Some days at work are easy. The asthmatic comes in for a tune-up and goes home. The heart failure patient was a little too indulgent over the holiday and now needs to be admitted, diuresed, and discharged after an observation period. The sprained wrist that may actually have a hidden fracture that needs a splint.
"The other day" (From here on I will now be referring to encounters as having occurred "the other day" to further obscure identities.) my shift was filled with "Oh yeah, and another thing" cases.
#1- First there was the cop that came in with what he was sure was a kidney stone as he had one in the past and it felt similar. So, after getting his pain under control, we checked his urine and ran him through the CT. Sure enough, he had a kidney stone. However, he also had a BULLET fragment in his back. It was very superficial, there were no scars on his skin and it didn't need to be removed. However, it seems to me like having been shot would be something you could kindly remember to mention in your medical history.
#2- Then there was the prisoner that I think just didn't want to go back to jail. Everything was wrong with this guy. He'd had seizures, and although he admitted to not taking his seizure-prevention medication, his case wasn't that simple. He also claimed he was attacked and blacked out when he was arrested the day before (head CT), was vomiting blood, had blood in his stools, a fever, and difficulty urinating.
Our whole workup process is based on the idea of a chief complaint and ruling out life-threatening issues. When you give me a bunch of unrelated crap, it just slows everything down. This guy was young, so he learned first-hand that if you complain of blood in your stools, you're getting a rectal exam. If you complain of bloody vomiting too, and your rectal exam is unfortunately positive, you are definitely getting a tube down your nose.
Getting a tube down one's nose also involves flooding your stomach with saline, and sucking said saline back out into the vacuutainer to make sure that there isn't any active bleeding going on. Meanwhile this involves hawking up all sorts of mucus, and nose lubricant-- which is, by the way, the one thing that makes ME sick to witness. And, this is all very entertaining for the officers accompanying you to the emergency department. Here's a hint: next time, stick with the seizures.
#3- Then there was my uncooperative patient. He had a history of some baseline mental retardation and lived by himself. He called his sister up, and told her he just "didn't feel right" and she had him transported to the hospital. He was stubborn and extremely frustrating to examine as he refused to follow directions and wouldn't give me any description other than just "feeling blah". He did seem to have some more distractability than he should have though, so into the CT scanner he went, with having a plethora of labs pending. This was at the end of my shift. I was dictating his chart the next day, and guess what? The guy had evidence of a recent stroke on his scan. We had no idea when the onset was, and there wasn't much to do acutely, but 30 year-olds who just feel "blah" shouldn't be going around having strokes. Now I am a little paranoid about sending anyone home.
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Posting around here has been scant this past week for two reasons:
1. My laptop's power cord wasn't connecting well enough to charge the battery. It had gotten to the point where no amount of jiggling would do. $135 and four days later it is better, but I think this machine may be nearing hospice-time as the power button is now sticking and it doesn't like to shut down.
2. We had a state chapter conference thing that was four days long. I survived rooming with McNeedy and even went out kayaking for the first time ever. It was a fun time, but between all the lectures and hanging out, I ended up exhausted.
"The other day" (From here on I will now be referring to encounters as having occurred "the other day" to further obscure identities.) my shift was filled with "Oh yeah, and another thing" cases.
#1- First there was the cop that came in with what he was sure was a kidney stone as he had one in the past and it felt similar. So, after getting his pain under control, we checked his urine and ran him through the CT. Sure enough, he had a kidney stone. However, he also had a BULLET fragment in his back. It was very superficial, there were no scars on his skin and it didn't need to be removed. However, it seems to me like having been shot would be something you could kindly remember to mention in your medical history.
#2- Then there was the prisoner that I think just didn't want to go back to jail. Everything was wrong with this guy. He'd had seizures, and although he admitted to not taking his seizure-prevention medication, his case wasn't that simple. He also claimed he was attacked and blacked out when he was arrested the day before (head CT), was vomiting blood, had blood in his stools, a fever, and difficulty urinating.
Our whole workup process is based on the idea of a chief complaint and ruling out life-threatening issues. When you give me a bunch of unrelated crap, it just slows everything down. This guy was young, so he learned first-hand that if you complain of blood in your stools, you're getting a rectal exam. If you complain of bloody vomiting too, and your rectal exam is unfortunately positive, you are definitely getting a tube down your nose.
Getting a tube down one's nose also involves flooding your stomach with saline, and sucking said saline back out into the vacuutainer to make sure that there isn't any active bleeding going on. Meanwhile this involves hawking up all sorts of mucus, and nose lubricant-- which is, by the way, the one thing that makes ME sick to witness. And, this is all very entertaining for the officers accompanying you to the emergency department. Here's a hint: next time, stick with the seizures.
#3- Then there was my uncooperative patient. He had a history of some baseline mental retardation and lived by himself. He called his sister up, and told her he just "didn't feel right" and she had him transported to the hospital. He was stubborn and extremely frustrating to examine as he refused to follow directions and wouldn't give me any description other than just "feeling blah". He did seem to have some more distractability than he should have though, so into the CT scanner he went, with having a plethora of labs pending. This was at the end of my shift. I was dictating his chart the next day, and guess what? The guy had evidence of a recent stroke on his scan. We had no idea when the onset was, and there wasn't much to do acutely, but 30 year-olds who just feel "blah" shouldn't be going around having strokes. Now I am a little paranoid about sending anyone home.
----------
Posting around here has been scant this past week for two reasons:
1. My laptop's power cord wasn't connecting well enough to charge the battery. It had gotten to the point where no amount of jiggling would do. $135 and four days later it is better, but I think this machine may be nearing hospice-time as the power button is now sticking and it doesn't like to shut down.
2. We had a state chapter conference thing that was four days long. I survived rooming with McNeedy and even went out kayaking for the first time ever. It was a fun time, but between all the lectures and hanging out, I ended up exhausted.
Posts
2 comments:
How did those shoulders feel after the kayaking?
Boooo computer problems...work you damn machine, work!
My favorite was Lesson 1....I agree....how do you forget to mention..."Oh yeah, I got shot in the back once". Maybe he is just embarrassed because it is a bad story, like his gun accidentally went off while he was on the commode or something :) You know if it was a cool story he would use every opportunity to tell it. "Yeah, I had fought of 5 of the Johnson Brothers bare handed when the 6th one shot me from behind with a .30-06 blunderbuss. I pulled most of the bullet out myself with pliers...I don't have time for hospitals."
Have a great weekend!
Chris
My Blog
My shoulders and back were ANGRY!
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