OK, this one is pretty subtle – and I imagine only a radiologist or a neurologist (no pressure Dr Grumpy) will see the abnormality on this head CT.
History is that it is a 60 year old male with extensive cardiac history who called EMS because of severe sudden onset vertigo, nausea and vomiting.
He got IV fluids and Zofran by paramedics and Meclizine by me and felt better.
He got the CT because he was on Coumadin and was a serious vasculopath (very bad vessels with a propensity for heart attacks and strokes, etc).
What we found required him to be admitted for a while despite his feeling better.
So, what is the finding, what caused it, and what do you do about it?
If you read my blog a while back, you might remember that I had a “difficult” conversation with a Dr who is a complete jerk. In fact, I called him a prick on the phone. That’s the first time I really told another doctor off. He deserved it. He is pathological. He’s an OB/GYN who bascially got pissed off at me when I asked him to admit a patient of his who had dysfunctional uterine bleeding with a Hgb of 6.4. Come on douche-bag, what do you want? You want me to wait to call you til she is coding?!??!
Anyway, this winner had another patient come in (I groan every time they do). This crap was even worse. The woman was 7 weeks pregnant (didn’t know it) and had severe lower abdominal pain. Her ultrasound was interpreted by the U/S tech as “3 cm mass in the right adnexa (the area around the ovary) with moderate free fluid in the pelivs. No IUP (intrauterine pregnancy), Highly suspicious for ectopic pregnancy”. To any normal OB, (and any doctor with any brains at all) this is all you need to tear ass in and take her to the operating room.
Not Dr Prick though. He was all pissy (as expected). He refused to come in (or even take any phone calls) until the scan was OFFICIALLY read by the radiologist (which would not happen for at least another 2-3 hours). Meanwhile, the patient is bleeding out….
What to do? Call someone else. Luckily, someone else that usually covers him was available and of course came in right away. Pt’s belly was full of blood but luckily her blood counts were stable enough to avoid a transfusion. Had to take the whole tube (fallopian) out but she did fine.
What about Dr Prick? Luckily the doc that took her to the OR called him and was like “What the F is your problem!?! Get in here and help me with this case!!!” He came in and without a word to anyone, slunk up to the OR to assist. I really hope somehow this guy loses his license. Hopefully it won’t take someone dying for him to do that. But to all you concerned citizens out there, yes, we have done something about it through the appropriate channels….
WhiteCoat here with another health care update. See more health care news from around the net over at my blog over at EP Monthly Magazine.
Bounty hunter trying to take patient into custody gets stymied by emergency department charge nurse. Too bad, Dawg. Bounty hunter then calls police who show up in the ED. Charge nurse gets threatened with obstruction of justice.
Good thing there’s no snow on the ground. Sledding injuries cause more than 20,000 ED visits per year. Studies of ED visits between 1997 and 2007 showed that 26% of the injuries were fractures, 34% of the injuries involved the head, injuries to boys beat out injuries to girls by a 3:2 margin, 4.1% of all emergency department visits required hospitalization.
Fewer concerns about fibromyalgia patients getting raped on a date. FDA panel rejects application to use GHB – a “date rape” drug – to treat fibromyalgia. After seeing this article, I had to look up the indications for actually prescribing GHB – also called sodium oxybate. Pretty much limited to narcolepsy and cataplexy. Nothing more.
LA County pays out $5.5 million to patient diagnosed with brain bleeding, hospitalized for 5 days, released, and then who returned the following morning with massive brain damage, retardation and paralysis.
Speaking about LA County - the number of malpractice settlement payouts against the county dropped by 70% from 354 to 107 … but … the payouts increased by 50% from $8 million to $12 million.
Improving patient safety one corrective action plan at a time. Newborn baby accidentally given morphine. Heart rate drops and requires intubation. Later discharged in healthy condition.After the mixup was discovered, the hospital was fined $50,000 and had to come up with a “corrective action plan.”
The hospital’s plan to prevent things like this in the future? “Medications would no longer be administered in the neonatal intensive care unit.” Hope this is just a typo, but if not, patients at the hospital should hope their critically ill infant doesn’t have sepsis and need IV antibiotics or need blood pressure medication – under this “safety measure,” he won’t get them.
I love it when I can disposition someone fast. I love it when I can make the diagnosis before I see them (I just read the triage) and actually type up the entire H and P based on it and discharge papers before I even walk in the room. I would say I am right about 9/10 times when the chief complaint makes for an obvious diagnosis. The challenging part is not the diagnosis, but the whole H and P. I guess I only have to change details once in 5 with most patients. Usually small stuff like 4 instead of 3 days of cough, or 2/6 murmur instead of no murmur, etc.
The other day I had a perfect one. Chief complaint “Cough” in a 3 year old. I saw the mom walk with the child back to the room and heard her cough once. It was like a barking seal. Done. Croup. I estimated the history (2 days of URI sx then barking cough for several hours), the exam, normal except for mild stridor, and typed up the Rx for steroids. I left the discharge papers with the nurse and walked into the room (the nurse was like WTF, you did not even see the kid!). It took me 3 minutes to talk to the mom and examine the kid and had to make no changes to my documentation or discharge instructions. One less in the rack….
My day shift over the weekend gave me a host of wonderful “leftover” sign-outs. The most notable of which was the lovely gentleman featured in the last two posts. However, he was only one of the characters who spent the night before in drug-addled binges.
One man came in with “Crack Overdose” – he did 500$ worth of crack in a short period of time and stated he “did not feel well”. He had chest pain and palpitations and while waiting for my evaluation, the RN found him with the cardiac monitor leads wrapped around his neck like a garrote. Hello psych consult.
Another man decided to smoke “an entire quarter” of weed and then pop about 6 Xanax. He started acting “strange” according to companions and they brought him in. He yelled at the PA who saw him claiming she had “invaded his house and dragged him in”. It escalated to spitting followed by a nice big fat 10 of Haldol.
A young woman met a young man at a party. They decided to go home and have sexual relations. The woman was brought in because she said “It was the best fu** I have had in a long time” but then she got sudden pelvic pain, stood up and passed out, striking her head on the floor. The most amazing part of this is that the guy did not just yell “Peace out Sista!” and bolt. He actually brought her into the ER and stayed with her. I guess he wants a second round next weekend.
Finally, a woman drank too much at a party and then when she awoke the next morning,while still in bed, vomited all over her husband. He got annoyed concerned and brought her in for a “bad hangover”.
Can’t wait til next weekend!!
RN (to the man in the post from yesterday): “Awww, come on! Look at the mess you made!”
Patient (in 10/10 affected lisping feminine voice): “YOU sound like a party-pooper! Here, have some more!!!”
Pt procedes to roll onto his side, spread is buttocks apart, and expel faeces all over the bed and floor
RN: “OK, there are some paper towels right there. You can start cleaning that up now please”.
When one is planning an orgy, the most important part is the guest list. Obviously you want hot people. People with clean bills of health. And people with good bodily hygiene. Most sane people would agree on this.
For some reason, if I were to organise a sex party, I might specifically try to exclude a known HIV+ man (on no meds for it nonetheless) with rotting teeth who shoots up Meth and is incontinent of stool. I don’t know, call me bigoted but I just don’t want that guy there.
Evidently some other people welcomed this guy to their orgy – basically a late 70’s-early 80’s bacchanal of gay men going at it with each other fueled by drugs. Unfortunately for this guy (and the other guests), he did too much Meth (he only shoots it he says because he doesn’t want it to “wreck his lungs”)after giving himself the pre-receptive intercourse enema and someone called EMS for his agitation and bizarre behaviour. By the time he got here he was defaecating all over himself.
Man, there goes the life of the party!
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Alcohol or Drug Addiction?
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