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Voices Carry

Wisecracking doc that I work with recently had a little surprise.  He was walking down the hallway and saw a nurse escorting a mother and her overweight young daughter into a room. Daughter was holding her right eye.  When the patient’s registration was completed, he signed up for the patient, took a swig of coffee, and said “OK, looks like it’s time to go see what’s wrong with Honey Boo Boo‘s eye.”  A couple of the nurses chuckled and he ...

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Hurry Home

  First of all, I’m having blog withdrawals. Seriously. I wish I could make a living writing a blog. It would be my dream job to write blog posts and troll the internet. Maybe some day. So a quick story before I go to bed for another long day tomorrow. At one of the hospitals where I moonlight, many nursing homes refer patients to the emergency department for routine medical care. Stuff like “patient has a rash for a week” or ...

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One of many ambulance transfers included a 80-ish year old nursing home patient who was sent by the night staff at the nursing home because they were too busy he had mental status changes. When the patient arrived, he seemed OK to me. Awake, alert, smiling. Held a relatively normal conversation. Watching the news on television. He even grabbed the remote and muted the sound when I came into the room. Unfortunately when a patient gets sent from the nursing ...

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Patient Encounters

Alert and Oriented x 3

A blast from the past … A nursing home patient was brought by ambulance for a complaint that they woke her from sleep, er, um she was having mental status changes. Her chart listed a slew of medical problems including dementia and the fact that she was “non-verbal.” It was busy that day, so the nurses ordered the basic “dementia” workup while the patient was waiting in the room. When it was finally her turn to be seen, I went ...

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Unnecessary Testing

An 89 year old little old lady is brought in because she is weak and doesn’t want to eat. She hasn’t eaten in about a week and she hasn’t been out of her home in longer than that. Finally a friend visiting her convinces her to come to the hospital for some IV fluids. When she arrives, her tongue is dry, she’s tachycardic, and she has no urine output. We begin fluids and obtain labs that show she is moderately ...

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Reasonable Conclusion?

When, over the period of 10 minutes, medical personnel hear the following statements from an elderly patient: 1. “You come any closer to me, I’m going to stick my boot up your a** so far, I’ll come out with a bare foot,” 2. “Up your a** with a meat cleaver,” and 3. [While making sure that the patient has a steady gait] “Stop following me. Next thing I know, you’ll be sticking something in my a**,” is it reasonable to ...

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Great Door to Balloon Time

Interesting but sad case that bypassed the ED but about which we later heard. An elderly female with previous coronary artery disease, diabetes, and hypertension called EMS for chest pain. Then she has a syncopal event in front of her husband. Medics arrived and found the patient in ventricular tachycardia.  They cardioverted her back to sinus rhythm, but she was still hypotensive. EMS transports her as a sudden cardiac arrest to a STEMI facility. The patient is taken directly to ...

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