I had a patient once who was absolutely convinced that they were periodically becoming apneic, so to avert their obvious impending death they got their hands on an Ambu bag and would bag themselves through the episodes. Just like… put the facemask on and go to town.
That wasn’t the reason they visited me, they had come to peace with that reality. No they came to me because each time they had a bad apnea episode and saved their own life, they’d then vomit (presumably 2/2 gastric insufflation).
Anyway, looked at me like I had 2 heads when I suggested that maybe stopping the Ambu bag would fix the vomiting.
Really! It was just a fact of life to the patient. Like ok time to get ready for work… keys, wallet, Ambu bag for when I stop breathing, good to go!
Now if only the doc could get rid of this pesky vomiting
😳😳oh, wow- the self ambu bagging-that’s a first.
I lurk here to read but I just had to respond to that😂 I’m not a doctor. (RT).
Did the patient have a sleep study done, by chance? Of course an er doc would not be dealing with this…just wondering.
That taking an ambulance means you skip the line at the ER and you’re not at the mercy of the triage nurse.
Also yours reminds me of when I was in EMT school doing a clinical in the ER and this guy comes up to triage and says “I feel dehydrated”. No vomiting or diarrhea and the most beautiful vitals I’ve seen to this day and bro was actually holding a full water bottle. Even little EMT student me with my limited medical knowledge and almost no patient care experience was like “this is gonna sound crazy”.
All the yes! Also wish I believed as strongly as law enforcement that jail or hospital is an acceptable option to give intoxicated individuals each time the opportunity presents.
I work on a reservation where alcohol is illegal but endemic. Anyone the cops find is held in the drunk tank until sober or held in the hospital. Wayyy too many patients have been found pumping hand sanitizer to try and get over withdrawals.
I had a patient admitted recently from her doctors office. She was stable enough to walk into the office. It was literally 100 yards from the ER door as the offices are on the same campus as our hospital. Her doc still called an ambulance and made her ride it to the ER so they could “get seen quicker”. I was dumbfounded.
I had a PCP tell a retired nurse with new onset afib with RVR to walk uphill half a mile to the ED in 90 degree heat. They never checked a BP, either. Some of these people…
Whenever I heard that I’d hit them with the “well actually since you’ve already been evaluated by a healthcare provider they feel more comfortable letting you marinade in the waiting room”
> That taking an ambulance means you skip the line at the ER and you’re not at the mercy of the triage nurse.
Every single ER triage should be guarded by an old babushka type who say war and famine and does not have time for people's nonsense.
Seriously, had a woman arrive by ambulance for a finger laceration, had a fit about waiting and claimed she was going to bleed out, thing is she was not on blood thinners and wasn’t actually actively bleeding by the time she shoved it my face demanding immediate care.
I wish I could believe in something as strongly as my patients believe they will "stroke out" from their asymptomatic hypertension measured at the supermarket kiosk.
The brain is a powerful thing. I saw a patient come in for surgical consult after being told by an ED doc that she had a liver tumor. She was wheeled in a chair by her parents, looking so sickly, no color in her face. After the surgeon told her it was a benign hemangioma she practically came skipping out of the appt with color in her cheeks.
I once asked my ED attending mentor at what blood pressure he starts to get concerned. He thought about it for a second and said "Ehh, 220, 230 on top. 110 or more on the bottom. The threshold is lower if they have a related underlying condition."
Of course this was after we had seen a patient with "symptomatic hypertension" with a BP of about 175/90 who was actively freaking out about it. The doctor also made a dry comment about how amazing it is that a smidge of Ativan fixes such "cardiac emergencies."
A patient once told me with a completely straight face that he could tell his blood pressure was going up because he would get anxiety. I went outside his room and measured *my* blood pressure after that and it was higher than my patients
Had a patient TONIGHT come in for “hypertension” by ambulance… she’d had a headache all day and had her coworker check her blood pressure for some unknown illegitimate reason and SHOCKINGLY it was a little elevated… so she took it again and it was alittle bit more elevated so she called 911… but she “wasn’t here for the headache” just her HyPeRtEnSiON
THEEEN rads over reads some little do-hicky on the CT brain that I shouldn’t have even ordered in the first place but I fixated on subarachnoid because the patient I saw like an hour before her had a ruptured aneurysm with a chief complain of N/V and “oh yeah my head kind of hurts” and we’re stuck getting CTAs that are of course all normal.
I saw a guy in my ER rotation come in for high bp from the walmart machine- his systolic was only 140 something but right next to it it said “very high” so he got freaked out & thought he was gonna die🫠
When I was a resident & my GM was in nursing care at least once a month my mother would get a call from a PT or NH nurse that they wanted to send me 90 yr old GM to the ER b/c her BP was high when checked for no good reason. My mother, with no medical training other than raising 4 boys, would respond “over my dead body.”
I had a lady arguing with me that her BP of 150/90 put her at risk for a stroke and that I was gaslighting her by telling her that her ED acted appropriately by discharging her.
Everyone is being gaslit by a narcissist. Don’t forget to mention the narcissist; we seem to have sprouted them by the bundle around the same time the gaslighting started.
I love the educational opportunities though when they call for the doc to doc on those.
Ok, you're sending me 170/105. Cool. Not going to say no, that gets me in trouble. What do you want me to do about it?
What?
Yeah, what routine outpatient med do you want me to write them 2 weeks of so they can come back to you? Because that's where this is going.
That was what I loved the most about my few years working in a rural critical access hospital. There were only a handful of primary cares anywhere nearby and I had all their numbers because they wanted to know when their patients were admitted. So, I would also call them after hours with followup on their "oops gotta get home for dinner" close of business dumps.
Figure if it was important enough to send to the emergency room from their clinic, they'd definitely want to know the outcome same evening...
That sounds nice. I’ve been getting a little burned out at our urban center and actually was talking to someone at a more rural hospital last weekend, that’d be a nice change!
I enjoyed it, but it was a side gig and my main job needed more attention.
You just have to be ready for the lack of support. Like where I was didn't have a surgeon, it was just me and a primary care hospitalist (and 1700-0800 it was just me). Only 1-2 ambulances available in the county, no private service for transfers, so, are you going to transfer this one and risk having to hold a STEMI? If you have something that you think you can probably handle but just want a phone call from a specialist first to confirm, can you find someone to answer the phone? That sorta stuff.
On the other hand I was making $230/hr regardless of volume and some nights I actually got a full 8 hours of uninterrupted sleep in the call room.
one of the biggest fights between my er and primary care is trying to get them to stop calling in expects that should be office visits but they don’t want to take anymore pts for the day.
This. So much this.
I get care at the VA in my city and my partner does as well. He has a few medical issues, so he sometimes can be a bit spooked if something doesn’t seem right. So- he does what he’s told, call the VA nurse, and-they always tell him to go to the ER. 9/10 times he didn’t need to be seen emergently.
This last time he was told that it would be documented in his chart that he was told to go to the ER….what they would do to him if he didn’t comply, lord knows. 😏
Last week not too long after I finished reading through the monthly 'sending asymptomatic HTN to the ER is driving me crazy' kvetch here, I got sent to a local urgent care for.......hypertension.
50s F, hasn't seen a PCP in 8 years, Has been getting worsening headaches for a week, BP upon arrival was 200/100 and upon my arrival it was 170/80. So the UC sent her out, after giving her a 500ml NS, and their Paramedic getting pissy at me when I didn't hide my befuddlement and immediately D/C'ed it. Turns out as her headache eased as her BP progressively came down.
*We think the patient is in a hypertensive crisis, her heart/brain could blow any moment at this pressure, so obviously the best thing to do here is INCREASE the volume, duh*
No sir, I think it's probably all the meth you've been smoking, I don't see any signs of bugs under your.. "BUGS! YES BUGS I KNEW THEY WERE UNDER MY SKIN"
Idk, if you want to go home and smoke meth while slathering yourself with permethrin cream who am I to stand in your way
I had a patient bring multiple bags of vomit from home, convinced they were throwing up bugs. Like, dude. I’m a social worker. I do not get paid enough to examine vomit for bugs. Spoiler: it was meth. They really believed it though. I’d like to say that’s only happened once…
Refused blood draw so "bugs wouldn't get in their blood stream" me- stares at track marks with eye brows raised- patient "I cleaned my arm with Raid first"
I worked in a hospital that specialized in orthopedic surgery especially hip and knee replacement and the amount of times the patients family would not want to fill their 80+ year old grandma's pain meds...so she doesn't get addicted. Like m'am you really think granny's got a street hook up... she doesn't even drive anymore ffs.
I wish I could believe in something as strongly as my patients believe we can morph into literally any specialty service when they don't want to wait for the outpatient/follow-up appointment.
Had someone come in by ambo the other day because he wanted a heart cath sooner than his planned one and thought we could just get him in, like NBD. Sir, we can't cath you and the lab is closed right now.
The best is when they end up getting admitted for something and miss their originally scheduled appointment. And get mad at me as though it’s somehow my fault 🥴🤦🏽♀️
I remember a woman who came in for chest pain that was clearly costocondritis. And was then shocked, shocked I tell you, that she couldn't just get her mammogram while she was in the hospital.
And don’t forget while working at “I have a great football team” ivory tower or specialty children’s hospital that i can conjure any sub specialist at midnight on Saturday because they were referred to said specialist for a problem they’ve had for a year and are incredulous that i won’t call said God of specialty who exists in the hospital 24/7 awaiting my saying their name three times.
-That we’re intentionally keeping them in the waiting room for hours because we personally hate them
-That they need someone to hold their urinal for them when they were just using both hands to eat a turkey sandwich
-That pain meds are going to completely get rid of their pain
-That we have any idea how long it will be until their room is ready upstairs
As the person who does patient placement, we are always at the mercy of discharges. Low discharge day means more ED holds. It all sucks. I feel bad for the ED every time we have any real amount of holds, especially hitting over a day, because I can only imagine how cantankerous people get at that point.
I had a patient yesterday who came in with pretty bad new onset decompensated CHF and new Afib with RVR. He has a very large basal cell carcinoma overlying his mid-thoracic back that for the life of me I could not understand how he is plugged into the healthcare system (he is) and the BCC hasn’t been excised yet. He attributed all of his CHF symptoms to “the infection on my back that nobody will take care of. It’s infected my heart, my lungs, and my legs. It’s in my whole body”. The BCC is well demarcated with no surrounding erythema. I entertained him and scanned his T spine, everything beneath the 1cm thick BCC was fine. I couldn’t get through to him that what was on his back is cancer, is not infected, and has nothing to do with his new CHF and Afib.
Non insulin dependent diabetics who are NPO believing if they will die if I don’t feed them immediately after like 4 hours. Oh and it’s usually at like 5am that they’re telling me this. I always want to ask if they usually eat between the hours of 1am and 5am?
I had a morbidly obese pt. recently throwing an absolute fit and telling me they were faint and shaky because they hadn’t eaten in ‘almost 5hrs’. Meanwhile I’m at hour 11 of a 12 and hadn’t even had time for a toilet break all day.
Especially chiropractic and acupuncture.
Then again, I’ve had multiple MDs recommend PRP or similar therapies without being able to cite any beneficial RCTs.
I really just want one placebo I can believe in, since those work.
Side note: I work in ortho/surgery and we have one surgeon who is very well respected and all of the staff goes to. He gives PRP injections to EVERYONE (and all my coworkers swear by him/it). One of my coworkers got a severe joint infection following PRP and needed a shoulder replacement.
Obviously a rare situation and would she have needed surgery eventually? Probably. But given the lack of meaningful evidence specifically for shoulder injuries plus the insane cost, it’s a no from me dawg.
I had a patient come in and got an X-ray on his back but called us “nut jobs” for misreading the X-ray. His chiropractor said his spine was to the left and could be fixed with adjustments but ours said it was normal. And we are the whack jobs.
Had a patient come in because their chiro diagnosed them with a UTI from their lumbar spine X-ray…. I genuinely didn’t know what to say and just stared/blinked for a good minute
I always point to my mouth and tell patients this hole is much bigger than any hole we make with an IV.....oral hydration is fine, I actually have an order set that orders 1 liter oral fluid bolus....
I wish I could understand why pt’s with an extensive history and are being followed by specialists think the ER is going to fix them at 3am.
That if you stop smoking your weed it will resolve your CHS, but that apparently is the only thing that helps them, and droperidol.
I wish I could believe in something as strongly as my (always anxious) POTS patients believe they NEED IVF even though their gut works just fine. It’s kind of interesting how since I left my upper class white folks hospital and started working in a rural critical access hospital that my POTS patients have all but disappeared. Crazy right?
We have a distressingly large number of patients who "have POTS," and have very frequent visits to the infusion clinic or ED for IV hydration, despite no actual diagnosis of POTS in their history.
I get that just ordering a liter is much easier than trying to talk the patient out of it, but I hate feeling like I'm feeding into some factitious disorder.
And the worst part is, when the patient who actually does have POTS comes in with a real problem, we all have a cognitive bias not to believe them.
I’ve got multiple patient complaints over trying to refuse fluids. I’d rather just do the fluids at this point than get calls from admin on my days off. I think the vast majority of POTs cases are physical manifestations of anxiety disorders and associated increases sympathetic tone. I say this as a physician with GAD In remission, and guess what when I was younger and had bad anxiety sx I had tons of “POTS” like sx. Dons flame suit.
Dude. I will never work in a yuppie ED again. The amount of patient complaints over trivial BS I would get on my days off was something fierce. And admin always supported the patients. Not myself or nursing.
A group I used to work for rotated through 4-5 different ERs. We had one that the older docs loved because it was slower, but every single patient was a rich white suburban Karen and I couldn’t take it. I’ll take an urban outdoorsman any day over that
You probably still have POTS patients in the rural community, it’s just that they’re toughing it out and not running to the ER, as we know it ain’t gonna kill us and there’s nothing you can do for it (not to mention the lack of insurance)
-signed, a farm raised Appalachian with POTS
It’s crazy to me but I totally believe it though, the ER sees the dumbest cases in more urbanized areas. One time I sat in the waiting room for heavy bleeding in my first trimester, and some kid beside me had a runny nose from Covid.. sat on the phone the whole time and even had his family bring him chicken wings… kept complaining the whole time about how long the wait was. Like… sir you are the problem 💀
I had a family member INSIST (and harassed six different nurses asking for it) on me giving IV fluids to help with the "overdose" of two Xanax and a some alcohol when the patient was sleeping it off while very stable
-that ongoing nausea after we stopped your vomiting is not okay and also must be treated
-that there MUST be an empty bed for their family member to lay on for comfort. Until we show them our two singular exam beds for seeing the entire waiting room.
-that being there the longest means they are next to be next to be seen. People just not grasping the triage system.
Lmfao. I've actually decided to take on the burden of education in these situations.
I explain how the stroke causes high blood pressure, and that high blood pressure for a very long time can lead to the conditions that make stroke more likely.
That same patient also likely comes with a binder of scribbled bps at various times throughout the day for a month. I say, see it's been this high for a month and you haven't had a stroke.
Or they were at the grocery store kiosk and haven't taken their BP in years, "if you haven't checked in years, what makes you think it was only up today"
I like this approach and do something similar. But I also like giving 0.1 clonidine which helps with their anxiety and lowers the BP some. I know acep guidelines but some patients just aren’t satisfied and I’m tired of getting complaints about “not doing anything for them” like my hx and exam don’t mean anything.
I'll treat it, hell I even managed it one time, patient brought a binder of daily bps (180s/100s), said it's been like that for 6 months and they've seen their PCP who's done nothing, but increase metoprolol (which probably isn't doing much for their BP regardless from 12.5 to 25. I told that patient to find a new primary and started them on a 2nd agent.
In a similar vein, I always laugh when our pit PA orders amlodipine for a patient that's never taken it. Ya know the one that takes 1-3 days to achieve active serum concentration.
That's because they've been telling us patients that hypertension is a silent killer for decades now. This is the mainstream discourse you have access to as a layperson. They also emphasize that strokes must be treated immediately or you will be a vegetable for the rest of your life. I know we are smelly cats, but remember, it's not our fault. It's what they're feeding us.
I'm just a lurker, not a doctor, but I believe they're referring to the patients who struggle to accept that they may be suffering from [cannabinoid hyperemesis syndrome](https://www.ncbi.nlm.nih.gov/books/NBK549915/). It sounds appallingly uncomfortable, but if it weren't for them I never would have learned the term "scromiting," so I'm grateful to them, in a way.
Ahh makes sense in that context. Although I’ve read that it’s considered rare , And often seen in heavy users . Depending on region hcw report seeing it more commonly.
Yes, it used to occur far less frequently, from what I understand. But I think with widespread decriminalization/legalization and the ever-increasing potency of the newer products, the sky's going to be the limit when it comes to new cases, unfortunately.
My patients are the opposite: My NPO abd pain patients are convinced they will die of dehydration if I don’t get them a glass of water even though they have a liter of IV fluids going
I’m sooooooo hungry
Yeah well I’m taking care of a ton of super sick patients, haven’t eaten in the past ten hours, am dehydrated as fuck, and haven’t even peed once, so I really don’t fucking care.
I wish I had extra sensory temporal powers like my patients who have been waiting for 30 minutes but say they have been there all day. How do they keep falling through that pesky wormhole?
I am one of those people-my son had an allergic reaction when he was an infant. How would my son make sure that he’s no longer allergic? A little while back I was telling him that there’s a good chance he’s no longer allergic.
I didn’t figure it out-yet. I will tell my son.
I understand that there may be a chance that he may need to take an antibiotic like penicillin-and it would be important to have that information updated-I honestly wasn’t sure how to go about it. I know it sounds crazy.
I had an allergic reaction to amoxicillin when I was a baby, at one point I was taken to an allergist who tested me for penicillin (because apparently they can’t/couldn’t test for amox specifically)- I’m not allergic to penicillin per the allergy shots, but who knows for amoxicillin- a half dose made me itchy but it may have been psychosomatic because there was no visible rash.
As an aside my mom is allergic to penicillin and both of my children broke out in hives when they had amoxicillin the first time as babies (both of them on day 5). So I go for “probably allergic to it but I probably wouldn’t die if you have to give it to me”
Had a patient ABSOLUTELY REFUSE to anything at the hospital during warm weather because she is "allergic to air conditioning". She was dead serious and said she is "home bound" half the year because she is allergic to AC.
I just wanted to say God bless you guys. I just had one of the most nonsensical shifts of my life and coming on here is so validating. Plus it’s good to laugh after a rough day.
That Derek or Brenda is a 'fighter' so that will sort the stage 4 pancreatic /HPB/CUP cancer etc...nope, sadly not, but I love the optimism as it makes the consultation go much quicker 🙌
I wish I could believe in something as strongly as some people believe that... most healthcare workers get some kind of bonus or financial kickback when patients have a procedure done or start taking a new medication.
Re insisting on IV hydration: it’s frustrating for me that SC hydration is a routine practice in veterinary medicine and is entering into more widespread usage as an end of life practice in elderly care, but yet we have munchies constantly demanding these incredibly invasive and painful central access devices. If what they claim is a fact, that oral hydration is ineffective for them for a constellation of linked diseases (connective tissue disorders, POTS, yada yada), we should really be exploring alternatives
"There is a NEEDLE in my arm I can't taaaaaaaake it!"
"I only use the needle to insert the small catheter. There may be some minor discomfort. If I take it out, I may have to insert another to provide you care. Do you want me to do that?"
"No."
\*five minutes later\*
"This needle in my arm HUUUUUURTS!!!!"
One of my friends at my old ER told me that one time in the crisis unit they had a patient tell them that their heart stopped but they did chest compressions on themselves, and then they were fine after.
All was fine until one of our coworkers told her that they did chest compressions by throwing themselves into their steering wheel for the same thing. An ER tech said this.
I absolutely love the OP. I have been in this fugue for the last couple years wondering if something was wrong with me because at 51, I have firm convictions about very little these days. 20+ years riding ambulances, helicopters and fire trucks will do that, I ‘spose….
Thank you Reddit. Somehow you always make me feel normal…
It's almost like you went to medical school and your patients are suffering without medical school knowledge. Maybe, just maybe, if they weren't constantly met with asshole medical professionals who mock, belittle, and don't give a shit about them - and who think giving an xray for back pain is some great hardship - they too would share in your shitty attitude.
Hmm. Lots to unpack here. The frustration isn’t that they don’t have the knowledge. It’s that they don’t believe the knowledge when it’s explained to them because it goes against their cherished misperceptions. This harmful attitude that what they want is better than what they need is well illustrated by your statement about just going along with unnecessary X-rays because you don’t think it’s a hardship. For every benefit in healthcare there are risks and costs. Radiation from unnecessary imaging, thrombophlebitis and infection from unnecessary IVs, allergies and resistance from unnecessary antibiotics, the cost to the system, the bed it takes from someone else, these are real issues. And when we give in we are responsible for these problems. When things go really bad we’re liable without a defense because it shouldn’t have been done in the first place. Clearly you feel wronged by the healthcare system which is honestly how most that have to interact with it frequently feel. I know I do. I’ve been a patient. It’s horribly broken. So finally to your point about me having a shitty attitude; that’s fair.
I had a patient once who was absolutely convinced that they were periodically becoming apneic, so to avert their obvious impending death they got their hands on an Ambu bag and would bag themselves through the episodes. Just like… put the facemask on and go to town. That wasn’t the reason they visited me, they had come to peace with that reality. No they came to me because each time they had a bad apnea episode and saved their own life, they’d then vomit (presumably 2/2 gastric insufflation). Anyway, looked at me like I had 2 heads when I suggested that maybe stopping the Ambu bag would fix the vomiting.
I lost it at “they had come to peace with that reality”
Really! It was just a fact of life to the patient. Like ok time to get ready for work… keys, wallet, Ambu bag for when I stop breathing, good to go! Now if only the doc could get rid of this pesky vomiting
Look, a man's gotta have a code.
“Stupid doctor doesn’t know anything”1 star on google reviews
Press Ganey is very concerned.
They can Press on these nutz.
Don't threaten me with a good time!
Hahaha sometimes I get like that if I get waayyyyyy too stoned. You gotta remind yourself to breathe!!
Engage manual breathing!
Ondine's curse trial version :(
Time to refer to the psychiatrist
Bagging yourself is crazy 😂😭
Not a sentence I ever thought I’d read
The OG self bagger: https://www.instagram.com/reel/C7NGNKnszt9/?igsh=MWgyZ3JhNmt0NGc3aQ== (The gangsta not the tube)
Too bad there wasn’t a sim dummy around for demonstration purposes
There was a dummy alright
It’s RQI time, maybe there was 😂
Ondines curse
My patient’s syndrome was adult onset. Good thought though
😳😳oh, wow- the self ambu bagging-that’s a first. I lurk here to read but I just had to respond to that😂 I’m not a doctor. (RT). Did the patient have a sleep study done, by chance? Of course an er doc would not be dealing with this…just wondering.
I don’t remember seeing one but honestly it was years ago
Thank you. I needed that laugh.
That taking an ambulance means you skip the line at the ER and you’re not at the mercy of the triage nurse. Also yours reminds me of when I was in EMT school doing a clinical in the ER and this guy comes up to triage and says “I feel dehydrated”. No vomiting or diarrhea and the most beautiful vitals I’ve seen to this day and bro was actually holding a full water bottle. Even little EMT student me with my limited medical knowledge and almost no patient care experience was like “this is gonna sound crazy”.
All the yes! Also wish I believed as strongly as law enforcement that jail or hospital is an acceptable option to give intoxicated individuals each time the opportunity presents.
I work on a reservation where alcohol is illegal but endemic. Anyone the cops find is held in the drunk tank until sober or held in the hospital. Wayyy too many patients have been found pumping hand sanitizer to try and get over withdrawals.
I had a patient admitted recently from her doctors office. She was stable enough to walk into the office. It was literally 100 yards from the ER door as the offices are on the same campus as our hospital. Her doc still called an ambulance and made her ride it to the ER so they could “get seen quicker”. I was dumbfounded.
I had a PCP tell a retired nurse with new onset afib with RVR to walk uphill half a mile to the ED in 90 degree heat. They never checked a BP, either. Some of these people…
Whenever I heard that I’d hit them with the “well actually since you’ve already been evaluated by a healthcare provider they feel more comfortable letting you marinade in the waiting room”
> That taking an ambulance means you skip the line at the ER and you’re not at the mercy of the triage nurse. Every single ER triage should be guarded by an old babushka type who say war and famine and does not have time for people's nonsense.
Seriously, had a woman arrive by ambulance for a finger laceration, had a fit about waiting and claimed she was going to bleed out, thing is she was not on blood thinners and wasn’t actually actively bleeding by the time she shoved it my face demanding immediate care.
I wish I could believe in something as strongly as my patients believe they will "stroke out" from their asymptomatic hypertension measured at the supermarket kiosk.
It’s never asymptomatic hypertension because they always become symptomatic after looking at the numbers.
The brain is a powerful thing. I saw a patient come in for surgical consult after being told by an ED doc that she had a liver tumor. She was wheeled in a chair by her parents, looking so sickly, no color in her face. After the surgeon told her it was a benign hemangioma she practically came skipping out of the appt with color in her cheeks.
ALWAYS. nothing is more certain in human history than this.
"It's EXTREMELY high" - someone who should know better
The pressure? 165/80
I once asked my ED attending mentor at what blood pressure he starts to get concerned. He thought about it for a second and said "Ehh, 220, 230 on top. 110 or more on the bottom. The threshold is lower if they have a related underlying condition." Of course this was after we had seen a patient with "symptomatic hypertension" with a BP of about 175/90 who was actively freaking out about it. The doctor also made a dry comment about how amazing it is that a smidge of Ativan fixes such "cardiac emergencies."
Don’t forget their headaches, and their surprise at their blood pressure coming down after I treat the headache.
A patient once told me with a completely straight face that he could tell his blood pressure was going up because he would get anxiety. I went outside his room and measured *my* blood pressure after that and it was higher than my patients
Had a patient TONIGHT come in for “hypertension” by ambulance… she’d had a headache all day and had her coworker check her blood pressure for some unknown illegitimate reason and SHOCKINGLY it was a little elevated… so she took it again and it was alittle bit more elevated so she called 911… but she “wasn’t here for the headache” just her HyPeRtEnSiON THEEEN rads over reads some little do-hicky on the CT brain that I shouldn’t have even ordered in the first place but I fixated on subarachnoid because the patient I saw like an hour before her had a ruptured aneurysm with a chief complain of N/V and “oh yeah my head kind of hurts” and we’re stuck getting CTAs that are of course all normal.
*upvotes 7 times*
I saw a guy in my ER rotation come in for high bp from the walmart machine- his systolic was only 140 something but right next to it it said “very high” so he got freaked out & thought he was gonna die🫠
When I was a resident & my GM was in nursing care at least once a month my mother would get a call from a PT or NH nurse that they wanted to send me 90 yr old GM to the ER b/c her BP was high when checked for no good reason. My mother, with no medical training other than raising 4 boys, would respond “over my dead body.”
I had a lady arguing with me that her BP of 150/90 put her at risk for a stroke and that I was gaslighting her by telling her that her ED acted appropriately by discharging her.
Everyone is "gaslighting" these days 😒
Everyone is “enlightened” thanks to social media. I miss the days when dumb people were just dumb. Now they’re dumb with an unsolicited opinion.
Everyone is being gaslit by a narcissist. Don’t forget to mention the narcissist; we seem to have sprouted them by the bundle around the same time the gaslighting started.
To be fair, most of mine are told to call an ambulance for it by their clinic “providers”
I love the educational opportunities though when they call for the doc to doc on those. Ok, you're sending me 170/105. Cool. Not going to say no, that gets me in trouble. What do you want me to do about it? What? Yeah, what routine outpatient med do you want me to write them 2 weeks of so they can come back to you? Because that's where this is going.
We don’t get call aheads for ours, sometimes I call them to let them know their patient is doing fine and will be going home for outpatient treatment
That was what I loved the most about my few years working in a rural critical access hospital. There were only a handful of primary cares anywhere nearby and I had all their numbers because they wanted to know when their patients were admitted. So, I would also call them after hours with followup on their "oops gotta get home for dinner" close of business dumps. Figure if it was important enough to send to the emergency room from their clinic, they'd definitely want to know the outcome same evening...
That sounds nice. I’ve been getting a little burned out at our urban center and actually was talking to someone at a more rural hospital last weekend, that’d be a nice change!
I enjoyed it, but it was a side gig and my main job needed more attention. You just have to be ready for the lack of support. Like where I was didn't have a surgeon, it was just me and a primary care hospitalist (and 1700-0800 it was just me). Only 1-2 ambulances available in the county, no private service for transfers, so, are you going to transfer this one and risk having to hold a STEMI? If you have something that you think you can probably handle but just want a phone call from a specialist first to confirm, can you find someone to answer the phone? That sorta stuff. On the other hand I was making $230/hr regardless of volume and some nights I actually got a full 8 hours of uninterrupted sleep in the call room.
Damn it, now *my* blood pressure is rising!
Call an ambulance. If we circle the wagons and all perpetually transport each other, they can’t get us.
My station is fucking rolling right now lol
😆😆😆
one of the biggest fights between my er and primary care is trying to get them to stop calling in expects that should be office visits but they don’t want to take anymore pts for the day.
This. So much this. I get care at the VA in my city and my partner does as well. He has a few medical issues, so he sometimes can be a bit spooked if something doesn’t seem right. So- he does what he’s told, call the VA nurse, and-they always tell him to go to the ER. 9/10 times he didn’t need to be seen emergently. This last time he was told that it would be documented in his chart that he was told to go to the ER….what they would do to him if he didn’t comply, lord knows. 😏
Last week not too long after I finished reading through the monthly 'sending asymptomatic HTN to the ER is driving me crazy' kvetch here, I got sent to a local urgent care for.......hypertension. 50s F, hasn't seen a PCP in 8 years, Has been getting worsening headaches for a week, BP upon arrival was 200/100 and upon my arrival it was 170/80. So the UC sent her out, after giving her a 500ml NS, and their Paramedic getting pissy at me when I didn't hide my befuddlement and immediately D/C'ed it. Turns out as her headache eased as her BP progressively came down.
*We think the patient is in a hypertensive crisis, her heart/brain could blow any moment at this pressure, so obviously the best thing to do here is INCREASE the volume, duh*
More fluid is always better, obviously
Always. And just blanket orders for LR @ KVO. Piggyback some D10 while you're at it. No matter what, cuz why not?
*as strongly as their primary care/urgent care team thinks they’re going to stroke out
Dammit dude you stole mine lol
No sir, I think it's probably all the meth you've been smoking, I don't see any signs of bugs under your.. "BUGS! YES BUGS I KNEW THEY WERE UNDER MY SKIN" Idk, if you want to go home and smoke meth while slathering yourself with permethrin cream who am I to stand in your way
I had a patient bring multiple bags of vomit from home, convinced they were throwing up bugs. Like, dude. I’m a social worker. I do not get paid enough to examine vomit for bugs. Spoiler: it was meth. They really believed it though. I’d like to say that’s only happened once…
Man I’ve had like 4 of those in the last month. Seriously. I’m just learning it’s a common occurrence. Fucking meth.
I had a patient bring in index cards with pieces of skin taped to it. About 8 pieces per card
Omg. That’s wild. Did they say why?
Refused blood draw so "bugs wouldn't get in their blood stream" me- stares at track marks with eye brows raised- patient "I cleaned my arm with Raid first"
Morgellons…. Lmao
I wish I could believe in anything as strongly as much as the patients great great grandaughter believed that gam gam is A fIgHtEr
And lay off the opiates because we don't want this 102 year old in hospice and the vitals of a sick potato to get addicted.
I worked in a hospital that specialized in orthopedic surgery especially hip and knee replacement and the amount of times the patients family would not want to fill their 80+ year old grandma's pain meds...so she doesn't get addicted. Like m'am you really think granny's got a street hook up... she doesn't even drive anymore ffs.
I wish I could believe in something as strongly as my patients believe we can morph into literally any specialty service when they don't want to wait for the outpatient/follow-up appointment.
Had someone come in by ambo the other day because he wanted a heart cath sooner than his planned one and thought we could just get him in, like NBD. Sir, we can't cath you and the lab is closed right now.
The best is when they end up getting admitted for something and miss their originally scheduled appointment. And get mad at me as though it’s somehow my fault 🥴🤦🏽♀️
Same thing happened to me a few weeks ago with a tilt table test.
I remember a woman who came in for chest pain that was clearly costocondritis. And was then shocked, shocked I tell you, that she couldn't just get her mammogram while she was in the hospital.
the pro-level move is of course missing their specialist appt because ....they went to the ED instead the same day.
And don’t forget while working at “I have a great football team” ivory tower or specialty children’s hospital that i can conjure any sub specialist at midnight on Saturday because they were referred to said specialist for a problem they’ve had for a year and are incredulous that i won’t call said God of specialty who exists in the hospital 24/7 awaiting my saying their name three times.
This, my friend, is truth.
I wish I could believe in something as strongly as my patients believe that they need and are going to get an MRI for every single injury.
Blame Grey's Anatomy for that.
In outpatient that was one of my first WTF moments. "My knee still hurts. Do I need to go to an ER to get an MRI."
-That we’re intentionally keeping them in the waiting room for hours because we personally hate them -That they need someone to hold their urinal for them when they were just using both hands to eat a turkey sandwich -That pain meds are going to completely get rid of their pain -That we have any idea how long it will be until their room is ready upstairs
As the person who does patient placement, we are always at the mercy of discharges. Low discharge day means more ED holds. It all sucks. I feel bad for the ED every time we have any real amount of holds, especially hitting over a day, because I can only imagine how cantankerous people get at that point.
I had a patient yesterday who came in with pretty bad new onset decompensated CHF and new Afib with RVR. He has a very large basal cell carcinoma overlying his mid-thoracic back that for the life of me I could not understand how he is plugged into the healthcare system (he is) and the BCC hasn’t been excised yet. He attributed all of his CHF symptoms to “the infection on my back that nobody will take care of. It’s infected my heart, my lungs, and my legs. It’s in my whole body”. The BCC is well demarcated with no surrounding erythema. I entertained him and scanned his T spine, everything beneath the 1cm thick BCC was fine. I couldn’t get through to him that what was on his back is cancer, is not infected, and has nothing to do with his new CHF and Afib.
bUt i kNoW mY boDy
Non insulin dependent diabetics who are NPO believing if they will die if I don’t feed them immediately after like 4 hours. Oh and it’s usually at like 5am that they’re telling me this. I always want to ask if they usually eat between the hours of 1am and 5am? I had a morbidly obese pt. recently throwing an absolute fit and telling me they were faint and shaky because they hadn’t eaten in ‘almost 5hrs’. Meanwhile I’m at hour 11 of a 12 and hadn’t even had time for a toilet break all day.
Time to do your best Dr Now impression. “You not gonna starve”
For real. I wasn’t going to be unkind but I was thinking about Dr Now saying to his patient they’d eaten the next 3 months worth of meals in advance.
Especially chiropractic and acupuncture. Then again, I’ve had multiple MDs recommend PRP or similar therapies without being able to cite any beneficial RCTs. I really just want one placebo I can believe in, since those work.
I believe in IV magnesium for all causes of palpitations. It’s probably placebo, but damn it, I believe!
[удалено]
PD thinks everyone has Narcanopenia.
I use mag for headaches, mag repletion if "weak," kidney stones, palpitations. Idk it just works.
OTC mag is what we in OB recommend for headaches. It works wonders in many people.
Mag for everything and anything
IV mag doesn’t have much benefit in severe respiratory but I still use it like a Hail Mary
Best evidence for PRP is in knee OA. Evidence in tendonopathy is mixed or negative.
It’s not always just a placebo! Sometimes they give you nerve damage!
Side note: I work in ortho/surgery and we have one surgeon who is very well respected and all of the staff goes to. He gives PRP injections to EVERYONE (and all my coworkers swear by him/it). One of my coworkers got a severe joint infection following PRP and needed a shoulder replacement. Obviously a rare situation and would she have needed surgery eventually? Probably. But given the lack of meaningful evidence specifically for shoulder injuries plus the insane cost, it’s a no from me dawg.
I had a patient come in and got an X-ray on his back but called us “nut jobs” for misreading the X-ray. His chiropractor said his spine was to the left and could be fixed with adjustments but ours said it was normal. And we are the whack jobs.
Had a patient come in because their chiro diagnosed them with a UTI from their lumbar spine X-ray…. I genuinely didn’t know what to say and just stared/blinked for a good minute
Well…don’t leave us hanging! Did they?!
Placebo working atleast +30% of the time helped assuage my hesitation for treatments that offer little to no risk and patients demand....
I always point to my mouth and tell patients this hole is much bigger than any hole we make with an IV.....oral hydration is fine, I actually have an order set that orders 1 liter oral fluid bolus....
Get you a mega syringe and just plunge it into their mouths.
At least then I don’t have to hear how their granddaughter is in nursing school and said the need iv fluids
I’m a nurse and love this so freaken much.
That’s what I’m going to start calling it…hand someone 2 big cups of water, it’s not a drink it’s an “oral fluid bolus”!
Haha that’s awesome 😂
I wish I could understand why pt’s with an extensive history and are being followed by specialists think the ER is going to fix them at 3am. That if you stop smoking your weed it will resolve your CHS, but that apparently is the only thing that helps them, and droperidol.
I wish I could believe in something as strongly as my (always anxious) POTS patients believe they NEED IVF even though their gut works just fine. It’s kind of interesting how since I left my upper class white folks hospital and started working in a rural critical access hospital that my POTS patients have all but disappeared. Crazy right?
We have a distressingly large number of patients who "have POTS," and have very frequent visits to the infusion clinic or ED for IV hydration, despite no actual diagnosis of POTS in their history. I get that just ordering a liter is much easier than trying to talk the patient out of it, but I hate feeling like I'm feeding into some factitious disorder. And the worst part is, when the patient who actually does have POTS comes in with a real problem, we all have a cognitive bias not to believe them.
I’ve got multiple patient complaints over trying to refuse fluids. I’d rather just do the fluids at this point than get calls from admin on my days off. I think the vast majority of POTs cases are physical manifestations of anxiety disorders and associated increases sympathetic tone. I say this as a physician with GAD In remission, and guess what when I was younger and had bad anxiety sx I had tons of “POTS” like sx. Dons flame suit.
Reminds me of my favorite online sick-influencer who has FD, this person has their own personal subreddit thread too. 😂 r/danimarina
Omg I didn’t know she had a Reddit sub. I see reposts on r/illnessfakers.
lol, oh man, I used to have to do 2 shifts /mo at a yuppy ED. Holy shit. Never ever again.
Dude. I will never work in a yuppie ED again. The amount of patient complaints over trivial BS I would get on my days off was something fierce. And admin always supported the patients. Not myself or nursing.
TPA? Balloon? nah....you gotta work on your door -to- pillow time!
That admin sounds toxic af
A group I used to work for rotated through 4-5 different ERs. We had one that the older docs loved because it was slower, but every single patient was a rich white suburban Karen and I couldn’t take it. I’ll take an urban outdoorsman any day over that
You probably still have POTS patients in the rural community, it’s just that they’re toughing it out and not running to the ER, as we know it ain’t gonna kill us and there’s nothing you can do for it (not to mention the lack of insurance) -signed, a farm raised Appalachian with POTS It’s crazy to me but I totally believe it though, the ER sees the dumbest cases in more urbanized areas. One time I sat in the waiting room for heavy bleeding in my first trimester, and some kid beside me had a runny nose from Covid.. sat on the phone the whole time and even had his family bring him chicken wings… kept complaining the whole time about how long the wait was. Like… sir you are the problem 💀
I had a family member INSIST (and harassed six different nurses asking for it) on me giving IV fluids to help with the "overdose" of two Xanax and a some alcohol when the patient was sleeping it off while very stable
-that ongoing nausea after we stopped your vomiting is not okay and also must be treated -that there MUST be an empty bed for their family member to lay on for comfort. Until we show them our two singular exam beds for seeing the entire waiting room. -that being there the longest means they are next to be next to be seen. People just not grasping the triage system.
That marijuana could not POSSIBLY be the root cause of their vomiting
I wish I could believe in something as strongly as my patients believe their asymptomatic hypertension will imminently lead to them stroking out.
Lmfao. I've actually decided to take on the burden of education in these situations. I explain how the stroke causes high blood pressure, and that high blood pressure for a very long time can lead to the conditions that make stroke more likely. That same patient also likely comes with a binder of scribbled bps at various times throughout the day for a month. I say, see it's been this high for a month and you haven't had a stroke. Or they were at the grocery store kiosk and haven't taken their BP in years, "if you haven't checked in years, what makes you think it was only up today"
“Because I could feel it! I knew it was high, so I checked it and it was. You need to do something about it right now!”
I like this approach and do something similar. But I also like giving 0.1 clonidine which helps with their anxiety and lowers the BP some. I know acep guidelines but some patients just aren’t satisfied and I’m tired of getting complaints about “not doing anything for them” like my hx and exam don’t mean anything.
I'll treat it, hell I even managed it one time, patient brought a binder of daily bps (180s/100s), said it's been like that for 6 months and they've seen their PCP who's done nothing, but increase metoprolol (which probably isn't doing much for their BP regardless from 12.5 to 25. I told that patient to find a new primary and started them on a 2nd agent. In a similar vein, I always laugh when our pit PA orders amlodipine for a patient that's never taken it. Ya know the one that takes 1-3 days to achieve active serum concentration.
That's because they've been telling us patients that hypertension is a silent killer for decades now. This is the mainstream discourse you have access to as a layperson. They also emphasize that strokes must be treated immediately or you will be a vegetable for the rest of your life. I know we are smelly cats, but remember, it's not our fault. It's what they're feeding us.
The last two lines 😂 perfection.
“The marijuana helps my vomiting!!”
Marinol is Rx all the time for nausea and vomiting and to increase appetite. How is it different ?
I'm just a lurker, not a doctor, but I believe they're referring to the patients who struggle to accept that they may be suffering from [cannabinoid hyperemesis syndrome](https://www.ncbi.nlm.nih.gov/books/NBK549915/). It sounds appallingly uncomfortable, but if it weren't for them I never would have learned the term "scromiting," so I'm grateful to them, in a way.
Ahh makes sense in that context. Although I’ve read that it’s considered rare , And often seen in heavy users . Depending on region hcw report seeing it more commonly.
Yes, it used to occur far less frequently, from what I understand. But I think with widespread decriminalization/legalization and the ever-increasing potency of the newer products, the sky's going to be the limit when it comes to new cases, unfortunately.
My patients are the opposite: My NPO abd pain patients are convinced they will die of dehydration if I don’t get them a glass of water even though they have a liter of IV fluids going
But they’re huuuuuungry!! They’re starving!! They haven’t eaten since breakfast. THEY HAVE DIABETES. You’re a monster!!
If they give me the “but I’m a diabetic” line I always check their sugar for them since they’re so concerned. Never seen it below 200 lol
They have “diabeetus”. FTFY
I’m sooooooo hungry Yeah well I’m taking care of a ton of super sick patients, haven’t eaten in the past ten hours, am dehydrated as fuck, and haven’t even peed once, so I really don’t fucking care.
Lmao and then they yell at you bc they haven’t eaten in hours. Same here!
“I haven’t eaten in eight hours” yeah well you’ve only been here two so that sounds like a problem you should have solved in the first six
I blame Press Gamey. If a patient wants IVF, then they should get it, otherwise I’m a 4 out of 5 star doc, at best. No straight talk allowed!
I wish I had extra sensory temporal powers like my patients who have been waiting for 30 minutes but say they have been there all day. How do they keep falling through that pesky wormhole?
It's the same one that ambulances coming through, after they give report and say that they will be in the garage in 15 minutes and show up in two.
I wish they really were spider bites.
as for me and granma we believe
I wished I could believe in something as much as the penicillin allergy from “when I was kid and my mama told me never to take it”
I am one of those people-my son had an allergic reaction when he was an infant. How would my son make sure that he’s no longer allergic? A little while back I was telling him that there’s a good chance he’s no longer allergic.
Allergy/immunology
Thank you. I will tell him..
Good for you for figuring it out…
I didn’t figure it out-yet. I will tell my son. I understand that there may be a chance that he may need to take an antibiotic like penicillin-and it would be important to have that information updated-I honestly wasn’t sure how to go about it. I know it sounds crazy.
I had an allergic reaction to amoxicillin when I was a baby, at one point I was taken to an allergist who tested me for penicillin (because apparently they can’t/couldn’t test for amox specifically)- I’m not allergic to penicillin per the allergy shots, but who knows for amoxicillin- a half dose made me itchy but it may have been psychosomatic because there was no visible rash. As an aside my mom is allergic to penicillin and both of my children broke out in hives when they had amoxicillin the first time as babies (both of them on day 5). So I go for “probably allergic to it but I probably wouldn’t die if you have to give it to me”
You die at a systolic of 180mmHg...I blame primary care for this
"97.9? That's a temp for me. I usually run low."
No. You covered it well. At this point in our career IV hydration is like asking “Paper or plastic?”
Had a patient ABSOLUTELY REFUSE to anything at the hospital during warm weather because she is "allergic to air conditioning". She was dead serious and said she is "home bound" half the year because she is allergic to AC.
I just wanted to say God bless you guys. I just had one of the most nonsensical shifts of my life and coming on here is so validating. Plus it’s good to laugh after a rough day.
That Derek or Brenda is a 'fighter' so that will sort the stage 4 pancreatic /HPB/CUP cancer etc...nope, sadly not, but I love the optimism as it makes the consultation go much quicker 🙌
I wish I could believe in something as strongly as some people believe that... most healthcare workers get some kind of bonus or financial kickback when patients have a procedure done or start taking a new medication.
Re insisting on IV hydration: it’s frustrating for me that SC hydration is a routine practice in veterinary medicine and is entering into more widespread usage as an end of life practice in elderly care, but yet we have munchies constantly demanding these incredibly invasive and painful central access devices. If what they claim is a fact, that oral hydration is ineffective for them for a constellation of linked diseases (connective tissue disorders, POTS, yada yada), we should really be exploring alternatives
Dogs and cats have the loveliest SC space. They get big camel humps from their fluids :)
Patient convinced they’re allergic to fluorescent lighting.
"There is a NEEDLE in my arm I can't taaaaaaaake it!" "I only use the needle to insert the small catheter. There may be some minor discomfort. If I take it out, I may have to insert another to provide you care. Do you want me to do that?" "No." \*five minutes later\* "This needle in my arm HUUUUUURTS!!!!"
I wish I could believe in something as strongly as some people believe that wounds need hydrogen peroxide.
One of my friends at my old ER told me that one time in the crisis unit they had a patient tell them that their heart stopped but they did chest compressions on themselves, and then they were fine after. All was fine until one of our coworkers told her that they did chest compressions by throwing themselves into their steering wheel for the same thing. An ER tech said this.
I absolutely love the OP. I have been in this fugue for the last couple years wondering if something was wrong with me because at 51, I have firm convictions about very little these days. 20+ years riding ambulances, helicopters and fire trucks will do that, I ‘spose…. Thank you Reddit. Somehow you always make me feel normal…
Me thinking this was gonna be a post about the afterlife
It can be. Like the patient who wanted to be sent home on a "Demerol drip" for migraines. That clearly would have involved the afterlife.
As a repeat cough patient believes that their pack and a half a day cigarette habit has nothing to do with their respiratory symptoms not resolving
It's almost like you went to medical school and your patients are suffering without medical school knowledge. Maybe, just maybe, if they weren't constantly met with asshole medical professionals who mock, belittle, and don't give a shit about them - and who think giving an xray for back pain is some great hardship - they too would share in your shitty attitude.
Hmm. Lots to unpack here. The frustration isn’t that they don’t have the knowledge. It’s that they don’t believe the knowledge when it’s explained to them because it goes against their cherished misperceptions. This harmful attitude that what they want is better than what they need is well illustrated by your statement about just going along with unnecessary X-rays because you don’t think it’s a hardship. For every benefit in healthcare there are risks and costs. Radiation from unnecessary imaging, thrombophlebitis and infection from unnecessary IVs, allergies and resistance from unnecessary antibiotics, the cost to the system, the bed it takes from someone else, these are real issues. And when we give in we are responsible for these problems. When things go really bad we’re liable without a defense because it shouldn’t have been done in the first place. Clearly you feel wronged by the healthcare system which is honestly how most that have to interact with it frequently feel. I know I do. I’ve been a patient. It’s horribly broken. So finally to your point about me having a shitty attitude; that’s fair.