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 'Ten out of Ten' source. Thu, 08 Jan 2009 11:39:43 +0100 http://trismus1.wordpress.com/2009/01/07/the-shadow/ We have a shadowing program in place with the local college.  Pre-meds who are interested in emergency medicine — or who need to buff up their med school applications — show up in the ER from time to time to follow us around.  Since I’m a “young doctor” and relatively easy going they come during my shift a lot which is great except that I hate it.  No offense aspiring doctors but I didn’t go into academics for a reason.  These shadows with their constant presence and questions imploring me to explain every little thing I do while I try to simultaneously run a busy ER makes me want to go a little crazy — really I just want to be left alone to do my job.  But I’m too nice (or too much of a wuss) to tell these pre-meds no after they’v... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=2087378 Thu, 08 Jan 2009 05:18:27 +0100 2087378 http://trismus1.wordpress.com/2009/01/06/blood-pressure/ You pull out your spiral notebook of meticulously recorded blood pressures and my heart sinks.  You go through the numbers with me, focusing on the sporadic readings that seem particularly high.  I see you searching my face, looking for evidence of the shock or dismay or panic that I surely must be feeling from seeing this objective evidence of your impending doom. But I don’t feel any of that, just marked indifference and a sense of wanting to move on to the next patient since your disposition has been made.  Now it’s my turn and I counter with my high blood pressure speech, offering reassurance in a flowing polished manner, a byproduct of giving this same talk hundreds of times before. When I finish I ask indirectly if you feel better about things and you almost always d... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=2084442 Tue, 06 Jan 2009 19:30:49 +0100 2084442 http://trismus1.wordpress.com/2008/12/30/get-the-lead-out/ Most chest pain is bogus, only occasionally is it legit.  Good triage nurses can tell the difference, which is how this guy ended up being sent straight back to a resuscitation room for evaluation.  His EKG confirmed the heart attack, and we started the standard cocktail of meds. Since we’re at a small hospital we don’t have an interventional cath lab available to bust up the clot sitting somewhere in his coronary arteries.  Instead we use the one in the big hospital south of us, relying on a helicopter to get him there fast enough to make it worth his while. The last few times I’ve initiated a helicopter transfer I’ve felt like the flight medics were moving too slow.  With this patient I timed them: it took 20 minutes from their arrival to departure for the hel... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=2075562 Tue, 30 Dec 2008 08:05:49 +0100 2075562 http://trismus1.wordpress.com/2008/12/26/how-pas-and-nps-can-help/ I’ve had a different experience with midlevel providers (MLP’s = nurse practictioners and physician’s assistants) than Scalpel. Coming out of residency I was looking for a place that didn’t employ MLP’s.  Since I’m the guy on the hook, I wanted to see the patient myself from beginning to end as opposed to relying on someone else’s evaluation.  If there’s a perfect job out there though I didn’t interview for it.  I took the job that had the most pluses/fewest minuses and that included a place with a fast track run by MLP’s. Our fast track is a four bed area in the ER that the triage nurse sends the least sick patients to.  The MLP’s run the show, working up and dispositioning the patients without direct supervision.   Ec... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=2068028 Fri, 26 Dec 2008 17:10:56 +0100 2068028 http://trismus1.wordpress.com/2008/12/22/25000-pyramid/ 60 seconds on the clock…here is your first subject…go! A window, a white lie, a pudgy middle-aged nurse’s white scrub bottoms. Things you can see through! Frat boy punch, Karch Kiraly, toddler fevers. Things that spike! A haunted house, an easy date, a nursing home transfer. Things that moan! A hummingbird’s wings, a soprano’s falsetto, grandma’s heart after her third eggnog. Things that flutter! A restaurant critic, a club DJ, a Medicaid patient. People who want samples! Marriage after dating three months, a car salesman’s complement, a young anxious dood’s chest pain. Things you don’t take seriously!  Cue music Sweet!  Thanks Dick Clark and Charles Nelson Reilly.        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=2056516 Mon, 22 Dec 2008 08:20:25 +0100 2056516 http://trismus1.wordpress.com/2008/12/06/been-there-done-that/ At the interdepartmental meeting the surgeon was irritated at all the hospital cafeteria food being fried and suggested offering some healthy entrees.  Turns out they tried that once before but could never sell the healthy stuff.        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=2018440 Sat, 06 Dec 2008 08:01:54 +0100 2018440 http://trismus1.wordpress.com/2008/11/24/old-school-abscess/ So many abscesses in this era of MRSA are wholly unsatisfying to drain.  I’ll cut into a large firm area of tender red skin looking for pus but finding instead this stringy straggly dried-out gunk.  MRSA isn’t just immune to certain antibiotics, it’s meaner and more aggressive too.  Anecdotally, the rise of MRSA has made draining boils a lot less fun. One good way to give yourself a boil is by shooting up, pushing a heroin/bacteria cocktail underneath the skin.  The lady I saw let this fester under her arm for about a week before finally coming in.  Her boil was old school though, a soft squishy skin-colored mass the size of a scoop of lunch lady mashed potatoes. I poked through the skin with an 11 blade and watched contentedly as greenish-brown pus erupted and oozed... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1985424 Mon, 24 Nov 2008 12:43:17 +0100 1985424 http://trismus1.wordpress.com/2008/11/17/pet-peeve/ Is your condition really so terrible that you can’t open your eyes to talk to me?        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1969652 Mon, 17 Nov 2008 12:50:41 +0100 1969652 http://trismus1.wordpress.com/2008/11/12/bingo-bango-bongo/ I went to a high school football game this weekend, which always reminds me of the greatest high school football game ever played.  Unintentional comedy from yokel announcers included at no extra cost.        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1952648 Wed, 12 Nov 2008 12:08:35 +0100 1952648 http://trismus1.wordpress.com/2008/11/04/the-worst-bone-to-break/ I see lots of broken stuff.  Noses, hips, fingers, toes, wrists, ankles, necks: all of which suck in their own unique way.  Still, when it comes to flat-out squirm factor nothing tops the broken penis. Just getting the story is awkward.  I put up the professional facade, pretend it’s business as usual, but there’s no getting around the uncomfortableness that hangs over the room for both me and this poor unfortunate dood.  ”So the two of you were having intercourse?  And she was on top of you…no…oh ok missionary style.  And you’re saying you came out, missed on the way back in, bumped up against her and felt a pop?” Gah!  Enough talking, although pulling back the sheet isn’t any better as I see what appears to be a giant eggplant sittin... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1933500 Tue, 04 Nov 2008 23:48:05 +0100 1933500 http://trismus1.wordpress.com/2008/11/02/the-ghost-of-hallway-four/ You know it’s halloween when Hallway Four comes back from the blogging dead to offer up a guest post.  You’ll find it convienently located below…    10/10, in case you ever have those days when you’re too darn lazy/tired/disillusioned to produce a blog entry (10: um, that’s like everyday), I have a little story for you from a recent shift that you (and possibly your many-thousands (try tens) of readers) might enjoy.  It goes like this (and, you should know, I am not exaggerating - this is the real deal…) The chief complaint on the chart was “Hernia”.  I walked in the room to find a morbidly obese female and her average-sized husband.  I began with my usual, “What brought you in to the ER today?”.  And so it began… Hu... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1927998 Mon, 03 Nov 2008 04:38:37 +0100 1927998 http://trismus1.wordpress.com/2008/11/01/fall-back/ One of my favorite days of the year is painfully being turned against me.  Instead of getting an extra hour of sleep tonight I’ll be at work trying not to self-implode as the clock resets from 2 to 1am.  And just to rub it in we have five hours of computer down time scheduled as well. I figure I can set the tone for the department by staying motivated and upbeat, or I can come in with a crappy attitude and needlessly sulk all night.  Obviously I’m gonna go with the sulking.        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1926799 Sun, 02 Nov 2008 00:02:22 +0100 1926799 http://trismus1.wordpress.com/2008/10/31/happy-halloween/ Try not to get smashed.        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1924989 Fri, 31 Oct 2008 21:24:28 +0100 1924989 http://trismus1.wordpress.com/2008/10/31/busted/ Some house supervisor from some other hospital: “I’m sorry, we can’t send your patient’s records to you.” Me: “Gosh I’m an emergency doctor calling from an emergency room it’s kind of an emergency.  Are you sure?” SHSFSOH: “Can’t do it.” Me: “Why is that?” SHSFSOH: “Well, it’s the weekend and our release of information department is closed.” Me: “Well ok no problem, can I just get your name and title?  Oh and also the names of the head of medical records and the chief nursing officer?  I better make sure they know that medical records are unavailable on the weekend.” SHSFSOH: “Oh you know what?  I just thought of another way to get you the record you’re looking ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1924990 Fri, 31 Oct 2008 21:20:02 +0100 1924990 http://trismus1.wordpress.com/2008/10/28/birds-of-a-feather/ Sometimes eccentric-to-say-the-least patients will show up with seemingly normal significant others, a phenomenon I find odd and somewhat fascinating. So even as I listened to the 30ish lady with twelve allergies and pseudoseizures dramatically tell me about a mishmash of jumbled symptoms, I looked across at her calm, nice looking, well dressed fiance and wondered what could possibly be in this for him.  Fiance?  Really?   When her tests all came back negative I went back to offer some reassurance that everything looked ok.  After answering a few questions they were good to go so I said I’d send the nurse in to discharge them.  They didn’t stick around though, the nurse found their room empty maybe five minutes later. This was a problem since she had an IV.  The nurse was... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1911816 Tue, 28 Oct 2008 07:04:40 +0100 1911816 http://trismus1.wordpress.com/2008/10/24/black-cloud/ I am a black cloud. You can ask any of the nurses. “Uh oh, it’s Dr. 10/10” they say as I arrive because they know there’s a very good chance an onslaught of patients will be following me into the ER. Some time ago I showed up for a Wednesday overnight, statistically the least busy shift of all.  Naturally I arrived to find the ER packed.  The nurses blamed me (good-naturedly), and even though I pointed out that these patients came in on another doc’s watch it fell on deaf ears.  Just having my name on the schedule, they explained, is enough to make things go crazy. Things stayed uncomfortably busy for a long time.  Patients kept showing up to triage, and the EMS radio kept dishearteningly crackling to life.  It’s just me on these weekday overnights since it tends ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1902391 Fri, 24 Oct 2008 08:45:23 +0100 1902391 http://trismus1.wordpress.com/2008/10/16/low-pain-tolerance-continued/ There’s this guy… Who we see once or twice a month, always for chest pain.  For him and us, it all started two years ago when he had a minor heart attack.  He got cathed, and had 3 stents placed to open up the clogged arteries feeding his heart. Ever since then he’s been coming back, always with chest pain that feels exactly like his heart attack.  He’s gonna get a cardiac workup for that of course, so when he came in again the other night I went ahead and ordered it while refamiliarizing myself with his medical record.  A repeat cath one year ago showing widely patent stents.  Some normal stress tests and echocardiograms since then, as well as a normal CAT scan of the chest.  Dozens of unchanged EKG’s, chest xrays, and cardiac enzymes.  I learned some... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1883770 Thu, 16 Oct 2008 17:04:26 +0100 1883770 http://trismus1.wordpress.com/2008/10/14/low-pain-tolerance/ A 20ish girl comes in with belly pain and clearly something is horribly wrong.  She’s had severe diffuse pain causing her to almost vomit and almost pass out multiple times since polishing off some tacos a couple of hours before.  Feeling too weak and too dizzy she lands in my ER after calling 911.  I push on her belly and literally bring her to tears, she’s sobbing from the exam and the pain. Then again, she also winces in pain when I first meet her and lightly shake her hand.  Her belly is reassuringly soft.  Her vital signs look ok, and clicking through her computer record I see she’s been to our ER 10-15 times in the last year, always for something trivial. I’m already 99% sure this is a whole lot of nothing, but I keep remembering those big tears spilling ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1876638 Tue, 14 Oct 2008 21:42:33 +0100 1876638 http://trismus1.wordpress.com/2008/10/08/terrible-twos/ The last three 2-year-old’s I’ve seen have: -swallowed half a bottle of fish bowl cleaner -swallowed two tacks -knocked the lid off a toilet, then walked over the porcelain shards gashing their foot They also don’t like to say “ah.”        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1859943 Wed, 08 Oct 2008 06:04:16 +0100 1859943 http://trismus1.wordpress.com/2008/10/06/code-blue/ Plenty of people out there abuse ambulances, calling for colds, hangnails, and other similarly trivial stuff.  Then there’s ambulance anti-abuse, where people don’t think to or choose not to dial 911 even as they are actively dying.  Like the family of my patient who watched him clutch his chest and collapse to the ground.  More than a time to dial 911, really this is the time to dial 911.  But for whatever reason they didn’t, instead they loaded him up in the back seat of their car and drove him frantically to my ER. It’s not very often that someone shows up unannounced in cardiopulmonary arrest.  Usually they come by ambulance and since they radio ahead to us it gives us a little time to prepare.  All of us I would imagine have our little rituals.  I like t... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1856643 Mon, 06 Oct 2008 22:23:04 +0100 1856643 http://trismus1.wordpress.com/2008/10/02/flu-shot/ I got my flu shot today.  Have you gotten yours? Last year 40,000 people in the US tested positive for flu, half of which I’m pretty sure I saw in my ER.  83 kids died last season of the flu or resultant complications.  Actual numbers, as always, are even higher. The flu shot is basically a syringe full of dead flu virus.  It’s not alive.  We won’t do CPR on the flu and bring it back to life before you get the vaccine.  You will not get the flu from the shot, cross my heart.   Your doctor can hook you up with the vaccine.  If you don’t have one try a Walgreens or CVS, or you can always visit your local health department.  Here’s a link to the American Lung Association’s on-line flu shot locator.  The flu is pure misery.  Do yourself a favor a... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1848268 Thu, 02 Oct 2008 22:33:55 +0100 1848268 http://trismus1.wordpress.com/2008/10/01/panhandling/ A patient left his room and started hitting up other patients for change.  We told him sorry but no panhandling in the ER.        (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1841478 Wed, 01 Oct 2008 10:22:13 +0100 1841478 http://trismus1.wordpress.com/2008/09/18/the-best-medicine/ I almost never laugh at work. I’m too focused on the task at hand, particularly when it’s busy — I’m pretty much all, well, business.  If it slows down I’ll lighten up a little, joke around some with the patients and staff but it’s rare for something to just out and out crack me up. The other day was ridiculously busy to the point where I broke some kind of personal record by seeing 21 patients in the first 4.5 hours, which basically resulted in me walking around like this.  After a brief timeout to mutter and get some coffee I went and saw patient #22, who turned out to have the first break dancing injury I had ever seen —  a college-aged guy who dislocated his toe.  It needed to be numbed so I placed a digital block by sticking a needle in t... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1803112 Thu, 18 Sep 2008 06:54:54 +0100 1803112 http://trismus1.wordpress.com/2008/09/10/i-dont-feel-quite-right/ Because I just finished up a run of four night shifts.  Generally speaking I feel worse and worse with each passing one, since I can’t seem to sleep very well during the day.  I have a room in my house completely blacked-out, I crank down the a/c, turn on a fan, no extraneous noise, but even with all that I’m back up after 5-7 hours of light sleep, feeling unnaturally awake, no alarm clock needed. After the final night shift I came home spent but wired from too much coffee.  After burning an hour or so reading stuff like this I finally head to bed where after some obligitory tossing and turning I sleep for four and a half hours. BEEP BEEP BEEP!  Seriously?  I just shut my eyes.  It has to be this way though, or I’ll never fall asleep later tonight.  Feeling like m... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1783160 Wed, 10 Sep 2008 21:17:50 +0100 1783160 http://trismus1.wordpress.com/2008/09/09/it-just-hurts/ Me: “Hello, so you’re having some chest pain?” Patient: “It just hurts.” Me: “When did it start?” Patient: “It just hurts.” Me: “Where on your chest?” Patient: “It just hurts.” Me: “Anything make it worse?” Patient: “It just hurts.” Me: “Ever had this before?” Patient: “It just hurts.” Me: “Fine, enough, I’ll just order a bunch of tests.” ————————————————————————————– Nurse: “Your chest pain patient wants to know what’s taking so long.” Patient: “So how ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1775935 Tue, 09 Sep 2008 10:33:20 +0100 1775935 http://trismus1.wordpress.com/2008/09/04/better-lucky-than-good/ A guy noticed as he was finishing up his fish taco that everytime he swallowed he could feel a little fish bone in the back of his throat. I looked back there but everything seemed normal.  ”It’s right here,” he said pointing to his right tonsil and so I put a glove on and touched the tonsil and sure enough I felt it. Even after palpating it I still couldn’t see it.  But I got a pair of alligator forceps anyways and clamped down in the general vicinity of where it seemed to be. Unbelievably out came a tiny fish bone, shorter than a grain of rice and almost impossibly thin.  There is no way anyone could have been more surprised than me, although I pretended like it was just business as usual. The lucky moments are way more satisfying than the unlucky ones, to say ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1764453 Thu, 04 Sep 2008 20:48:41 +0100 1764453 http://trismus1.wordpress.com/2008/09/01/no-chance/ Some of the little kids I take care of in the ER are painfully cute – innocent-eyed, bubbly, untainted with the promise of their entire lives stretched out before them. Then I look up at their parents and feel sad because I know these kids have no chance. (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1750599 Mon, 01 Sep 2008 16:37:44 +0100 1750599 http://trismus1.wordpress.com/2008/08/27/allergies/ Me: “Any allergies?” Patient: “Milk products, apples, peas, cats.” Kinda looking for allergies to medicines, but duly noted I’ll be sure not to rub a cat up against you or anything. (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1739680 Wed, 27 Aug 2008 14:04:15 +0100 1739680 http://trismus1.wordpress.com/2008/08/12/its-too-hot-here/ The last trip was kind of a pseudo-vacation, but this next one is the real deal.  If you’d like to check out some classic posts, well you really won’t find any here but feel free to peruse the blogroll.  Maybe I’ll post some pics from my trip, otherwise see you guys in a week or so. (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1701700 Tue, 12 Aug 2008 20:57:29 +0100 1701700 http://trismus1.wordpress.com/2008/08/05/open-up-and-say-ah/ At first I can’t tell what’s wrong, just that things look really strange.  I keep staring and finally like a Magie Eye I’m able to make some sense of it.  Instead of hanging in the back center, the uvula is smushed all the way over next to the back left molar.  The wall behind the right tonsil is bulging and squishy.  It’s pretty much the biggest and most impressive peritonsillar abscess that I’ve ever seen. We have to get the pus out of there I explain to the patient or you’ll never get better.  I numb up the back of his throat and stick a needle into the bulging squishy part in the back.  Alot of times with these I’ll just get a couple of cc’s or so of pus, but here I fill up one syringe, and then another, and then a third.  Thirty ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1683683 Tue, 05 Aug 2008 16:39:14 +0100 1683683 http://trismus1.wordpress.com/2008/07/29/funniest-thing-a-patient-has-said-to-me-in-a-while/ I chained my bicycle to that helicopter out front.  That’s not a problem is it? (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1664916 Tue, 29 Jul 2008 15:22:39 +0100 1664916 http://trismus1.wordpress.com/2008/07/26/ed-v-er/ When I decided to become an ER doctor, one of the first things I learned was that I wouldn’t be an ER doctor. “It’s not the ER,” sniffed the program director, “it’s the ED.”  “The ED?” “Yes, the ED.  It’s not a room, it’s a department.” I learned that in the world of academia he was absolutely right.  Saying ER to a professor of emergency medicine was like saying stewardness on an airplane: borderline acceptable, but decidedly non-progressive. I dutifully substituted ED for ER without fail while on the residency interview circuit.  When match day came, bam I landed my first choice.  Coincidence?  Unlikely. I stuck with ED throughout residency, even though it seemed to be just us emergency residents wh... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1657480 Sat, 26 Jul 2008 23:40:02 +0100 1657480 http://trismus1.wordpress.com/2008/07/23/plan-a/ Vacation serves as a reminder that life as an ER doc can actually be pretty fun once you escape the emergency department.  My conference was in a beautiful location at a posh hotel where I met and exchanged ideas with all sorts of nice, interesting people.  Thanks to two years of attending-level paychecks, I didn’t have to sweat every meal out or sight seen.  I came back feeling rested and energized. Which lasted for all of about 15 minutes into my first shift back.  That shift is always one of the toughest, I think, because the contrast between a relaxing vacation and the chaotic ER is so jarring.  I constantly felt a step slow, everything that could go wrong did, and I left basically wanting to pull my hair out. Working serves as a reminder that there’s plenty to ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1649473 Thu, 24 Jul 2008 00:42:39 +0100 1649473 http://trismus1.wordpress.com/2008/07/22/back/ Did I mention I went on vacation?  No?  Well that was kind of sorry of me.  Anyway, I’m back now and hope to have some new posts up soon. (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1646623 Wed, 23 Jul 2008 01:48:49 +0100 1646623 http://trismus1.wordpress.com/2008/07/12/iphone-3g-epocrates/ What does a kidless tech-loving ER doc do with a day off?  Braves the lines at the nearest Apple Store, naturally, because obviously he can’t do the reasonable thing and wait like a week to pick up the iPhone 3G. There are hundreds of fantastic things about the iPhone, but this blog will concentrate on the free app Epocrates Rx, which I am pleased to report is real and spectacular.  Here are some screen shots that basically tell the story:   There’s also as seen above a very handy-dandy pill ID function that lets you identify all twelve meds the patient brought mixed together in a ziplock baggie. I have no stock or financial interest or whatever in Epocrates, rather I have just found it to be the most useful medical PDA software since we were first introduced ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1616748 Sat, 12 Jul 2008 19:57:42 +0100 1616748 http://trismus1.wordpress.com/2008/07/09/manners/ When the glucometer says “HI,” is it rude not to wave back? (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1597123 Wed, 09 Jul 2008 10:52:03 +0100 1597123 http://trismus1.wordpress.com/2008/07/04/your-eye-is-not-your-fingernail/ In a sense, every doctor’s birthday is July 1st.  This is the day our training begins, with each subsequent first of July marking another step up the residency food chain.  I’m now entering my sixth year with MD after my name and my third since finishing residency.  Literally tens of thousands of patients seen, and yet stuff still walks through the door that I’ve never seen before.  As an old attending once told me, the variety is a curse at the beginning of your career and a blessing at the end.  So not too long ago I saw for the first time a lady who had glued her eye shut.  For the record if you are so inclined to wear fake nails, and go on to catch pink eye, and are prescribed antibiotic drops as opposed to ointment, whatever you do don’t store the�... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1577613 Fri, 04 Jul 2008 16:45:26 +0100 1577613 http://trismus1.wordpress.com/2008/06/27/practice-tips-for-new-em-grads/ Shadowfax already posted a really nice list but I have some ideas I’d like to share too, in particular some practice tips I have picked up in the now two years since I finished residency. Many of you may have discovered these things long ago, I don’t know what to tell you except that I’ve always been ahead of the curve when it comes to being kind of slow. On with the list… Find out why your patient came to the ER. I saw a young woman awhile back who had a bunch of vague subacute complaints that didn’t seem to add up. Finally I managed to figure out that she was worried about possibly being pregnant. All of a sudden that’s an easy dispo, a quick urine test or if you’re looking for a fight directions to the Dollar Store. Other common roundabout pre... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1552282 Fri, 27 Jun 2008 08:18:27 +0100 1552282 http://trismus1.wordpress.com/2008/06/23/lose-lose/ An old woman had some chest pain and shortness of breath, or at least that’s what she told the staff at her nursing home.  Saying things like that leads to a predictable series of events.  The supervising doc was notified, a trip to the ER was approved, and the patient was loaded up into an ambulance and transported next door to us. Who knows if she was really experiencing these things — she had fairly advanced dementia and the validity of anything she said was questionable at best.  Just a few weeks prior, however, she was brought to the ER and ultimately admitted for what turned out to be a small heart attack.  With her advanced age and declining mental function her cardiologists opted to treat her non-invasively with medications only.  End of life discussion... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1544331 Tue, 24 Jun 2008 02:57:29 +0100 1544331 http://trismus1.wordpress.com/2008/06/17/a-bug-crawled-into-a-guys-ear/ A guy came in because he thought a bug had crawled into his ear while he was sleeping and sure enough looking through the otoscope I saw the unmistakable hard backing of some beetle-like thing. Just seeing it made me feel a little repulsed.  Blood, pus, poop, sweat, discharge, vomit whatever the usual healthcare stuff gives me no problem but I don’t like bugs.  It’s not pathological or anything, it just kind of creeps me out to have a spider running up my arm or hear a roach crunching under my shoe. I wanted that thing dead, for both the patient’s sake and mine, so I squirted some lidocaine into his ear.  He said it wasn’t moving around so I stuck some alligator forceps into his ear canal and pulled out a nasty half-inch long creature that looked a lot like the... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1527305 Tue, 17 Jun 2008 11:30:15 +0100 1527305 http://trismus1.wordpress.com/2008/06/16/a-little-lesion-causes-a-big-problem/ Tim Russert’s death was yet another reminder that life can be snatched away from us at any time — and in a hurry. Mr. Russert’s physician revealed he had asymptomatic coronary artery disease, asymptomatic at least until the time of his death.  Within a large artery supplying his heart was a very small cholesterol-containing plaque.  This gave him no trouble whatsoever until a blood clot formed on top of it, blocking all blood flow to a large portion of his heart, disrupting its electrical system and ultimately causing it to stop beating. Ironically, these small lesions can be more dangerous than large ones.  A 20% lesion sits there without any warning signs, while a 90% lesion alerts you with some chest pain or shortness of breath.  A 20% lesion won’t s... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1522681 Mon, 16 Jun 2008 09:13:35 +0100 1522681 http://trismus1.wordpress.com/2008/06/13/sneaky-disgusting/ There is plenty of stuff in this world that is inherently recognized as disgusting and as such avoided.  Not too many of us I don’t believe would be interested in chewing on a piece of used gum offered from the mouth of a coworker.  Yet there are many other equally germy scenerios that we ritually engage in without so much as a second thought.  So without further ado, here is my official Top 5 list of Sneaky Disgusting Things. Honorable Mention Payphones It is my understanding that there was a time when everyone and their cousin did not have a cell phone.  To make a phone call in public one allegedly had to follow a series of steps, which included finding the phone, having change on your person, inserting said change into the phone, pushing a series of grimy button... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1517022 Fri, 13 Jun 2008 18:45:21 +0100 1517022 http://trismus1.wordpress.com/2008/06/10/just-go-ahead-and-order-the-scan/ Last post, I mentioned that we work in a system that can encourage unnecessary testing.  I then went on to see a patient that really hammered this point home for me. A young insured high schooler tripped and fell, hitting his head against a window sill and knocking himself unconscious with seizure-like activity for about ten seconds.  His dad found out about it the next day, talked to his wife who had a friend who knew a nurse who told them he could have a brain bleed and that’s the story of how we ended up meeting. It was now almost 24 hours after the fall.  I talked to him and looked him over and decided that he had not had a seizure, only passed out (not that it really made any difference) and that everything about him was completely normal. There were no outright expect... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1509587 Tue, 10 Jun 2008 16:22:41 +0100 1509587 http://trismus1.wordpress.com/2008/06/04/perspective/ When doctors work the system, we blame the system.  If I end up ordering a defensive test, I blame the everpresent threat of a patient bringing suit or the lawyers who will follow through.  When I add to the chart that I’ve reviewed all systems in order to maximize my billing, I blame Medicare and insurance compaines for making me jump through hoops to receive fair compensation.  I really shouldn’t do these things, but sometimes I do.  I rationalize it, immediately and subconsciously, and really don’t give it any further thought.  When patients work the system, we blame the patients.  If they call an ambulance for a cough, or bring the entire family to “just be checked out,” or show up for a pregnancy test, we are flabbergasted and bemoan the a... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1492490 Wed, 04 Jun 2008 11:31:24 +0100 1492490 http://trismus1.wordpress.com/2008/06/01/its-changing-how-i-interact-with-the-world/ The nice thing about emergency medicine is you can leave work at work.  No taking call, no worrying about a pager going off.  You’re responsible for all of it while you’re there and none of it when you leave. Except I’m finding this isn’t entirely true.  The longer I do this, the more I find myself looking at the world not like the just-some-guy I’ve always been, but instead with ER doctor eyes.  When I see a guy leaving a convenience store with twelve beers, a pack of cigarettes, and a who-knows-how-old hot dog, I think I’ll be seeing you someday one way or another. When I see James Thompson’s ear swell up against Kimbo Slice I think hey an auricular hematoma and what I might do to fix it. When my visiting one year-old niece went missing fo... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1485112 Mon, 02 Jun 2008 11:15:00 +0100 1485112 http://trismus1.wordpress.com/2008/05/26/medical-jeopardy/ Answer: Massive Diarrhea Question: What is the end result of eating nothing but beans and peaches all day? People are so weird. (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1470343 Mon, 26 May 2008 16:55:39 +0100 1470343 http://trismus1.wordpress.com/2008/05/19/death/ I am not saddened by death.  It’s just part of my workday, occurring sporadically, occasionally in tragic fashion though much more typically the end result of too many years or poor health decisions.  I used to feel a sense of disquiet, but this has long been displaced by ambivalence through emotion-numbing repetition.  I remain unfazed, and simply move on to the next task at hand. I am saddened by grief.  I dread telling people a loved one has died, all the more so when they are unprepared.  I dread the reactions, the sadness and anguish and tears and while I can’t comprehend the full extent of their pain, I feel a small part of it course through me.  I wonder if I’ll be numb to this someday too.       (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1452066 Mon, 19 May 2008 08:07:14 +0100 1452066 http://trismus1.wordpress.com/2008/05/11/glidescope/ Anyone out there using the glidescope?  I’d like to know what you think, we are thinking about getting one. (Source: Ten out of Ten) Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1437243 Mon, 12 May 2008 04:23:04 +0100 1437243 http://trismus1.wordpress.com/2008/05/08/we-are-so-screwed/ Says Whitecoat, ranting about the indiscriminate use of antibiotics, and I couldn’t agree more.  In the last five years I’ve seen cipro transform from a “big gun” to a throwaway antibiotic, useless against skin infections and ineffective (at least locally) in one of four UTI’s. So I too try to do my part.  No shots of rocephin or Z-paks for the various ways viruses decide to show up in my ER: bronchitis, sinusitis, gastroenteritis, or my personal favorite: the all encompassing “viral syndrome.”  Strep throat?  Penicillin works just fine, thank you very much.  Ditto amoxicillin for toddler pneumonia.  No you don’t need anything “stronger,” there’s really no such thing, what you think of as stronger is really br... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1429470 Thu, 08 May 2008 21:36:34 +0100 1429470 http://trismus1.wordpress.com/2008/05/06/were-uglier-too/ Recap of Last Week’s ER: The TV Show A guy and a girl get in a bad car wreck.  Unbeknownst to ER staff, they had just stolen tens of thousands of dollars worth of jewelry.  The girl decompensated, and ended up in cardiac arrest.  After undergoing an unsucessful emergency thoracotomy the team was ready to call the code.  Not so fast, said the guy, brandishing a gun and ordering the team to keep trying.  They recommended surgery, but having barricaded them in the trauma bay he refused them access to the OR.  No surgeons no OR no problem, the ER team tried the operation themselves but unfortunately without much success.  Meanwhile, word of the hostage situation made its way though the hospital, resulting in a mass evacuation and activation of law enforcement.  Finally, it ... Ten out of Ten blogs http://www.medworm.com/rss/comments.php?id=1423980 Tue, 06 May 2008 20:05:27 +0100 1423980