…on the 4th of July while the ER is full of people with lacerations due to ETOH (alcohol) - fueled fighting, for BED BUG BITES. Yes, call EMS for itching due to bug bites. No fever, no pus, no other signs of infection. No attempt to take any benadryl. Then she says she wants to sue her landlord unless they pay for her to put up in another apt while they exterminate. Oh, yeah, she is on methadone for IVDA(intravenous drug abuse) and has had multiple visits here for drug OD’s. Great.
Well, it was not long into the holiday weekend when we saw the first typical 4th of July injury. No, not fireworks- induced. But this was almost a careless. A woman was trying to light her Propane BBQ grille - turning up the gas. Unfortunately it would not light with the ignitor so she went to go get a match. You can see where this is going….
So, because the match was very short she had to lean over the grille - right where all the propane gas had collected. WHOOOM! up it went. Singeing her nose hairs, burning the eyebrows and lashes, and burning her throat. She probably swallowed some flames!! Luckily we scoped her larynx and there was no damage - so she got discharged after we watched her for awhile. Next time, don’t use a match!!!
Most people don’t like worms, myself included (although earthworms are pretty benign and useful for the soil). I count myself lucky that I have only diagnosed helminthic infestation a few times. I have diagnosed pinworm infection now and again - once by the scotch tape test (patients are usually not thrilled about this test but it is really not that bad - just gross) and had one patient’s Ova an Parasite test come back positive for a form of Ascaris (although luckily they did not pass the worm in the ED!). Now, I read an article the other day here that describes research where it has been shown that purposeful infection with hookworms can possibly prevent or cure asthma and allergies! In it, there is described a researcher, David Pritchard, who has run several trials where people (including himself ) were purposely given 10 hookworms which once they burrow through your skin and get into your GI tract, are allowed to live but essentially feeding off you! With only 10 worms present (they do not replicate in the body - their ova are passed and fertilised through the stool and only get back in if you allow them to break through the skin again, so there is no chance of suddenly having hundreds inside your guy), the side effects are very minimal (mild anaemia, occasional mild diarrhea and cramping). However the worms appear to somehow secrete a substance that turns off the immune responsive that the body mounts against them - thus they survive. Interestingly, this immune response is the exact response the body makes that leads to allergies - seasonal, asthmatic, etc. As a result, allergies appear to be vastly improved or gone! The studies have been small so far but the research is encouraging - so larger trials will be done. Apparently there is no shortage of allergy sufferers willing to infect themselves - they must be miserable to get to that point. Hopefully research will allow us to eventually isolate the worm’s immune-suppressing chemical so that drugs could be made from it. Now, many Americans have pets - but it looks like many people might get 10 more!
This surveillance video captures a pretty unfortunate case in a Brooklyn Psychiatric Emergency Department. This woman suddenly slumps over and collapses on the floor while other patients and staff apparently ignore her. It is nearly an hour later when the security guard goes over and tries to rouse her, finding her unresponsive, he calls for the RN’s who then wheel the code cart over. Her death might have been able to be prevented - I would guess that standard policy in the hospital is that if someone collapses, staff should go investigate. Maybe is just a psych patient trying to get attention - but as in this case, maybe it is someone dying! I’d like to think that would not happen in my waiting room - as the registrars and triage RN tell us if anything strange is happening in the waiting room. I think part of the problem is that in psych units, the staff are not well trained at all to handle true medical emergencies. It seems that once a patient is on the psych unit, it is thought that they simply can’t develop a medical problem! In this case, however, I think the staff just was being lazy and assumed the woman just threw herself to the floor on purpose, or just decided to sleep there!
Everyone in medicine is talking about patient satisfaction scores - I have posted about them several times. I believe they are inherently flawed - although over the long term - (ie at least a year) they will tend to stablise and are SOMEWHAT reflective of what sort of provider you are (at least as patients perceive you). However, individual scores or comments are utterly useless by themselves and they are all over the place no matter if you are the nicest guy on earth (or if you “stare” at patients like Dr Scalpel evidently does….).
About a year or so ago one of my colleagues got one of the funniest Press-Ganey reports. In the space where comments are written (the guy had given the doc all “1’s” out of 5 for everything), appeared:
“After I saw Dr P****, I was more fucked up than before I got to the ER”.
Meanwhile Dr P had very good scores on average - which led me to believe - no Percocet Rx?????
A friend of mine referred me to this recent article in the New Yorker magazine. Entitled “The Itch” it chronicles a young woman’s insufferable itchy scalp - which taken to the the level described below sounds to me more like Urban Legend!
” One morning, after she was awakened by her bedside alarm, she sat up and, she recalled, “this fluid came down my face, this greenish liquid.” She pressed a square of gauze to her head and went to see her doctor again. M. showed the doctor the fluid on the dressing. The doctor looked closely at the wound. She shined a light on it and in M.’s eyes. Then she walked out of the room and called an ambulance. Only in the Emergency Department at Massachusetts General Hospital, after the doctors started swarming, and one told her she needed surgery now, did M. learn what had happened. She had scratched through her skull during the night—and all the way into her brain.”
Um, she should sleep with mittens on!
Reference is here.
The other night I had a young “kid” of 23 who came in for severe abdominal pain and diarrhea - to the point of incontinence. He had severe Inflammatory Bowel Disease - more specificially Ulcerative Colitis. This was his third admission in a month severely dehydrated and needing large doses of Dilaudid to control his pain. He is now scheduled for a total colectomy since his disease is uncontrollable with standard medications (Asacol, 6-MP, and prednisone). He is looking forward to it - I can’t imagine how desperate someone has to be to look forward to a colectomy. Luckily he will be getting a relatively new procedure whereby after the colon is removed, a new reservoir is created out of loops of small bowel and attached to the area where the rectum was. Called often a “J Pouch” for its shape, it will allow him to not have a colostomy - something NO ONE wants - especially a 23 year old. He will have to alter his diet and will go to the bathroom more often but he is looking forward to not ending up in the ER every few weeks completely miserable.
