GetMeOuttaThisMess Posted November 30, 2017 Share Posted November 30, 2017 Just remember that the 3 am cough could be pneumonia, or at least that’s what I used to tell myself.Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 30, 2017 Moderator Share Posted November 30, 2017 2 hours ago, BruceBanner said: For sure, even worse. I just cant understand that in 2017 people still think there is something the doctor can DO about their cold. I partly blame antibiotic overuse for this mentality. in 2017 patients need an RX for sudafed in many states....their pcp should write it though, not an ER provider... Link to comment Share on other sites More sharing options...
sk732 Posted December 1, 2017 Share Posted December 1, 2017 6 hours ago, EMEDPA said: I have no problem with folks going to see their pcp for a cold. that's better than when they come to the EMERGENCY department at 3 am for 2 days of sniffles...and then complain about the wait... They wait for 2 days??!! Wow, I get them usually around hour 2...so many stupid people, no live ammo. Or more correctly - so many wussy people, FULL STOP. PS - I worked a full 12 hour today, with a mask on my face when seeing people, with a horrible sinus headache - jumped over the fine line between hard and stupid...again. SK Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted December 1, 2017 Share Posted December 1, 2017 I usually say I'm going to place you on abx called loratidine-d. Jk.Sent from my SM-N950U using Tapatalk Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 1, 2017 Administrator Share Posted December 1, 2017 2 hours ago, Marinejiujitsu said: I usually say I'm going to place you on abx called loratidine-d. Or maybe some obecalp would be in order? Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted December 1, 2017 Share Posted December 1, 2017 Or maybe some obecalp would be in order?Had to look it up.....nice :)Sent from my SM-N950U using Tapatalk Link to comment Share on other sites More sharing options...
sk732 Posted December 1, 2017 Share Posted December 1, 2017 My SP said they used to write orders/Rx's for Obecalp in South Africa for a number of years until someone thought it might be unethical... Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 2, 2017 Administrator Share Posted December 2, 2017 10 hours ago, sk732 said: My SP said they used to write orders/Rx's for Obecalp in South Africa for a number of years until someone thought it might be unethical... It would be unethical to lie to patients, if they were, in fact, your patients. If they're consumers, then giving them something non-harmful that increases their satisfaction in the transaction is, well, no less unethical than any other business transaction. If you're getting rated on customer satisfaction, you're in the service industry, not in the medical field. Link to comment Share on other sites More sharing options...
Guest Paula Posted December 2, 2017 Share Posted December 2, 2017 These stories reminded me of a patient who really needed to be seen because she was getting her usual sinus infection. Age 70. Looked healthy. Told me she was sick for two days with a runny nose and sore throat with a bit of a cough. I did the exam and told her: Good news, you have a cold and don't need an antibiotic. She said: I get this every year and my doctor always gives me an antibiotic for my sinus infections. I get these about 6 times a year. I said: NO, you have what is called the common cold and is probably the rhinovirus. She said: I've never had a cold in my life....what is a cold anyway? I explained to her signs and symptoms of a cold and told her the 6 sinus infections she gets every year are probably colds. I told her to wait it out for 10 days and gave her tessalon pearls. Don't know what happened to her, don' really care. BUT Really???? 70 years old and you've never had a COLD? Give me a BREAK!!!! This is a perfect example of Pavlov's dog. Link to comment Share on other sites More sharing options...
sk732 Posted December 2, 2017 Share Posted December 2, 2017 I lump antibiotic demands (most people don't request them - they get more worked up than many narcotic seekers do) in with all other forms of drug seeking behaviour...and I'd have to say it's more common than narcotic demands/requests. Observationally of course...though I'm sure we could really bring up a pile of data if we even half heartedly looked into it. SK Link to comment Share on other sites More sharing options...
Boatswain2PA Posted December 2, 2017 Share Posted December 2, 2017 Worked a shift in an UC yesterday. Wanted to take a cyanide pill halfway through it. 30 patients. Two needed to be seen urgently. 20 of them had colds. One 23 yo had a cold, seen by PCM day before, given augmentin for her "sinus infection" (no fever, HA, or even TTP over sinuses). Augmentin made her throw up so bad she vagaled out and hit her head. Link to comment Share on other sites More sharing options...
sk732 Posted December 2, 2017 Share Posted December 2, 2017 2 hours ago, Boatswain2PA said: One 23 yo had a cold, seen by PCM day before, given augmentin for her "sinus infection" (no fever, HA, or even TTP over sinuses). Augmentin made her throw up so bad she vagaled out and hit her head. At least she has a headache now...I'm going on day 6 of feeling like someone beat me with a bag of hammers, still drug free except Tylenol and the odd Neo-Citron. #StopTheResistance Just now, GetMeOuttaThisMess said: TTP is so subjective that I don’t even bother. You even act like you’re going to touch them and they flinch and say how tender they are. If you have subjective tenderness you had better have snot rolling out otherwise you don’t get partial credit for the “test question”. I give them the good news that Sent from my iPad using Tapatalk Most people that truly have full blown sinusitis look like people with migraine - squinting or sunglasses, talking gingerly, etc - and don't always have rhinorrhea - thick, gooey post nasal drip is pretty frequent. If you don't want to touch their sinuses, accidentally on purpose drop something and ask them to pick it up for you while you do something else and see if they cry or not ;-D. SK Link to comment Share on other sites More sharing options...
MCHAD Posted December 2, 2017 Share Posted December 2, 2017 I wanted to say to the patient with the uri symptoms X 12 hours that I saw yesterday “I’ve had the same symptoms as you for the same time frame and I’m at work! Go take Tylenol and ibuprofen, you don’t need antibiotics!!!” Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted December 2, 2017 Share Posted December 2, 2017 41 minutes ago, sk732 said: At least she has a headache now...I'm going on day 6 of feeling like someone beat me with a bag of hammers, still drug free except Tylenol and the odd Neo-Citron. #StopTheResistance Most people that truly have full blown sinusitis look like people with migraine - squinting or sunglasses, talking gingerly, etc - and don't always have rhinorrhea - thick, gooey post nasal drip is pretty frequent. If you don't want to touch their sinuses, accidentally on purpose drop something and ask them to pick it up for you while you do something else and see if they cry or not ;-D. SK Now THAT's a horse of a different color (no pun intended). True sinus pressure is exacerbated by forward flexion. Example I use is trying to bend over to pick something off the floor and not being able to do so without in turn squatting to do so. Ethmoid/Sphenoid sinuses are going to be harder to get goo from. That's where the Neti pot can be used as a diagnostic tool. "When you use the irrigation do you get nasty drainage out when you blow your nose?" Link to comment Share on other sites More sharing options...
sk732 Posted December 2, 2017 Share Posted December 2, 2017 The other thing people forget is that headache around the vertex is often sphenoidal sinus in origin, and as you said, getting goop out is difficult without a rinse out or taking a good look in the posterior pharynx...getting people to pant like a puppy really lifts up that soft palate and drops the tongue to allow you to see that oogie gooeey goodness running down the throat. And yes, I used "oogie" as a descriptor - it's my all purpose medical adjective for pus, poop, pee and other stuff that is just not right. @MCHAD - remember these words: IF YOU'RE NOT SICKER THAN ME, GO HOME. :-D. SK Link to comment Share on other sites More sharing options...
Boatswain2PA Posted December 3, 2017 Share Posted December 3, 2017 3 hours ago, MCHAD said: I wanted to say to the patient with the uri symptoms X 12 hours that I saw yesterday “I’ve had the same symptoms as you for the same time frame and I’m at work! Go take Tylenol and ibuprofen, you don’t need antibiotics!!!” I have actually told patients that I am sicker than they are! And now you see why I can only do EM. Link to comment Share on other sites More sharing options...
sk732 Posted December 3, 2017 Share Posted December 3, 2017 Last person I saw that was likely sicker than me now is the patient I blame for making me as sick as I am now - they're still in ICU with ARDS likely secondary to viral pneumonia...I'm scaring people by saying it's SARS 2.0, lol. SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted December 3, 2017 Share Posted December 3, 2017 Anyone ever wonder about the erythematous central streak on the pharynx with snot c/o? It’s the acidity (discovered about 1980 or so). Gets better with antacid liquid. Just an FYI. Link to comment Share on other sites More sharing options...
sk732 Posted December 3, 2017 Share Posted December 3, 2017 You just about had me loading my NeilMed with Diovol, lol. SK Link to comment Share on other sites More sharing options...
thinkertdm Posted December 3, 2017 Share Posted December 3, 2017 -"I have a fever" despite not owning a thermometer (literally, no one in central NY owns a thermometer, but every.single.one has a fever) -"I'm going on a trip/vacation/meeting and don't want to be sick" -"I don't want my elderly /newborn/whoever to get sick" -"am I contagious?" -"I've tried allergy medicine" -"I've tried EVERYTHING" -"I've tried Mucinex" -"xyz antibiotic doesn't work" -"I need" Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 3, 2017 Moderator Share Posted December 3, 2017 "amoxicillin doesn't work for me anymore so I list it as an allergy...." Link to comment Share on other sites More sharing options...
sk732 Posted December 3, 2017 Share Posted December 3, 2017 A doc I used to work with was working in a WIC one day when a patient wandered in and came right out and asked "Do you prescribe antibiotics?" to which she answered "Yes, if I think you need them." Patient got up and walked out the door. It's hysterical that we have "Stop the Resistance" posters up all over the place, brochures about how to look after a viral illness, what antibiotics treat and all, but everyone seems to think they are the snowflake that Tincture of Time won't help. The "I can't afford to be sick" thing makes me laugh...especially if I'm at work sick. Another favorite is "I don't want to hear that it's a viral problem"...to which I usually reply "My job isn't to tell you what you want to hear, but tell you what you NEED to hear." SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted December 3, 2017 Share Posted December 3, 2017 You just about had me loading my NeilMed with Diovol, lol. SK Woodford Reserve works well also, but it seems such a waste of good whiskey. [emoji6] Link to comment Share on other sites More sharing options...
sk732 Posted December 3, 2017 Share Posted December 3, 2017 More of a Crown Royal (it's actually made about 50km north of me) guy actually :-D. SK Link to comment Share on other sites More sharing options...
MCHAD Posted December 3, 2017 Share Posted December 3, 2017 One of the funniest things I had a patients mom tell me when I said “well the good news is your kiddo doesn’t have a fever” and she was dead serious “I don’t care what your thermometer tells me, my mommy thermometer (hand on forehead) tells me it’s a fever” Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.