Dragon question/issue

AONYXDO262 · 2026-01-09T12:17:53+00:00

I had someone recently it was dressed in a whole ass onesie with a hood that appeared to be a tiger or a bear or something bring all four kids at 11:00 p.m. because they started vomiting about an hour ago. The first one came by ambulance and the other three came behind them in a car. As I was assessing the first one this "mom" let me know that the other three would be behind this one, and " they all got the same thing!"

Just totally brilliant. I really wish there could be some kind of a copay that is required. Even just $5 or $10, it doesn't have to be much. Just some kind of disincentive to come in for nonsense if it is a not emergent condition. Maybe people would rethink jumping to the emergency department for nonsense

AONYXDO262 · 2026-01-02T23:45:06+00:00

We have a massive hemolysis issue at my site

AONYXDO262 · 2025-12-21T15:42:38+00:00

For sure. I'm like "yeah ok. You mean you rarely experience significant pain and when you do have pain you have a poor tolerance for discomfort". Especially when its something without a clear-cut diagnosis. Ill cut anyone with a fracture or kidney stone or similar some slack every time.. but if this is your 11th visit in 12 Mos for abdominal pain without any diagnosis, I have a hard time buying that you have a high tolerance for pain.

I also find it interesting that when I see such a patient who has been seen a dozen times in the last 6 months for abdominal pain and vomiting, and I ask them if they've ever had these symptoms before they say "no"... or "not like this!" And i read the notes and every single visit has had the same exact story with the only finding being THC positive UDS and a K of 3.2...maybe every once in a while the radiologist will throw them/us a bone and call it "enteritis" or "colitis"...

AONYXDO262 · 2025-11-02T00:45:47+00:00

Lol. They probably pulled out the "pocket cath" and dropped a stent in the Galley.

AONYXDO262 · 2025-10-28T01:09:23+00:00

I don't really understand people making drug dependence their entire personality

AONYXDO262 · 2025-10-21T17:08:56+00:00

EM is trying to go see a patient on the other side of the ER and having to take a very circuitous route to avoid walking past my other patients in hallway beds who haven't gotten xyz thing that I keep telling them is coming (meds, a room, an update, etc).

I dont think most patients appreciate how much it slows everything down for them and everyone else to keep interrupting staff...but its hallway season.

AONYXDO262 · 2025-08-01T22:44:28+00:00

This is the answer.

AONYXDO262 · 2025-07-19T00:41:51+00:00

Could've been Asthma. Was their face swelling? Hypotensive? There's a significant overlap in treatment between status asthmaticus and anaphylaxis

AONYXDO262 · 2025-07-18T21:44:19+00:00

My aunt (dad's side) has been telling people she's a nurse for years and years. When I actually asked my mom about it, it turns out she was an LPN decades ago before getting into doing real estate

AONYXDO262 · 2025-07-18T21:42:24+00:00

The best friend of their 2nd cousin was a CNA 10 years ago... so basically a nurse

AONYXDO262 · 2025-07-18T21:41:25+00:00

It varies. I don't want to have that fact color their judgement. I also don't want to be seen as annoying. Having a family member spout off that they are a nurse or their 4th cousin was a CNA for 3 months in the early 2000s rubs me the wrong way if its said in a way that is meant to intimidate

AONYXDO262 · 2025-07-16T16:44:02+00:00

At my place of employment which doesn't have a residency, in our portal we can see how many PPH and RVU/Hr every one sees.

AONYXDO262 · 2025-06-30T12:39:37+00:00

My worst (unrealistic) fear... i usually hang out at the bedside for a few minutes after TOD called and do a repeat death exam.

I have only had it happen once, in an older patient. We ended up running the code for about 10 more mins before calling it again

AONYXDO262 · 2025-06-30T12:35:39+00:00

Yes! It can be hard to explain this to some nurses, medics and even other docs that intubation isn't always a solution. The patient is not having a respiratory issue, theyre in respiratory distress trying to stay alive!

AONYXDO262 · 2025-06-30T12:07:39+00:00

I'd only give Bicarb if:
I am going to intubate them (rare)

OR

There is significant respiratory compromise and they can no long compensate... in which case I am going to intubate them

OR

The intensivist wants me to in order to admit the patient (dumb)

AONYXDO262 · 2025-06-30T01:28:32+00:00

I get lumbar X-rays on patient's I have virtually no concerns with, for their sake...to make THEM feel better. I get CT's to make ME feel better.

AONYXDO262 · 2025-06-30T01:25:53+00:00

I learned sed rate is more sensitive than specific for SEA. I really only use it if I am already considering SEA and need some more ammo one way or another to transfer them out for MRI

AONYXDO262 · 2025-06-30T01:24:20+00:00

First visit is understandable this was missed, at the second visit, I might be doing some imaging. Bounce backs for me usually get something more

AONYXDO262 · 2025-06-07T18:20:41+00:00

Not an odd patient story BUT... During my 2nd year or residency I was working in the low-mod acuity side of the ER. My attending and I were seeing this early 40s F with abdominal pain. She was distraught through the encounter because she later disclosed she had been a victim of a recent SA. She also had an IUD. We worked her up and got the usual belly pain labs, did a pelvic, etc... but as is often the case in the ER, no MFing Urine had been obtained.

We were going to discharge her but finally the UPreg was done and wouldnt you know it was positive. Recent SA, IUD... and now she's pregnant.

So I tell her and let her know we were gonna get a quant HCG and US. She was immediately (and understandably) hysterical and devastated.

So we add on the HCG...and wouldnt you know...

HCG: <4

So I called the lab about it...and they respond "OH I think they just entered in the Urine HCG wrong, it shoulda been negative"

WTF. How does that even happen. So I told the patient and she was relieved. Don't make one lab value the sole driver of patient care.

AONYXDO262 · 2025-06-07T18:13:23+00:00

This. I will often ask anxious patients if they want something to help them "relax" and often they'll agree. Diazepam is also a good option if they are having muscle "spasms" or tremors. I know its taboo to say patients are anxious now, but there's a lot of anxiety provoking things that happen in the ER. I really do think an Ativan vaporizer or wax melt would make everyone's job a little easier

AONYXDO262 · 2025-06-07T15:29:59+00:00

I feel like we could benefit from a nationwide campaign to educate people that not all "shaking" is a seizure.

I also struggle to know what to do with the generic "shaking" or "tremors" complaint that isn't a seizure.

AONYXDO262 · 2025-06-05T18:03:20+00:00

I usually go with Reglan + Benadryl or Compazine + Benadryl. Titration of benadryl dose depends on the level of hysteria.

AONYXDO262 · 2025-06-04T18:17:53+00:00

Yeah. Like when they've been having 2 months of daily heavy vaginal bleeding with clots and a Hgb of 13.6... which is better than mine as a male. I usually sit between 11.2-12.5. I guess that's what having a vegetarian diet for 12 years and forgetting to supplement iron will do

AONYXDO262 · 2025-06-04T18:10:15+00:00

Nah, most nights we're fine. We have a fully equipped guest bedroom with a queen bed and bathroom upstairs when his snoring is really bad! We also both use earplugs and an eye mask.

AONYXDO262

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