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Things that make me go hmmm


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On 6/29/2021 at 10:56 PM, Komorebi said:

I'm in psych. My big "hmmm" moment is when the patient says "I'm just switching providers and need to continue my routine medications, Adderall and Xanax." 

I had that happen; Adderall's dose was 30 mg tid and Xanax also something crazy 

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15 hours ago, EMEDPA said:

I love it. people think the ER is a crime lab or something. 

"test this pizza/drink/waffle/strand of my hair for poison!"      No

I actually did run some toxicology tests for a woman who was going through a particularly nasty divorce, but this was in family medicine, and I warned her that the cost might not be picked up by insurance... Nothing was found, as expected.

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How about I had a surgery at hospital A last week, but I've decided to come here at hospital B emergency room for re-evaluation because I don't feel right. By the way, I am not sure exactly what surgery I had and I don't know the name of the surgeon.

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9 hours ago, Reality Check 2 said:

“You should have all of this information. I know your systems communicate.”

Nope. Not even a little.

Or when they forget we can look up their controls.. even from other states.

I had a lady try to convince me she was prescribed fentanyl for a tooth infection in ER

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20 hours ago, iconic said:

Or when they forget we can look up their controls.. even from other states.

I had a lady try to convince me she was prescribed fentanyl for a tooth infection in ER

No lie 

15 years ago a patient of mine went to the ER for AECB.  Came out with script for OxyContin.  Seriously!   He talked the ER doc (not PA or NP) in refilling his chronic pain meds......  WTH!

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So I volunteer at our local fire department in a First Responder role. Got called and responded to a call of a lady who dislocated her hip. This was the 2 - 3 time we had been there in the last year for this complaint. We made her as comfortable as we could and awaited the paramedics to arrive to transport. Anytime we tired moving her she would scream bloody murder. So we just let her lay. The paramedics arrived and told her they were going to give her some Fentanyl to control the pain before we moved her.  She replied that Fentanyl doesn't work and she needed Ketamine. 

Unanimous hmmm could be heard by all the medical and police in the room.

Paramedics said they didn't carry Ketamine and all the had was Fentanyl. Well if that all you have then give me that.

Another unanimous hmmm.

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Had a patient complain to a hospital where I worked in the ED that my diagnosis of opiate overdose was "judging her" and caused children's services to take away her kids.  She was demanding her chart be changed.  Never mind that:

  • she was unresponsive on scene until the medics gave her narcan and then she became responsive
  • I had had to give her ativan to get her calm enough to assess because she was hysterical after the police had removed her children from her residence - and the officer accompanied her to the hospital
  • she claimed I had diagnosed her with a "heroin overdose"

Fortunately the assistant ED medical director and the hospital admin backed me 100%.  I had told them that I diagnosed her with an opiate OD, not a heroin OD, because I didn't have any idea what opiate she OD'd on.

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Had a patella dislocation last week, patient previously had a record of this happening. Stated they needed propofol for reduction. Patient was pretty hysterical and ended up with a wiff of fentanyl and versed. After reduction asked for 30 tabs of oxy to go home with 🤦‍♂️ Needless to say that didn't happen and they then wanted to see a "real" doctor. And before anyone asks we imaged for fractures and they were unremarkable 

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5 hours ago, kettle said:

Had a patella dislocation last week, patient previously had a record of this happening. Stated they needed propofol for reduction. Patient was pretty hysterical and ended up with a wiff of fentanyl and versed. After reduction asked for 30 tabs of oxy to go home with 🤦‍♂️ Needless to say that didn't happen and they then wanted to see a "real" doctor. And before anyone asks we imaged for fractures and they were unremarkable 

For comparison, when I was in the ED for a CT-confirmed kidney stone, I asked for 6 percocet, some Zofran, and Flomax until I could get in to my primary. The attending had apparently forgotten that I was a PA and looked briefly shocked at how sensible my request was.  I gather it was a breath of fresh air. 🙂

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Just had a patient who is taking 4 10mg hydrocodone daily, 3 10mg Flexeril, and 1800mg of Gabapentin daily but won't take B12 because it makes him sleepy.

He looked confused when I told him it wasn't B12. It's a confusing world I suppose

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Today was extra “special” kind of day.

“I think the radiologist didn’t really look at my study. I looked at it and zoomed in and it is obviously abnormal.”

Throw in general chaos and the last minute - “Are you having any chest pain?”……… “Well, yes, I am”………

I am toast. Don’t drink and can’t figure out why right now. 

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11 hours ago, Reality Check 2 said:

Today was extra “special” kind of day.

“I think the radiologist didn’t really look at my study. I looked at it and zoomed in and it is obviously abnormal.”

Throw in general chaos and the last minute - “Are you having any chest pain?”……… “Well, yes, I am”………

I am toast. Don’t drink and can’t figure out why right now. 

I had a guy like that the other day. (Well, both actually; one lady messaged me and and said she looked at her hand X-rays and she KNEW what to look for, and what was the plan?). The other fellow with a stent about a decade ago said he had been having “not pain, but a heaviness” in the left side of his chest.  When he mowed the lawn.  Got better when he mowed slower, so he mowed at his own pace.  He also wanted to talk about his diabetes and how to reduce his a1c from 8.6.  Was he having this sensation now?  Of course he was.  I talked to the cardiologist (luckily across the hall, excellent doc) about his ekg, who recommended we ship him out.  Why was the rn waiting on the asa? Basically the only thing the rn did was wait for the asa? I got to call 911, give report to them, call the hospital, give report to them, fill out the Ed consult.  Oh, rn refused to do ekg until I ordered it.  Verbal apparently not good enough.  Then focus on the next nightmare.

also had a guy in the past who figured the best way to get seen at my little va clinic was to claim he had covid (this was in the early days).  Oh, btw, can I look at his knees?  How does he get a service connection for his knees?  Wasn’t sleeping. What about that?  I walked out at that point and left him with the rn (different than above) who told him the best way to get a seat on a plane was NOT to tell people he had a bomb.

 

 

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On 7/5/2021 at 1:28 PM, rev ronin said:

I actually did run some toxicology tests for a woman who was going through a particularly nasty divorce, but this was in family medicine, and I warned her that the cost might not be picked up by insurance... Nothing was found, as expected.

What kinds of stuff did you test for? There's thousands of things that could poison someone. 

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8 hours ago, rev ronin said:

I forget what all, it's been a few years. but arsenic and heavy metals were in there.

Lasagna, manicotta, or souffle.  Perhaps eggs.  You are right, so many permutations on casserole...you would have pages and pages of results.

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I'm blessed with nurses who've got great skills and initiative.  On a chest pain or dyspnea patient if I'm not in the room at the same time they are, they'll be handing me the EKG to look at (and then order) and a rainbow will be already on its way to the lab for whatever I'll order.  The patient will already have an IV (as long as they have half-way decent veins).

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16 hours ago, ohiovolffemtp said:

I'm blessed with nurses who've got great skills and initiative.  On a chest pain or dyspnea patient if I'm not in the room at the same time they are, they'll be handing me the EKG to look at (and then order) and a rainbow will be already on its way to the lab for whatever I'll order.  The patient will already have an IV (as long as they have half-way decent veins).

As it should be...

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Unfortunately, there are some providers (doc/PA/NP) who get bent out of shape when nurses do things without orders.  I think that's a big mistake.  Most nurses (at least ED nurses) are pretty smart and motivated people.  It's only right to encourage that - often they know what to do and respond like we all do to thanks, praise, and teaching.  Plus, no matter what size your department is, you can get overwhelmed.  So, having everyone there work at the top of their skill sets really helps.

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The 2 nurses I work with daily are expected to work to the top of their license and they do. It is amazing and we really are a team. 

They use their gut and smarts and make my life easier.

Having EKGs, vaccines, labs added on and just forethought is so nice after years of nothing but sketchy vitals and no real insight to the patient.

We work to make sure the patient gets what they need and do the orders and such in whatever order we have to. Just get it done.

Even when the patient makes me go HMMMMMM at high volume, I have one less thing to worry about with my team. 

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