Great Healthcare Video (Funny)

http://www.youtube.com/watch?v=B98muhufAGE

Milk the Balls??

A 27 year old male came in withe the chief complaint of testicular pain. On exam he had extremely enlarged, red/purple testicles. There was active drainage, he was febrile and tachycardic, and the infection had spread to his lower abdomen and thighs. It was basically a surgical emergency.

Usually this kind of infection stems as a complication from diabetes...but not in this guy. No past medical history. So what could it be?? The story is very hard to believe. His girlfriend told him that she heard "milking the prostate" can feel really good and make your man parts larger. Problem is they didn't know what that meant or where the prostate was. They KNEW the prostate wasn't in the penis, so it had to be in the testicles. So...they got a needle and syringe INJECTED MILK into his scrotum! Ouch.

I try to educate my patients as much as possible on things. I don't always do a good job when its really busy. But this time I was sure to explain what "milking the prostate" really is.

Poor guy lost both of his testicles from necrotizing fasciitis. Milk doesn't always do a body good.

-ER Doc

Reminder

Working in a county hospital emergency department reminds me everyday that our healthcare system needs reform. I saw a patient the other day that was a sad example of this.

The patient was a hard working handyman who had been recently diagnosed with metastatic cancer. He had noticed a lump on his ribs a month prior, and it was discovered that lump was actually metastatic cancer to his ribs from a gastrointestinal source. He was in the ER for worsening pain. I looked through the computer to see what follow up appointments he had, and I noticed he was to be see in palliative care clinic in the next few weeks. Right then I knew his prognosis. Patients don't go to palliative care for cancer treatment, they go there so their pain can be controlled as the cancer spreads until they die. I talked to him and his wife for a bit, and could tell they still had hope of possible treatment. The past month had been a shock for them, as it would for any of us.

So let me get this straight... an honest, hardworking man who struggled to support his family now has an incurable cancer that was found only after it spread and became noticeable.... YES. We see it all the time. Why wasn't it caught earlier? Only if this patient had a primary doctor who noticed he was having months of weight loss (a classic historical point in cancer patients) or was anemic and needed further workup. If only he had a routine screening colonoscopy for a man of his age. Unfortunately, a lot of the time hard working people who support their family cannot afford health insurance, and in the end they sacrifice.

Health care in this country is the greatest example of the haves versus have-nots. I don't want to paint the picture that people who don't have healthcare are poor and homeless. They have jobs and families but just cannot afford the high cost of medical coverage. I see them every shift in the emergency department. It costs more to take care of a patient who has had a stroke because of untreated chronic hypertension than it is for that patient to have a primary doctor and take daily blood pressure medication. We practice reactive, not preventative medicine. Reactive medicine not only increases health care costs, it hurts people. I am not saying we need a socialist system, but people should not have to choose between medical care and supporting their family. That we should all agree on.

-Nice Doc

Sleep Walking

We all know that sleep walking can be dangerous...but I never thought of this happening. The cat scan shown is that of a poor patient from yesterday. 29 year old make walked in confused, wide based gait, and bruising around his eyes (racoon eyes).
Classic picture of someone with an epidural hematoma, and that's what he ended up having. His girlfriend said he was sleepwalking and accidentally fell down the stairs...about 22 of them. They had a gate on the stairs to prevent this, but I guess it didn't work. He quickly declined and had to go to the operating room to drain the blood. So far he is still alive and he should do ok.

-ER Doc

Think Gland

While I am mostly in clinic during this year of training, I do cover our psychiatric "urgent care" one day per week. Most of the time, the patients in that clinic are fairly stable and just need med refills. This week, I saw the sickest patient that has ever made it to that clinic. He was a 21 year old male, already on Medicare (so that means he is legitimately ill), but I still have to laugh about this. What I have in quotes below is word-for-word what he wrote on his patient questionnaire. I didn't change the spelling.

HPI: "Abilify 10 mg for my think glands it clears it. Zantex For my Enziety promblems helps me For Breaking out in stuttering in throwing up."

The interview was even more interesting. He was discharged from our inpatient unit 9 months ago for assaulting family members, had moved to another city to live with an uncle and was being prescribed the above medications (Abilify for his thinking gland and Xanax/Zantex). He moved back here to live with his grandfather. He had been out of his medication for 4 days. I asked him how he had been getting along without his meds and he replied, "I've been self-medicating by drinking 40s and watching cartoons. Cartoons really help me chill." I wish now that I had asked him which cartoons.

I tried to get him to tell me more about his thinking glands, his stuttering and vomiting issues, etc., but he was getting frustrated. "Look doc, I know you're trying to help, but I already said all I gotta say on that paper right there. I just need to get my meds. Give me some credit, man, I've made a 360 degree turnaround from when I was hospitalized right here a year ago."

The icing on the cake was when I asked him what he wanted to do with his life. "I want to go to college, probably be a doctor. Definitely something medical."

I hope his think gland can handle med school. Mine barely did.

I have to do this blog just to keep my think gland from exploding.

And no, I did not give him Xanax. Or Zantex. But I Abilify-ed the sh!t out of him!

- Psych Doc

Viva America

Everyone, welcome a new guest blogger...NiceDoc. He really is one of the nicest people I know. As far out as his story might sound, I have experienced the same thing 2 different times in the last year. Enjoy, ER Doc
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It was thirty minutes before the end of my shift. I had almost tied everything up and was planning on leaving on time for once. Out of nowhere, paramedics burst through the doors of the ER with a very sick patient. The patient was a 400-plus pound intubated Mexican man. No one in the ER knew he was coming in. We always get an alert when an ambulance or helicopter are on their way to us. With this case there was no report, no one called ahead, NOTHING! As the paramedics came closer, I noticed something out of the norm. All of the paramedics were Hispanic, and the writing on their uniforms were in Spanish. "This can't be what I think it is," I thought.

So as we got him into our critical care room, we learned that he was in a Mexican hospital for the past week and his family was disgruntled with the care he was receiving there. The doctors tried to transfer him to us a couple of days prior, but our hospital refused (It's not a law that we have to accept transfers from other countries). So after being rejected, his family paid a large some of pesos to rent a jet to fly him to the states, and had a helicopter waiting once they landed to transfer him to our hospital. That explained why we didn't receive any advanced notice of the patient. It was an illegal transfer, and the chopper just landed on our roof!

Not only was the patient critically ill and on the ventilator, he was unstable. The only history we had was a patient summary from his hospital stay in Mexico...and it was hand written in Spanish. His oxygen saturation was low despite being on the vent, his blood pressure was low, and his heart rate was through the roof. He had medications hanging through an IV, but the IV wasn't working! It was a mess. Eventually we stabilized him, and he made it to the ICU.

What's going to happen to the Mexican hospital? Nothing. They don't abide by our country's hospital ethics laws. What's going to happen to the patient? I don't know, but I do know that we just inherited all the substantial medical costs to take care of this unfortunate gentleman... and I left my shift and hour and a half late :)

-NiceDoc

Perverts

A couple of male patients kind of weirded me out today. Both married med in their 50s.

The first needed a prostate exam to rule out prostatitis. He said he never had this exam done. After the exam, he thanked me and said it was the most action he had gotten in awhile, and said he couldn't wait to tell his wife that he was right... putting something in there doesn't hurt that bad. I asked that he wait until he gets home to tell her that.

The second needed a foley to measure his post void residual volume. I have NEVER met a man who enjoys getting a foley....but there is always a first. He thanked the nurses over and over again, stating that it felt so great and that he hasn't "gotten any" in over a year. He laid back and relaxed and asked for a cigarette!

No wonder I found my self washing my hands more than normal today.

-ER Doc

The Best Medicine--Your Husband

A 65 year old female arrived via ambulance with a heart rate of 220 and feeling very dizzy and lightheaded. After a 12 lead ECG, it was determined that she had a rhythm called supraventricular tachycardia (an arrhythmia originated above the ventricles resulting in a very, very fast heart rate).

I proceeded to give her the standard treatment... a fast acting medicine called Adenosine. I gave her 6 mg IV push and the heart rhythm never changed. I then gave her 12mg IV push and saw the characteristic long pause on the ECG (looks likeasystole )...which is the medicine "resetting" the heart back to normal. After the long pause, however, the heart went back to 220 beats a minute. I debated shocking her, but decided to give her someAmiodarone b/c the second ECG looked more wide complex then the first. After I gave her 150mg Amiodoarone her heart rate slowed down to the 160s, but had yet to revert back into a normal heart rhythm.

I left the room to check on another patient when the nurse pushed the code button and started screaming for help. I immediately ran back into the room expecting to see my patient inasystole... but instead found the patient's husband passed out on the ground. Unknown to us at the time, the husband had a habit of passing out in medical situations. After tending to the husband, I looked back up towards the wife. To my delight the husbands vasovagal episode scared the patient so much it caused her vagus nerve to fire strongly... which reverted her back into normal sinus rhythm!!!! She had failed three different drugs, but in the end all it took was her husband to pass out.

I told her to bring her husband to the hospital the next time she goes into SVT.

-Doc Sensitive

Cold Foot

Funny story from a colleague about a cold foot:

A patient from a neighboring country had a vascular problem with her foot. The prognosis given to her foot was grave, and she wanted a second opinion. Someone from her family recomended our hospital (which again is in another country) as her saving grace. They packed up and got in the car and started to drive. For some odd reason, they put her foot in ice for the drive to "stop the infection from spreading." So they drove, and drove, and drove (passing many large cities and hospitals on the way) for about 20 hours to our hospital....all with the foot in ice. So needless to say when she arrived her foot was hypothermic, black, and dead.

Not much could be done at that point. I guess second opinions can be overrated.

-ER Doc

Stolen Material

Here are a couple of things I read that I had to share. The first is from a blog call "The Central Line." It is a blog done by the American College of Emergency Medicine. The second is a comment from one of our readers Bubba. Again...not my material.

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#1
Non-Clinical Clinical Prognostic Indicators

Good Prognosis:
-Your doctor hasn’t seen you yet, and you’ve been waiting for (insert average wait time) hours.
-You’re in a bed in the hallway.
-Your complaint consists of “months” or “years” of pain/nausea/headache/X Y Z.
-You’ve come to the emergency department for a second opinion, despite multiple subspecialist evaluations.
-You answer yes to every symptom the doctor asks you about.
-You get a blood draw, but no IV.
-The only medication you’re given is tylenol.
-Your doctor says the words “probably” and “virus” in the same sentence.
-You are talking on your cellphone, playing a game, or chit-chatting.
-You are talking on your cellphone, playing a game, or chit-chatting and the doctor has to ask you to stop.
-You “just wanted to get it checked out.”
-Your primary care doctor sighs on the phone when the emergency physician calls him or her.

Bad Prognosis:
-You get not one, but two IVs.
-You remark, as my GI bleeder did last night, “Boy, I’ve never been to a hospital so attentive and efficient!”
-You get your own personal doctor to take you to the CT scanner.
-Multiple doctors, nurses, and staff greet you in your room.
-The triage nurse walks you to your room and points at you while speaking to the doctor.
-You get a room all to yourself.
-You get a monitor.
-Your monitor keeps beeping, even though you’re not doing anything.
-Your doctor keeps checking on you.
-Your doctor sticks a finger in your bottom.
-You don’t argue with the doctor about getting this treatment or that one.
-You are kind, good-natured, and have been a good person in this life.

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#2
Bubba said...
I will seek and find you.. I shall take you to bed and have my way with you. I will make you ache, shake & sweat until you moan & groan.I will make you beg for mercy, beg for me to stop. I will exhaust you to the point that you will be relieved when I'm finished with you. And, when I am finished, you will be weak for days. All my love, The Flu


-ER Doc