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one of those days


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Second to last fellow today left the hospital four days ago after having a left heart cath, but has been experiencing nausea, vomiting, diarrhea, since he left.  Nothing significant on ekg, aside from tachycardia, but both cardiologist and I thought 911 should be called.  However, I heard the patient arguing with his sons mother about GETTING HER CAR which he apparently drove to the appointment.  I mean, literally arguing.  

Last fellow today was sent to the ed last night from another pcp; he was a new patient to me and they handed me a transfer sheet which had STEMI on the top.  When asked why they left the ED, they said "the bed was uncomfortable, and/or they wouldn't let him eat".  So I sent them back.  But they didn't want to take an ambulance.  So they left my clinic ama. 

I swear, you can't make this up.  I mean, you could, but where's the fun in that?

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yup yup yup. Had a guy having a STEMI in the UC (where he didn't belong in the first place) get up and leave when I told him I was transferring him to the ER BECAUSE THERE WERE TOO MANY FOOTBALL GAMES ON HE WANTED TO WATCH SO HE WOULD GO LATER.

 

In my younger years I would have come unspun. Now I just shrug, document, and figure we have to cull the herd somehow.

Edited by sas5814
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Couple of days ago I had an appy leave so she could go home and take care of her animals (despite my suggestion that the 20ish daughter who brought her could do this).  So, AMA she went, but did agree to come back.  2+ hours later she returned, so we called her preferred destination for transfer (we're a rural critical access hospital with no surgical capabilities) as she was checking in.  She overheard us saying that they were on diversion, so she left to have the same daughter driver her to that hospital.  I had told her before that we would have to check availability before we could decide on transfer destination.

However, her strategy worked for her.  We called ahead to the ED at her destination.  I talked to the attending, FAX'd my note & lab results, and pushed her CT results to the cloud so they could see them.  She got there, got accepted by the surgeon, and had her appendectomy there the next day.  Guess they found a bed somehow.

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10 hours ago, sas5814 said:

yup yup yup. Had a guy having a STEMI in the UC (where he didn't belong in the first place) get up and leave when I told him I was transferring him to the ER BECAUSE THERE WERE TOO MANY FOOTBALL GAMES ON HE WANTED TO WATCH SO HE WOULD GO LATER.

 

In my younger years I would have come unspun. Now I just shrug, document, and figure we have to cull the herd somehow.

My life is better now that I don't deal with these issues any longer!

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I agree.  It’s mostly (and by mostly, I mean 100%) that it put me behind.  My previous teams had a capable nurse but currently lacking this, so I pretty much had to call 911, give report to the ems crew, call the Ed, give report to them, do the transfer paperwork, write the note.  

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We had a guy with a STEMI sign out from our ED with the interventional cardiologist at the bedside ready to go to the cath lab because he liked another facility better and demanded that his wife drive him there. . His ama signed by every staff member in the dept as witnesses said simply "If you leave now you will be dead within the hour". He was.

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2 hours ago, EMEDPA said:

We had a guy with a STEMI sign out from our ED with the interventional cardiologist at the bedside ready to go to the cath lab because he liked another facility better and demanded that his wife drive him there. . His ama signed by every staff member in the dept as witnesses said simply "If you leave now you will be dead within the hour". He was.

I guess he showed you guys who was the boss!

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7 hours ago, CAdamsPAC said:

Just don't  come back to me claiming I am somehow  responsible for stupid people's decisions and acts!!

I remember seeing a guy at 10 pm who presented to the ED with CP and widespread ST elevation. We recommended a LHC of course but he left AMA. He returned around 3am with similar complaints. Needless to say the interventionalist was pissed. Interestingly, no CAD on LHC. 

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18 hours ago, bike mike said:

I remember seeing a guy at 10 pm who presented to the ED with CP and widespread ST elevation. We recommended a LHC of course but he left AMA. He returned around 3am with similar complaints. Needless to say the interventionalist was pissed. Interestingly, no CAD on LHC. 

Pericarditis?

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20 hours ago, bike mike said:

I remember seeing a guy at 10 pm who presented to the ED with CP and widespread ST elevation. We recommended a LHC of course but he left AMA. He returned around 3am with similar complaints. Needless to say the interventionalist was pissed. Interestingly, no CAD on LHC. 

Probably didn't check for Prinzmetal’s.  Wife’s co-worker had a recent cath and I had mentioned it to her.  Clean cath.  She mentions it while on table, he says that its very rare but he’ll check anyway.  Yep,  coronary spasm.

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14 hours ago, Apollo1 said:

Pericarditis?

No. Turns out this guy's baseline ECG was one that looked like a STEMI. We didn't have a previous to compare so obviously we were thinking STEMI all the way. We finally tracked down a previous EGG the next day from another hospital. Turns out this guy was homeless and wanted to spend the night in a warm place with something to eat. He apparently was known to go to several other hospitals in the area from time to time to get a bed and a meal. He had even had a LHC before with some vascular complications but continued to pull off this stunt. 

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2 hours ago, bike mike said:

No. Turns out this guy's baseline ECG was one that looked like a STEMI. We didn't have a previous to compare so obviously we were thinking STEMI all the way. We finally tracked down a previous EGG the next day from another hospital. Turns out this guy was homeless and wanted to spend the night in a warm place with something to eat. He apparently was known to go to several other hospitals in the area from time to time to get a bed and a meal. He had even had a LHC before with some vascular complications but continued to pull off this stunt. 

That's awesome.  It's almost like rapid evolution...dude developed a physiologic adaptation to ensure survival in his environment.  False STEMI > Sammich and bed, next night, next hospital repeat

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I had a guy sign AMA when I was a medic with an Anteior Septal MI, had him talk with a doctor over the radio that told him he was going to die, he still signed AMA, three hours later he was in full arrest and his spouse called, we worked him, he didn't make it.....

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Today had a male in Afib RVR.  Came in 3am with DIB and wanted a Neb.  He was seen by someone else this morning, they identified Afib RVR, started Cardizem drip, etc, and admitted.  Waiting to get an ICA room, he put in his head, if not in an ICA bed by 0730 he would leave.  Well he left AMA.... Came back and saw me now at 3pm still having DIB, wanting another neb.  No idea it was his heart causing DIB.  This time he stayed, his wife got him to come back.   

 

Kettle, you guys get any trouble from the widow after the fact (sued)?  That situation just sucks all the way around. 

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20 hours ago, cc56 said:

Kettle, you guys get any trouble from the widow after the fact (sued)?  That situation just sucks all the way around. 

We didn't she was there as I talked with him, the partner I was working with (dual medic that day) and the ER Dr via the radio. She wanted him to obviously go in but she reluctantly agreed with her husband. He felt like if it was his time it was his time. She even thanked us for trying so hard during resuscitation when we came back but he was a slow PEA to asystole for 35+ mins. Not a day I'd like to relive.

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I get it.  I had an 87 year old lady with STEMI in the office sign a refusal for EMS transport and drive herself to the hospital because she didn't believe me when I said it wasn't shoulder arthritis.  She went so they would give her something for pain. 

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4 hours ago, Sherijane said:

I get it.  I had an 87 year old lady with STEMI in the office sign a refusal for EMS transport and drive herself to the hospital because she didn't believe me when I said it wasn't shoulder arthritis.  She went so they would give her something for pain. 

For a truly acute thing, I don't even hint to patients that signing AMA is an option.  I call 9-1-1 and they can sign AMA with the medics.

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