In the ER, we like to treat ONE problem - it emergent or urgent one that brought you in to see us. Extraneous, chronic “oh by the way” complaints do not interest us. We like when we make a nice tight diagnosis that explains all the symptoms and findings. However, I know this does not always happen - in fact, when people “go down the drain”, ie, start “crumping” or getting really sick, all hell breaks loose and one has to deal with it all.
The other day I had an elderly woman who was a moderately healthy dialysis patient (not that they can really be that healthy to begin with) who had just several hours before had a diagnostic bronchoscopy and was released. She abruptly developed SEVERE shortness of breath and was brought n looking pretty bad. She had been a heavy smoker in a prior life and I am sure had lungs of swiss-cheese. She was wheezing but also sounded like she was in acute pulmonary oedema. What transpired? She crapped out and had to be intubated urgently then:
She developed a high fever
She started having a big-time lower GI bleed
Her CXR looked sort of like a combination of pneumonia and oedema and her O2 sats were barely 95% on 100% FiO2
Her liver functions tests were all screwed up
Her initially sky-high BP dropped like stock market of late from 260 to 100 and we had to take her off Propofol (used for sedation) - she then started becoming very combative
The low BP prevented her from being dialysed
She ripped out her foley and one IV
Her EKG looked like she was having some cardiac ischaemia
The bronch as it turned out showed she had lung cancer
Her family was storming around, wanting to sue the pulmonologist who “caused all this shit”
OK, WAAAAY too much going on! She could not go up the ICU fast enough!
isn’t that about right it couldn’t be that she smoked a carton a day her whole life it had to be the hospital’s fault… ugh
I think the Elizabeth Kubler-Ross 5 stages of grief should include “Lawsuit” as the first stage. “Oh god, I might die! Who can I sue for this?!”
Just a layman here — is “crapped out” a medical term?
I ask because you mentioned that in your post and my doctor has used that term in the past to explain how diabetes forms. I believe he said, “Then the pancreas craps out…”
So I was wondering if that was a term used in the medical community.
p.s. I have no idea how a foley catheter is “secured” in place, but doesn’t it hurt to rip it out of one’s own body?
I had one during my labor and it was uncomfortable in the sense that it made me feel full, if you know what I mean. But I was afraid to touch it, much less rip it out.
Sorry, yes “crapped out” is a colloquial term used in the medical community to discribe someone who is deteriorating. A foley is held in the bladder by an inflatable balloon so ripping it out means it has to pass through the urethra! Ouch!!!!
Crapped out is a medical term.
Now you know what we do in the ICU all day. It’s why we sometimes can’t answer pages immediately or always drop everything and run to the ER to admit my 28 year old with chest pain after running out of Lortab.
Erik, hence the reason I did not want to work in the unit…..
And I don’t know what hospital you work in that would admit a 28 year old with chest pain to the CCU withdrawing from narcs - my unit consultants would laugh.
Hmm…. stat Ethics consult and DNR order?
Pre-existing comorbidities, new CA diagnosis, hypotension/CHF, liver dysfunction, high O2 requirements, perhaps new PNA, all evidence that the circling had started. Hope the pulmonologist got the DNR before the lawyer got contacted.
Dialysis patients have other problems NOT related to dialysis. Myself end of August had myoclonus of right arm and leg with dystoina of upper body-head included. Everyone in ER said “Dialysis related!” my nephrologist knew me well–THANK GOD!!–that I’m as compliant as they come!! Never missed a treatment or come off early. Only 42 and been on hemo-dialysis just over 11 years. Guess what it was?! Fractured cervical 5 and 6 the myoclonus of right side arm and leg with aslipped disc broken off pushing on my spine and the upper body dystonia and balance problems–parkinsons disease. We’re not all idiot’s , non-compliant and dialysis patients actually get illnesses NOT related to dialysis. Please listen to us! I was dismissed by everyone except my nephrologist and the neurologist he called in—after another neurologist stood their ground for hours that it was dialysis related and just dialyze her. All my labs were good!!! Later told by neurosurgeon I could have easily ended up a quad if the neurologist hadn’t realized two things were going on and had me sedated and did a MRI of spine! Thank you for the good doctors–don’t ever assume!!