Bad Vision, Bad Luck

A 43 year old male came in after an eye injury at work. He had a history of bilateral cornea transplants as a teenager because of a congenital scarring disorder. He works as a air conditioner technician.

While working on an AC, a valve popped off and hit him in the face. When I took off the bandage, all I saw was a big crater in the center of his eye. His cornea had been torn off and he leaked out a ton of vitreous fluid. I wish I could have taken a picture of this one, but I felt too bad for him to ask. It was obvious he was going to loose vision for good in that eye. Poor Guy.

Here is a similar picture that I found on the web of what his eye looked like. The one on the right is closer to what his looked like except the pic shows it being repaired.

-ER Doc

Images removed due to graphic nature and wimpy stomachs of readers. Links provided below

CLICK HERE IMAGE ONE

CLICK HERE IMAGE TWO

Assault Your Own Mother?

A 59 year old women came into the ER with a broken jaw and a broken arm. Her story was suspicious. Eventually she admitted that her 33 year old son beat her. Turned out this was nothing new in their relationship, and she agreed to press charges. The police were called and APS was notified.

The police came up with a nice little plan. We agreed to call the son and tell him that his mom was being discharged and was ready to be picked up. The police then positioned themselves for when he arrived. When he did, they charged after him. The son was pretty quick, and the police had to chase him on foot. They eventually tased him. This was the first person I have ever seen tased in the head. It was pretty funny. The cops must have had there way with him...because he had another barb in the neck AND a broken clavicle. I didn't rush to get him pain meds though, and no one felt sorry for him.

I hope he stays in jail for a long time.

-ER Doc

A week in the life...

With apologies to my co-bloggers, I haven't contributed much in a while. Granted, I have been on vacation 2 of the past 3 weeks (score!), but in my first week back, here are my stories. All from this week.

Today, I worked our walk-in clinic. Kind of like an urgent care for psych. Saw many, many patients for med refills/acute crises. Saw 3 guys, all African American gentlemen, from a halfway house. Two years ago, this would have scared me. Today, it was, "Yes, Boss" and "No sir", just like I was Tom Hanks in "The Green Mile". Again, these guys were all pleasant and appropriate. Not trying to be racist or anything. But they were all wearing ankle monitors (one guy because he just eloped from the halfway house and got caught). I include all of this for justification of the Lindsay Lohan pic (ankle monitor, get it?)

I have tons of patients with borderline personality disorder. One that I saw this week epitomizes this condition. 20-year old female. History of several hospitalizations for suicide attempts, always tells me about cutting, etc. She disappeared from clinic for about 6 months and came in. Said everything was going fine except boyfriend broke up with her. This was interesting, because there was a male with her int he waiting room. I asked who he was. "oh just a guy I met yesterday." I told her I was surprised that she would let him know so soon that she was seeing a psychiatrist. "Well, I can't be alone. I need to have a man."

I asked how school and work were going. "Not so good. I have to come up with $1000."

Me: Why

"Well I totalled my mom's Honda. I have to come up with the deductible. So I'm having to work lots of extra shifts at Hooters to get the money."

From child clinic this week. Teenager with ADHD/ODD comes in with Mom and a cousin. It's summer, so these kids are usually going okay b/c they're not in school. The cousin has a hellacious sunburn. Most of his body is tanned but his shoulders and bald head are pink and peeling off. I made a comment about how bad it had to have hurt (I am severely white-been there before). The mom said, "I let these kids go down to Louisiana to stay with their dad. These boys came back with a sunburn. Louisiana gave my daughter herpes around her mouth."

It was all I could do to not laugh or ask any further questions pertaining to that.

All I can say is this: Ladies, watch out for a guy named Louisiana.

-psych doc

Oprah and Medical Advice

A 49 year old female with high blood pressure came in last night about 11pm. She was very big and jolly, had on a huge bow that made her resemble Minnie Mouse, and spoke in the highest voice I have ever heard from an adult before.

Me: "Hello, I am ER Doc. What brings you in tonight?"

Oprah's Twin: "I have been gaining a lot of weight lately. I used to only be 200 pounds. Now I shot up to 300. I walk to get my mail lately to stay in shape. So something has to be wrong."

Me: "Are you eating more things....like chips and fatty foods."

Oprah's Twin: BLANK STARE FOR TEN SECONDS. "I watch Oprah. Her weight changes like mine, and she said that we should get our thyroid levels checked. I would like that done, get my cholesterol checked, and have an EKG and CXR."

Me: BLANK STARE BACK AT YA, then talking slow me so my words might make it through her fat head. "Ma'am, this is the ER. Those aren't emergent tests, and you have no symptoms to warrant a CXR and EKG. And I think Oprah's problem has more to do with her munchies.....Do you have a primary doctor to see? You know, the one that prescribes you your high blood pressure medicines?"

Oprah's Twin: "Yes, yes I do. But you have to call her and make an appointment! And then it might take 2 weeks to get in!"

Me: "If your doctor can see you in 2 weeks, you have a pretty good doctor. Call tomorrow and make an appointment. Goodbye."

---This went on for about ten minutes. She just didn't get it. I hope she doesn't watch Dr. Phil too....or else Psych Doc might get a visit from her. That is....if he is still around. Where have my co bloggers gone?!?!

-ER Doc

Another Cock Ring Mishap

A 27 year old male was brought in by his partner b/c his cock ring was stuck. Let's call him Cock Sucker. Of course....Cock Sucker used a metal cock ring. If you haven't read my previous post on metal cock rings.....don't use them! If you must wrap something tight around your wang to make you last longer....use a rubber one.

Cock Sucker made the mistake of putting his penis AND his testicles though the ring. I have never worn one, but I am guessing there is a warning label on the package (cock ring package that is) to NOT do that.

With the perfusion to his balls and penis decreasing, we got to work. Lube wasn't helping. Ring cutters....nope. Eventually we got a heavy duty cutter from the OR that got the thing pretty loose. We had ice all over his package to shrink things up as much as possible. The intern lubed him up again to try pulling the ring off again.

Apparently Cock Sucker liked all the pulling...because he got a massive hard on. He closed his eyes and started breathing and panting heavy. Right as the intern (male) pulled the ring off, Cock Sucker got off and shot a huge load on the interns scrubs! He then smiled and let out a big sigh. I was expecting the partner to pull his pants down and ask for the same.

We are expecting great patient satisfaction scores from this guy.

-ER Doc

We Finally Made a List, EMT blogs

We finally made a list!

http://www.firesciencedegree.com/top-43-emt-blogs/

#23 of the top 43 EMT blogs. 23 is my favorite number....so I am pumped. Maybe it's good karma for the week. Even though I probably don't deserve good karma!

-ER Doc

Choking

A spanish couple who spole no English came running into the ER with their very gordo 1 & 1/2 year old boy screaming and motioning that he was choking. Generally, if you are coughing or passing any air, you are not choking. This child was in distress. One second he would be pink and breathing, the next he would turn ashy and not pass air. His oxygen sats would drop then pick up. Something was intermittently obstructing his airway.

This was at an adult ER, so everyone was kind of tense. We started a line and got ready to try to get this thing out. He was too anxious for me to do this without meds. I was going to have to sedate him, go in with an laryngoscope, and try to pull the unknown object out of his airway with some long foreceps.

I was scared shitless. Putting him down carried risks, and if I couldn't get out what was obstructing him on the first try he could die.

We pushed the ketamine (medicine to put him out), and he went to sleep. I got in and saw a metal object that was stuck in his valecula. When he would breath, it was moving into his airway causing the intermittent obstuction. It looked tiny, but as I started to pull it got longer and longer (thats what she said HAHA). I was afraid I was going to drop it into his airway completely from all the secretions. Luckily I got it out. The picture is below. It was somekind of bookcase hinge.

Another life saved. Another save without getting a thank you from the family. Oh well.



- ER Doc

High Pressure Injection Injuries

A 19 year old male came in for finger pain. There was no obvious signs of trauma, and he denied any trauma. There was just a little swelling to the finger....

One thing to look out for in suspicious cases like this is high pressure injection injuries from things like paint. It is a common injury from pain sprayers. But it is hard sometimes to get a patient to admit to the injury if they were doing something illegal....like graffiti. This is a big mistake, because early on the physical exam of the finger is almost totally normal. but within 24 hours the finger can become necrotic and need to be amputated. Early debridement is key.



The white cloudy stuff is the paint/oil


-ER Doc

Love Me

A 27 year old male was found by police passed out in his car. He had all kinds of drugs with him. When he became combative, so they brought him to the ER.

He had a shirt on that said "IT'S ALL FUN AND GAMES 'TIL THE COPS COME." He sure nailed that one!

When the nurse (probably our best nurse in the department) tried to start an IV, he tried to bite her. So he was tied down to the bed. The same nurse go to have revenge by starting a foley on him. But the best part of all.....when she started the foley she noticed he had a tattoo on the shaft of his penis that said "Love Me."

You have to admire his dedication to get that tattoo. That had to hurt. The nurse told him, "Don't worry, I am sure you will get plenty of love in jail!"

-ER Doc

Pull the Plug

Sometimes (ok all the time)....I really wish we could choose who we are going to spend thousands and thousands of dollars working up or saving. I'm not talking about the elderly demented or terminally ill. We will save that argument for another day.

Most county or community ERs have "frequent fliers." They are patients that come over and over for no good reason. Most are homeless, drunks, or drug addicts. The ER staff usually refers to them as trolls. Here's a link about 9 patient's that accounted for 2,700 ER visits in Austin, TX.

In my residency, I have at least 20 patients like this. All the staff knows them by name. We know what they want. We hate them. They suck the life out of us. No respect for the system. No respect for the taxpayer. They are extremely demanding, can ruin your day, and we have to see them each time.

One such patient, we will call him Troll-A, came in obtunded from drinking himself into a stupor. He was found down outside of the hospital under his normal bench. He was so drunk he could barely breath. So what do we do???? We have to save him. Why??? I still don't know the answer. I guess b/c we don't get to pick our patient's and who we choose to help in the ER. Even though EVERYONE in that hospital knew it was going to cost someone a ton of money to put Troll-A on a respirator and in the ICU.

So we did what we had to do and intubated him so he could keep breathing off his alcohol. About 16 hours later, his alcohol wore off to the point that he extubated himself....literally pulling the breathing tube out himself....and left AMA (against medical advice). Of course he pissed on the floor and cussed out the nursing staff before leaving. 2 days later he comes back for his chronic low back pain trying to get narcotics!

What the fuck ever. Just don't say "it's job security" like so many people do about these trolls. B/C its not. They are too dumb to go get on medicaid, so know one pays. When no one pays, it wastes money and therefore isn't job security.

Enough of my rant....bc If I don't stop now this post will get much, much longer.

-ER Doc