007/04/loss-of-autonomy.html I guess I do owe you, my blogspace friends, an explanation of my previous post. I am taking a sabatical from my job at "Crack City" Medical Center. Heck, I've actually already turned in a letter of resignation with the required 6 months notice, but instead have been coaxed into an indefinite leave of absence. In essence, I'm still on the medical staff just in case I change my mind. "We don't want to lose someone of your caliber" convinced the folks in my group. At any rate, I've agreed to finish out next month's schedule, since it has already been made. Then afterward, I'm outta there.Years ago when I was but a numbskull, doe-eyed medical student, I was already well forwarned by one of my mentor attending that this day would come. I told myself that if the day ever come when I am being tol... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=525561 Fri, 06 Apr 2007 12:22:00 +0100 525561 http://fingersandtubesineveryorifice.blogspot.com/2007/04/taking-break.html I'm taking a sabatical and won't be blogging for a while. Will explain later. I've had tough days at work before but what I'm currently going through has driven me over the edge. Medicine's too depressing right now. Lawsuits to deal with, hospital politics, the usual CRAPPOLA that have sapped the energy out of me. It's all a slippery slope that I've ranted about last February. Here's an excerpt: "Now I'm no card carrying left wing liberal who espouse socialized health care either, so don't even go there. I'm merely pointing out the fact that we have a real national crisis at hand and it seems that none of our politicians know how or even care to solve. When ~47 millions of Americans do not have health insurance, we have a big problem. When a person in America has to make a decision between... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=522942 Thu, 05 Apr 2007 12:53:00 +0100 522942 http://fingersandtubesineveryorifice.blogspot.com/2007/04/generation-gap.html Me to 95 y/o patient with a displaced femoral neck hip fracture and an impacted humeral neck fracture after a fall at home:"Ma'am, are you allergic to any medication? I just want to make sure so we can get you good pain relief."Patient (nonchalantly): "Oh, that's alright, I got Bufferin at home."Holy cow! She was sharp as a tack, too. Looked like she was 55 instead of 95. Serious!Same night, different patient who was 22 y/o.....Patient (moaning and whining): Can I have some pain medication? This hurts really bad! It's killing me! OMG! ...Moans some more...Me: I pulled that little roach out of your ear already. It shouldn't hurt that bad anymore. Besides, your eardrum looks fine and intact. It's not perforated at all. It's not even red or inflamed. And Your ear canal has no abrasions or ble... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=520263 Wed, 04 Apr 2007 04:34:00 +0100 520263 http://fingersandtubesineveryorifice.blogspot.com/2007/04/i-cant-swaller.html Hallway Four posted a clinical vignette about a patient who can't swallow. Many years ago, I had a somewhat similar case but with the usual Crack City twist.I once saw a 13 y/o girl with similar symptoms of “I can’t swaller” x 3 1/2 wks. She was seen by her family doc who had diagnosed her with a “strep throat.” She had finished a course of liquid Amoxil followed by a course of Augmentin and was on Cleocin when I saw her. Examination of her throat was normal, of course (otherwise I wouldn’t have told this story). But her neuro exam showed definite bulbar symptoms. She was also ataxic, couldn’t walk in a straight line heel-to-toe fashion. She was also very dehydrated due to poor PO intake. By the time I saw her, she was drooling and couldn’t handle her secretions.In addition... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=520262 Wed, 04 Apr 2007 04:08:00 +0100 520262 http://fingersandtubesineveryorifice.blogspot.com/2007/04/whos-boss.html Drug seeker of the night:Patient: Can I have some Demerol and Phenergan for pain, it's the only thing that works for me. That and Dilaudid.Me: (in a surprised tone) But I've only put a li'l Dermabond glue on your arm to close that tiny cut.Patient: I'm dying in pain here! I need some pain medication, man!!Me: Aren't you exaggerating a bit? C'mon, that cut wasn't even that deep. It didn't even go into the fatty layer. Demerol or Dilaudid? Really?Patient: (In escalating, louder voice now) You don't understand, I usually have a very high pain tolerance, but this hurts really bad! It's killing me! I need something for pain!Me: It ain't but a 1/4 inch cut, for goodness sakes! High tolerance you say, huh? Killing you? C'mon!Patient: Yeah, but you didn't numb it up when you cleaned it and glued i... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=516412 Mon, 02 Apr 2007 14:52:00 +0100 516412 http://fingersandtubesineveryorifice.blogspot.com/2007/03/ode-to-butterfly.html Sweet Barbados Butterfly, you are so missed! I click to your blog everyday, ever hopeful for your return. Saddened. Then I started an ode, just a few lines, but found this much more eloquent one by Thomas Wentworth Higginson. Ode to a ButterflyTHOU spark of life that wavest wings of gold,Thou songless wanderer mid the songful birds,With Nature's secrets in thy tints unrolledThrough gorgeous cipher, past the reach of words,Yet dear to every childIn glad pursuit beguiled,Living his unspoiled days mid flowers and flocks and herds!Thou winged blossom, liberated thing,What secret tie binds thee to other flowers,Still held within the garden's fostering?Will they too soar with the completed hours,Take flight, and be like theeIrrevocably free,Hovering at will o'er their parental bowers?Or is thy ... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=514571 Wed, 21 Mar 2007 15:23:00 +0100 514571 http://fingersandtubesineveryorifice.blogspot.com/2007/03/why.html "Ma'am, your grandmother is dying. She fell and has a head injury. She has some bleeding in her brain, a subdural hematoma, it is small in size for now, but being on a blood thinner doesn't help matters much. She must have fallen hard because she also broke her right hip. But I think the reason why she fell, though, is because she has an overwhelming infection that has spread throughout her body. She is in septic shock. The severe infection has caused her blood pressure to be extremely low. She's unresponsive, comatosed in fact. She has severe pneumonia in both lungs, what we call multilobar pneumonia. She's not breathing and not oxygenating well at all. She is also severely dehydrated. She is in kidney failure and has a very bad urinary tract infection as well. She is GRAVELY sick. She al... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=485703 Wed, 21 Mar 2007 06:09:00 +0100 485703 http://fingersandtubesineveryorifice.blogspot.com/2007/03/through-childs-eyes.html THROUGH A CHILD'S EYES (I got this in an email, I couldn't resist)My absolute favoritest (just as my daughter would say it):I hope you enjoyed that as much as I did. (Source: Fingers And Tubes In Every Orifice) Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479285 Fri, 16 Mar 2007 16:11:00 +0100 479285 http://fingersandtubesineveryorifice.blogspot.com/2007/03/fingers-and-tubes.html Boy, I really felt like a buffoon the other night. Talk about "DO AS I SAY, NOT AS I SPEW!"Every ER doc has a collection of "interesting" xrays featuring a certain foreign object lodged in a bodily orifice, like this one or the one below:C'mon, admit it! You got 'em. I would bet that Grunt Doc, Trenchy, Scalpel, and Shadowfax have file cabinets full of them. For teaching purposes, of course. ;-) And they certainly can top what I have in my stash, I think, though I would dare say that it'd be pretty damn hard! Here's the lateral view:Note the dual, size D batteries. In the words of my trusty Irish charge nurse Annie after we pulled this foreign body out, "Holy shiet! That thing is a monster!"But back to my comment about "Do as I say..." and me looking like a buffoon, the story goes like thi... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479287 Wed, 14 Mar 2007 04:47:00 +0100 479287 http://fingersandtubesineveryorifice.blogspot.com/2007/03/tombstone.html I haven't had to give any thrombolytics in over 8 years for an acute MI (heart attack) because the standard of care has since evolved to emergent rescue angioplasty and coronary stenting across the country. At CCMC, our door to cath lab time is under 14 minutes. That goal was set by yours truly many years ago and achieved without a glitch. Actually, my goal was under 20 minutes but having fine-tuned things over the years, we've shaven it down even further. Back then I had to push hard to equip all of the ambulances in the area with machines that can fax EKG's to our ED, as we are the only facility within the 7 surrounding counties with a cracked enough team of dedicated cardiologists and competent cardiothoracic surgeons willing to take calls 24/7/365. The EMS folks applauded such aspirati... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479288 Thu, 08 Mar 2007 10:52:00 +0100 479288 http://fingersandtubesineveryorifice.blogspot.com/2007/02/clam-shelled.html Ordinarily, I would call it DOA in situations such as this, fatal GSW (gun shot wound) to the chest with no vital signs upon arrival. Thoracotomies are the absolute worse case scenarios, much less a bivalved/clamshell one. However, extraordinary circumstances called for more than just the routine care. I had to take that extra step and brought it up a notch because he was an off-duty police officer who was in the wrong place at the right time. His heroic actions saved the lives off many who were involved on that tragic, unfateful day. For sakes of privacy and HIPAA, I will not reveal the full circumstances of the event but only the medical aspect behind it."Officer down! Officer down!...." The announcement came across the static radio of a policeman who happened to be in the ED at the time... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479289 Thu, 22 Feb 2007 22:34:00 +0100 479289 http://fingersandtubesineveryorifice.blogspot.com/2007/02/murder-mystery.html Something interesting I came across so I'll post it here.Read this question, come up with an answer and then scroll down to the bottom for the result. This is not a trick question. It is as it reads. No one I know has gotten it right. A woman, while at the funeral of her own mother, met a guy whom she did not know. She thought this guy was amazing. She believed him to be her dream guy so much, that she fell in love with him right there, but never asked for his number and could not find him. A few days later she killed her sister. Question: What is her motive for killing her sister? [Give this some thought before you answer; see answer below.] Answer: She was hoping the guy would appear at the funeral again. If you answered this correctly, you think like a psychopath. This was a te... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479292 Fri, 16 Feb 2007 17:59:00 +0100 479292 http://fingersandtubesineveryorifice.blogspot.com/2007/01/mcgyver-md.html Sorry I haven't posted in a while, but I have been a li'l busy with keeping my New Year resolution to spend more time with my family, as well as training for the 2008 Boston Marathon. I did pretty decent in this past Disney marathon. Haven't ran a full marathon in a very long time, but I've been keeping up, logging about 2-5 miles at least once a week over the years. My time was respectable, at least for this old geezer anyway. The exhausting experience made me realize how out of shape and what a complete slug I've let myself deteriorated to over the years. So my goal is to run in the 2008 Boston Marathon. I've ran in several other marathons over the years but never the grandest of them all in Boston. I've already qualified for my age group, but I'm in no shape to run by this April. So I'm... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479295 Thu, 01 Feb 2007 03:41:00 +0100 479295 http://fingersandtubesineveryorifice.blogspot.com/2007/01/first-xrays-story-later-after-i-have.html First the xrays, as usual:Story later after I have some time. I'm not sure what caliber that bullet is. We rarely ever see small caliber GSW in Crack City. Usually there's a big ol' slug. Look at where the bullet is and you can probably guess how he presented clinically. Single GSW, entrance at base of the occiput. No exit.PART IIYou could say that the dude fully deserved what was coming to him. But then again, who could ever wish such an atrocious injury on anyone? Perhaps too extreme for poetic justice?He robbed a local convenient store owned by a simple immigrant family. It's your typical Mom & Pop, junior store off the main highway selling the usual items of cigarettes, beers, sodas, candies, chips, etc... He shot the owner of the store in the head and unloaded a few more rounds into t... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479294 Fri, 05 Jan 2007 02:45:00 +0100 479294 http://fingersandtubesineveryorifice.blogspot.com/2007/01/eye-for-eye.html I approached him from the blind side so he couldn't see me when I entered the room."The doc is here, Mr. Cochran," introduced the nurse."Can't see out of left eye" read the chief complaint on the chart.Mr. Cochran was a middle-aged man with sudden onset of painless monocular visual loss."Hi, sir, I'm Dr.____(common surname). What happenned to you?""All of the sudden I became blind out of my left eye, doc. Can't see a damn thing!""How long ago did this happen?""About 2 and a half hours, I thought it would go away but it didn't so I'm here. Am I having a stroke?"I go on through the routine questions and review of systems. No other neurodeficits. No bulbar symptoms. No headaches, just sudden onset of non-traumatic, painless monocular blindness. The past medical history was also unremarkable a... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479290 Wed, 03 Jan 2007 04:59:00 +0100 479290 http://fingersandtubesineveryorifice.blogspot.com/2007/01/lost-in-translation.html "Hey Charity! Do you habla?""Yeah, I habla.""Go into Room 8 with me and...I got an illegal alien...""...Man, you really need to learn how to habla, Mark. Ya can't work in an ER these days without knowing how to habla."....So we walked into the room....."OK, tell him I gotta suture his face and ask him when his last tetanus was."Me, grabbing sterile towel from lac tray...."Hey man, pick up your head."Dude picked up his head for me to slide the towel underneath. "Busted!!!" I laughed."He don't need no stinkin' translator!" I told Mark and left the room. (Source: Fingers And Tubes In Every Orifice) Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479298 Wed, 03 Jan 2007 04:38:00 +0100 479298 http://fingersandtubesineveryorifice.blogspot.com/2006/12/my-old-lady.html First the Xray:Yup, that's a long kitchen knife that you're seeing on the xray.Here's how the guy looked:It was entirely subcutaneous! No pneumothorax. No intrathoracic injury. Lucky SOB! His spine protected him as the knife's blade was bent almost 90 degrees. Once again proving the ER axiom that you just can't kill these guys! They are invincible supermen! Riddled with bullets, juged and knifed, drunk as skunk & ejected from moving vehicles at high speed...they walk away from it all. As one of the trauma surgery attending during my residency used to say, "Might as well put a zipper in their belly!" because the rate of recidivism in these individuals is extremely high."So who stabbed you, man?"Ah, here's where the story gets interesting. Though not as dastardly notorious, there is actually... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479301 Fri, 29 Dec 2006 04:28:00 +0100 479301 http://fingersandtubesineveryorifice.blogspot.com/2006/12/crack-citys-gun-knife-club.html Guts and gore, all that and so much more. It's all hardcore, baby! No blood, no glory at Crack City Medical Center. Definitely not for the faint hearted. You've been appropriately forewarned.In anticipation of a very busy New Year's Eve shift that I must cover, here are some highlights of our G&K club:Typical mess seen on floor after a massive resucitation.Check out those new white shoes! He had to trash them at the end of the shift. Always wear the blue booties. Always!GSW (gun shot wound) to the face. He lived. Can't kill these dudes!No puny 9mm's in Crack City. These dudes all pack high caliber hand guns and assault rifles! 0.203, 0.308, 0.38 special, 0.40, 0.45 are the rounds of choice. This guy's arm, was blasted by an AK-47.Funny thing was, the cops brought fragments of his blown up ... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479297 Wed, 27 Dec 2006 14:39:00 +0100 479297 http://fingersandtubesineveryorifice.blogspot.com/2006/12/twas-my-night-before-christmas.html Whatever happened to the true midnight mass on Christmas Eve? Lately, it seems that no church has a true midnight mass. My parrish's Christmas Eve mass was at 8PM and ended at 10PM. We were there but it's just not the same without the real midnight deal.After the event, we headed home for our traditional Christmas celebration. My kids were all excited and ready to rip open the presents under the tree that my wife and I had spent hours wrapping while they were sleeping several nights earlier. Their eyes were fixed on the clock, counting down and waiting for the chime of midnight. Grandparents were also there. 11:00PM, my phone rang. I thought it might have been one of my sisters who always call to talk to the kids during special occasions and holidays."Daaad, it's for you! It's the hospital... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479302 Mon, 25 Dec 2006 20:58:00 +0100 479302 http://fingersandtubesineveryorifice.blogspot.com/2006/12/lack-of-posting.html Man, you know how difficult it is to get anything done this time of year when the wife wants you to go Christmas shopping every spare moment ya have? She's the "I gotta see it before I buy it" and not the internet shopper type. Unfortunately, she's also the type that doesn't want to go shopping for anything alone, including the grocery. She usually goes with her sisters or friends but they're all out of town this past week. And I just worked the past 5 nights in a row, too, so I can get Xmas eve off in a trade for New Years Eve and New Year Day. Not entirely a very smart trade because Christmas Eve and Christmas Day shifts are usually slow. It just sucks being there but the nice thing about it is that it's traditionally never busy and you can literally sit on your ass drinking egg nog (yuc... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479304 Tue, 19 Dec 2006 19:14:00 +0100 479304 http://fingersandtubesineveryorifice.blogspot.com/2006/12/race-against-time.html He had just loaded up a Christmas tree that his grandson had chosen onto the roof of his car. About a block later, he ran off the road and hit some bushes. He managed to get out of his car then collapsed on the ground. The smart little 6 years old boy used his grandpa's cell phone and called 9-1-1.They called him in to us through EMS radio as a "trauma code, single vehicle MVA." But when he hit the door boarded and c-collared, I couln't find any signs of trauma on him. They brought the kid in, too. He was fine, zero complaints. The police reported that there wasn't even a scratch on the car."We couldn't get an IV!" informed one of the paramedics. "Stuck his EJ's twice."Time was ticking too quickly off the precious "Golden Hour". And as it turned out, grandpa had much less than an hour. He ... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479291 Wed, 13 Dec 2006 08:55:00 +0100 479291 http://fingersandtubesineveryorifice.blogspot.com/2006/12/stepping-up-to-plate.html I just had to admit a 34 y/o homeless guy with a nasty perineum abscess that I I&D'ed under a Dripivan drip. He had a huge cellulitis to the entire area as well but he wasn't toxic in appearance. In essence, his ass and crotch were all red. Pus was draining. It looked like MRSA. Any other non-immunocompromised patient, I would've sent home, arrange for infusion center IV Abx, outpatient whirlpool therapy, wound re-check/packing removal in 48 hrs., and wound care center follow up next week.This homeless guy claimed that he couldn't even afford 8 bucks for Bactrim DS and Doxycycline (Walmart's price, matched by CVS and even our outpatient pharmacy). He also doesn't have a ride back to the hospital, nor to the wound care center. Though, funny how he could afford the pack of cigarettes in his ... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479306 Tue, 12 Dec 2006 04:12:00 +0100 479306 http://fingersandtubesineveryorifice.blogspot.com/2006/12/membership-has-its-privilege.html I'm not cheap or anything but these membership dues are ridiculous:American Medical Association - AMA = $420/yrAmerican College of Emergency Physicians - ACEP = $515/yr. On top of that, you must also belong to your local state chapter, mine wants over $300/yr. That's a whopping total of over $815/yr! SHEESH. I like ACEP and all, their journal and publications are decent, but I can think of better uses for >$815.AAEM - American Academy of Emergency Medicine. The dues are only $365/yr, or $1/day, and you don't have to belong to your local state chapter to join either. Pretty reasonable, I'd say. I strongly support AAEM and it's rogue mission statement, being residency trained and ABEM board certified myself. But let's face it, it's not as big as ACEP and ACEP's journal and publications are w... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479308 Mon, 11 Dec 2006 18:13:00 +0100 479308 http://fingersandtubesineveryorifice.blogspot.com/2006/11/lawsuit-6-shotgun.html Cases like this one involving me are known as shotgun suits. The plaintiff attorney digs into the patient's medical records and subpoenas everyone whose name was ever mentioned in the charts and alleges malpractice on all, even if you never saw the patient. Yes, everyone gets sprayed. How can something like this happen, you ask? And why is a physician's name on a chart if he/she never saw the patient? It's typical in a high volume ED that there would be more than one physician on duty at any given time. When a patient's chart gets generated, a physician's name may be printed on there but that doesn't necessarily mean that he or she is the treating physician. Another physician may have picked up the chart and handled the case. Often, too, orders are entered into the computer under the name ... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479309 Wed, 29 Nov 2006 04:28:00 +0100 479309 http://fingersandtubesineveryorifice.blogspot.com/2006/10/how-hurricane-saved-some-lives.html No, not that kind of hurricane, not the storm. This ONE: Yeah, the big ass one!It's weird how rare cases often come in 2's or 3's. You go on for months to years without seeing such a case of this or that, then BAM! Out of the blue, you see a bunch in a row that's worthy of documenting. I saw 3 patients recently that were all on the brink of death, 2 adults and one pediatric. They were all unrelated and came from different areas. Guess it just wasn't their time. The strange turns of events were entirely kismet. Had to be. It was very fortuitous that I just happened to be there and got involved in their care at all. They weren't even my patients through the ED. Well, one of them was a patient in the ED, but he wasn't mine. He was already admitted and waiting on a bed upstairs.Case #1"Hey Dr.... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479296 Fri, 13 Oct 2006 15:34:00 +0100 479296 http://fingersandtubesineveryorifice.blogspot.com/2006/10/denver-area-hospital-ed-under-heat-for.html The folks working at St. Anthony Central Hospital in Denver obviously do not know about GHF and have not been properly schooled in the art of discreetly discharging a homeless drunk from the ED.Could someone please forward them a link to my blog.Several observation after viewing this news video footage,1. Only in America can a homeless person, such as this lady, be so morbidly and massively obese! She hadn't eaten in 3 days? Puhleeze, she could use the diet!2. Check out the mullet on one of the "good samaritan" who called 911. Good Gawd!3. If those 2 are such damn "good samaritans", why didn't they offer to take the drunk homeless lady into their own abode instead of calling 911?4. I notice that the TV reporters used the words "dumping" in the literal sense. I see no EMTALA violations here... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479293 Fri, 06 Oct 2006 04:17:00 +0100 479293 http://fingersandtubesineveryorifice.blogspot.com/2006/08/bring-it-on.html This morning I attended our departmental quarterly meeting. Our Press-Ganey scores have topped out and remained piss poor. We did improve for several months but then dipped back down again and now appear to be leveling out. We're still at/in the very bottom percentile group of allegedly comparable hospitals, despite hospital administration spending big bucks on staff retreats and so forth on "service," "sensitivity," and "diversity" training, etc...This, of course, have now left the administrative folks all a-tithered and their panties bunched up in knots at the cracks. They spent gobs of money to boost up the Press Ganey score but so far it has been like a pendulum swinging up and down. I stood up in disgust to point out an important fact that seemed to have gone unnoticed and unmentioned... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479307 Fri, 04 Aug 2006 15:09:00 +0100 479307 http://fingersandtubesineveryorifice.blogspot.com/2006/06/when-shit-hits-fan.html Two patients came in at the same time around 4:45 AM the other day with similar symptoms and complaints of chest pain "like an elephant sitting on my chest," radiation to neck and arm, shortness of breath and diaphoresis. The first one was clearly an inferior MI (heart attack, for the non-medical folks) with ST-elevations in leads II, III, and aVF with lateral reciprocal changes. He was in cardiogenic shock. The second patient's EKG is above.Me to cardiologist over phone: "Hey Heart MD, I've got 2 acute MI's here in the ED who've just rolled in. Both hit the door at the same time, just now. One's a tombstoning inferior who's in cardiogenic shock. The other one looks like one of those tricky septal on the EKG but with stable vitals. Both have crushing substernal chest pain radiating to neck... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479305 Thu, 29 Jun 2006 04:02:00 +0100 479305 http://fingersandtubesineveryorifice.blogspot.com/2006/06/shot-through-heart-and-whos-to-blame.html First the teaser....as usual...story later. Yes, that IS a bullet slug in the heart and the finger is in the hole! Just worked 4 nights in a row. Need sleep, first. Thanks for tuning in.Current Time: Midnight, Wed. June 15th. I've been a little busy lately. For the past 2 days, I've had to attend this boring brainstorming strategic planning committee meeting with the big wigs of the hospital including the CEO, CFO & COO (who all by the way still don't know who heck I am, honest), along with several other medical staff members and nursing supervisors. Boy, as soon as I find out who in my group "volunteered" me, OOOh I'm gonna make him/her pay big time. I'm gonna get even! You betcha, and it ain't gonna be pretty. I fight dirty!Enough of xplaining...now on with the story.Shot Through The Hea... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479303 Mon, 12 Jun 2006 22:47:00 +0100 479303 http://fingersandtubesineveryorifice.blogspot.com/2006/05/full-circle.html During my last year of residency (mind you this was over 16 yrs ago) I was more than ready to bust out of Gotham. 4 years of intense training at perhaps the busiest ED and trauma center in the whole world had not only opened my eyes but toughened me. As Chief Resident in my final year, I felt unflappable. There was nothing that I haven't seen, no procedure that I haven't done a few dozen plus times at least, hundreds of central lines, Swans, art. lines, transvenous pacers, hundreds of intubation whether by brutane, nasally, or with RSI, chest tubes, thoratomy, crics, crash C-sections, ventriculostomy tubes....phtttt...I've done them all. Hell yeah I was cocky and confident as the big dog in the pound. Four years at Gotham Medical Center have forged me into an Emergency Medicine machine and... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479286 Fri, 19 May 2006 05:03:00 +0100 479286 http://fingersandtubesineveryorifice.blogspot.com/2006/03/ewww-way-too-much-information.html "SOB" was written on the chart under chief complaint. "She has an O2 sat of 82%," said the triage nurse as she placed the chart in the rack ahead of all the others. (For the non-medical folks SOB=shortness of breath)I walked into the room, introduced myself, the usual pleasantries, and asked, "What problem made you come to the Emergency Department?""Now tell him everything, OK" said the middle-aged looking lady, who turned out to be the mother of the patient.I was somewhat puzzled by that comment of the mother. Quickly glancing at the patient...She was moderately tachypneic, no accessory muscle use, not in too severe distress. But on the monitor, her O2 sats were in the low 80's."I'm a whore. And I used to do anal sex...." were the first words that came out of her mouth. Honest! She just b... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479299 Thu, 23 Mar 2006 18:24:00 +0100 479299 http://fingersandtubesineveryorifice.blogspot.com/2006/03/last-minutes-of-hero_14.html Just what do you say to a 4 year old boy whose father is a cop gunned down senselessly during a routine traffic stop?The charge nurse came up to me during the night and said, "EMS dispatch just called to give us a heads up, officer down."Sensing the ominous, I asked, "What's the ETA? And what is it about?""They didn't say much. Just officer down. GSW (gun shot wound) to the chest. Don't know the ETA or anything specific yet. Ground crew haven't radioed in. Dispatch just wanted to give us a heads up."We dropped everything and prepared for the worse. O neg. blood called for, Level One rapid infuser fired up, warm IV fluids, chest tube trays, pleura-vac, thoracotomy tray just in case, ventilator, laryngoscope, 8.0 ET tube, Etomidate, Succ...Surgical team and OR notified....Officer down, perha... Fingers And Tubes In Every Orifice blogs http://www.medworm.com/rss/comments.php?id=479300 Wed, 15 Mar 2006 04:28:00 +0100 479300