Moderator EMEDPA Posted July 18, 2020 Author Moderator Share Posted July 18, 2020 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 14, 2020 Author Moderator Share Posted October 14, 2020 So I started a new rural per diem job in april. have been doing 3-6 shifts/month. I applied for this position because I saw that they were not able to fill a half time position for quite a while. Looks now like they will. I am there today and spoke to the scheduling folks to see how this would affect me. Apparently the chief wants to add extra shifts on busy days a few times a month to give me regular shifts rather than have me do very occasional shifts. Nice to feel wanted and appreciated. 3 Quote Link to comment Share on other sites More sharing options...
sk732 Posted October 31, 2020 Share Posted October 31, 2020 After 6 years, left my place and started a new gig in an urban ER - the place my ortho patients go to from where I just left...and some ICU patients too. A bit happier and much more relaxed, though have a 45 minute one way commute instead of 3. My first real day, picked up an "easy" patient to start - small laceration to back of foot. Noticed they were lame - turned out they lacerated their Achilles ...Have had 2 ruptured ectopics in as many weeks...This is incidentally in the "Minor/Low Acuity" zone. My poop magnet followed me. SK 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted November 1, 2020 Share Posted November 1, 2020 On 10/31/2020 at 12:31 AM, sk732 said: My poop magnet followed me. And perhaps your good triage nurse did not..... 1 Quote Link to comment Share on other sites More sharing options...
sk732 Posted November 4, 2020 Share Posted November 4, 2020 Perhaps... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 26, 2020 Author Moderator Share Posted December 26, 2020 well, you don't see this at your typical community or urban ER job.....This poor individual was walking through the woods at night and attacked by a cougar with no provocation. Similar wounds on opposite side of leg. Xray neg for fx or fb. Gave abx, pain control, and rabies vaccine and immune globulin. additional doses needed day 3,7,14. TD was already utd. wounds left open. Yet another reason I love rural EM. 3 Quote Link to comment Share on other sites More sharing options...
MediMike Posted December 27, 2020 Share Posted December 27, 2020 (edited) 7 hours ago, EMEDPA said: well, you don't see this at your typical community or urban ER job.....This poor individual was walking through the woods at night and attacked by a cougar with no provocation. Similar wounds on opposite side of leg. Xray neg for fx or fb. Gave abx, pain control, and rabies vaccine and immune globulin. additional doses needed day 3,7,14. TD was already utd. wounds left open. Yet another reason I love rural EM. I mean, someone comes walking through MY house at night I'd probably attack 'em too! Edit: On a review of other cougar attack wounds these look pretty different. Hard to judge without perspective but the distance between those marks seems to indicate a massive toe spread. Sure this guy wasn't up to some shenanigans? Edited December 27, 2020 by MediMike 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 27, 2020 Author Moderator Share Posted December 27, 2020 2 hours ago, MediMike said: I mean, someone comes walking through MY house at night I'd probably attack 'em too! Edit: On a review of other cougar attack wounds these look pretty different. Hard to judge without perspective but the distance between those marks seems to indicate a massive toe spread. Sure this guy wasn't up to some shenanigans? coulda been up to shenenigans, but the hx was that those were bites, not scratches. He let me inject 10 cc of rabies immune globulin directly into the wounds, so if he was trying to fake me out for some narcs, he was committed and it worked. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 11, 2021 Author Moderator Share Posted January 11, 2021 Heard of this before, but never seen it....alcohol intoxication from drinking hand sanitizer. Guess what you can get for free in the era of covid from homeless shelters, etc? Bingo. Blood alcohol 390. That stuff apparently can MESS YOU UP. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 24, 2021 Author Moderator Share Posted January 24, 2021 Cool case: Benadryl OD of > 4800 mg in an adult. classic anticholinergic toxidrome with confusion, hallucinations, agitation, weird nystagmus, etc 2 large bore IVs, Intubated soon after arrival. NG tube placed for charcoal. Foley placed. Arrival to ICU transfer 40 min. Teamwork! 3 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted March 5, 2021 Share Posted March 5, 2021 38 y/o/m brought in by friends after "altercation". Entire left side of face swollen, eye swollen shut. Patient clearly intoxicated: slurred speach, stumbling. He says he'll walk out - doesn't want to be treated. I don't think he has the capacity to make an informed decision to go AMA. Police called & respond: say they can't do anything - local prosecutor won't support arresting people for d/c or intox if they have come to the hospital for treatment. But, the officers say I could put the person on an emergency detention order - Indiana's version of a mental health hold. This requires a judge's signature. Once I say I will, they tell the patient he has to stay. They do a great job of verbally deescalating. I complete the form and the copier emails the county judge - his email address is in there for just this reason. I call the judge to alert him to the request and he answers personally - at midnight. I describe the situation and he says it sounds like it makes perfect sense - that he'll sign the form as soon as he gets it. Less than 5 minutes later, he calls back. He's happy with the form, but I forgot to fill in a return email address. He takes it over the phone and 3 minutes later I have the form. Incredible personal and very friendly service. Once shown the form,the patient makes an attempt to read it - clearly can't but does agree to stay. Officer and I walk him to the scanner - he wouldn't stay in bed or tolerate a C-collar, and he gets his scans. Fortunately negative - I release him and release the order, literally minutes before the helicopter arrives to fly out my non-compliant diabetic in DKA with a pH of 6.6. Blessed to have such a great judge, and 4 officers from 3 different departments (75% of the LEO's on duty in 1 county and 50% of those on duty in the next county over) who together protected a patient who was a PITA from himself - and the hospital and me from a huge legal risk. 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 14, 2021 Author Moderator Share Posted March 14, 2021 #1 is why I don't use spinny blades. seen day #3. pain out of proportion to exam. clinical concern? #3 tracking board: "He's the one they call Dr Bad labs" Think Motley Crue. 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted July 17, 2021 Share Posted July 17, 2021 (edited) Typical night: Nurse snapping green beans between patients Treat & street: need for work note, 5 y/o/m with poison ivy guess where after peeing, onychomycosis, victim of DV, hyperglycemia w/o DKA Admit 2: COVID-19 with mild hypoxia, 70 y/of/ hypoxia with no clear etiology - had COVID months ago, ? post COVID lungs Discharge 1 unwanted guest from waiting room: Edited July 17, 2021 by ohiovolffemtp 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted July 17, 2021 Share Posted July 17, 2021 As I was slowly scrolling down on my phone it looked like it was going to be a picture of a platter of burritos, thought some family member may have brought you a gift. The end result was not as appetizing. 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 5, 2021 Share Posted August 5, 2021 The CEO of the hospital just dropped off a 5 gallon pail of sweet corn on the porch of the house where we stay. Makes up for the night before with the late 20's female meth OD who hid a bag "internally" which broke when she pulled it out. Had to do a speculum exam and a "wash out" to remove remnants. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 6, 2021 Share Posted August 6, 2021 On the other hand, I've given a gram of ketamine in the past 3 days. Sigh.... Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted March 28, 2022 Share Posted March 28, 2022 Nurses on the in-patient floor call me and tell me that a demented patient is looking out her window and thinks there is a drug deal going on in the parking lot. It's about 03:00, the "parking lot" the patient sees is a gravel area where staff parks that has probably 4 cars in it, no people, and maybe the occasional raccoon on the way to the hospital's dumpster. The nurse asks if I can drive through the parking lot with my red lightbar on. Of course I do. Of course the patient sees it. Of course she thinks the police are there. Of course she asks if the officer can come in and take a report from her. 3 2 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2022 Author Moderator Share Posted March 29, 2022 On 3/27/2022 at 8:38 PM, ohiovolffemtp said: Nurses on the in-patient floor call me and tell me that a demented patient is looking out her window and thinks there is a drug deal going on in the parking lot. It's about 03:00, the "parking lot" the patient sees is a gravel area where staff parks that has probably 4 cars in it, no people, and maybe the occasional raccoon on the way to the hospital's dumpster. The nurse asks if I can drive through the parking lot with my red lightbar on. Of course I do. Of course the patient sees it. Of course she thinks the police are there. Of course she asks if the officer can come in and take a report from her. Um, what is up with this? Side job as a tow truck operator? 2 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted March 30, 2022 Share Posted March 30, 2022 6 hours ago, EMEDPA said: Um, what is up with this? Side job as a tow truck operator? Volunteer firefighter paramedic. Carry a pager, respond with red light & siren either to the scene or to the station. Many of us, especially those that don't live close to the station have red lights & sirens on our personal vehicles. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 30, 2022 Author Moderator Share Posted March 30, 2022 31 minutes ago, ohiovolffemtp said: Volunteer firefighter paramedic. Carry a pager, respond with red light & siren either to the scene or to the station. Many of us, especially those that don't live close to the station have red lights & sirens on our personal vehicles. gotcha. When I was a volunteer in philadelphia we got blue lights. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 6, 2022 Author Moderator Share Posted August 6, 2022 You know you work at a rural hospital when you have 2 unrelated pts on your tracking board with a c/o "stepped on by cow". Great, we have a serial stomping cow in the community. 2 1 Quote Link to comment Share on other sites More sharing options...
VentiMacchiato Posted August 6, 2022 Share Posted August 6, 2022 28 minutes ago, EMEDPA said: You know you work at a rural hospital when you have 2 unrelated pts on your tracking board with a c/o "stepped on by cow". Great, we have a serial stomping cow in the community. They may be lactose intolerant; no, they are bovine intolerant. 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 7, 2022 Share Posted August 7, 2022 8 hours ago, EMEDPA said: You know you work at a rural hospital when you have 2 unrelated pts on your tracking board with a c/o "stepped on by cow". Great, we have a serial stomping cow in the community. Treated a patient who was about to lose a testicle after it had been stepped on by the bull that had thrown him off during a bull riding event at a rodeo. He was asking when he could go back to bull riding. I asked him if he really wanted to do this because "you just lost your only spare". He still wanted to go back - go figure..... 3 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 7, 2022 Author Moderator Share Posted August 7, 2022 42 minutes ago, ohiovolffemtp said: Treated a patient who was about to lose a testicle after it had been stepped on by the bull that had thrown him off during a bull riding event at a rodeo. He was asking when he could go back to bull riding. I asked him if he really wanted to do this because "you just lost your only spare". He still wanted to go back - go figure..... I saw a dude like that a few years ago. had orchitis with fever of 104. also wanted to go back riding... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 16, 2022 Author Moderator Share Posted October 16, 2022 No ortho available within 100 miles to take a pt to the OR to irrigate out a nasty 12 cm lac full of gravel and dirt? No problem. I borrowed the paramedics' firehose and with the pt's consent irrigated their lac out in the ambulance bay. Worked really well. 1 Quote Link to comment Share on other sites More sharing options...
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