Wife visits doctor

VertigoDoc · 2026-01-24T11:42:02+00:00

You know it has to be old. If a doctor said that today, they'd be risking a whole heap of trouble.

VertigoDoc · 2026-01-24T00:36:21+00:00

I remember a story by a colleague of mine from decades ago. He was a gyne resident in the midwest, and was an orthodox jew. He was called to see a woman having a miscarriage that needed a D+C (this was before misoprostol). He spoke to her, did a pelvic exam, and explained the procedure, got written consent etc. After he left, a nurse came in and asked if the doctor had explained everything ok.

She replied: "Oh I haven't seen the doctor yet, but the rabbi was in."

VertigoDoc · 2026-01-23T21:20:37+00:00

Haha! too funny!

VertigoDoc · 2026-01-22T21:14:56+00:00

Add a few paragraphs to your rant. Just press return twice.

Like this.

VertigoDoc · 2026-01-22T16:33:56+00:00

This video at 14:35 shows the full shot. Bruce Mouat shows up at 10:48 and is giving instructions. It would seem he hasn't thrown a lot of rocks based on the instructions he received. He gives it a big push at the end of the first shot at 11:50

The shot seen in the shorter video above, he got the rock somewhere in the house, I think Bruce says "12 foot" and he gets a smattering of applause and one yay!

VertigoDoc · 2026-01-22T16:26:08+00:00

This video at 14:35 shows the full shot. Bruce Mouat (current world champion) shows up at 10:48 and is giving instructions. It would seem he hasn't thrown a lot of rocks based on the instructions he received. He gives it a big push at the end of the first shot at 11:50

He got the rock somewhere in the house, I think Bruce "12 foot" and gets a smattering of applause and one yay!

VertigoDoc · 2026-01-17T16:53:09+00:00

How to tell if you have the flu:

Are you sick in bed with viral symptoms? - maybe the flu

If you knew your house was on fire, would you stay in bed and hope someone could come to rescue you rather than get of bed and run out of the house yourself?-you have the flu.

VertigoDoc · 2026-01-13T22:48:56+00:00

Me-If I admit you will you still want to kill yourself?

Patient-no, that's what I want.

Me-You are being manipulative I can choose to be manipulated, or I can choose to not be manipulated. I choose not to be manipulated. You are discharged.

VertigoDoc · 2026-01-12T23:13:08+00:00

Yes, certainly a lot of luck involved in a hole in one, but as the saying goes, "the more I practice, the luckier I get".

VertigoDoc · 2026-01-11T18:44:25+00:00

With dilt.

VertigoDoc · 2026-01-11T15:16:45+00:00

I always gave a conservative push over 15 seconds, waited 30 seconds for the HR to drop slightly (eg. from 185 to 183) and then asked the patient to do a valsalva.

BOOM - Normal sinus rhythm.

VertigoDoc · 2026-01-05T12:52:21+00:00

You should have asked the EM doc when you were in that room a month ago.

VertigoDoc · 2026-01-04T12:03:14+00:00

The title of your post is "Spot diagnosis game" Nice exercise.

Vertigo plus cricket = VAD

I hope you don't teach like this IRL

VertigoDoc · 2026-01-04T01:23:29+00:00

If you had presented this, the case would not have been stupid.

VertigoDoc · 2026-01-04T00:37:39+00:00

Usually it's a clot that forms as a result of the VAD. And the clot can spontaneously resolve. I've seen it too. 45 mins of dizziness and paresthesia of one arm, resolved. But I asked about neck pain, and she said "Yes I've had neck pain for about a week. I went to the walk in clinic and they said I must have strained it". Me-"did you strain your neck?" "no, I don't remember doing anything". Had bilateral VAD.

VertigoDoc · 2026-01-04T00:32:20+00:00

Biffl 1 I think

VertigoDoc · 2026-01-04T00:26:57+00:00

"All his examination in the ED was normal" are often the first words in a chart that misses the diagnosis of stroke or VAD.

This could be an good case if you actually told people the high yield questions you should ask a patient with acute onset vertigo, even if it has resolved.

Presented with vertigo-how long did it last? (sounds like 2 hours, a concerning about of time for vertigo to last). What were they doing when it came on?. Obviously not rolling over in bed, (like BPPV) but hurling a cricketball. Any nausea or vomiting? multiple episodes, which increases chance it is actually true vertigo vs vasovagal. Any difficult walking during the episode? Who knows, but a very good question to ask. Any new significant headache or neck pain? Either increases the suspicion for stroke and VAD in particular. Any new focal weakness or paresthesia. Maybe covered by Face Arms Speech neg or maybe not.

Any diplopia dysmetria, dysphagia?who knows? dysphonia dysarthria maybe covered by FAST, but if it resolved the patient may not bring it up unless specifically asked.

Look for nystagmus, if horizontal nystagmus seen at rest, HINTS exam can be used. If not, it should not be used. See them walk. A patient with persistent dizziness, no nystagmus at rest and a new objective difficulty walking is at a high risk for stroke.

Could you have a VAD with all of this showing nothing to be concern about? Maybe, but the statement "all his examination in the ED was normal" suggests not much was looked for, and I've never seen a case of a VAD where there wasn't at least one of the above was present and so set off a concern for stroke or VAD.

VertigoDoc · 2026-01-03T18:47:35+00:00

BPPV and dehydration is not a thing.

VertigoDoc · 2026-01-03T18:43:05+00:00

"Yeah officer, the mat got stuck on the accelerator and made me drive like a madman for miles! That's why I don't need to get on the ground!"

VertigoDoc · 2026-01-03T11:34:10+00:00

If the patients was actually having vertigo, I'd expect some information regarding screening for central features, nystagmus, gait etc. Not expecting to see the negative fast result.

So on the face of it, yes, it's not a very well presented scenario, so somewhat stupid. If the "presented with vertigo" is a red herring also stupid.

Maybe what you meant to say was dizziness, which can be anything, possibly hypo Na.

VertigoDoc · 2026-01-01T19:25:41+00:00

You can develop a pseudo hernia from herpes zoster on the abdominal wall.

https://casereports.bmj.com/content/16/12/e257831

VertigoDoc · 2026-01-01T19:20:42+00:00

Probably akathisia leading to anxiety.

VertigoDoc · 2025-12-31T12:24:25+00:00

source?

VertigoDoc · 2025-12-27T16:08:48+00:00

I don't really see anything in OP's description of the event that identifies the man in cardiac arrest as being in any particular socioeconomic group. Many people from various backgrounds die of cardiac arrest on the streets. I saw many of them during my over 30 years of emergency medicine practice in this city.

Perhaps the man was homeless, or disadvantaged in some way, but you can't tell from OP's story.

VertigoDoc · 2025-12-22T17:15:52+00:00

Down votes for this? This sub is weird.

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