MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'encounters'. Sat, 03 Sep 2011 02:29:00 +0100 http://www.medworm.com/index.php?rid=5159015&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F08%2Fchoose-c%2F In case anyone was wondering, I am a rude racist doctor who discriminates against poor people and who has no idea how to provide medical care for children. This message was transmitted to the emergency department nurse, the nursing supervisor, the Director of Patient Affairs, and the secretary to the hospital CEO. Want to know why? I didn’t write a prescription for over-the-counter antifungal cream to treat a 3 week old case of ringworm on a 13 year old patient. The caller kept asking “So what, is it a ‘race’ thing, a ‘Medicaid’ thing, or is it just that the doctor doesn’t want the state to pay for the medicine?” Since most patients are happy to know that they can purchase a $5 tube of cream over the counter to treat their problem, and since ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=5159015 Fri, 26 Aug 2011 01:39:02 +0100 5159015 http://www.medworm.com/index.php?rid=5159016&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F08%2Fstrangest-complaint-of-the-night%2F A patient came in with the following chief complaint: The FBI told me to come in for evaluation The patient’s wife followed behind him, telling the nurse that the patient had “lost it.” OK. Paranoid delusions about the FBI calling him. No problem. “No,” the wife stated, “the FBI really did tell him to come in for evaluation. I talked to the agent.” It seems that Barack Obama was projecting visions of himself into the patient’s brain and was able to communicate with the patient telepathically — a la Obi Wan Kenobi. Mr. Obama was getting jealous of the patient due to the President’s stress and because the patient had so much freedom in his daily life. Therefore, the President telepathically told the patient that he was going to send... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=5159016 Wed, 24 Aug 2011 13:00:44 +0100 5159016 http://www.medworm.com/index.php?rid=5103348&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F08%2Fthe-boxer%2F Paramedics had a difficult time with the patient. Call went out for a patient named Joanne Doroshow that was reportedly “man down” on the city bus. By the time the paramedics arrived, the patient was laying on the sidewalk with a crowd of bystanders around him. He had shallow breathing. His pupils were constricted. Ahhhhh. A sign suggestive of opiate overdose. Paramedics loaded him into the ambulance and tried to get an IV. No luck. One paramedic then mainlined some Narcan. Yup. It was probably a heroin overdose … and the patient wasn’t happy about losing his high. He woke up, then started yelling, cursing, and swinging. He was a little better by the time he arrived in the emergency department, although he still took a swing at one of the paramedics when being trans... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=5103348 Fri, 05 Aug 2011 15:38:31 +0100 5103348 http://www.medworm.com/index.php?rid=5077699&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F07%2Fhuh%2F Possibly submitted from a reader e-mail A patient comes in complaining of swelling to her right foot. No pain. No injury. Just swelling. A quick glance at the patient’s foot showed that there was no swelling whatsoever. Examination … nothing. Range of motion … normal. However, the patient insisted that her foot was swollen. “Where do you feel that your foot is swollen?” “Look. Right here,” pointing at the outer ankle. “Um … ma’am. That’s your ankle.” “No … that’s swelling.” So I went and got a tape measure. I measured around both feet, around both ankles, and around both lower legs, then compared numbers. Exactly the same in both legs. “See? The sides are the same. No swelling.” &#82... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=5077699 Thu, 28 Jul 2011 20:52:27 +0100 5077699 http://www.medworm.com/index.php?rid=5028240&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F07%2Findependence-from-fingers-day%2F I was going to write about the worst July 4th accident I had seen in the ED prior to July 4, but I got bogged down in other things and then had to take an unexpected road trip out of state. The story is below. If you’re wondering why I’m telling the story after July 4th, continue reading. There was a contender for the worst injury that was seen for a follow up visit yesterday. The first patient was a man in his early twenties I saw many years ago. Still remember his case very well. He was riding around as a passenger in a car after July 4th with some friends when he saw someone that he knew who was driving a car up ahead of him. He had some leftover fireworks, so he pulled out an M-80, and, as they got closer to the acquaintance’s car, he rolled down the window and lit th... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=5028240 Wed, 13 Jul 2011 16:10:51 +0100 5028240 http://www.medworm.com/index.php?rid=4893466&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F06%2Fb-r-b%2F A teenager is brought in by her mother after falling while skateboarding. She was whisked off to xray shortly after arriving – and before I had gotten into the room to evaluate her. I walked into room and was talking with her mother when a cell phone buzzed on the bed under pillow. “Is this yours?” I asked, worrying that it may have somehow been left behind by the previous patient. The mom said “No, it’s hers,” referring to her daughter who was still in the x-ray department. “You better keep it in your purse so it doesn’t get lost.” “Don’t worry, it’s attached to her hand 99% of the day. She’ll know it’s gone 10 seconds after she gets back into the room.” I came back in the room after reviewing the x-... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4893466 Fri, 03 Jun 2011 17:31:59 +0100 4893466 http://www.medworm.com/index.php?rid=4893467&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F06%2Fcorrelations%2F Has anyone else noticed the following correlation? The more narcotics that a patient has received in a given month, the less likely that a patient is to be able to pronounce the names of those medications. For example, a patient with chronic abdominal pain and multiple negative workups came into the emergency department for a recurrence of her pain. She had a rather lengthy printout from the state controlled substances database as well. The patinet wanted the same medications that made her feel better the last time she was in the emergency department earlier in the week. “What medication did you receive?” “Ummm. Let’s see. Toradol, Compazine, Zofran, and some other medication that started with a ‘D’. Deh … Deh … Deh …” “You ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4893467 Fri, 03 Jun 2011 03:17:09 +0100 4893467 http://www.medworm.com/index.php?rid=4883585&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F05%2Funique-medical-allergies%2F Had a rather heated discussion a couple of years ago about the difference between allergies and adverse medication reactions, so when patients tell me about strange allergies to medications, most of the time I just smile and move on. But … while reading through a patient’s typewritten two page list of allergies in a recent emergency department visit, I did come across two allergies that I had never seen before. Allergy: Colonoscopies. Reaction: Hives Allergy: Antihistamines. Reaction: Makes breast implants shrink. There has to be a scholarly paper somewhere in there. (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4883585 Sun, 29 May 2011 16:32:11 +0100 4883585 http://www.medworm.com/index.php?rid=4841487&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F05%2Fthe-diesel-fitter%2F I took care of a patient who was a pipefitter and which reminded me of another patient I had long long ago. I looked back through the blog and never mentioned this story before, so here it is. The patient was rather intoxicated and he said that he had hurt his leg at work. So naturally I asked him what kind of work he does. “I’m a diesel fitter.” “You mean a pipe fitter?” “No, a diesel fitter.” “Well what does a diesel fitter do?” “I work on an assembly line in a factory.” “In a truck factory?” “No I work in a factory that makes nylon products – like panty hose.” “Doing what?” [this was the wrong question to ask] “Weeeellllll … when the panty hose come off the end of the ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4841487 Wed, 18 May 2011 02:44:37 +0100 4841487 http://www.medworm.com/index.php?rid=4780315&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F05%2Fnow-about-that-nasal-congestion%2F I’m still a little skeeved out by this. An adult patient comes to the hospital for evaluation of wrist pain she has had for three months. I get a little history and then start to examine her hand. I turn over her wrist so I can tap on it to check for Tinel’s sign … and there is a giant booger on the pad of her index finger. [shudder] (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4780315 Wed, 04 May 2011 03:25:31 +0100 4780315 http://www.medworm.com/index.php?rid=4744823&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F04%2Fglad-i-could-help%2F A mother brings her 9 year old son into emergency department. The chief complaint on the chart was “red lips.” The young man sitting on the bed did indeed have red lips. Nothing else appeared wrong. The mother stated “He has chapped lips.” Yes. Yes he does. Petroleum jelly works great. Just ask Suzy Chapstik. “You need to tell him to stop licking his lips.” “Excuse me?” “I want you to tell him to stop licking his lips. He’s making them get all chapped by licking them and he won’t listen to me when I tell him to stop.” “OK. Johnny, you have to stop licking your lips. They won’t heal if you don’t stop licking them. Understand?” [Nods head] The paperwork involved in the visit took ten times longer ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4744823 Sat, 23 Apr 2011 21:53:30 +0100 4744823 http://www.medworm.com/index.php?rid=4714745&cid=t_337374_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2011%2F04%2Fwatch.jpg I recently participated in a Twitter Chat about physician-patient communications. A common refrain from some of the providers in the group was that “there isn’t enough time” during the typical office visit for physicians to worry about communicating effectively. What’s up with that? The goal of patient-centered communications is to engage the patient in their own health care. While most physicians endorse the concept of patient centered communications, many seem reluctant to employ such techniques in their own practice.  Why?  I suspect that many fear that too much patient involvement will increase the length of the visit. Take the patient’s opening statement aka “patient agenda” in patient centered lingo.  This is where the doctor asks the patient why they are there.  T... Better Health blogs http://www.medworm.com/rss/comments.php?id=4714745 Thu, 14 Apr 2011 14:00:41 +0100 4714745 http://www.medworm.com/index.php?rid=4696639&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F04%2Fhow-to-assure-your-norco-prescription-isnt-filled%2F 1. Go to your primary care physician’s office and refuse to take a random drug test when you entered into a contract to do so in order to get your pain medications refilled. 2. When the doctor threatens to terminate you from his practice, go into the bathroom, urinate in a cup, and then throw the cup all over the bathroom and hallway. 3. Run out of the office before the police get there. 4. Come back to the office after the police arrive go up to the desk, point at the secretary and yell at her that you “know where she lives.” 5. Get a ticket for trespassing. 6. Go to the emergency department in the same town immediately afterwards and say that your family doctor wouldn’t give you your pain medications because he “got too friendly” and you refused to sle... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4696639 Sun, 10 Apr 2011 01:50:46 +0100 4696639 http://www.medworm.com/index.php?rid=4658391&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F03%2Frepost-fix-the-problem-doc%2F One of my favorite stories. Originally posted October 2007 An old fellow got brought in by ambulance. His wife was waiting for him as he rolled into the room. A tire fell off of his bicycle, he fell, hit the curb, and got banged up. Ripped his shirt, ripped his pants, knocked the lens out of his glasses. He had a good sized hematomato and laceration to the side of his head. And he was not happy. The paramedics sarcastically told us “he’s in a good mood.” He wouldn’t give the registration clerk any information at all — his wife had to give us his name. Taking his vital signs was a chore. The nurses tried to get a history from him. In a gruff voice, he would tell them “There’s nothing the matter with me!” One of the laws of nature is that defecation follows gravity down an in... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4658391 Wed, 30 Mar 2011 15:38:13 +0100 4658391 http://www.medworm.com/index.php?rid=4636447&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F03%2Frepost-yee-haw%2F [Originally posted February 2008] When someone kicks at the locked door between the waiting room and the triage room, it usually isn’t a good thing. Most often it is someone who has been shot, someone who is being dragged in by any available body appendage as a drug overdose, or someone with a bad asthma attack. So my heart sank when we heard kicks at the door and heard a frantic mother screaming “My baby! My BAAABY!” “Go grab the peds crash cart,” I told the tech standing next to me. Then the door opened and I had to do everything I could to keep from laughing. A rather large mother busted through the door holding her two year old son. The son was holding on for dear life with one hand as the mom shuffled back and forth looking frantically for … ME. The mom would start walking... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4636447 Fri, 25 Mar 2011 13:44:07 +0100 4636447 http://www.medworm.com/index.php?rid=4626838&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F03%2Fkarma-victim%2F Sometimes karma works in strange ways. Parents bring their child in for evaluation of the child’s cough and runny nose. About the tenth such case of the day and no one wants to get their kids flu shots. The child’s dad is standing next to the bed holding the child’s hands and talking baby talk to the child – which is already grating on my nerves. “We dunna find out what’s wrong wif you.” “Sir, I’m going to need to get in there so that I can examine him.” He kind of scooted up to the head of the bed, but wouldn’t leg go of the child. He was kneeling down, still holding his child’s hand, and still doing the baby talk. I listened to the child’s heart, listened to the lungs, pressed on the belly, felt for lymph nodes... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4626838 Wed, 23 Mar 2011 11:12:14 +0100 4626838 http://www.medworm.com/index.php?rid=4592408&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F03%2Flet-go-answer%2F Remember the post last month about the snapping turtle stuck on the patient’s lip? EP Monthly updated the story this month to tell everyone how the emergency department staff got the snapping turtle off the patient’s lip. See the answer at this link. (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4592408 Tue, 15 Mar 2011 10:36:15 +0100 4592408 http://www.medworm.com/index.php?rid=4577909&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F03%2Fstroke-victim%2F A 27 year old woman is brought in by ambulance. The call comes in as “patient having a stroke.” When the patient arrives, she is dressed up with nice clothing, makeup, and high-heel shoes. She looks like she was out at the clubs. In fact, she was drinking at home with her boyfriend and was getting ready to go out to a bar. Then there was an argument. The patient was able to “feel her blood pressure going up.” She demanded that her boyfriend apologize for the things he said to her. He refused. She sat in a chair, grabbed her head with both hands, and went “unresponsive.” She didn’t “wake up” until she arrived in the emergency department and had no idea what happened. It must have been a stroke. She was sure of it, because this was her ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4577909 Sun, 13 Mar 2011 02:39:54 +0100 4577909 http://www.medworm.com/index.php?rid=4545269&cid=t_337374_180_f&fid=38609&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDavidSeah-BetterLivingThroughNewMedia%2F%7E3%2FoCrSCiRYovU%2F SUMMARY: Some personal reflections on hanging out at a very relaxed “piano karaoke” event as a non-singer. The first Thursday at every month is Piano Karaoke night at Studio 99, one of the many brainchildren of my friend Elise MacDonald. She maintains a “listening room” music venue here in downtown Nashua, which has over the past couple of years blossomed unexpectedly into the center of a musician-focused music renaissance. venue downtown. Elise, who started the space to provide music lessons for her collective of fellow teachers, found that there were many people in the area that just wanted a place where they could play music together. This led to a quick change of business plan, and now Studio 99 hosts numerous music jams for a variety of genres and age groups.... David Seah - Design, Development, Inspiration, Empowerment blogs http://www.medworm.com/rss/comments.php?id=4545269 Fri, 04 Mar 2011 07:43:33 +0100 4545269 http://www.medworm.com/index.php?rid=4540569&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F03%2Fchief-complaint-insomnia%2F Me: Hi. I’m Dr. WhiteCoat. What brings you here this evening? Patient: I’m stressed and I haven’t slept in 5 days because those bitches at work don’t keep up with their work and so I have to do their work AND my work so finally I had it the other day and started punching one of them in the face while I was shaking the other one by the hair which is how I broke my wrist [holds up her wrist splint] so now my boss wants to fire me but I think that is really because Enrico talked to him because I turned Enrico into the Feds for drugs and now Enrico is hiding out from them, but he’s also trying to hunt me down to kill me for narcing on him, so I travel light and stay with a lot of friends and I never sleep in the same place more than one night – not that I&#8... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4540569 Thu, 03 Mar 2011 04:26:06 +0100 4540569 http://www.medworm.com/index.php?rid=4517172&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F02%2Fdoctors-work-notes-and-medical-ethics%2F I wrote the story below before all of the Wisconsin issues popped up, but the “doctor fraud” scandal segues nicely with the issues in the patient encounter I wrote about. Kevin, MD had a post yesterday linking to an article in The Atlantic about how physicians in Wisconsin were standing on street corners and writing work excuses for protesting teachers. Videos in the Atlantic article showed the the doctors were writing notes for “stress” based solely on a patient’s history without performing physical examinations. The Atlantic article questions the physicians’ integrity and states that the “profession of medicine has a black eye in this case.” The author of the Atlantic article is a physician who also writes on health care policy. He calls do... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4517172 Thu, 24 Feb 2011 18:43:09 +0100 4517172 http://www.medworm.com/index.php?rid=4512400&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F02%2Fsign-of-the-times%2F The comment thread just died down on the post about filming the birth of babies. Then a real-life example occurs in our emergency department. Tell me that the following scenario would have even taken place five years ago: A patient’s mother completely freaked out on one of our nurses because her child wasn’t getting Demerol for her chronic back pain. So she holds her iPhone up to the nurse’s face and says … “Smile, bitch, you’re going on YouTube!” I told the nurse to call the police, but she wouldn’t do it. I tried finding the video by doing a search for “advanced techniques for enabling drug seeking children” but apparently the video hadn’t been posted yet. (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4512400 Wed, 23 Feb 2011 03:27:42 +0100 4512400 http://www.medworm.com/index.php?rid=4498278&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F02%2Fcup-check-x-2%2F Today just wasn’t my day in the emergency department. First, I’m taking care of a patient with shortness of breath. I’m standing at the side of the cart. He leans forward and I listen to his lungs with my stethoscope. Sound good. Then I lean the bed back a little so that I can listen to his heart and press on his abdomen. The sides of the cart are up and I usually just lean over the sides of the cart to put my stethoscope into position. I rest one hand on the cart rail and lean over with the stethoscope in my hand to listen to the patient’s abdomen. Well the damn cart rail wasn’t locked into place, so when I lean on it, it folds down and I lose my balance … falling forward into the patient … and the side of my head lands firmly in his genitals. Yes... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4498278 Sun, 20 Feb 2011 03:03:23 +0100 4498278 http://www.medworm.com/index.php?rid=4450294&cid=t_337374_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdifficult-patients%2F2011.02.08 Physicians see nearly one in five patients as “difficult,” report researchers. Not surprisingly, these patients don’t fare as well as others after visiting their doctor. Researchers took into account both patient and clinician factors associated with being considered “difficult,” as well as assessing the impact on patient health outcomes. They reported results in the Journal of General Internal Medicine. Researchers assessed 750 adults prior to their visit to a primary care walk-in clinic for symptoms, expectations, and general health; for how they functioned physically, socially and emotionally; and whether they had mental disorders. Immediately after their visit, participants were asked about their satisfaction with the encounter, any unmet expectations, and... Better Health blogs http://www.medworm.com/rss/comments.php?id=4450294 Tue, 08 Feb 2011 16:00:00 +0100 4450294 http://www.medworm.com/index.php?rid=4450299&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F02%2Flet-go%2F Interesting case just published on EP Monthly’s site regarding a snapping turtle. Patient comes in via ambulance with a 25 pound snapping turtle firmly attached to his upper lip. The turtle isn’t letting go. See the link for a picture. http://www.epmonthly.com/clinical-skills/visual-dx/when-turtles-attack/ How do you get the turtle off of his lip? (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4450299 Tue, 08 Feb 2011 11:17:37 +0100 4450299 http://www.medworm.com/index.php?rid=4436754&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F02%2Fquestion-for-the-day%2F Question: Why was the patient not complaining of any pain from this injury? Answer: She was highly intoxicated … and she was driving a motorcycle at a high rate of speed … without a helmet … when she crashed … and broke her neck. Such a sad case. She has kids that she will now never be able to dress for school again. She’ll never be able to comb her hair, brush her teeth, or go to the bathroom without help. She went from someone who cared for her family to someone who will need to receive care from her family the rest of her life. Everything changed in an instant because of one bad decision. Please don’t drink and drive. (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4436754 Fri, 04 Feb 2011 15:57:28 +0100 4436754 http://www.medworm.com/index.php?rid=4399531&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Fits-about-time%2F It was a busy night in the emergency department as many nights are. All of the rooms were full and there were 6 to 8 patients waiting just to get back to the emergency department. I hadn’t taken a break in several hours, and though I was hungry I just drank sips of Gatorade and ate handfuls of cashews between patients to keep my energy up and to keep my stomach from growing too loudly at me. Sometimes during nights like this it seems like the “powers that be” try to mess with your mind. Every time you discharge one patient, two more patients register to be seen. If you discharge two patients, three patients register to be seen. The more you try to get ahead, the more behind you get. Then you start thinking. If I didn’t discharge anyone, th-e-e-en how many patients w... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4399531 Tue, 25 Jan 2011 23:47:14 +0100 4399531 http://www.medworm.com/index.php?rid=4372053&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Funfulfilled-expectations%2F A patient came into the emergency department at 3:00 in the morning with broken peritoneal dialysis catheter. Actually, the catheter wasn’t broken, there was a small leak in the catheter at the distal end of the tubing. She had clamped the shunt off as she was instructed to do in the past and she came to the hospital because she wanted an ambulance ride to tertiary care center 100 miles away. Instead, I cleansed the area, cut about a half centimeter off of the distal end of the tubing, removed the hub from the leaking portion of the tube and inserted the hub back into the shortened tubing. I gave her a dose of vancomycin as a precaution, then discussed discharge instructions with her. “Well how am I going to get to Metro Regional?” she asked. “I checked with your di... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4372053 Wed, 19 Jan 2011 11:20:40 +0100 4372053 http://www.medworm.com/index.php?rid=4322514&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Fdo-they-have-gastroenteritis-or-antimony-poisoning%2F Hey all, it’s ERP from erstories.net. Haven’t done a guest post in a while but here ya go. Recently there has been a huge uptick of visitors to my ER violently ill with vomiting and diarrhoea.  They (the CDC) thinks it is Norovirus, but that got me thinking.   We see episodes of this sort of thing so often that we almost turn off our brains as clinicians.  We say “you have a virus” before the patient has finished telling us the full story.  We blindly order Zofran, IV fluids and check some electrolytes.  If they feel better after a bolus of fluids and they tolerate some liquids, they go home.  Quick and easy.  Anyway, I got to thinking, what if something else is going on?  Something weird or random (I know I am a geek like that). Something sinister?   Dur... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4322514 Fri, 07 Jan 2011 07:01:29 +0100 4322514 http://www.medworm.com/index.php?rid=4318340&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Fthe-case-of-the-cyanotic-hands%2F I went in to see a patient whose hands suddenly turned blue at work. She stated that she couldn’t feel any of her fingertips once they started turning blue and said that she was “cleaning” before the symptoms occurred. As I walked into the room, all of the fingers on both her hands were definitely dusky appearing. Her upper arms appeared OK. Her lips weren’t cyanotic. So I sat there taking a history thinking to myself what the hell could be causing this. Raynauds doesn’t affect the whole hand like that. Sudden onset of a cyanotic heart lesion wasn’t very likely. She wasn’t working in the cold, and she was cleaning toilets with a scrub brush, so she didn’t have an exposure to some kind of industrial solvent. She didn’t have pain, so it w... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4318340 Thu, 06 Jan 2011 14:10:36 +0100 4318340 http://www.medworm.com/index.php?rid=4314050&cid=t_337374_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F01%2F05%2Foptimism-and-the-psychology-of-chance-encounters%2F “…chance encounters play a prominent role in shaping the course of human lives.” ~ Albert Bandura Former president, American Psychological Association “Did you ever observe to whom the accidents happen? Chance favors only the prepared mind.” ~ Louis Pasteur A friend of mine recently went through a tough time: a personal crisis. She was scouring for signs of something positive, anything that would offer a ray of hope or light for her situation. She decided to go out for some tea when she encountered a woman, unknown to her, who began chatting about the trials and tribulations of her life. The woman spoke of gratitude for those who had courage, and at the end of what was essentially a monologue the woman said to my friend: “Everybody goes through difficulties. Surround yourse... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4314050 Wed, 05 Jan 2011 11:05:00 +0100 4314050 http://www.medworm.com/index.php?rid=4309620&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Fmemories%2F I picked up the chart of a very nice little old lady who fell on the ice and broke her arm. When I walked in the room, her husband said “Oh good! He’s the best doctor here.” I thanked him for his compliment and went about treating her injury. All three of us joked back and forth and it was overall a very pleasant interaction for everyone involved. It just so happened that the patient’s daughter works at our hospital. She wrote me a quick e-mail thanking me for taking such good care of her mom. She also stated that her dad doesn’t like many people, but he took a liking to me after I treated him for pneumonia a couple of years back. He didn’t remember a thing about my examination, what medications I gave him, or what I said to him. Know what the only thing... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4309620 Tue, 04 Jan 2011 21:18:22 +0100 4309620 http://www.medworm.com/index.php?rid=4302863&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2011%2F01%2Fnow-see-here%2F I’m hoping that everyone enjoyed the evening last night. We went out for dinner and, under the influence of sake, I bet each of my kids $10 that they wouldn’t be awake past midnight. I lost $40. Was also getting text messages from several people working in the emergency departments describing how crazy things were getting. An example is paraphrased below. When a drunk and belligerent [patient] is brought in by police after his girlfriend’s husband beats the snot out of him, is it OK to chart that visual acuity is fine when he is able to read “DO” from my name badge and ask for a “real doctor”? I see a new blogger in the making. Everyone have a safe and happy New Year’s Day! (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4302863 Sat, 01 Jan 2011 16:03:57 +0100 4302863 http://www.medworm.com/index.php?rid=4258875&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F12%2Fone-liners%2F As more and more state databases come on line, those “patients” who feign pain seeking narcotic pain medications are finding it more and more difficult to find prescribers willing to oblige them. As a result, the patients are adapting by suffering acute injuries for which they need immediate narcotic pain medications to relieve their suffering. Reality check: One or two falls is one thing. When you call around to other hospitals and to the physicians listed on the state databases and find that the patient has “fallen” a half dozen times in the past 10 days, it is quite another. One such unsteady patient was brought by ambulance after falling on the ice. His feet slipped out from under him and he fell flat on his back “like one of those Dudley Doo-Right cartoon... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4258875 Tue, 14 Dec 2010 10:44:30 +0100 4258875 http://www.medworm.com/index.php?rid=4253148&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F12%2Ftoo-much-information-about-aicd-function%2F A 350+ pound man comes in for evaluation after his cardiac defibrillator discharged. When defibrillators discharge once, there isn’t a lot to do with the patients. The defibrillator did what it was designed to do – sense and terminate an abnormal cardiac rhythm. When there are multiple shocks, that is a different story. Multiple things to worry about including persistent abnormal rhythm, MI where ST changes are being sensed as an abnormal rhythm, lead fractures, loose connections, and electrolyte abnormalities – to name a few. Patients with multiple defibrillator discharges need their defibrillators interrogated and usually need to be admitted to the hospital. By the way – All you docs out there know what to do if you use a magnet to temporarily deactivate an AICD i... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4253148 Sun, 12 Dec 2010 21:42:10 +0100 4253148 http://www.medworm.com/index.php?rid=4237906&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F12%2Finevitable-malpractice%2F I’ll preface this post by saying that, as I usually do when discussing specific patient presentations, I made multiple factual changes in the factual information regarding the patient. An 87 year old lady who is in excellent health comes into the department because she couldn’t move her leg. When she woke up and was fine. Her family helped her get dressed. She read the newspaper at breakfast. Then she went to the bathroom, was in there about 15 minutes, and began yelling for help because her leg hurt and she couldn’t get off the toilet. The family thought that she was sitting too long on the toilet, irritating her sciatic nerve, and thought she just needed to let her leg relax for a little while. A couple of hours later, her leg was hurting her more and she still couldn&#... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4237906 Tue, 07 Dec 2010 19:17:16 +0100 4237906 http://www.medworm.com/index.php?rid=4197077&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F11%2Fthe-giggles%2F Sometimes there is just something that strikes you as funny, even though it may not be appropriate and it probably wouldn’t be funny to someone else. And you can’t stop laughing about it. Kind of like this Dutch comedy show spoof. Well, our dog BrownCoat has this habit. When he hears car keys jingle, he’s all about going for rides. He’ll run over and sit by the garage door and watch whatever you do. Get your coat. Grab your backpack. Call someone. He sits there watching you intently. Then we ask him “Want to go for a riiiide?” He cranes his neck, cocks his head to the side, and furrows his eyebrows. We can’t figure out if he really understands us, because he gives us the same look and cocks his head to the side if we say “Wanna stay insiiiiid... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4197077 Wed, 24 Nov 2010 15:18:48 +0100 4197077 http://www.medworm.com/index.php?rid=4151804&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F11%2Fthe-freebie%2F If you’re eating, if you like lollipops, if you are a member of the clergy, if you are under age 18, or if you frequent gentlemen’s clubs, you may not want to read this post. You have been warned. While out at dinner of all places, one of my friends asked me about the weirdest and the grossest things that I have seen in the emergency department. There were a few incidents that popped into my mind, but the incident below always seems to beat the other ones out on the weird-o-meter. Remember. You are reading this at your own risk. Back in my residency, senior residents used to team up with a junior resident to moonlight in a couple of smaller emergency departments in pairs. Most of the emergency departments were inner-city. Another resident and I were working one night when an at... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4151804 Wed, 10 Nov 2010 18:26:59 +0100 4151804 http://www.medworm.com/index.php?rid=4086274&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F10%2Funpleasable%2F “So how is your pain doing after the morphine shot?” I asked the 87 year old little old lady who had fallen at home. “I don’t have pain any more,” she replied. “That’s great! Well I have some good news. The x-rays show a lot of arthritis, but no fractures.” I thought that the patient and the growing numbers of family members in the room would have been happy with that statement. I was wrong. Grandma had fallen when trying to get out of her chair. She appeared frail and it was apparent that ambulation was always going to present a risk of another fall. But she had a walker and she refused nursing home placement, so there wasn’t much else to do to help her. When I explained my plans to discharge her, I started getting a bunch of questions. The patient’s husband wanted ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4086274 Wed, 20 Oct 2010 23:30:45 +0100 4086274 http://www.medworm.com/index.php?rid=4045106&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2Fwp-content%2Fuploads%2F2010%2F10%2FBlue-Cross-Blue-Shield-Caremark-Message.wav Below is a link to a recent phone message from one of Mrs. WhiteCoat’s patients who was “begging” Mrs. WhiteCoat to help her because she was “going crazy with that Caremark.” Blue Cross Blue Shield Caremark Message This poor lady is 89 years old, is legally blind, and needs multiple medications. She can’t get her prescriptions because Caremark believes that she only needs to be taking one of her medications three times per day instead of four times per day as prescribed. The patient doesn’t care. All she knows is that she needs her medications, she can’t get them, and she doesn’t want to “go through this every time.” She can’t get help through Blue Cross Blue Shield because they “transfer her from one department ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4045106 Fri, 08 Oct 2010 13:21:35 +0100 4045106 http://www.medworm.com/index.php?rid=4003264&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F09%2Fthank-god%2F As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial. “Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every chance we get. When she turned around, the look she gave me signaled that it was no time to joke. Tears were running down her cheeks. “What’s …?” She cut me off. “Thank God you’re here. Get into Room 7 now.” When patients are really sick, it has been said by people much smarter than me that your worth as a physician can be judged by how people invoke deities. There are the “Oh God” docs and there are the “Thank God” docs. Being classified in the latter category by a nurse whom I ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4003264 Mon, 27 Sep 2010 14:06:08 +0100 4003264 http://www.medworm.com/index.php?rid=3965437&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F09%2Fdamienne%2F When I got to work this morning, I had several people tell me that they wished that I was working the day before. A little five year old girl was brought to the emergency department for suicidal and homicidal ideations – at least according to the social worker who accompanied the patient to the emergency department. When the patient arrived, she was uncontrollable. Throwing things. Knocking over chairs and garbage cans. Trying to punch or bite anyone who came near her. All the time, the parents were just sitting there playing their little pocket electronic solitaire games and doing nothing to control their kid. That would have been it for me. You act like an animal, I don’t care how old you are. You’re going in leather restraints. I’m not endangering my staff. Then ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3965437 Tue, 14 Sep 2010 00:34:39 +0100 3965437 http://www.medworm.com/index.php?rid=3958082&cid=t_337374_180_f&fid=38609&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDavidSeah-BetterLivingThroughNewMedia%2F%7E3%2FXdKGst1RVsM%2F My buddy Alen, who has been the grandmaster of the venerable Japanese toy robot site ToyboxDX for nearly as long as I’ve known him, has been slowly building an army of original character toys. His latest: a licensed Voltron: Defender of the Universe, in a diminutive 2G USB Flash Drive package Alen’s first run of toys was based on his nekosaur design back in 1998. A self-funded labor of love, Alen has both been beset by shadowy figures in the toymaking underworld on one side and guided by the enlightened hero masters of his childhood. His original designs draw heavily on the influences of his youth, cartoons that I never actually have seen, but recognize as a primal source of his creative energy. The first run of toys (right) were also a series of USB thumb drives using an in... David Seah - Design, Development, Inspiration, Empowerment blogs http://www.medworm.com/rss/comments.php?id=3958082 Sat, 11 Sep 2010 03:09:47 +0100 3958082 http://www.medworm.com/index.php?rid=3920846&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F08%2Fserious-injuries%2F We receive this transfer from an outlying hospital for a neurology evaluation. The patient is in his 30s and was out at the bars when he was hit in head with beer bottle during an altercation. Since that event, he has complained of dizziness, headache, loss of vision in one eye, pain all over his body, and repeatedly running out of pain medications. He had multiple CT scans and an MRI looking for causes of his symptoms at the referring hospital. All were normal. He also had multiple x-rays and physical exams without positive findings. He went back to the emergency department and was reportedly “pissing himself” and “s**tting himself” – as in he was sitting on the couch watching a movie and didn’t know he urinated on the couch until his girlfriend told hi... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3920846 Tue, 31 Aug 2010 10:54:09 +0100 3920846 http://www.medworm.com/index.php?rid=3911706&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F08%2Fno-lol-matter%2F It’s sad when you hear about deaths due to texting while driving. Dr. Frank Ryan recently drove off a California cliff while reportedly making a Twitter post about his dog. We recently had a 22 year old patient come in from a bad motorcycle accident. Road rash all over the place. Wasn’t wearing a helmet. As we began to examine him, it became evident that he had a spinal cord injury. He had priapism and reduced rectal tone. His legs weren’t moving. MRI showed a T6-T7 injury. It was even more sad learning how the injury occurred. He told the paramedics that he was riding his motorcycle at a high rate of speed using one hand to steer and using the other hand to talk on his cell phone. On a speeding motorcycle. He was making plans to meet a friend that evening to go out to th... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3911706 Fri, 27 Aug 2010 10:22:54 +0100 3911706 http://www.medworm.com/index.php?rid=3827077&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F08%2Fdouble-gotcha%2F For a few hours, our emergency department was Octogenarian Central. It seemed like every patient that registered to be seen was in their 80’s. Weakness. Dizziness. Constipation. Chest pain. More weakness. Hip pain. Eight out of ten patients were octogenarians. Family members accompanied all of the patients and helped us piece together the multiple medical problems. After my second disimpaction of the afternoon, I longed for a kid with an ear infection. Then we got an ambulance call. Patient down. Full arrest. Family trying to perform CPR. Yup … he was 81. The story was especially difficult. The patient was sitting in his living room watching TV with his wife. He suddenly had trouble breathing. He told his family to call the ambulance because he felt like he was going to die. Wh... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3827077 Thu, 05 Aug 2010 10:53:27 +0100 3827077 http://www.medworm.com/index.php?rid=3776400&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F07%2Fwhats-fair%2F The parent of a patient that we saw in our ED last night upset staff members. One of her three children was out riding a bicycle without shoes and her foot got cut on the pedal of the bicycle. As we were cleansing and sewing up the laceration, the mother promised to take the children to get ice cream after we were done. I discussed follow up instructions with the mother and she asked whether her child would be in pain. I told her that there might be some pain, but that Motrin should take care of it. She asked me if I planned to write a prescription and I told her that the over the counter Motrin would be fine. Then she got a little more assertive. “We have Medicaid. I want you to write a prescription so we don’t have to pay for it.” “You can get a bottle of liquid M... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3776400 Wed, 21 Jul 2010 19:39:16 +0100 3776400 http://www.medworm.com/index.php?rid=3750066&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F07%2Fconcerned-family%2F A patient in her early 70’s was brought in by ambulance for difficulty breathing. She had been a smoker all of her life and her lungs were clearly wearing out on her. After the patient arrived, a daughter teetered up to the registration desk and asked if she could see her mother. The smell of whiskey on her breath was unmistakable. The daughter went back to the room and sat with her mother for a little while as the smell of Jim Beam wafted through the air. We informed her that things with her mother weren’t looking good. As the respiratory therapist tried to work his magic, the patient’s daughter got up and teetered back out of the room. The respiratory therapist’s “healing vapors” had no effect. None of our efforts were improving the patient’s con... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3750066 Tue, 13 Jul 2010 11:17:56 +0100 3750066 http://www.medworm.com/index.php?rid=3718406&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F07%2Fanother-reason-they-call-it-dope%2F In case you wanted another reason not to use drugs, here it is: You don’t know where the drugs have been. A woman got brought into the emergency department in police custody. She was intoxicated and complaining of pain to her ankle and hip. The story we were given was that she jumped out the window of a house that was being raided by police and injured her ankle and hip in the jump. Following the trauma protocol we did the Airway/Breathing/Circulation/Disability/Exposure routine. As the patient was being undressed, the nurse noted a piece of newspaper sticking out of the crotch of the woman’s underwear. A little more investigation determined that there was a wad of newspaper stuck into a place where I’m guessing that not many police officers frisk. When the newspaper was ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3718406 Thu, 01 Jul 2010 19:34:20 +0100 3718406 http://www.medworm.com/index.php?rid=3710564&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F06%2Fit-wasnt-me%2F Between about 6PM and 9PM on most Sunday evenings, our emergency department seems to become more crowded with kids and their parents. It used to be less because Sundays were school nights, but now that the kids don’t have to be in school the following morning, the numbers seem to be increasing. I’ve also noted a trend in the presenting complaints. You see, due to many court orders governing divorced parents with custody rights, said custody of offspring must change hands at some point in the week. In our county, it appears that the courts like the children to be transferred between parents at 5PM on Sunday evenings. Of course, after being in the custody of that other evil parent all week (or all weekend as the case may be), the parent with the halo then notices a plethora of bi... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3710564 Tue, 29 Jun 2010 10:33:16 +0100 3710564 http://www.medworm.com/index.php?rid=3695581&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F06%2Fblunt-ness%2F A man in his mid-30’s gets brought by ambulance with palpitations. His mom arrived right behind the ambulance. The patient was obviously anxious and was dripping with sweat. We hooked him up to the monitor and he’s in SVT up to the 160’s. No medical problems. Occasional alcohol. Smokes half a pack a day. No drugs. This same thing happened to him a year or so ago, the doctors did a bunch of tests and didn’t find anything. Nothing out of the ordinary on his physical examination. We ordered some labs and gave him an IV calcium channel blocker. His heart rate came down to the low 100s. He still appeared anxious, so I have him a little bit of a benzo to calm him down. Soon he was feeling better. His labs came back normal – everything except his positive marijuana s... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3695581 Thu, 24 Jun 2010 19:03:37 +0100 3695581 http://www.medworm.com/index.php?rid=3687106&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F06%2Fwhy-freddies-girlfriend-was-removed-from-the-ed%2F Freddie came in as a drug overdose. The medics couldn’t get a line on him. He was unresponsive and his skin tone was somewhere between blue and purple. A sternal rub didn’t do much to awaken him. We artificially ventilated him with an Ambu bag. His pupils were barely visible. Track marks were on his arm. Yup. He’s an overdose. The nurses worked flawlessly as a team – applying the cervical collar, inserting IVs, checking blood glucose, then injecting Narcan. “Watch out,” I told the nursing student who was putting on the EKG leads, “things are going to go wild in about 15 seconds.” Fifteen seconds went by. Nothing happened. Damn. Twenty seconds. The nursing student looked at me. I shrugged my shoulders. Hmmm. Maybe this wasn’t an overdose... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3687106 Tue, 22 Jun 2010 16:34:15 +0100 3687106 http://www.medworm.com/index.php?rid=3652415&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F06%2Foverheard-in-the-waiting-room%2F The registration clerk in the emergency department overheard the following statement from one patient waiting to be seen made to another patient in the emergency department waiting room who is on “The List“: “Just remember – you’re the addict and I’m the dealer. You get what I give you after they prescribe it to me. Understand?” Hmmmm. Wonder how much you’ll get for that Tylenol prescription the doctor gave you. (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3652415 Fri, 11 Jun 2010 11:15:47 +0100 3652415 http://www.medworm.com/index.php?rid=3621701&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F06%2Fquote-of-the-day-214%2F Lots of strange offhand comments from patients lately … Patient who took an ambulance to emergency department at 2:30 AM when she noticed vaginal bleeding. “When was your last period?” “About a month ago.” “Was there something different that made you think this wasn’t your period this month?” “No. I just wanted to be sure.” [after physical examination showing small amount of vaginal bleeding] “OK. It sure looks like you’re having your period again. You can follow up with the on-call physician if you have any problems.” “How am I going to get home?” “You’ll need to call a friend or family member.” “I don’t have any.” “Well, then you’re welcome to call a c... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3621701 Wed, 02 Jun 2010 12:53:24 +0100 3621701 http://www.medworm.com/index.php?rid=3603611&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Fquote-of-the-day-212%2F Patient brought in by ambulance after allegedly drinking a bottle of Windex – making gruff statement about his previous history … “Hey! This isn’t the first time I’ve committed suicide, you know.” The nurse and I just looked at each other, made those faces where you raise your eyebrows and open your mouth but keep your lips pursed together, and nodded our heads. What we felt like saying: “OK, great. Can I get you anything to drink? Like some O-negative blood, maybe?” Then in a whisper “tell the secretary to get some garlic from the cafeteria – STAT.” … or maybe … “Very good, Mr. Christ, Social Services will be down here shortly to arrange for your transfer.” (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3603611 Thu, 27 May 2010 13:54:57 +0100 3603611 http://www.medworm.com/index.php?rid=3592216&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Fhavent-i-seen-you-before%2F Ambulance call goes out for a patient who is in “excruciating pain all over.” She has a history of fibromyalgia and ran out of her pain medications at home. Time of call: 18:35 on a Friday night. Being out of pain medications after office hours on a weekend is a red flag. When she arrives, she happens to just have moved into town this week. Another red flag. The emergency physician working at the time looks her up on the state database. She has received medications from 13 previous physicians. Red flag #3. She gets a shot of Toradol, is informed that we do not refill prescriptions for chronic pain medications in the emergency department, and is sent on her way. About 2 hours later, another ambulance call goes out. A 36 year old woman fell while walking up steps, hit her forehea... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3592216 Mon, 24 May 2010 12:56:21 +0100 3592216 http://www.medworm.com/index.php?rid=3590345&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Fplacebo-power%2F This is a repost from a couple of years ago. I actually had a new post planned, but had to reference something on this post. When I moved from my old blog to EP Monthly, this post apparently didn’t get transferred. Some fond memories below. —– The effect of a placebo is based on someone’s belief that an inactive substance is going to help them. This belief can actually cause the brain to release chemicals that mimic the effect of antidepressant medications and/or analgesia. Some placebos are not just “sugar pills.” For example, some people with viral upper respiratory infections must have antibiotics to make them feel better. Physicians know (or at least they should know) that using antibiotics for viral infections is a useless proposition. Like spraying Raid on d... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3590345 Sun, 23 May 2010 03:23:37 +0100 3590345 http://www.medworm.com/index.php?rid=3569815&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Ftelephone-advice%2F What the secretary is required to say: “I’m sorry, ma’am. We’re not allowed to give medical advice over the telephone. He’s welcome to come to the emergency department to be evaluated at any time, though.” What the secretary wanted to say: “What’s the matter with his head?” What the patient’s primary care physician wanted to recommend: “One quart of Bisquick batter by mouth STAT!” What the person calling the emergency department was asking: “My teenage son just drank a quart bottle of maple syrup. What should I do?” (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3569815 Mon, 17 May 2010 02:40:33 +0100 3569815 http://www.medworm.com/index.php?rid=3549311&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Freverse-psychology%2F The ED secretary gets a call from an unknown caller. “Is Dr. WhiteCoat working? I’ve seen him before and he’s a really good doctor. I only want to see him for my problem. Is he there tonight?” “Ummm … no, unfortunately he’s not here tonight.” “Can you tell me when he will be working again?” “No, ma’am, we can’t give that information out.” “OK. Thank you.” Fifteen minutes later, one of our frequent flyers comes limping in with severe back pain and she’s just plum out of Vicodin. The secretary hears her talking to the registration clerk and recognizes the voice as the person who just called her 15 minutes ago. You’re good lady. But the doctor that is working isn’t giving you a re... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3549311 Mon, 10 May 2010 03:35:53 +0100 3549311 http://www.medworm.com/index.php?rid=3522636&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Frisk-factors%2F Hi all, it’s ERP, from ERstories.  I brought my blog back from the dead about a week ago after a major crash. Unfortunately, I lost nearly all my photos that I had uploaded but luckily did not lose the old posts and comments.  Anyway, there are no pay-per-click ads at this point so you should not get any spam or viruses. Also the layout and theme are different.  Let me know what you think. Anyway, onto the post. Which of the following cardiac risk factors alarmed me the most? 1.70 y/o Male 2. Hypertension 3. High Cholesterol 4. Diabetes 5. Family history of MI 6. He was of Indian ethnicity from Guyana. If you guessed #6, you’re on the money.  I have never seen more people from a single country with worse coronary disease. My youngest patient ever with an ST elevation MI was... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3522636 Sat, 01 May 2010 12:34:39 +0100 3522636 http://www.medworm.com/index.php?rid=3511542&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fmore-satisfied-customers%2F As our hospital administrator emphasizes the importance of high patient satisfaction scores and “pleasing every patient every time,” I’m really becoming disenchanted with emergency medicine. He’s getting his directives from the hospital board and being pressured by statistics on some web site that only administrators look at, so it’s tough to blame him, but this medical system is really heading the wrong way fast. Patient #1: A 18 year old female is brought in by her mother complaining of lower abdominal pain. She’s doubled over while she’s walking. After the nurse gets the history, she hands the patient a gown and tells her that she needs to get undressed for the exam. “I’m not getting undressed for you. You’re all stupid here.&#... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3511542 Wed, 28 Apr 2010 10:19:22 +0100 3511542 http://www.medworm.com/index.php?rid=3505159&cid=t_337374_180_f&fid=38609&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDavidSeah-BetterLivingThroughNewMedia%2F%7E3%2FYC0YIZdv4JM%2F SUMMARY: A chance encounter with an acquaintance resets Dave's understanding of Excellence and Productivity. One of my favorite proverbs is Old age and treachery will overcome youth and skill. I like it because it paints an image of the classic generational conflict between old people in power and those who are powerful. On the side of Oldness, there's experience and the foresight born it, plus the insight that many so-called rules are easily broken. On the side of Youthful Power, we have confidence born of ability, coupled closely with a fatally simplistic view of the rules. Sweetening the game is the expectation that Old Age has everything to lose, with the old entitlements of power slipping away more rapidly with each passing year. Youth, by comparison, has everything to gain, and ther... David Seah - Design, Development, Inspiration, Empowerment blogs http://www.medworm.com/rss/comments.php?id=3505159 Mon, 26 Apr 2010 00:43:10 +0100 3505159 http://www.medworm.com/index.php?rid=3494314&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fthe-medications-worked%2F A grandfather brings in his 14 year old grandson because the boy hurt his wrist … for the second time in two days. The first time he was  brought to the emergency department, x-rayed, and was diagnosed with a Salter Harris Type I fracture. He was put in a splint and sent home. This time, he was wearing the splint, fell while walking, and had more pain in his wrist. There wasn’t really any point tenderness or deformity on his exam, so I explained that we weren’t going to change the management and we didn’t need to repeat an x-ray because even if there was a small fracture, he was already in a splint. The grandfather argued with me for several minutes because he felt the patient needed an x-ray to make sure there was no fracture. I finally got fed up trying to reason... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3494314 Thu, 22 Apr 2010 14:34:15 +0100 3494314 http://www.medworm.com/index.php?rid=3482900&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fthis-isnt-football-maam%2F If you’ve ever tried to insert an intravenous line before, you know how difficult of a task it can be with a child. Adults usually have thinner skin and most of the time have (not always) less fat on their arms. Infants and toddlers have lots of pudge on their arms and seeing a good vein is usually difficult and often impossible. The nurses who are really good at starting IV lines – the ones that everyone in the hospital calls in a pinch – have their little tricks for getting IVs in place. Often the veterans know that you can’t always go by sight. Sometimes veins are deep enough below the skin that you can’t see them, but you can feel them. When the hospital staff ties the tourniquet around your arm and starts prodding you with their fingertips, they’re ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3482900 Mon, 19 Apr 2010 11:54:38 +0100 3482900 http://www.medworm.com/index.php?rid=3460164&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fzofran-moment%2F A 52 year old intoxicated lady gets brought in by ambulance after getting in a fight with her ex-boyfriend. She had been thoroughly punched and kicked in her face. Both of her eyes were black and blue and were significantly swollen. One eye was swollen shut, the other was open just enough so you could see the subconjunctival hemorrhage about her iris. One of her teeth was knocked out and her breath smelled like someone poured Pabst Blue Ribbon and rotten eggs into someone’s sneaker and then she drank out of it. Literally corrosive. She went into the bathroom, looked in the mirror and began bawling. “I look like a Star Wars character!” I had to admit that she made a good analogy given her rather impressive blood alcohol level. Later in the evening, I went to tell her about... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3460164 Mon, 12 Apr 2010 11:35:15 +0100 3460164 http://www.medworm.com/index.php?rid=3437693&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fmmm-huh%2F Maintaining our sanity in the emergency department sometimes means that we do silly things like giving patient reports in an Arnold Schwarzenegger voice, talking like a pirate, or repeatedly singing “Pants on the Ground.” No one thought too much of it when one of our nurses started a new trend by in the nursing station by spontaneously saying “mmm-huh” after every sentence. “It’s going to get up to 70 degrees today, mmm-huh.” What’s wrong with you? Nothing at all, mmm-huh. So I started thinking. Did I say mmm-huh to someone? Was this some new YouTube video or song that I hadn’t seen or heard yet? What started this new little fad? Grabbed the next chart and went into see a little old lady who came in with mental status changes. I walked ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3437693 Mon, 05 Apr 2010 11:03:24 +0100 3437693 http://www.medworm.com/index.php?rid=3437694&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fresurrection%2F It is appropriate that this incident happened in the early morning hours of Easter … A guy gets brought in by ambulance when he was found “unresponsive” in the front yard by two relatives. According to one of the relatives, all had been drinking to celebrate the Easter holiday. Didn’t know Easter was one of those “drinking” holidays, but that is beside the point. Relatives called 911. The ambulance arrived within minutes. As the paramedics rolled up to the scene, their headlights illuminated one man laying on the ground flailing his legs, another man holding his arms and pinning him to the ground, and a third man doing chest compressions on the flailing man. “Thank GOD you guys are here!” says Moe. “Is he stable now?” asks Larry. ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3437694 Sun, 04 Apr 2010 16:39:26 +0100 3437694 http://www.medworm.com/index.php?rid=3432882&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fnow-thats-gotta-hurt%2F   ERP from Erstories.net  here for a quick post while White Coat is out for a little while.  Some people have bad luck.  I mean, it is bad enough luck to fall down in the bathroom when  you are 70 years old because  you don’t get around so great any more. But to fall onto an old-style toilet paper holder and have it impale you in your perineum, penetrating through into the vagina really is horrible.     And no, get your minds out of the gutter – this was not one of those “I don’t know HOW this could have happened!!” excuses when someone inserts some foreign body into an orifice and has to make up some weird story.  She just had bad luck – for real! Luckily she was successfully patched up in the OR. (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3432882 Fri, 02 Apr 2010 10:42:13 +0100 3432882 http://www.medworm.com/index.php?rid=3416029&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F03%2Fpaybacks%2F He wasn’t your ordinary patient in police custody. A burly kid in handcuffs was brought in by police after being in a fight with his girlfriend. He had been drinking and when the police arrived, he wasn’t exactly cooperative. In fact, he irritated the officer enough that the patient got “tazed.” The patient fell to the ground and whacked his head pretty good. Then he just laid on the ground and rolled on his back. One of the other things that happened during the incident was that the patient lost control of his bowels and bladder. As he was walking down the hall, he had feces all the way up his back and both pant legs were soaking wet. We could smell him coming. The officer was leading the patient down the hall by the arm with one hand and holding his other hand up ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3416029 Mon, 29 Mar 2010 10:30:00 +0100 3416029 http://www.medworm.com/index.php?rid=3374132&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F03%2Fwhy-sadies-daughter-almost-became-a-patient%2F A middle aged woman walked up to the emergency department registration window and loudly announced that her mother was in the car and needed help. Several people ran out to the car to assist the woman’s mother. It appeared that her mother was suffering from ATATPA. Unfortunately, she also weighed at least 300 pounds and … she was dressed in a nightgown. The patient was awake and was looking around at everyone, but she wouldn’t get out of the car. We asked the daughter what was wrong with her and the daughter told us that her mother was moaning at home. Sadie, the patient, had suffered a previous stroke so she couldn’t talk to us, but she would moan and nod her head every once in a while. No matter what we said, Sadie wouldn’t get out of the car. Sadie’s ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3374132 Wed, 17 Mar 2010 10:10:04 +0100 3374132 http://www.medworm.com/index.php?rid=3362394&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F03%2Fyou-dont-listen%2F Little ol’ Marge came waddling up to the registration desk asking to see a doctor because she was urinating blood. In tow behind her was her obviously unhappy husband who was making it clear that the reason for his unhappiness was his wife’s trip to the emergency department. “Great. Now we can sit in the waiting room so people can cough on us,” he said at the triage desk. Marge and Charlie finally made it back to a room. Marge was having painless hematuria that began around dinner time. Painless hematuria in an elderly person generally isn’t a good sign. Through the whole history and physical exam, Charlie kept shaking his head and nose breathing. When Marge gave us a urine sample, it was a medium shade of red in color. “See what I mean?” She asked... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3362394 Fri, 12 Mar 2010 23:12:34 +0100 3362394 http://www.medworm.com/index.php?rid=3335591&cid=t_337374_180_f&fid=38609&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDavidSeah-BetterLivingThroughNewMedia%2F%7E3%2F82g2OZsrqew%2F A number of years ago I was looking through the latest round of inductees to the 9rules Network, then a growing community of blogs hand-picked by the people who ran it. I clicked past many of a site, impressed as always by the quality of content, but not particularly moved. That is, until I came across Jeff Ngan's blog Equivocality. I don't quite remember exactly what it was that caught my eye; perhaps it was the carefully crafted prose or the meticulous attention to meaningful visual details, that caused me to read a little deeper. I was struck by the quiet power of the voice behind the writing. I've been a fan every since. A few days ago, Jeff emails me that he's coming to New Hampshire for some training on behalf of his company, and he recalled that I lived somewhere there. How far awa... David Seah - Design, Development, Inspiration, Empowerment blogs http://www.medworm.com/rss/comments.php?id=3335591 Fri, 05 Mar 2010 06:12:12 +0100 3335591 http://www.medworm.com/index.php?rid=3318390&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fthe-patient-who-lived-at-mcdonalds%2F Yup. 7151 W. Main Street, Apartment 1 is not a residence. There’s not even an apartment there. It’s a McDonalds. A patient came in with a “hard lump” on his stomach which ended up being an abscess with quite a bit of surrounding cellulitis. The doc did an incision and drainage on the abscess and started the patient on Bactrim, suspecting that the infection was MRSA. We got the report back while I was working and the doc was right. It was MRSA. But the MRSA was resistant to Bactrim and the patient needed to be started on a different antibiotic to treat the cellulitis. We called the phone number the patient gave us. Disconnected. We looked up the patient’s address to see if there was an alternate phone. As a matter of fact, there was … Welcome to McDonalds... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3318390 Sun, 28 Feb 2010 19:32:47 +0100 3318390 http://www.medworm.com/index.php?rid=3302322&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fthe-other-brown-paper-bag%2F When grandma called the ambulance to come take her husband to the emergency department for his chest pains, she was all in a dither. They just got back from eating at the local diner and he wasn’t feeling good at all. Paramedics swooped through the home, scooped up grandpa, grabbed his brown paper bag full of medications, and brought him to the emergency department. Some oxygen and a couple sprays of nitroglycerin had the patient feeling better by the time he arrived. The full bag of medications got passed to the nurse so she could spend her time following JCAHO protocols and write out all of the medications, their doses, and their frequency for the umpteenth time of the day — instead of taking care of the patients. As the nurse opened the bag, she got a strange look on her fac... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3302322 Tue, 23 Feb 2010 19:03:31 +0100 3302322 http://www.medworm.com/index.php?rid=3291869&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fthe-black-knight-of-the-night%2F A lady gets brought in by ambulance for suicidal ideation. During the radio report we can hear her screaming at the paramedics in the background. Bad sign. She started messing around with Jose Cuervo and Jose got her good. Drunk off her rocker. Going to kill herself and everyone around her. And she was an angry drunk, not a happy drunk. She was cussing at the police. She was cussing at the staff. She would bug her eyes out of her head and scream when someone tried to examine her. She threatened to hit the staff and then cocked her fist at the security guard. Stick a fork in you, lady, you’re getting matching sets of leather wrist and ankle bracelets. Police and the patient’s sister helped hold her down while the restraints went on. “You BITCH! How could you let them do th... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3291869 Sat, 20 Feb 2010 19:52:44 +0100 3291869 http://www.medworm.com/index.php?rid=3275801&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fchronic-nosebleeds%2F The cause for this patient’s chronic nosebleeds became more apparent when the patient wasn’t able to blow her nose and the resident was unable to insert a sponge into the patient’s nostril to stop the bleeding. A history of chronic headaches and of more recent vision changes prompted the resident to order a head CT. A large brain mass which had invaded the patient’s nasal passages and had eaten through the patient’s nasal septum, completely occluding the nasal passages. Sad case. (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3275801 Mon, 15 Feb 2010 17:11:53 +0100 3275801 http://www.medworm.com/index.php?rid=3272946&cid=t_337374_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F02%2F15%2Fwhat-if-i-run-into-my-therapist-in-public%2F Should I hide behind the magazine rack? Duck over to the canned goods aisle? Uh oh, she already saw me! Now what? Do I say hi? Pretend I don’t see her? Whenever we see people out of a familiar setting it can be awkward. The other day I was having dinner with my husband at a restaurant when a very familiar lady walked by and stopped to say hello. I couldn’t remember for the life of me where I had seen her before. My poor brain sifted through the files until finally it reported that she worked at the library where my kids and I go once a week. Whew. Embarrassment averted. Occasionally I run into old or current patients in public, resulting in another kind of challenge. Do I say hello or not? In my dad’s day, there would have been no question. Psychoanalytic thinking was ve... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3272946 Mon, 15 Feb 2010 15:01:15 +0100 3272946 http://www.medworm.com/index.php?rid=3248530&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fwtf-moment-871%2F A guy in his mid-60’s came in thinking that he had a stroke. He “felt funny” but wasn’t having any other symptoms. The initial part of his exam was normal, so I started doing a neuro exam. I break a cotton swab in half and use it to lightly poke his arms and legs to test his sensation from side to side. “Ow, Goddammit! Cut that out!” I thought he was kidding at first, but when I looked up at him, he furled his brow at me. “I’m just checking your sensory nerves, sir.” Then I tell him I’m going to use a reflex hammer to test his reflexes. [Tap tap] I hit his patellar tendon. “Stop hitting me with that damn thing.” “OK, fine, but it’s going to be hard for me to see whether you’ve had a stroke if I can&#8... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3248530 Sat, 06 Feb 2010 21:17:52 +0100 3248530 http://www.medworm.com/index.php?rid=3239571&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fexpect-it%2F A patient came in for evaluation of head congestion. As the nurse was getting his vital signs in the room, he asked her who the emergency physician was. “Dr. WhiteCoat,” she replied. He turned his head to the side and asked his wife over his shoulder “Is that the one?” His wife answered “Yup.” The nurse asked him if he had a problem with me in the past. “Not unless you call some guy shoving his fist up your ass a problem.” The nurse looked shocked. “I came in here with abdominal pain and I threw up blood. This guy tells me he needs to ‘check my rectum for blood.’ Then he buries his arm in my ass up to the elbow. I could have told him there wasn’t any blood up there. He ain’t coming nowhere near me with a pair of ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3239571 Wed, 03 Feb 2010 18:21:13 +0100 3239571 http://www.medworm.com/index.php?rid=3197644&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F01%2Fsometimes-you-wonder%2F Sometimes you wonder why a mom brings her 6 year old daughter with cerebral palsy into the emergency department at 2:00 in the morning for a fever. What were they doing up at 2:00 AM anyway? Sometimes you wonder whether parents even know how to take a temperature. The kid’s “fever” was 100.6 when she arrived in the emergency department. Sometimes you wonder what you’re supposed to do when the mother tells the triage nurse that the child “isn’t acting herself.” How exactly are we supposed to test to see who the child is acting like that evening? Sometimes you wonder why it always seems to take so long to get vital signs on children. How hard can it be? Sometimes you wonder why the pulse oximeter doesn’t seem to work on kids. Her fingers are co... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3197644 Fri, 22 Jan 2010 11:19:27 +0100 3197644 http://www.medworm.com/index.php?rid=3197645&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F01%2Fcant-win-for-losing%2F Had a recent patient encounter that just underscored the importance of Dr. Edwin Leap’s recent article on patient satisfaction. A demented patient was brought by ambulance from the nursing home. He was allegedly short of breath, but, when asked, stated that nothing was wrong. He was clinically stable, we diagnosed him with pneumonia, and I told the patient’s family that I planned to admit him. Even though his primary care physician was on staff, the family wanted him transferred to the university hospital because in the past when the patient was hospitalized for pneumonia, he got worse and had to be put on a ventilator. I told the family that the patient was stable and that we had the capabilities to manage his pneumonia, so a transfer at this point probably would not be consid... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3197645 Fri, 22 Jan 2010 01:53:22 +0100 3197645 http://www.medworm.com/index.php?rid=3175876&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F01%2Fhow-to-get-rid-of-a-customer%2F Hello, ERP here from ER stories. The other day we had a woman come in the the ER with complaints of vague chest and back pain for many months.  We noticed she had never been there before and was from out of state.  When asked why she suddenly decided to come in for this problem, she stated that she a seen an ad for our hospital’s new ER on a bus in her neighbourhood and thought, “Hey, that hospital looks great! I think I will go over there right now!”. Some of the docs joked about how our hospital’s marketing dept was doing too good of a job – in attracting the wrong type of customer!  This hospital wants insured patients to come and schedule elective surgeries and have expensive out patient studies done.  Instead, they got someone with out of state Medica... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3175876 Fri, 15 Jan 2010 11:20:31 +0100 3175876 http://www.medworm.com/index.php?rid=3167126&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F01%2Ffor-an-elephant-maybe%2F A patient comes to be seen for intractable hiccups. When the secretary brings him back and puts him in a room, she gives us a look and says “here’s a weird one for you.” He gives a long drawn out story about how he had his hiccups for more than a week and he was sick of them and all the things he tried to do to get rid of his hiccups … including sticking his finger down his throat, drinking water upside down (how?), swallowing sugar, pulling on his tongue … nothing worked. He couldn’t sleep. In fact, he was hiccuping so much that he was making himself vomit. In a last ditch effort to curb the hiccups, he drank some vodka to see if that would help … a whole fifth. His mother had to drive him to the hospital because he was a little too intoxicated to... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3167126 Wed, 13 Jan 2010 00:30:10 +0100 3167126 http://www.medworm.com/index.php?rid=3096860&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F12%2Ftext-this%2F What is wrong with us? In December 2008 alone, Americans sent 110 BILLION text messages. That amounts to more than 3 billion text messages per day. My thumbs hurt just looking at those numbers. I’m guessing a good few hundred thousand of those messages were probably sent from our emergency department … and this whole texting thing is getting on my nerves. A LOT. One guy comes in worried about abdominal pain. I’m trying to get a history from him and his eyes are fixated on his CrackBerry. He repeatedly hesitated answering my questions so that he could read his 27th urgent text message taking precedence over his abdominal pain. I tried to give him the hint a couple of times and repeated the questions when he hesitated with his answers. No clue. Finally, I asked him “S... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3096860 Thu, 17 Dec 2009 11:28:26 +0100 3096860 http://www.medworm.com/index.php?rid=3079342&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F12%2Fill-take-that-as-a-compliment%2F Fractured Distal Radius (see Arrows) Complete Posterior Elbow Dislocation Hello, guest poster ERP here. If you read my blog, recently I posted about the first “Ice” day of the year. The day that always seems to surprise people, haplessly stepping out onto the stuff in their driveway, front steps, or sidewalk. We always get a big bolus of patients with falls – often with nasty injuries. Anyway, one of the poor guys I saw that day was the unfortunate owner of the above x-rays (well, ones that were nearly identical to them). He slipped backwards and fell while trying to get into his car. He was in a world of pain (and yes, before everyone goes crayzee, he got PLENTY of IV narcotics!). Realising that I had to reduce that dislocated elbow, and since he had not eaten or drunk... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3079342 Fri, 11 Dec 2009 15:03:29 +0100 3079342 http://www.medworm.com/index.php?rid=3039800&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F11%2Fjust-another-night-in-the-ed%2F Grandpa was brought in by ambulance after being found “unconscious” on the floor of the kitchen. He either got the deal of a lifetime on candy canes at Walmart that night or he hit the peppermint schnapps a little too hard. His garbled sentences and my diagnostic acumen led me to choose the latter reason for his reported unconsciousness. He was moving all extremities, was saying “please” and “thank you” and didn’t have any signs of injury. We hooked him up to a monitor and let him sleep it off. Grandpa’s wife comes to the window wanting to know how grandpa is doing. She’s bawling and howling and throwing her hands up in the air. One whiff of her confirmed that she must have eaten some candy canes, too. Grandpa’s wife was 40 years ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3039800 Sun, 29 Nov 2009 09:55:12 +0100 3039800 http://www.medworm.com/index.php?rid=3018995&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F11%2Fthat-aint-it%2F A guy comes in for evaluation of rectal bleeding. After dealing with patients like this, I have a healthy respect for people who complain about rectal bleeding. The first thing I noticed was that he had changed out of his pants and into a gown. His bloody underwear were sitting on the floor. Not good. “I just woke up this morning and thought I crapped my pants. Instead, there was a bunch of blood there.” Nothing abnormal in his history. His vital signs were normal. Nothing abnormal with his physical exam … until I got to the rectal region. A whole lot of blood and clots were present. When I wiped those away, I saw the reason for all the blood. He had an inch-long laceration and some bruising to his perirectal area. Nothing abnormal on the inside as far as I could tell and... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3018995 Mon, 23 Nov 2009 10:45:30 +0100 3018995 http://www.medworm.com/index.php?rid=2992672&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F11%2Fat-least-his-mouth-is-clean%2F The nurse while doing her rounds on the patient who had been admitted so that he could detox from his alcohol binges. His mouth appeared full. “What are you chewing on?” “Nothing” said the patient, his voice slightly muffled from the wad of gum in his mouth. “There’s something in your mouth, what is it?” “Gum.” Then the nurse went to give the patient some medication into his IV line and noted that there weren’t any alcohol packets in the drawer. She walked out of the room to get some more and saw that the garbage can in the room was full of alcohol packet wrappers. “Let’s see that ‘gum.’” The patient tried to spit the gum into his hand, but pieces of it flopped onto the bed. Kind of whitish in color, ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2992672 Sat, 14 Nov 2009 11:20:53 +0100 2992672 http://www.medworm.com/index.php?rid=2977286&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F11%2Fyoure-going-to-work%2F A 22 year old patient comes in with a positive review of systems (says “yes” every time you ask if he is having problems with a body system) … the Macerena (pain or other symptoms anywhere you touch your body while doing the dance) … whatever you want to call it. Symptoms were present for more than 2 weeks and included cough, headache, fever to 100.6, runny nose, sore throat, weakness, loss of taste, increase in body fat (he used to be 10% body fat, now he’s at least 15%), funny looking diarrhea stools that float more than usual (including vivid description of how stool should slide right from rectum into the toilet bowl and his are not), abdominal cramps, episodic vomiting (with an episode of fretching while waiting to be seen resulting in the hawking up of a... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2977286 Tue, 10 Nov 2009 11:27:44 +0100 2977286 http://www.medworm.com/index.php?rid=2977287&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F11%2Fhistory%2F The nurses started riding me as soon as the patient’s chart hit the “discharge” rack. A sweet little old lady was brought in because she had a “coughing fit” in the nursing home. The nursing home said that she was still coughing after a breathing treatment, so they called 911. For her age, she was pretty healthy. She had osteoarthritis and a little bit of dementia. But her breathing was fine. “You’re actually discharging a 93 year old whose doctor sent her in by ambulance with shortness of breath? You go, WhiteCoat! Better hope she doesn’t get worse.” Ahhhhh. Fear of the bad outcome … the bane of an emergency physician’s existence. “She’s fine. We x-rayed her. Her oxygen level is normal. Her breathing is normal. If she gets worse, they’ll send her back.” Still... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2977287 Mon, 09 Nov 2009 21:06:28 +0100 2977287 http://www.medworm.com/index.php?rid=2970214&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F11%2Fthe-triumvirate%2F   ERP here from ER Stories.  I hope you enjoy my ramblings.   You might also call these three diagnoses all together “The Bermuda Triagnle” or “Triple Threat”.  All I know is that when they all appear on the chart of an ER patient, you just gird your loins (like the two Roman references?)  before you go in.   You know it is going to be painful. I experienced the wrath of the Triumvirite the other night – blindsided as I walked into the room. The triage RN wrote:  50 year old woman c/o headache, vomiting, abdominal pain, body aches, and maliaise.  Fine, I thought, probably a viral syndrome or the flu.  Vitals were fine.    But then I looked down the triage sheet and saw them. Those three diagnoses staring me right in the  face.  My mood sank, ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2970214 Sat, 07 Nov 2009 08:49:09 +0100 2970214 http://www.medworm.com/index.php?rid=2963094&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F11%2Fdestabilization-of-psychiatric-services%2F As resources become more scarce and as more patients lose insurance funding, psychiatry beds for mentally ill patients are becoming harder and harder to secure. In turn, psychiatry patients who need further care are putting an increasing stress on emergency departments. Subtle financial cherry-picking of patients makes it extremely difficult to obtain necessary care for patients. When called for a potential transfer, psychiatric institutions require an informational “face sheet” containing demographic … and insurance … information to be faxed to them prior to releasing a bed. Then the fun begins. Patient #1 A young lady with pre-existing psychiatric problems used a Ginsu knife to cut her throat after her boyfriend broke up with her. She had been drinking … a l... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2963094 Wed, 04 Nov 2009 19:12:23 +0100 2963094 http://www.medworm.com/index.php?rid=2881170&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F10%2Frealism%2F A patient was brought in by his boss after getting some sawdust in his eye while working at a distribution center for machinery parts. As I examined the patient, the first thing I noted was his red eye. The second thing I noted was the fact that his breath smelled like he had just gotten home after a night out drinking at the bars. “This just happen before you got here?” I asked, wondering if maybe he went out drinking after it happened. “Yeah, went to the office and my boss drove me straight here. He’s sitting in the waiting room.” I got the piece of wood out of the patient’s eye. The patient’s boss was in the room by the time the patient was getting ready for discharge. “Does your company require drug and alcohol screening on injured patien... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2881170 Sun, 11 Oct 2009 12:33:00 +0100 2881170 http://www.medworm.com/index.php?rid=2855581&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F10%2Fkarma%2F A patient wanted me to drain a sebaceous cyst that was causing pain on his back. I told him that it would be better if it was removed intact by a surgeon, but he didn’t want to wait to have it done. OK, no problem. I got out a needle to anesthetize the area, the patient took one look at the needle, and he nearly DFOed on the floor. Got all sweaty and nearly puked. We had him lie back on the table, but he couldn’t lay flat on his back because the cyst was hurting. So he laid on his side – facing the nurse. I told him that I was going to start numbing up the area. Then I looked at the nurse whom he was facing toward, gave her a smile and a wink, and mouth the words “Now he can puke on YOU!” I made the universal puking hand gesture while sticking my tongue out ju... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2855581 Fri, 02 Oct 2009 11:42:12 +0100 2855581 http://www.medworm.com/index.php?rid=2851776&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F10%2Fseven-years-bad-luck%2F A mirror fell over onto a young teenager. She held her arm up to protect herself and the mirror broke over her arm and head. As an aside, if you’re interested in the reason why breaking a mirror gives you bad luck and how to get rid of the bad luck, read this. Anyway, the girl had a few cuts, but fortunately was otherwise unharmed. One of the cuts was a two inch gash to her upper forearm. The girl’s mom said that they pulled a piece of glass from the wound. Apparently they didn’t get it all … (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2851776 Thu, 01 Oct 2009 12:57:13 +0100 2851776 http://www.medworm.com/index.php?rid=2842540&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fhow-you-know-youre-a-frequent-flyer%2F The doctor walks in the room after being on vacation for a few weeks and the first words out of your mouth are … “Gee. Haven’t seen you in a while. What, have you been on vacation or something?” (Source: WhiteCoat's Call Room) WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2842540 Tue, 29 Sep 2009 11:36:28 +0100 2842540 http://www.medworm.com/index.php?rid=2834262&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fa-classic-dr-so-and-so-patient%2F ERP from ERstories.net  here again today and tomorrow… You know, WC needs a weekend off now and then….. Why is it that certain doctors (usually primary care) attract a certain subset of patients? Our community is very heterogenous but I still find that several MD’s have tapped into certain subpopulations whether intentionally or unintentionally. Often, I find myself guessing (usually correctly) about who a patient’s doctor is before asking them. Clues like the med list, the last name, the insurance (or lack of it) they have, and PMH all give clues. I chuckle to myself when I ask them who the MD is and find I am correct. For example: One doc seems to have about 90% of all the living Holocaust survivors in the US as his patients. (and he was not one himself) – ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2834262 Sat, 26 Sep 2009 13:00:05 +0100 2834262 http://www.medworm.com/index.php?rid=2828200&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Flucky-in-more-ways-than-he-knows%2F Hey all, I this is ERP from ERstories doing a guest post on Whitecoat’s Blog. I want to give him and the EP Monthly staff my thanks for accepting some of my occasional ramblings. Drunk people are often victims of their own stupidity. However, just as often they manage to avoid disaster by some miracle. For example, intoxicated persons have a tendency to end up face down in the street and often manage to avoid getting run over. Sometimes they are even luckier. Of course they never really realise this since after all, they are drunk. Hopefully when they sober up they count their blessings but often they simply can’t remember enough! Anyway, we had a guy who was brought in by police intoxicated outside someone’s house. Apparently he was visiting the area and was staying with... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2828200 Thu, 24 Sep 2009 13:00:42 +0100 2828200 http://www.medworm.com/index.php?rid=2820228&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fyoure-dead%2F This wasn’t my patient, because if it was my patient I would have spent the whole shift looking for people videotaping me to catch the looks on my face and the phrases coming out of my mouth. A pediatric patient is brought in by ambulance for evaluation of suicidal and homicidal ideations. Great. The kid is already seeing a psychiatrist and is taking Strattera and Clonidine. Fine. I have issues with kids being started on psych meds, but what do I know? I’m just a dumb emergency physician. The social worker met the ambulance at the hospital and called the children’s psych facility immediately upon her arrival. She kept saying “He’s gotta go. This is it. This time he’s really gotta go.” The parents had the patient brought in by ambulance and wanted h... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2820228 Tue, 22 Sep 2009 11:45:28 +0100 2820228 http://www.medworm.com/index.php?rid=2807594&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fsmiles%2F Every once in a while you run across a patient that just makes you smile for no particular reason. For me, usually it’s a little kid. This time, it was someone at the other end of the age spectrum. A 98-year-old grandmother was brought by ambulance because she was found in a nursing home laying on the floor beside her bed. She didn’t complain of any pain. She was just laying next to her bed … singing. Because she was suffering from Alzheimer’s Disease, the nursing home sent her to the emergency department for evaluation because they couldn’t determine whether or not grandma had hurt herself. When grandma arrived in the hospital, she was smiling and calm. She was a little hard of hearing, so we had to raise our voices to talk to her. As she was being transferre... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2807594 Thu, 17 Sep 2009 23:46:07 +0100 2807594 http://www.medworm.com/index.php?rid=2790269&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fyou-talkin-to-me%2F A young lady who has logged nearly 90 visits to our emergency department over the years was having pain all over the right side of her body. Just out of the blue, she developed sharp stabbing pains in the right side of her head, neck, chest, abdomen and her outer right leg. No other symptoms, just pain. Her vital signs were normal. Her physical exam had no abnormalities – except for being a little anxious. I did an EKG that was unchanged from several other EKGs that were in her old records. We even did a trial of controlled hyperventilation and her symptoms got worse. So I gave her a shot of Toradol and told her about my plans to discharge her. “You’re not going to do any lab tests?” “I hadn’t planned to. What is it that you want to be tested for?”... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2790269 Sun, 13 Sep 2009 04:09:13 +0100 2790269 http://www.medworm.com/index.php?rid=2788583&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fbe-careful-what-you-wish-for%2F Ever hear the story about the man who caught a leprechaun and then wished his woo hoo was so long it would touch the ground? The leprechaun didn’t like him very much, so he shrunk the man’s woo hoo and made both the man’s legs fall off. Just like Mr. No-legs, a new tech in our ED should have been more careful about what he wished for. The tech was eager and wanted to see some action that night. Apparently he was aware of the Candyman Phenomenon, so he kept saying “I want to run a code tonight. I really want to run a code tonight.” He got to five requests in about the first half hour. Then he tempted fate and kept saying it. “I really want a code to come in.” We told him to stop it, but he persisted. Wouldn’t you know it. A gentleman got broug... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2788583 Tue, 08 Sep 2009 19:54:03 +0100 2788583 http://www.medworm.com/index.php?rid=2788584&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fthe-cavalry%2F A young girl was brought in by ambulance after being involved in an argument with her boyfriend and attempting to cut her throat with a knife. Yet another of the many suicidal patients we have seen lately. When her father arrived, he told her to get her things together because they were leaving. “Ummmm … sir … you can’t do that. She’s going to require admission for psychiatric evaluation.” “The hell she is. Not in this place.” “She needs to be hospitalized.” “Listen. You waited on my wife last year. You diagnosed her with a throat infection and gave her antibiotics. Two days later the side of her face swolled up like this (cupping his hand against the side of his face as if holding a softball against his cheek). We went to t... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2788584 Sat, 05 Sep 2009 04:52:35 +0100 2788584 http://www.medworm.com/index.php?rid=2788586&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F09%2Fthe-nectar-of-life%2F A patient with a penchant for telling me what sexual acts to perform on myself and what kind of sexual acts my mother performs in a place that rhymes with “smell” was brought in for suicidal ideation associated with … of all things … alcohol intoxication. She got into it with the nurse. “Ma’am, you can’t keep taking your clothes off and walking around naked. There are other patients in the department. “[Perform a sexual act on yourself]!” “OK. But you’ll still need to keep your gown on to avoid public indecency.” “Oooh. Who are you? Mr. Big Shot? What’d you take a test and get an ‘A’?” Then a patient gets brought in by ambulance after he was witnessed staggering out of a bar, into an alley... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2788586 Wed, 02 Sep 2009 20:56:23 +0100 2788586 http://www.medworm.com/index.php?rid=2788588&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F08%2Fa-broken-heart%2F A stoic man in his early 60s walked up to the registration window and even the registration clerk could tell that something wasn’t right. He looked sallow and was a little sweaty. The clerk asked him what was wrong and he calmly said “chest pain.” He was whisked back to a treatment room to begin the standard chest pain protocols. We could still smell the remnants of that last drag he took off his cigarette before walking in the hospital doors and flicking the cigarette butt onto the parking lot. A pack of Pall Malls abutted his heart in his left front shirt pocket. As we questioned him, we learned that he had been having the pain on and off for more than a week. Only that morning did the pain become constant. He sat at home for 9 hours going about his business and hoping ... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2788588 Mon, 31 Aug 2009 11:37:38 +0100 2788588 http://www.medworm.com/index.php?rid=2788592&cid=t_337374_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2009%2F08%2Fyoure-kidding%2F It was busy in the emergency department (isn’t it always?) when the secretary picked up a phone call. On the other end, a male voice started screaming at her. “You better have a cart at the back door when my daughter gets there. She was eating lunch with us and all of a sudden she started hemorrhaging from down below!” “Sir, it is very busy now and we don’t stop seeing patients in order to wait for people to arrive. We will take care of her when she gets here.” Click. He hung up. A minute later the nursing supervisor calls and asks us what’s going on with the woman hemorrhaging to death. Apparently, the man then called her to tell her to go wait for his daughter at the back door. He was told that only ambulances can go to the back door and that she... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=2788592 Mon, 24 Aug 2009 15:15:05 +0100 2788592 http://www.medworm.com/index.php?rid=2288510&cid=t_337374_112_f&fid=34799&url=http%3A%2F%2Fmwwak.blogspot.com%2F2009%2F03%2Fthank-god-someone-speaks-american.html So, I actually made it to the meeting today, kind of. Long story short, I thought today was the 19th, and I'd signed up for some of the courses on the 19th (I didn't pay for any of the postgraduate courses, you know, the kind that cost $200+ for a single day of class). Anyway, I've gotten back into jogging (was out of it for 2 months because of a bad ankle sprain), but maybe overdid it a tiny bit (Glasgow's hilly! The midwest is not!), and have been a bit sore (esp in the iliotibial band type area). Mostly I just tell myself to suck it up because pain builds character (or whatever), but found myself feeling grumpy, so I decided to buy some acetomenophen/tylenol.Stopped into a pharmacy (apparently all drugs are behind the counter here), asked for acetomenophen and tylenol (trying to think..... Midwife with a Knife blogs http://www.medworm.com/rss/comments.php?id=2288510 Wed, 18 Mar 2009 13:13:00 +0100 2288510