Sunday, November 29, 2009

Suprise Packing

Recently an unresponsive Hispanic female was brought in after a MVC to our trauma center. She was intubated and the normal trauma protocol was followed. We normally get routine pelvic Xraysin trauma. In this case, there was a very interesting finding. Forgive me that I don't know how to draw arrows...but if you look in the middle of the pelvic ring you will see something that looks like a ball of pebbles. At first I thought it was just hard stool. But the radiologist read it as unknown foreign bodies.

So when the patient got sicker and we couldn't figure out what was going on, the surgeons decided to see what exactly that possible foreign body was. Turned out it was about $10,000 dollars worth of cocaine stuffed inside of her. It was removed and IV antibiotics and time did the trick.

-ER Doc

Sunday, November 22, 2009

Chief Complaint of the Week

Sometimes we hear medical terminology and associate it with what we think it sounds like. I had a patient who did suck that last week.

Phlebitis is defined as inflammation of a vein. My patient came in because she had been around fleas and wasn't feeling well. She was afraid she might have been bitten by the fleas and caught a case of "Flea-Bitis." Classic.

-ER Doc

Wednesday, November 18, 2009

Magic Needle

A 24 yo large Hispanic male arrived in the ED carrying plain film X Rays from an outside hospital. Since he only spoke Spanish, I went over and pointed at his films so I could at least see what was going on before the translator arrived. To my surprise, he had a sewing needle in his left thigh. I couldn't wait to hear how the needle implanted there.

When the translator arrived, I asked him "How did the needle get into your thigh?"

He said, " I'm not sure."

I then asked him, "Don't you remember that LARGE needle going into your leg. You had to feel it when it happened."

He said, "No, but about two weeks ago I started feeling a sharp prick every time I walk. Maybe the needle was in my pocket and it just went in. Or maybe I laid on it."

I was puzzled as to how a large sewing needle got stuck in his thigh. I examined his thigh and he didn't even have a mark on him. To this day, I am scratching my head. We gave him an appointment to see a surgeon to have it removed.

-Doc Sensitive

Monday, November 16, 2009

More Weirdness

Some more weird complaints from patients from my last moonlighting shift in the boonies:

Patient 1: Chief complaint of "I think I have forceps coming out of my vagina!" Oh course everyone was cracking up before I went into the room. The patient stated that she had a c section done a year ago. Since then, she had pain and pressure to her lower abdomen. She was convinced the doctors left forceps in her uterus and they were slowly falling out. I did the vag exam, and of course no forceps. But....Before I left the room I got some forceps from the drawer, gooped them withe some jelly, and brought them out of the room with my gloves on. I had a shocked looked on my face and told the nurses, "Look! She really did have forceps in her snatch!" I couldn't hold my laughter for long and they quickly figured out the joke.

Patient 2: Was actually a phone call to the nurses. The person called at 3 am b/c she cut her dogs toenails too much and they were bleeding. She was frantic and didn't know what to do. My nurse told her to call a vet. She said all vets were closed. So my nurse said, "So go to sleep!" and hung up the phone. Greatness

-ER Doc

Thursday, November 12, 2009

What do vegetable juice, milk, and worms have in common?

The answer? My patients! Here are a couple of word-for-word triage notes from a recent shift:

Patient 1:
Patient states she thinks someone put something in her vegetable juice this am at 0500. She says that she woke up and drank the juice and shortly after she felt "like my stomach was swelling up and then I had nasty orange diarrhea". Pt states she then drank 1/2 gallon of milk and then had the more diarrhea, this time a lighter orange. Pt appears in no acute distress in triage. Pt states she feels fine now.

Patient 2:
Patient with chief complaint of "I have an abscess on my head and i found a worm in it."

-ER Doc

Monday, November 9, 2009

Milk the Balls??

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

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

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

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

-ER Doc

Thursday, November 5, 2009


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

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

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

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

-Nice Doc

Tuesday, November 3, 2009

Sleep Walking

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

-ER Doc