2 Visits For The Price Of One ? Nope!

Psych Doc mentioned he would be posting an addendum to fill in the gaps for his previous post. But basically, whenever a psych patient gets violent like that, he must be restrained. At some point during that process, the patient apparently coded (which resolved quickly and allowed him to continue with his terror on the staff). Anyways back to my post......



A 54 year old male came in for a deep laceration to his leg. It needed to be repaired, obviously. But before I was allowed to do the repair, the patient demanded to get a "price quote." It was an unusual request, but we obliged and came up with a quote.

When he heard the price, he became very anxious and upset. He then developed chest pain, nausea, and diaphoresis. We quickly got an EKG, and sure enough he was having a heart attack. He got so worked up over the price of the lac repair that he had an acute MI!

I didn't tell him how much the price of his visit was going to skyrocket on his way to the cath lab.....

-ER Doc

'Twas the night before the night before Christmas

This is a true story. Once upon a time on the night before Christmas Eve, a few days ago, ER doc and I exchanged some texts that prove that the karma police don't take the holidays off.

What follows are a chain of events and text messages that I couldn't make up if I tried. This occurred at a psych moonlighting gig. Text messages are exactly as written that night.

11:43 p.m. Psych doc gets paged about a verbally agressive antisocial patient who is threatening to kill the staff's families and their children over a candy bar. Psych Doc orders emergency medication.

11:48 (text from ER doc): I'm working tonight and next 2 also if u get bored.
11:49 (text from psych doc): Im on tonight but i am done with admits. Gonna go sleep now. Knock on wood, hoping for no seclusions.

(note: if there is a seclusion, I have to get out of bed and go see the patient.)

11:51 (text from ER doc): Sleep work. Lucky
11:55 (psych doc): Thats psych for ya. Pretty cool til somebody codes and I sh!t myself.
11:58 (ER doc): U can call me

( I go to the call room, brush my teeth, take a leak, set my alarm. Close my eyes.)

12:11 am (I get a call from the same unit above, about the same patient.)
(psych doc) Right on cue a patient just stabbed a tech with a pen.

12:14 am (ER doc): Hahaha

Between this time and 2 am, I sent 2 techs and the patient to the hospital. The patient coded, or else he was faking it really good. I don't think the AED would lie. Either way, I somehow managed to keep my britches streak-free and everyone else alive. The patient was critical and was admitted.

02:14 am (psych doc): (Expletive)
02:16 (ER doc): what happened

I recounted the past 2 hours, 160 characters at a time, to my ER colleague 60 miles away.

02:20 (ER doc): Thats crazy sh!t man. I feel sorry for you. You gotta blog it though, its hilarious.

Lesson learned, for like the 100th time; don't say how quiet it is, or how likely you're gonna get some sleep ANY night you're on call. Karma, God, Buddha, Santa, or somebody is up there waiting to get you.

-Psych Doc

The Lost Tampon

A 24 year old woman came to the ER because she couldn't find her tampon. She stated that 3 days earlier her and her boyfriend "got trashed" to celebrate his birthday. She was on her period and didn't want to have sex (I agree with that notion btw).

The rest her story is kinda sketchy. She states she doesn't remember anything from the night after that. She realized a couple of days later that she couldn't find her tampon.

I don't have a vagina, but I would guess a tampon is something that you check on and replace regularly. Anyways, she started interrogating her boyfriend, and he admitted to having sex with her the night of his birthday while she was drunk and basically unconscious.

So she really came to the ER because she was afraid he "rammed it up there."

Sure enough, he did. In the back of her vaginal vault was a rotted, crumpled up, disgusting tampon.

-ER Doc

White People

Let me preface by reminding everyone I am Puerto Rican.

Yesterday at about 9 AM I had a very drunk African American Female come in after falling and bruising her ribs. I refused to give her narcotic pain meds since she was drunk, and of course she threw a fit.

As my nurse (who was an older very black woman), and myself (a tan Puerto Rican) were attempting to discharge her, the patient shouted "YOU WHITE PEOPLE ARE ALL THE SAME."

The nurse and I both looked at each other to make we we hadn't lost our natural colors, shared a laugh, and I replied "Ma'am, there isn't a white person in this room!"

Imagine being that drunk on a Tuesday morning.

-ER Doc

Bite Me

Apparently postal workers aren't the only profession that have to worry about getting bit by dogs. A young, obese, female pizza delivery worker came to the ER after getting bit in the ass while delivering the pizza. After handing over the pie, the dog chased her to her car and grabbed a chunk of her butt steak. I wonder if the family had trained the dog to do this to get out of paying for deliveries.

-ER Doc

Medication Reaction

All, welcome our newest blogger, ER PA. He is a physician assistant in our ER, and put's my writing vernacular to a shame.

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I was working the 12p-12a shift in the ER and grabbed this fateful chart at about 2230. As the chief complaint, it read "Pt states he is having a medication reaction." African American male in his 20's, taking Flagyl for a trich infection.

I go into the room and find the patient still wearing his hat sideways, grill in place, dressed in a gown. I introduce myself and ask him, "What kind of reaction are you having to this medicine?"

The patient, looking flustered, stands up ... faces me ... pulls his gown up to his chest ... and declares, "The medication I been takin is makin my penis smaller!!"

"Excuse me?" I reply.

"I took four of these pills last night, and they done made my penis smaller. And every time I'm smokin marijuana, my penis feels weird."

I'm a little ... surprised ... but keep pressing on.

"Did you happen to smoke marijuana before coming in tonight?" I expectantly asked.

"Yeah I did!"

We are having this conversation with his gown pulled up the entire time.

To either appease his fears or give him the benefit of the doubt, whichever, I examin the penis in question.

"Sir, I see nothing wrong with your penis ... and I really don't have anything to compare it to."

"WHAT DO YOU MEAN?!?!" he said angrily, "I CAME HERE SO YOU COULD FIX THIS!! IT'S SMALLER ... AND WHAT ABOUT ALL THOSE WRINKLES!?!?!?!"

At this point, I want to hang my head in shame ... for him!

We then begin to have a conversation about how I have never heard of a medication causing anyone's penis to be smaller, and that I have no treatments whatsoever to make his penis longer.

"Why do you think it feels weird when I smoke my marijuana?"

"Well, sir, smoking marijuana probably doesn't help the situation. You should probably stop."

"Yeah ...I guess you're right. I should probably drink more water too, right?"

"Absolutely sir ... absolutely."

-ER PA

Another Great Mom

It's been a while since we had a World's Best Mom post. Here is another nominee:

A 21-year-old female came in for heroine intoxication. She was 6 months pregnant. She had been abusing heroine most of her pregnancy. She had been in 3 different detox programs, but left them all AMA to go use and abuse again.

The only reason she came in this time was because her grandmother caught her shooting up and called EMS.

I heard her on the phone with her dad...."Are you going to bring me cigarettes up here or not?"

I called our psych team, and they could do nothing for her due to her leaving AMA all the time. Same went for our social worker. All I could do was notify CPS. They already had a case against her.

Personally, I think since she is harming a child she should be legally locked into a room AGAINST HER WILL until she detox's. It won't kill her.....too bad that can't happen.


- ER Doc

Ouch!

(Story and picture are provided from a colleague)

So a 44 year old female was outside in the woods and saw a snake. She wanted to see what kind it was, so she got closer. She quickly discovered the snake was huge....about 6 feet long. She figured it out after the snake JUMPED OUT and bit her.

The damn thing would not let go. EMS brought her in with the snake attached as above. The only thing to do was to get a big ass knife from the OR and cut the snake in half to kill it. That was successful, and the woman was admitted for antitoxin.

Her face will never look the same, and hopefully for now on she won't be so curious.

-ER Doc

Have It Your Way

.....That's at Burger King, not the Emergency Department.

A 64 year old male came in to "have his cataracts taken out." He thought we just had a eye doctor sitting around in the ED waiting to take care of him. When I told him we didn't, he was upset because he would have to make an appointment with an eye doctor, wait for the appointment, and pay money for it! The audacity!

I have had multiple similar encounters with people wanting there breast lumps taken out and diagnosed for cancers, colonoscopies, and even skin biopsies. Emergency department folks, emergencies only please.

-ER Doc

Divine Intervention 2

A 41 year old black female comes by EMS in full cardiopulmonary arrest. She had been "down" for at least 30 minutes before arriving to the ED. EMS had no return of circulation en route. I coded her for another 30 minutes b/c she was young. There was never of a pulse despite multiple rounds of epi. This lady had NO signs of life. There was nothing I could do to save her.

I have no clue what she died from, but that's not the point of this post.

I went to go break the news to the family. As usual, I was accompanied by a nurse and a chaplain. When I arrived to the room, there were about 10 family members holding hands in a circle praying. They were saying "amen" to the prayer leaders pronouncement that the Lord will bring her back and that it was already done.

It was a really awkward moment b/c I had pronounced her dead but they were still praying as if she was alive or had a chance. I just kind of stood there at the door. I didn't know if I should go hide, interrupt the prayer and tell them to stop b/c there was no use, go pretend like I was still working on her, or undo the body bag and actually start working on her again. I don't even know what I believe in anymore....but what if I was ruining a miracle??

I felt like I was in the middle of them and divine intervention. I knew there was nothing left to do for the patient, but man did I feel like I was playing God all of a sudden.

So I asked the chaplain to call me when they were done, which turned out to be less than a minute later. I broke the news, and they freaked like no family I have ever seen. There were broken walls, plants, and doors. The patient's mother ripped my white coat after grabbing me and shouting at me to get back in there and save her daughter.

So.....my question is what should I do if I walk into a family room to tell them their loved one is dead while they are praying for a miracle. Please, no comments on how we play God in medicine all the time, that's not what I am getting at here. More of how to get out of this awkward situation.

-ER Doc

Gobble Gobble

Thanksgiving evening... Swallowing foreign bodies are very common on Thanksgiving. This one was a first for me.

A 49 year old male came in after swallowing his partial dentures. He swallowed them right into his lung! He says he was eating his turkey too fast and bam....aspirated his fake teeth. Usually foreign bodies will go into the right mainstem bronchus, but this guys went into the left. Here is his actual X Ray:



What makes this even funnier?? How about that the guy did the SAME THING 2 years prior. Here is his X Ray from then, when his dentures went to his right lung.



I guess history really does repeat itself!

-ER Doc

Multi-Tazerings

TWO different tazerings, if that's a word, in the SAME shift.

Patient #1: A 33 year old male, upstanding citizen, allegedly high on PCP was attempting to steal a car. The police quickly got involved and tried to arrest him. But the PCP gave him superhuman strength. After EIGHT police officers could not contain him, they tazered him. One tazer, no response and he kept coming. Second tazer, no response and he kept coming. Third tazer, and he dropped dead.

He was brought to me as a full cardiopulmonary arrest. There was no saving him. The combination of the catecholamine surge from the drugs and the tazers was too much for his hear. And of course his family is making a huge deal about it and wants to sue the police. In my opinion, they should of just shot him.

Patient # 2: Same night about 4 hours later a 37 year old male was admitted for altered mental status and DKA. He was in full alcohol withdrawal, but also his metabolic system was also in terror from the DKA. He had a foley in place to monitor his urine output. He was on tons of fluids and insulin for the DKA, but he was also on an ativan drip for his agitation and alcohol withdrawal.

Eventually he became too hard to control as well. As I was ordering more sedation, or hospital police showed up. Problem is....there is no reasoning with an altered person from drugs or alcohol.

The patient ran out of the room naked into the halls, RIPPED out his foley and started attacking the police with it!! So the police tazered him in the middle of the ER. It was awesome.

-ER Doc

Psych Doc Interprets ER Doc's Patient: Blue Balls

I had a 43 year old white male come in for penile pain. He was accompanied by his wife. They seemed like very nice, affluent people.

So I asked him what happened....I wasn't expecting the response I got.

Mr. Blue Balls: "I tried to freeze my penis off 2 days ago by leaving ice packs on it."

Me: "Uhhh...ok. Why did you do that?"

Mr. Blue Balls: "I don't know."

So I proceeded to take a look at the damage. When he dropped his pants. I noticed his testicles were gone. His wife told me that 2 years ago he cut off his testicles HIMSELF. Never said why....always would just say I don't know. She said he was never diagnosed as psychotic or bipolar or schizophrenic. She said he was just diagnosed with being severely depressed. I've seen some really depressed people, and none of them had self mutilated their genitalia!

His penis had 2nd degree burns. It will turn out better than his nuts did. I called our psych team to come out for an eval (team of trained professionals but not physicians). I figured they would deem him a threat to himself and get him admitted to a psych center. Nope. They said he seemed genuinely regretful and set him up with outpatient counseling. Of course, he couldn't tell them why he did it either. So I was left with no choice but to discharge him.


So Psych Doc....what's your interpretation? How much denial is this family in? Should he have been committed?

-ER Doc

-------------------

Wow. First off, I hate to question other professionals, but I can't see how this guy didn't get admitted to a psych unit. He meets "Danger to self" criteria more clearly than a lot of the drug overdoses we see. And he's done similar, serious things twice now.

He may or not have been psychotic; however, I would think that if he had been, the evaluating team would have seen it (as would you and the family.) He could have been briefly psychotic, i.e., under the influence of drugs.

My hunch is that this guy has some sexual deviation that is very socially unacceptable. In other words, he probably has urges to commit violent sexual acts. This guy doesn't hate himself; he hates his intrusive, impulsive sexual thoughts. The symbol of the sexual deviance, his own genitalia, have become his enemy.

I have had two male patients that have hinted at things like this. Both of them have intrusive thoughts of molesting kids. One of them admits that when he sees teenage girls at the mall, he visualizes himself raping them. Then he thinks about where he could bury them. Both of them have asked for chemical castration. They both know that these kinds of thoughts are morally and socially unacceptable, which causes them a lot of distress and feelings of shame and guilt. They have problems with depression and anxiety, and both swear they have never acted on these thoughts.

Your patient likely does need some intense outpatient counseling. He may be an outwardly very pleasant, kind, and peaceful person. But the demons are hidden in there. I hope he can afford some good therapy. And I hope that the neighborhood kids stay away from his house.

-Psych Doc

A Twisted Case of Constipation

(Warning....for non medical readers, you will have to google a lot on this post as it has a lot of medical jargon)



I had a 83 year old male present with constipation and a "knot" to his neck. He was in good shape and health for being 83 years old.

Anyways, his belly felt a little more distended and tympanic than I was expecting for constipation, but he looked really well. Every part of me wanted to just give him an enema, make him poop, and send him home. But because of the mild distension I decided to get an abdominal series (a series of X Rays of the abdomen and chest).

What did I find in the X Ray?? The abdomen looked OK, but his chest X Ray showed a huge lung mass. I then did a full workup, and a cat scan showed diffuse metastasis to the liver, intestines, and bones. That "knot" to the neck was a cancerous lymph node

Next I reviewed his medical history. 6 months ago he was seen in the ER for chest pain and shortness of breath. A X Ray at that time showed a nodule in the lung, and a cat scan was recommended by the radiologist. The patient was admitted to the hospital by the ER Doc. For some reason, the hospitalist decided to a pulmonary embolism work up. His creatinine was a little high so he didn't get a cat scan but a worthless V/Q scan. The V/Q scan was negative and the patient was discharged.

The patient's doctor was never notified about the abnormal chest X Ray. The PATIENT was never notified about the X Ray. And now the patient has horrible cancer. Lots of things went wrong. The hospitalist had 1 diagnosis in mind and chased it....and was wrong. The patient couldn't get the cat scan with contrast, but he could have had a regular cat scan to evaluate the nodule. Even if the hospitalist didn't do the cat scan during admission, he should have informed the patient and the patient's doctor.

I hate to place blame on other doctors. I am sure this was multifactorial. If the ER doctor would not have admitted the patient, it would have been his job to inform the patient's primary doctor about the nodule....but that wasn't the case. The facts in this case are clear. And the prognosis = death.

-ER Doc

Society's Wh%$#

Today, I was working in the Psychiatric Emergency Center. A patient that I had not seen walked over to me, said he couldn't breathe, needed to go to the medical ER, and get a nebulizer treatment. Keep in mind, he got out of a chair and walked about 20 feet to tell me he couldn't breathe. When I told him I would order a PRN rescue inhaler, he said, "Nah, I don't need that, I have a nebulizer machine in my belongings." (When patients come onto a psych unit, all their items are stored in a secure area.)

I asked him why he needs to carry a nebulizer everywhere he goes. He said, "Well, I never know when I'll have trouble breathing. And, I never know when I'll find some crack." So this guy taught me something new today: When you open your airways, crack gets you even more high. Needless to say, your Medicare dollars paid for that nebulizer.

This story is good if it stopped right there. But oh no, my droogs. He proceeded to tell everyone how he had HIV and was "Society's Wh*%&" (a derogatory term for a woman who has sex in exchange for money). During his maniacal rant, he asked the nurse if he could see Psych Doc again. "Why?", the nurse asked. "He already said you can have some Albuterol."

"Well, it's just that I haven't been taking my psych meds like I'm supposed to," he stated. "Can Psych Doc come back out here and spank me for being a bad boy?"

I love this job.

-Psych Doc

Football Baby

I love football. Modern day gladiators! The NFL has really been cracking down on viscous hits and has been taking closed head injuries more serious, which is great. Hopefully there will be a trickle down effect to college and high school football.

A 15 year old QB came in after a hard hit to the head. He lost consciousness and was confused after. Neuro exam was essentially normal. He didn't remember the event but was alert and oriented. Here is a similar cat scan of what he had:















As you can see by the bright white blood.....he had a little head bleed. I was shocked. The kid looked great. He ended up doing just fine. But still amazing to think high school, JV football can cause this kind of injury.

-ER Doc

Random Post

Sorry for the lack of posts. I have specialty boards coming up in 2 weeks so have been busy studying. In Emergency Medicine, we have a lot of tests. After residency, we have our specialty written boards. If we pass that, then we have oral boards. After all that we can be considered "Board Certified" in Emergency Medicine. To maintain that, we have to keep up with a small refresher test based on current literature every 2 years. So...right now I am a fully licensed regular doctor, residency trained in EM and "board eligible."

Anyways, work has been boring lately. No great saves to talk about.

I did have 2 patient's today that both had trich (STD) on random urine tests. It was funny b/c they were both in their 60's. One male and one female, in rooms right next to each other. I wondered if they had hooked up in the past, but due to the HIPPA police I couldn't ask.

I had another lady that I diagnosed with Scabies. When I told her I would be sending her home with medicines, she was pissed b/c she had to actually BUY the medicines. She said she had no money to buy them, and I basically told her to figure it out. Of course she didn't like that. So I asked who paid for the cell phone she had been texting on. She replied, "My sugar daddy, but he's in Florida now b/c he is a truck driver." I suggested that her sugar daddy pay for them. She was ok with that as long as I called Sugar Daddy for her and explained to him that she did have a medical condition that required treatment. I guess he isn't a very trusting Daddy.

-ER Doc

Strange Side Effects

True report by patient who is about to be discharged from inpatient psych unit: "I don't like so much Risperdal. It makes me sh!t like clay." Despite numerous attempts to allow her to expand on that description, all she can come up with is, "It is like clay. I don't know what else to say."

Another adult outpatient >50 years old that I saw recently said "I think I have ADD." He was already on 60 mg BID Adderall from an internist. Of course, he met hardly any criteria for ADHD. 9th grade education, no GED, and a history of alcohol and marijuana abuse. 50 years old and works as a mechanic. No depressive symptoms. The only reason he wanted it was to increase productivity at work. I offered some Wellbutrin. "I don't want that, I know somebody who took that and gained 100 pounds. What about some Adderall? My PCP has been prescribing it for 12 years."

FWIW, Wellbutrin causes hardly any weight gain, and sometimes causes weight loss, especially when added to SSRI for treatment resistant depression.

He told me, "I'll just keep getting it from my private PCP. I thought I could go through the county system and get it prescribed for free."

-Psych Doc

Worms

Long time, no see. I guess I must see pretty funny stuff all the time, but by this point, I am immume to it. I have been doing some moonlighting, but in all honesty, it is much less acute than the county hospital where I train. Nevertheless, here are some moonlighting cases.

1. Psychotic older guy comes in because he is watching kids get on the school bus. Not so bad, right? Well, what if he was totally naked. At 8 in the morning. Standing in the street. He walks into the office doing some kind of breakdancing moves. Gyrating his hips. He is looking at my computer monitor like he hears music coming from it. I asked where the music was coming from. He said "From my d!ck." I tried to get some kind of history from him, but to no avail. I finally asked, "Is there anything that we can do to help you?"

"Yeah, prescribe me some pu$$y".

2. A lesson for all the non-psych docs that follow the blog. 30 year old female with history of depression presented from a rural county ER. She was complaining of worms coming out of her head. She had large scratches and excoriations on her forehead and scalp because she was trying to get the worms out. Also, spiders had laid eggs in her neck. She could not walk without holding onto a wall. She kept repeating "10 steps North, 4 steps West." and "Katie is a pretty girl". She was not oriented to person, place, situation. Only psych history was some treatment with Prozac. Further history (provided from transferring hospital) noted that she had been picked up by police 4 days ago for a DWI warrant. Had none of these symptoms until day 3, when she was taken to the ER.

What is the diagnosis?

No, it's not Prozac withdrawal.

Let's try Delirium Tremens.

I sent her to the local ER immediately, they loaded her up with benzos, and she came back 8 hours later.

Mental status exam: perfectly normal.

To all you med students and board eligible docs out there, you're welcome, because if you read this, you just got a question right on some B.S. exam

-Psych Doc

Out of Jail Free B/C It Stings When I Pee!?

In a previous post, I ranted about people who are brought to the ER in police custody because after they were arrested they had a medical complaint.

Most of the time the police have to bring them because they complain of something like chest pain. They usually get discharged quickly. But the police did NOT need to bring this guy in.

Me: "Hello sir. What did started bothering you today after you got arrested that you needed to come to the Emergency Department before going to jail?"

Patient Inmate: "Man....it stings when I pees. I think it is because I sleep with too many whores."

Me (Pissed off that the police would bring him in for that when they know that can be handled by the jail doctor): "That's why they brought you here!? We will give you some meds...be sure not to catch anything in jail!"

-ER Doc

Why I Like Working In The Hood

I have talked in the past about why I choose to work in the less affluent neighborhoods. The hospitals aren't fancy and the patients don't have great, if any, insurance. There are no frills. But the cases are great. In affluent areas, the patients generally are not as sick. So the ER isn't used to the good stuff, the nurses are less experienced with sick patients, and it's just not as fun. So yes it's a little less money in the hood but too much fun to pass up.

My group has a mix of hospital settings, from fancy to flat out ghetto. I usually split my time with the ghetto hospital in the hood to the poor-to-middle-class hospital in the nicer hood. Tons of sick patients. Today....I got to do stuff some ER docs never see.

1-Pericardiocentesis: Post dialysis CPR in a 45 year old male. Regular code meds (epi, atropine) were not working. I put the ultrasound probe to his heart and there was a huge tamponade (blood in his pericardium constricting his heart from beating). So I grabbed the 18 gauge spinal needle and 20cc syringe, and stabbed him in the heart with it! I have been waiting to do that for a long time. I withdrew about 20 cc's of blood, and wallah there's your heart beat!

2- Thoracotomy (Cracked Chest): Not a procedure I would generally do. The survival rate is less than 1% and it really isn't advocated anymore.

A 25 year male was coming in CPR after a gunshot wound to the chest. If I was alone, I would not have cracked his chest. But....the other doc on (my boss and hero) is a trauma guru and loves to crack chests, so I figured I might as well take advantage of the situation and do the procedure with a pro.

Within 2 minutes of the patient's arrival, I had cut down and spread the ribs apart, grabbed the heart, opened the pericardial sac, and started repairing the big ass hole in his right ventricle. It was freaking awesome. As soon as I had that hole put together, he got a strong heart beat back. He did not end up making it, but hopefully the experience will save someone else in the future.

-ER Doc








(not an image from my case but a google image)

One Tough 13 Year Old

A 13-year-old African American male came in by EMS for altered mental status. The history was very vague. All they knew was that he got hit in the head and didn't really respond after that.

He was no more than 5 feet tall and 100 pounds....tiny little guy.

Mom arrived and said that she didn't know what happened. She said he spends most of the time in the streets, smokes marijuana daily, and only drinks alcohol on weekends! He also had a big tatoo on his arm that said "I Don't Play." Remember....this kid was 13!!! Hell I am from the hood myself but don't remember any 13-year-olds this hard

He ended up just having a bad concussion. He was transferred to the local children's hospital where he can teach the other kiddos how to keep it real.

-ER Doc

Intubate Me X 3

Sorry for the lack of recent posts. I have been on a string of nights and getting ready for boards, and as usual my co bloggers are MIA. Here are a few notables from the shift I just ended. The common denominator was they all got intubated.

1) A NINETY-SIX year old female came in as a CPR. When the EMT heard that a 96 year old code was coming in, he prepped the bed in the white morgue bag so she would be placed in the open bag on arrival. One of the funniest things I have ever seen.

Of course, her children in their 70s wanted everything done. I had to intubate her b/c of it, and called the code as soon as it was medico-legally possible.

2) Drunk driver goes down the wrong side of the road and has a head on c0llision. He gets intubated due to being basically comatose. Ended up having a large liver and head bleed. Thankfully the only one he hurt was himself.

I am really starting to hate drunk drivers with a huge passion. Within the last 2 years, TWO of the best physicians I have known have been killed by drunk drivers.

3) Another drunk.....he drank himself into a coma. Blood alcohol level was 501. That was the 2nd highest I have ever seen. He was having trouble breathing, was vomiting, and had no gag reflex....so he got intubated as well.

Can't wait to see what Saturday night brings me!

-ER Doc

That IS a Medical Problem

There are about 6 questions I need to ask when I see a patient:

1- What brings you in?
2- What medical problems do you have?
3- Do you take any medicines daily?
4- Have you had any surgeries?
5- Do you smoke, drink, or do any drugs?
6- Are you allergic to anything?

The rest is just gravy. I am REALLY getting annoyed with question # 2 lately. I have tried phrasing it many different ways...but people for some reason don't think that high blood pressure, high cholesterol, or diabetes are medical problems anymore.

They will say NO they don't have any medical problems, but when I ask do you take any medicines daily, they will reply yes for my high blood pressure! Well genius that's a medical problem, not a gift from your grandmother.

Recently I had a patient say she had NO medical problems at all. No matter how I asked it she said no. I kept prodding b/c she looked like she had lots of problems. I found a previous discharge summary, and below were her actual medical problems listed:

• High blood pressure
• HIV
• Diabetes
  
• Gout
• Anemia
• Hypothyroidism
• GERD
• Schizophrenia
• Cervical Cancer

Guess what....those count!

Now I just say "do you have any medical problems including high blood pressure, diabetes, high cholesterol, chronic stupidity, etc??" It's getting annoying

-ER Doc

Well That's Just Not Fair

I wanted to post this a few days ago when the story came out...but I have been very busy.

A new study by George Washington University Scholars showed that it costs women nearly twice as much as it does men to be obese. Researchers tabulated the cost of medical bills, employee sick days, health insurance, lost productivity and even the need for extra gasoline to fuel cars carrying heavier passengers. In total, they found that the average yearly cost of being obese in America is $4,879 for a woman and $2,646 for a man.

I'm all for bringing up more reasons to have the fatties loose some pounds. Day in and day out in the ER, the majority of cases I see can either be attributed to or complicated by obesity. Now we have a study that brings up the obvious...being fat costs more money. Sometimes it takes saying the obvious to make an impact.

The reason, though, why it costs women more to be fat??? The study says it is because they get paid LESS than their fat male counterparts. Now that sucks.

Now for my liberal side....it is HARD to eat healthy when you don't have a lot of money. It costs a hell of a lot more. That's not an excuse for not exercising or controlling portion sizes...but there needs to be better regulations on what goes in food and their needs to be more AFFORDABLE healthy options. I was poor until moonlighting in residency.....that dollar menu used to be very appealing.

Now enough of the serious stuff. Let's get some funny comments about why it costs more to be fat. If you are sensitive, don't read.

-ER Doc

BTW, it doesn't take as much as you would think to be classified as obese. To calculate your BMI, click here. (Mine is 23...booyah!)

Discharge to Jail

All too often arrested people come to the ER and get a "get out of jail free" card. I take great pleasure when justice is served.

On weekends, we get tons of accidents from drunk people. Last week, 3 of my drunk drivers were taken to jail. It was a great feeling. Usually the police officers don't wait around for the patient to be discharged, so they get off the hook for the most part. After a night full of drunk MVCs and stabbings, it was nice to see some people leave my ER with cuffs on!

Just as bad are the people who get chest pain when they are arrested. Today I had a 41 year old male who "started to have the big one" after being arrested for shoplifting. Normal EKG and discharge to jail!

Drink...Drive...Go to Jail!

-ER Doc

To and Fro the Government

Case 1: To the Government

A 57 year old female came to the ED with COPD exacerbation. She didn't even require home oxygen yet, but stated that she just started receiving medicare and disability for her COPD! After she told me this, I asked her if she still smokes. Of course the answer was yes. I then replied something smart ass'ish like "Wow it sure is nice of the government to pay for your cigarettes and your medical problems that you caused for yourself." She didn't appreciate that. Oh well.

Case 2: From the Government

A 19 year old female came in for "nausea." When it came down to it, she had a + pregnancy test yesterday and wanted confirmation that she was pregnant. Why did she need confirmation??? Well she asked that I fax her records to her Army recruiter. She was supposed to report to boot camp the following day. She was very happy she was pregnant and didn't have to go to boot camp. My suspicion is that she got pregnant on purpose b/c she changed her mind about the army.

-ER Doc

Yet Again, The Rectal Fun Continues

Ironically the day I posted the last rectal fun post, another one came in that night.

This time it was 3am and a 65 year old male! He looked like Doc Brown from back to the future. He was thin, disheveled, and had thin wirery hair. Of course he came in complaining of constipation.

Me: "Hello sir, what brings you in today?"

Crazy Old Man: "I am really constipated. I have been receiving less of my social security money lately b/c they are taking it all for child support. So I have been living off of bread and water and it has made me really constipated. It hurts really bad. I think if you just give me something to have a big bowel movement I will be fine."

Me: I didn't say anything yet, but had a really confused look on my face that this old man said he is paying freaking child support from social security. So after the long pause he said.....

Crazy Old Man: "OK, I will be honest with you. I'm not constipated. I was having vigorous anal sex with myself and now I am in a lot of pain."

Me: Totally taken aback..."What do you mean you were having anal sex with yourself?"

Crazy Old Man: "Like with a Dildo, but I am not gay."

You know the rest from here. Dildo stuck in rectum. Taken to surgery to get it out...blah blah blah. I wonder if this is the first time Medicare had to pay for a dildo removal from rectum.

-ER Doc

Great Phone Call: Rectal Fun

Rectal posts are always popular. So here is another....

We frequently get calls to our ER from potential patients asking medical questions. The nurses always say the same...."I am sorry but we cannot give medical advice over the phone. If you are concerned please come in." Never do they transfer the call to the doctors, but last week one of the nurses did.

Me: "Hello, this is ER Doc how may I help you."

Phoner: "Yeah, uh high. I know you can't give medical advice over the phone, but I have a shower head stuck up my ass and I am wondering if you have the capabilities at your hospital to get it out."

Me: "Come right in!"

He really did have a big shower head stuck up his ass. He had to go to the operating room to get it out. He said he stuck it up there b/c he had such bad diarrhea he wanted to "plug it up." Yeah right.

Check out my other rectal fun posts....one of them has a man who shoved something in there b/c he said he was constipated. I guess it goes both ways.

-ER Doc

Come On Guys

At busy high acuity hospitals, the Emergency Department can become very overwhealmed. The constant beating gets to everyone, and stress levels rise quickly. I admit, sometimes during pointless codes you hope that chronically ill patients with no quality of life will not get a pulse back. We all think it. Less work, less resources, time to decompress the ED, etc. But a couple of responses from colleagues really took me back today, especially b/c the patients were not GOMERS.

1- A 64 year old male came in combative and confused. End diagnosis was hypertensive encephalopathy. I had to intubate him and put him on a couple of different drips to control his BP. I called the hospitalist to admit him and told him the story. His response, "64 years old...damn too old for Medicaid and too young for Medicare."

WTF?! Come on man. I guess I just forget that some docs think about the insurance first off. As ER docs, we have to see them all and treat them the same regardless of insurance.

2- This one really got to me. 50 year old female brought in full CardioPulmonaryArrest. She did have a cardiac history, but still was young. EMS coded her for 10 minutes before arrival. I intubated her, started a central line, and continued the code. After 12 minutes (22 minutes total CPR), the charge nurse came in the room and said, "Hey, she has been down over 20 minutes now. Why don't you just call it b/c it will be much easier if she dies than if you get her back."

WTF?! Hell no. If she was 90, yes I probably would have called it. Not at 50. 2 minutes later the patient had return of spontaneous circulation. Instead of being happy, the charge nurse was upset b/c now there was more work to be done. Yes the department was chaotic, but the patient was 50....so get over it.

She is now in the ICU, weaning off pressors, over-breathing the vent, and has NO signs of anoxic brain injury.

....BTW these were my FIRST 2 patients of my shift yesterday (Tuesday afternoon). They came in within 15 minutes of eachother. Lots of critical care today. The day after a holiday is never good.

-ER Doc

Good Ole Mom

Mom's can mean well, but sometimes they can be just a little frustrating too. Here are some funny examples from the last week.

1) A 28 year old female drove her car into an overpass b/c she was so distraught. Why was she so distraught??? Because she walked in on her mom doing her ex boyfriend who just broke up with her!

2) A 38 year old male called EMS for a sore throat and being upset after his mother told him to "Get a job not a dog!"

3) A 53 year old male came in for severe constipation. He was mad b/c his mom gave him some of her medicines, but they weren't working. The medicines were Dulcolax suppositories. When asked how he was taking the medicines, he stated with a glass of water....meaning he was swallowing them. For those who don't know, suppositories are meant to be placed up the butt, so no shit they weren't working (pun intended).

-ER Doc

Chief Ccomplaint of the Week

Last Sunday, working in Psych ER. Here is a word for word transcription of triage nurse's note (with drug names deleted/altered).

"49 year old white male presents for evaluation for treatment of insomnia. He went to his VA clinic Friday, where he received prescriptions for (mood stabilizer) and (sleep aid). He filled the prescription for (mood stabilizer), but did not fill the prescription for (sleep aid). Wants something to help him sleep."

I swear I'm not making this up. In case you don't know why this humors me so, let me count the ways:

1. Insomnia is neither a medical or psychiatric emergency.
2. The guy has access to regular, routine psychiatric care. Why burden an ER?
3. Why not fill the sleep aid Rx? Believe me, it wasn't a financial issue, because it would cost him 80-100 times LESS than the mood stabilizer if he paid cash. Probably 5 times less if he filed it with his insurance.

Don't ask me what happened. I had to see some patients that were actually in need of care that day. He was punted to the next shift. He probably waited 12 hours to see a doctor and went home sometime around 2 or 3 am. His sleep would have been jacked up anyway. And by 8 am, he coulda just called his clinic.

-Psych Doc

Saying Goodbye

Sorry for the long post...

Saying goodbye can be hard. As you all know, I am pretty numb to most things. Everyone once and a while there will be a few cases or families that bring my emotions out.

1- A 78 year old man came in confused. EMS suspected a drug overdose b/c they saw a bottle of Vicodin in the house. He did not look like a 78 year old pill popper, so I didn't let that story blind me. He was very nauseous and was diaphoretic (sweating), which always makes me nervous. I suspected a heart attack, so got an EKG which showed a posterior wall MI. As soon as I went to call the cardiologist to cath him, he started to code. So I went through the normal motions...intubation, central line, ACLS. We got him back with epinephrine. Then the following repeated itself like 10 times...code, chest compressions, one round of epinephrine, return of pulse for about 5 minutes. Over and over it happened.

Normally I wouldn't have gone so long on a 78 year old, but the patient's wife really got to me. She was so sweet. She truly loved him. She told me he was one of the original "Top Gun's" and a war hero, that he was all she had, and they were supposed to go on a cruise in 2 weeks. She asked me to do everything. Instead of being numb I wanted to save the guy for her. I tried and tried, but I couldn't....

2- A 41 year old female with a history of pulmonary arterial hypertension (much different than regular high blood pressure). She called EMS for weakness. By the time they arrived to the ER she lost her pulse and respirations. She was young so we went ALL out. After about 25 minutes of coding her, I went to talk to the family outside of the room. The patient's family present consisted of an 11 and 13 year old daughter, mother, sister, husband, and brother. Every generation.

They pleaded for me to save her... so it was time to empty the crash cart. I went through every vial of epi. I would occasionally get a pulse back, but then no blood pressure. Dopamine barely helped with that. After being maxed out on 3 pressures and having a pulse (albeit only at a rate of 30), she went into 3rd degree heart block. So I floated a transvenous pacer for the first time in my career....and it worked...but only for about 10 minutes. After 90 minutes, I had no choice but to pronounce her dead. Never before (and I hope never again), do I have to tell so many generations...offspring, spouse, siblings, and parent...that their loved one died. They were screaming. I held the 11 year old as she cried.

3- In this case, it was not hard for someone to say bye. A 47 year old female recently found out she had widely metastatic stage 4 ovarian cancer. She wasn't to start treatment for another 2 weeks. I can't imagine knowing I have a horrible cancer and having to wait weeks to start treatment, even though it really doesn't make a difference. When her husband found out, he said HE couldn't deal with it so he bolted and left her. Selfish ass. She didn't want to go home alone, so I made up an admission of "intractable nausea and vomiting" and admitted her to the hospital.


-ER Doc

Coincidence

This morning at 8 am there was an email from the pharmacy to the medical staff notifying us that they're having a shortage of (for the sake of having some anonymity) "Awesomely Potent IV Narcotic." The memo basically advised physicians of the indications for said narcotic and to use it only when needed.



At 1 pm I went over to cover our psych ER. There is a nurse from a med-surg unit being triaged in for psych eval. Nurse reports, "This patient is a nurse in our hospital. This morning, she got busted for stealing Awesomely Potent IV Narcotic intended for patients for the past week. She said she was stockpiling it in order to overdose on it."



I showed this to my attending and hilarity ensued. Hospital storage of narcotics....wait for it... because a nurse is stealing right from under your nose!!



There is obviously more to the story, but none of it was cool enough for this blog.



-Psych Doc

Chew Your Food!

An 11 year old boy came in by EMS choking on his chicken fried steak. He took a huge bite and didn't quite chew enough. Bystanders and EMS failed with the Heimlich maneuver. When he arrived to the ER he was blue and about to pass out. Somehow transferring him from the the EMS stretcher to our stretcher while performing the Heimlich maneuver dislodged the meat. Here is the pic of the monster meal.




His oxygen saturation never rose about 86% on room air after the event, so he had to be transferred to a children's hospital for monitoring, bronchoscopy, and further workup. My suspicion is that he aspirated part of the meat.

-ER Doc

Needle Drop Off

Working a shift when a local neighborhood patron brought by a water carton full of needles. She thought she should "turn it in" to us.

This was a pretty good thought b/c they needed to be disposed of, but the police might have been a better place to start.

Anyways here are the pics I took of the stash.









- ER Doc

Friday The 13th

Wow....what a Friday the 13th for our department. Not all of the cases below were my patients. Some were from my co-workers, including the lost blogger Doc Sensitive.

-Epiglottitis in a 40 year old male. This is a pretty rare diagnosis, and can be deadly. Follow the link for info about it. The on call ENT doc ended up coming in to intubate him.

-A 23 year old was shot in the chest at around 5pm and killed. We intubated him, put in bilateral chest tubes, and contemplated cracking his chest open but there were no signs of life.

-A 43 year old came in with angioedema. He got progressively worse. ENT felt like they had done their on call duty for the day from case #1 and would not come in. So for the first time, I did an awake nasal intubation with a fiberoptic scope. Scary shit but it worked.

-No shortage of the intoxicated patients. One was 24 years old who had her 5th child 2 weeks prior. She was horribly intoxicated screaming profanities about her children. Besides being drunk, she was positive for cocaine and marijuana. She couldn't even complete a sentence. "Dad" said all she does is drink...so I called CPS and sent her to a psych facility for postpartum depression. Who knows if she was really postpartum depression or just a low life, but I felt if I just let her sober up and go home....that by the time CPS showed up one of those kids would be dead.

-A 68 year old female with fibromyalgia who felt "anxious and stressed" after spending the night at a church lock in. WTF ?!?

-A 41 year old female that was soooo fat she could not take care of herself and had to live in a nursing home. Disgusting. Now for all your purists....she had NO medical reason to be this fat. She came in with shortness of breath....b/c she was literally TOO FAT TO BREATH. She ended up in the ICU

-Ended the shift with an average stab wound to the chest. Those "two dudes" were out again last night I guess, as they stabbed this poor patient in the chest as he was walking back to his car leaving the club minding his own business. He did fine, but if anyone can locate these two dudes (they have popped up in older posts), please notify your local authorities.

ER Doc

Pregnant and Not Pregnant

Lonnnnnggg day today. Sent 8 to the ICU. But in the middle of it all there were some humerus things to share.

1: Pregnant

A 25 year old pregnant lady. Why is that humerus?? Well it was more messed up than funny I guess. This was her 11th pregnancy! She was G11/P6/A4...which means 11 total pregnancies including her new one, 6 that were born, and 4 abortions or miscarriages. I recommended a tubal after this pregnancy. I am pretty sure she had been told that before though.

2: Not Pregnant

A 27 year old male came in after being discharged from a psych facility.

• Me: "Do you have any medical problems?"
• Him: "No, I just see things and hear voices."
• Me: "Ok, what brings you into the ER today."
• Him: "I came to get a pregnancy test."
• Quick double check at the chart to make sure this patient was indeed a male. "Uh sir...you are a man, why are you worried about being pregnant?"
• Him: "Well, a priest came inside me recently. He said he was baptizing me. So I thought maybe I was pregnant with Jesus."

Disposition back to psych facility!

-ER Doc

Divine Intervention

I think I believe in divine intervention.....

A very frail 84 year old female came in after passing out. Where did she pass out you might ask??? At the DMV renewing her drivers license!!! She was sitting down to take the picture and "fell out." The culprit was her blood glucose. She was very hypoglycemic. She took all her insulin in the morning but forgot to eat. Yes...that's who we need driving.

There had to be a power from above that intervened before her picture was taken.

-ER Doc

Out of Jail Headache

A 48 year old male decided to celebrate as soon as he was released from his 8 year jail sentence. He went straight to the bar. By 1pm....he was in my ER with a traumatic brain bleed. He drank himself into a stupor, got into a fight with "2 dudes" and was thrown against a moving car! Ouch!




His jail cell will not go empty long though. A few hours later we had a high speed motorcycle crash come in. This guy was a 27 year old who, when approached by the police, tried to throw his bag of crack in the bushes and take off on his motorcycle. When the police neared him, he jumped off his bike. Unfortunately (and amazingly) for him, he had no major injuries and was taken to jail shortly after.

-ER Doc

Is Church Bad For You?

No, of course not. But it makes for a good title.

Any Sunday in the ER there are always a couple of people that come in from church. Today, though, I saw FOURTEEN people who came in after getting sick at church. Two of them were preachers. It was really strange. Maybe God took the day off?

They ranged from the simple, "I got chest pain in church" to " I passed out in church" to "Grandma slumped over and couldn't move her left side during church and has been drooling since."

Most seem to come from Catholic church. I think it is from all the standing and kneeling. I heard that's what they do there. The Pentecostals come in a lot b/c of the emotional experience they tend to have at church. I am surprised we don't get more Muslims from all of their bowing when praying. I guess they are in better shape since they do it 5 times a day.

In summary, there were a lot of freaking sick people in church today. Be careful next time you go. I hope I didn't offend anyone too much. OK, that's a lie b/c I don't give a shit. Its my blog and I think its funny. Probably b/c I haven't been to church in a while and my conscious has gone missing. My mom would be so disappointed in my right now I hope she doesn't read this one

-ER Doc

The Picture Album

I love doing psych consults so much that I just did an extra elective. Something cool about hanging out with "real doctors" and seeing all the medical/psychiatric interactions. Or something. Anyway, I find that most consults are pretty interesting, and I've seen every imaginable kind of delirium, suicide attempt, drug withdrawal, etc. Or so I think. It's those stories outside of my normal comfort zone that make it to this blog.

Warning: Those with kids, especially moms, especially if you're a pregnant mom, be forewarned. You may not want to read this one.

Getting a psych consult to the Labor and Delivery floor can never be good. Usually it's some case of post-partum depression/psychosis, usually requiring a report to be filed with appropriate child welfare agencies, moms with 10 kids and no way to care for them, etc. Today, it got dialed up to an 11 for me.

A G6P3 21 y.o. female presented 2 days ago with acute pelvic pain. She was at 34 weeks' gestation. Sono showed intrauterine demise of the fetus. While waiting to spontaneously deliver, she got very labile, asking to go to a different hospital, etc. Basically, she was angry that the primary team didn't just surgically remove it. Seems reasonable to me, but damned if someone shows some normal human emotion in a hospital or else psych gets called in.

I saw this lady the day after she delivered. She is understandibly sad, tearful, and grieving. Her life had not gone according to plan, as evident in her age, 6 pregnancies, and 3 total miscarriages now. She reported her prenatal care, psych history, support network, etc., as I obtained a complete history and mental status exam. I gave her referrals to several different grief counselors and recommendations for meds and follow-up.

As I was wrapping up the interview, she asked me if I wanted to see pictures of her baby. I felt this twinge in my gut, telling me to say no. No human part of me wanted to see a dead baby. However, I knew it would be better for her therapeutically to show interest in her plight in this way. The patient needed her doctor to do this. To connect with her. It was going to be hard.

She brought out a small album. Her and her mom had put a new little red dress with a matching cap on the baby. They took 6 or 8 pics. Different poses. Closeups of face, hands, feet included. At first glance, it looked like a normal newborn album. But the reality of it all could be seen in the skin color and turgor. I was able to manage "She's beautiful" or somesuch, quickly tied up any loose ends, and left her room.

I just hope I helped her in some way. Because those pictures are gonna stay with me for a while.

-Psych Doc

Give Me Back My Child!

A 27 year old male came in for multiple lacerations. Let's called him Patient Dumbass. He had been doing PCP that day. Apparently, when he does PCP, he gets very "touchy."

While Patient Dumbass was fried out of his mind on PCP, he went over to visit his friends who had a 9 month old child. Apparently, when Patient Dumbess does PCP, he gets very "touchy." He decided to hold the baby, and became very touchy since he was high. This freaked the parents out, and they wanted him to hand over the baby. Well Patient Dumbass didn't want to let go of the cuddly lil' booger, so in normal PCP fashion he held on to the kid and tried to take off. With the baby in his arms, Patient Dumbass ran straight through a glass door, causing injuries to himself and the baby.

Word from the Childrens Hospital was that the baby would be just fine. The police weren't interested in Patient Dumbass, so I deemed him "a threat to himself and others," and he was shipped to a local psych hospital. I don't really think his issues were psychiatric but more just drug related, but there wasn't much I could do and I didn't want to just discharge him.

-ER Doc

Pregnancy Headache

Warning: Sad case for any pregnant readers.

A 23 year old, 16 weeks pregnant female came in with headache, vision changes, and right sided weakness. With pregnant females, we are always very conservative. But in this case, we had to do a cat scan. She was obviously having a big brain bleed.


Before her presentation with the bleed, she was completely healthy. We think she had a AVM that had always been asymptomatic. To date, she and the baby are still alive.

Weird thing is we had the same case in our ER 1 week ago, except the patient was 33 years old and 26 weeks pregnant. She wasn't as lucky.

-ER Doc

Borrowed Post, Condom Inhalation

While blog rolling recently, I found an interesting post from a blog called Life in the Fast Lane. Its from a group of Australian EM Docs.

Anyways, this post is about a women who inhaled a CONDOM! Wow. Had to be a stripper. Why else a condom during fellatio? At least now I can ask my patients with a cough, "Have you been sucking d**k lately and a load fired so strongly the wrapper came off?

Here's a copy of the post and the link.

------------------------------
27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve.

A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe.

Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed the presence of a condom.

Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio.

-ER Doc

Expensive Day

Today was the beginning for me to start repaying my student loans from college and med school. I haven't even been out of residency one month! More importantly, I haven't even been paid yet! Expensive day to say the least. Only 29 more years and 11 months to go at least.

-ER Doc

The Little Things

Where I work is action all the time. Today I intubated 2 people, 1 central line, sent 3 to the ICU, 1 chest tube, etc. But sometimes it's nice to get one of those classic cases that are simple, but offer the patient relief. Here are a couple of examples


1) A 76 year old female came in with severe dizziness. It had been getting worse over the last few weeks. Immediately all the bad stuff started going through my head like stroke, electrolyte imbalances, etc. But when I looked in her ears...look what I found!

















She said she thought she lost a cotton swab Q-Tip about a month ago. Looks like I found it. Treated her with some antibiotics and she should do fine. Probably the only 75+ year old I have been able to send home with dizziness.

2) A mom brought in her 18 month little girl in for a "red eye." Mom was convinced it was pink eye. Not a bad thought, but when I looked at the eye, I saw no signs of pink eye. Her eye was red, but just didn't look like conjunctivitis. And she was kind of guarding her eye with her hand. So I told the mom I wanted to stain the child's eye to make sure she hadn't accidentally scratched her cornea, causing a corneal abrasion. The mom thought I was crazy, and it took a lot of convincing for her to allow me to do the exam. Low and behold, this is what I found! (Similar image from online. Not actual image from patient didn't want to make her have to take a picture after her enduring me staining her eye for the exam)



Poor thing probably scratched her eye with her nails. She should do fine as well.


Neither case was exciting, but they weren't everyday things for my practice and they offered patient's actual treatments with good outcomes. In a very high acuity ER, this is nice.

-ER Doc