Tales from the serenity now hospital may 2010 anoxic ischemic encephalopathy

Sometimes (ok all the time)….I really wish we could choose who we are going to spend thousands and thousands of dollars working up or saving. I’m not talking about the elderly demented or terminally ill. We will save that argument for another day.

Most county or community ers have frequent fliers. They are patients that come over and over for no good reason. Most are homeless, drunks, or drug addicts. The ER staff usually refers to them as trolls. Here’s a link about 9 patient’s that accounted for 2,700 ER visits in austin, TX.

In my residency, I have at least 20 patients like this. All the staff knows them by name.

We know what they want. We hate them. They suck the life out of us. No respect for the system.Anoxic ischemic encephalopathy no respect for the taxpayer. They are extremely demanding, can ruin your day, and we have to see them each time.

One such patient, we will call him troll-A, came in obtunded from drinking himself into a stupor. He was found down outside of the hospital under his normal bench. He was so drunk he could barely breath. So what do we do???? We have to save him. Why??? I still don’t know the answer. I guess b/c we don’t get to pick our patient’s and who we choose to help in the ER. Even though EVERYONE in that hospital knew it was going to cost someone a ton of money to put troll-A on a respirator and in the ICU.

So we did what we had to do and intubated him so he could keep breathing off his alcohol.Anoxic ischemic encephalopathy about 16 hours later, his alcohol wore off to the point that he extubated himself….Literally pulling the breathing tube out himself….And left AMA (against medical advice). Of course he pissed on the floor and cussed out the nursing staff before leaving. 2 days later he comes back for his chronic low back pain trying to get narcotics!

What the fuck ever. Just don’t say it’s job security like so many people do about these trolls. B/C its not. They are too dumb to go get on medicaid, so know one pays. When no one pays, it wastes money and therefore isn’t job security.

Enough of my rant….Bc if I don’t stop now this post will get much, much longer.

-ER doc

A common phrase in the ER is you can’t fix stupid.Anoxic ischemic encephalopathy here are a few stupid things I have observed lately in the ER.

• A 33 year old hispanic male came in for chest pain. I asked him what made the pain go away. He said taking his cholesterol pill took care of the pain, so it must be his heart. Yeah genius….Daily cholesterol meds don’t fix acute pain.

• A 29 year old female came in for pelvic pain. She could barely walk. Why? Bc on exam she had horrible herpes. She was so confused. How could she have herpes….She has only been with her husband…And there is no way he has been with anyone else! Naive.

• patient came in with chief complaint of my nose feels too warm.

• A 41 year old female who wanted her prescription in liquid form b/c she can’t swallow pills.Anoxic ischemic encephalopathy

• A 15 year old male who came into the ER for the 2nd time b/c when he lays flat then flexes his stomach, he see’s a bulge in his lower abdomen. He was skinny. The bulge was his freaking abdominal muscle.

• an overprotective mom brings in her 9 year old son for a fever. How high? 102. She was concerned b/c he usually doesn’t run ‘ high fevers.’ her daughter, on the other hand, always runs high fevers so she doesn’t worry bout her getting a temp of 102. But mama’s lil boy isn’t supposed to get that hot I guess. Please.

• A 22 year old female came in b/c she had vaginal bleeding. Her last period was 2 months prior. She never took a pregnancy test, and assumed she was pregnant when she missed a month.Anoxic ischemic encephalopathy so when she started bleeding, painlessly I might add, she came in to make sure she wasn’t miscarrying. She STILL hadn’t taken a home pregnancy test. We did one and it was negative. Congratulations dumb ass, you started your period.

• this brings up other stupidity….EVERY patient that comes to the damn ER to get a pregnancy test when we use the same shit the dollar store sells.

-ER doc

We have talked a lot about the rectum on this blog. From foreign body objects stuck inside to prostate exams….It’s always something to talk about for a laugh.

Last week I had a 57 year old guy who needed a rectal exam to check for blood. Boy did this spark up conversation. For some reason before he would allow the exam, he wanted to talk about how no one should get married.Anoxic ischemic encephalopathy he was on his 5th marriage, and said he was talking from experience. He then told me a story how he caught the clap from a girl in his 20s. He broke up with her, then saw her at a club that weekend and told her and her new boyfriend that she gave him an STD. He said a week later his doctor told him he did not have the clap….But had prostatitis.

Ok sir….Can I check your stool for blood now?

If you have to doc. How far do you have to stick it in there? I never could understand how people do this for pleasure. Thank god you hands aren’t bigger.

I think this guy was a closet homo….Not that there’s anything wrong with that. But….Married 5 times, prostatitis in his 20s (shouldn’t happen unless you are playing bedroom catcher), and the quotes from above set off my gaydar.Anoxic ischemic encephalopathy

-ER doc

The ER is for EMERGENCIES. I understand that with our health care system, the ER the safety net for most peoples health care. But if you come into the ER for a freaking cold and you have to wait a few hours longer because we are taking care of real emergencies… Like heart attacks, strokes, traumas, etc….Then you need to freaking chill and be appreciative that you are even going to be seen. Here are a few non emergent middle of the night complaints from a previous shift:

1) A 55 year old nigerian male who is studying to be a nurse came in for nasal congestion. He used to get allergy shots, but says he can’t get them anymore b/c of school. So he wants me, the ER doc, to give him freaking allergy shots once a week.Anoxic ischemic encephalopathy he is tearful b/c the nasal congestion is sooo bad that sometimes he wakes up in the middle of the night breathing out of his mouth. Grow some freaking balls man! I offered him a decadron shot and some decongestants, but of course he wasn’t happy with that.

2) A 39 year old hispanic female came in b/c she had TMD (total me duele). She was off her etolodac and wanted a refill. I sighed and thought fine let me refill this ladies meds and get her out of here. But no….She wanted more. She wanted a pain shot b/c the total body pain had gotten too mucho AND a B12 shot to give her energy. I told her it wasn’t going to happen b/c it wasn’t an emergency. She quickly stated it was an emergency to her and kept demanding the shots.Anoxic ischemic encephalopathy in the end, she got nothing.

3) A 41 year old hispanic female (could have been sisters with the above patient) came in b/c every time she goes outside her eyes water and she sneezes. Wow…What an emergency. Take some freaking allergies pills (over the counter ones of course) and get out of my fucking ER.

4) A 49 year old white male presented for wanting his blood pressure and pain meds refilled. At first I played along. He needed his vicodin for his chronic back pain and clonidine 0.3mg (huge dose) for his hypertension. He said had been out of them for 3 weeks bc he was in jail. Funny thing was, though, his previous ER visits did not list clonidine as one of his meds.

Sir, what did they give you in jail for your pain?Anoxic ischemic encephalopathy I asked.

He said they gave him motrin for pain and nothing for his blood pressure. I said, great, so you have been off your vicodin for 3 weeks now… You should continue the motrin. And your blood pressure is normal today, so you can see a primary doctor for a refill on your BP meds.

That didn’t go over well, and he continued to demand his vicodin and clonidine. Enough games I thought. Look man, your not getting either. I am not dumb. I know what happens when you mix clonidine and hydrocodeine ( you get a prolonged high ). You are either going to get high yourself with it or sell it. I looked at your history and clonidine isn’t one of your meds. You aren’t getting either, so get the hell out before I call the police!Anoxic ischemic encephalopathy

Such a rewarding career.

-ER doc

A 26 yo hispanic female arrived to the ED with multiple chief complaints- including headache, dizziness, numbness, tingling, weakness, and palpitations. When the patient arrived, I reviewed the nurses notes and eye balled her. I quickly realized this patient had nothing wrong because she had a bouquet of positive review of systems. So I turfed the patient to my intern and let him see the patient. I stood close by to observe the encounter.

He walked into the room with the spanish interpreter (because we don’t make out immigrants learn our language) and politely asked her what brought her in. In typical hispanic hystericus, she immediately started pointing to her head, chest, and made the infamous my finger are numb signal.Anoxic ischemic encephalopathy within ten seconds I knew that she had anxiety and needed an outpatient psych consult….But my intern pressed on.

After asking her multiple questions regarding things that make her symptoms better or worse, he sat down and held her hand! He then said, I’m here to help you, please tell me what’s really bothering you? So she let it all out. She said well, two weeks ago I was working at the hotel and a lesbian rubbed my temples! Since then that’s all I keep thinking about! It consumes my thinking and is causing great distress in my marriage. I can barely sleep!

I could barely contain myself. Now every time I see a hispanic hystericus, I can’t help but think that LTR or lesbian temple rubbing, might be the root cause!Anoxic ischemic encephalopathy

-doc sensitive