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