goldenbodhi Posted June 4, 2009 Share Posted June 4, 2009 I have told 12 year olds they are pregnant and just told a 14 year old she was pregnant last week. If she bleeds do a pregnancy test. I fshe says she doesn't, do a pregnancy test. If she says, I'm here in your ER to get a pregnancy test. Send her to WalMart. 3 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2009 Author Moderator Share Posted June 4, 2009 If she says, I'm here in your ER to get a pregnancy test. Send her to WalMart. they actually have preg tests at dollar tree for , you guessed it, 1 dollar...but of course a 500 dollar er bill that you never pay that ruins your credit forever is worth it if you can save that buck to spend on cigarettes.... 1 Quote Link to comment Share on other sites More sharing options...
primadonna22274 Posted June 4, 2009 Share Posted June 4, 2009 IME the majority of women who come to the ED at 3am "for a pregnancy test" either a) are soldiers who just got off-shift and won't pay the bill anyway or b) don't care about the bill and don't care about their credit. they actually have preg tests at dollar tree for , you guessed it, 1 dollar...but of course a 500 dollar er bill that you never pay that ruins your credit forever is worth it if you can save that buck to spend on cigarettes.... Quote Link to comment Share on other sites More sharing options...
Apoptotic Posted June 5, 2009 Share Posted June 5, 2009 IME the majority of women who come to the ED at 3am "for a pregnancy test" either a) are soldiers who just got off-shift and won't pay the bill anyway or b) don't care about the bill and don't care about their credit. what do you mean by "soldiers" ? Quote Link to comment Share on other sites More sharing options...
bcstout Posted June 5, 2009 Share Posted June 5, 2009 All active duty US military will have ER services payed for by tricare regardless of which hospital. Quote Link to comment Share on other sites More sharing options...
primadonna22274 Posted June 5, 2009 Share Posted June 5, 2009 um, yeah, the girls they let in as new recruits these days...what modern times we live in... :rolleyes: what do you mean by "soldiers" ? Quote Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 22, 2010 Moderator Share Posted May 22, 2010 On the alcoholic/head injury front......had a nice pickup last night- 40-something year old guy found smoking wet and having "a few beers" sitting on the curb not far from the hospital- bystanders called EMS for unknown reason. They sat him in a hallway bed, and he's perfectly awake and alert- but repeatedly asking "Why am I here??". He's approrpriately tachying away at around 110 due to the PCP with hypertension, but something just doesn't add up. On the sheet behind his head are small, fresh blood spots. When I notice this, I feel the back of his head and notice a large hematoma with a fresh abrasion. He doesn't know how it got there. Put him in a c-collar and scan his head and neck- wouldn't you know it- small subarachnoid bleed. Scary to think this guy could've been left to rot in the hallway bed for hours waiting to "sober up" 1 Quote Link to comment Share on other sites More sharing options...
Contrarian Posted May 22, 2010 Share Posted May 22, 2010 Nice catch.... and illustrates the point that each and every patient deserves an unbiased, objective professional... because "horses aren't the only things that produce hoofbeats"... Good job...!!! Contrarian Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 22, 2010 Author Moderator Share Posted May 22, 2010 another thing to remember: just because someone is in the e.d. for a workup for "psych clearance" doesn't mean they aren't also having cardiac chest pain...like my pt last week sent over for "hearing voices" who also had ischemic chest pain that everyone else conveniently blew off... Quote Link to comment Share on other sites More sharing options...
Contrarian Posted May 22, 2010 Share Posted May 22, 2010 another thing to remember: just because someone is in the e.d. for a workup for "psych clearance" doesn't mean they aren't also having cardiac chest pain...like my pt last week sent over for "hearing voices" who also had ischemic chest pain that everyone else conveniently blew off... AMEN..!!! and my Biggest current DAILY Pet-Peeve... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 23, 2010 Author Moderator Share Posted May 23, 2010 dude sat in an unmonitored bed with ongoing ischemia for > 1 hr waiting for his "medical clearance for psych admit". when I went to see him I asked why he was there today and he said " I hear voices sometimes but my chest really hurts ever since I ran out of my atenolol, ntg, lisinopril, lovastatin, and aspirin. it makes me really nervous so I smoke more....." Quote Link to comment Share on other sites More sharing options...
medic25 Posted May 23, 2010 Share Posted May 23, 2010 AMEN..!!!and my Biggest current DAILY Pet-Peeve... I second your amen. Our nurses are always in a hurry to clear these patients to psych without any workup. As I always tell them, every crazy person eventually dies from a physical ailment! Quote Link to comment Share on other sites More sharing options...
Contrarian Posted May 23, 2010 Share Posted May 23, 2010 Got a dude last week with a white count of 15... When I called the Ed doc and asked about HIV meds/tx... a CD4/8 count, a Viral load, a CXR (since the TB test we give will likely be useless)... there was silence on the other end as they had not noticed he was a HIV patient and therefore had not considered "HAD" (Hiv-1 associated dementia) or ordered the required labs. I then reminded our admitting nurses that when we accept a admission, we are essentially stating that we CAN properly care for these people and that accepting this patient without the required info... we are basically LOCKING this severely immune compromised patient into a germ-infested environment and exposing them to the virulent bugs and germs of the other psychotic booger-pickers we treat. We then scheduled and had a admitting and Lab interpretation in service to prevent this from re-occurring. We get psychotically manic patients all the time without a TSH/T4/T3/RevT3. I have instructed the nurses to start refusing admissions unless ALL labs and tests are done and faxed to us and in their hands. Not trying to be a a$$hat but, our facility is a non-profit with minimal staff and resources. These patients are in custody and at the hospital surrounded by a couple million dollars worth of diagnostic equipment. They may as well get it all done before they get to us, because the only way we can do a lot of what is needed is to send the patient BACK to the hospital by private ambulance, in 4 point restraints, escorted by staff. So yeah... the whole "oh... its only a Psych Patient, so we don't need to be objective and thorough" gets me a little animated... Contrarian Quote Link to comment Share on other sites More sharing options...
kmash Posted August 17, 2017 Share Posted August 17, 2017 Some things I've picked up as a scribe... Don't push propofol assuming nurses placed the the pads for cardioversion... Always ask medics if POLST form is available Don't discharge patients with unexplained tachycardia Don't give heparin to AMI patient who already has a headache If a patient confirms their chest pain is made worse with movement, clarify movement of the torso, because they can interpret movement as going up stairs. Diabetic shoulder pains=rule out AMI Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 18, 2017 Share Posted August 18, 2017 Send home a tachycardic patient without a rationale explanation. If you do, then the attorney will ask you to come up with one. 1 Quote Link to comment Share on other sites More sharing options...
11BtoPA Posted January 6, 2018 Share Posted January 6, 2018 On 4/23/2004 at 3:03 PM, EMEDPA said: 47.wait to call neurosurgery for as long as possible Don't call for a consult to "get us on board early" without at least a head CT already done which reveals some abnormality. AMS with a normal head CT does not warrant a neurosurgical consult, that belongs to neurology or more likely psych. Quote Link to comment Share on other sites More sharing options...
Derbingle Posted January 6, 2023 Share Posted January 6, 2023 For the ortho exstensor tendon repairs, etc…..in ER in many big cities, for systems without residents, most of the hand ortho guys ask “well did you pull the ends together?” ….NO…..”why not? Go ahead and then splint and send to the office”. Ive had a guy with 3 degloved fingers and skin/tendons all there but severely mangled and the hand surgeon said “put it back together as best you can after thouroughly cleaning it and send him to the office”. i did it, bc he wasnt coming in to see him. These are ortho on call docs covering for up to 6 facilitis at once and usually never come in during non bankers hours. Its frustrating bc if you dont do it, the pt is stuck. Sometimes I just admit them and tell the orthopod he’ll be in hopsital waiting to see him in the AM. Ortho only: What is right and appropriate for the pt is getting further from what was the norm and impossible to get done. If pts are uninsured, majority of docs dont want anyting to do with them. Example: partially ampuated finger, i see the guy 5 weeks after his initial visit, asking have you seen the hand surgeon? With my eyes bugging in surprise (just a little) as he unwraps his healing deformed digit. (Tip of the no e almost covered with granulating skin but not quite) Him: “yes. He said I needed 2500 deposit”. And then sent him home again. Day laborer barely making rent. So he is asking me for suggestions on what he can do to keep it healing. (Jaw drop) bc many of the surgeons simply arent going to treat the patient that isnt or cant guarantee theyre going to pay. So repairing necessarry tendons (like exstensor of the index finger) is something you learn and then ask the patient if theyre willing to accept the risks. Really dislike this part of ER 1 Quote Link to comment Share on other sites More sharing options...
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