A tale of two transfers...

[DrQuinn]

Just a glimpse into what I saw tonight on a baby 6 hour shift:

One transfer, for a healthy 20 year old female with foreign body in her eye. ? of what the item was, but a small speck 6:00 to her pupil. They tried irrigation, and q-tips to "remove" the spot on her cornea.

On slit lamp exam, I couldn't find any item whatsoever. She has no fb sensation. Weird. Fluorescein exam: she has a tiny tiny corneal abrasion 6:00 to her pupil. No seidel's sign, no ice skating rink sign. Otherwise normal exam.

Poor little 20 year old probably had to endure a non-anesthetized q-tip debridement of her cornea where she was at. *sigh*

Other transfer, "aneurysm that is about to blow, go to Washington Hospital Center, you could die at any minute." 64 year old helathy male complains of night sweats and weight loss x 2 months. PCP did a "pan-scan" CT chest/abd/pelvis, looking for malignancy. Ends up finding a true ascending aortic aneurysm.

Weird.

Yes, I did indeed see these patients back to back.

Q

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[Painter1]

Had a similar "emergent" referral from a PMD who wrote in a RX note: "eye foriegn body, needs evaluation and management"

13yo with no foriegn body sensation, no photophobia, no eye pain, no vision changes. On exam, mild bilteral injected scleral with absolutely no foriegn body anywhere after an exhaustive exam.

some of these pmds are something else.

 

[WilcoWorld]

What's the "Ice skating rink" sign? I can imagine repeated abrasions from an FB under the lid resembling unZambonied ice, but I've never heard of it.

 

[DrQuinn]

What's the "Ice skating rink" sign? I can imagine repeated abrasions from an FB under the lid resembling unZambonied ice, but I've never heard of it.

exactly what you describe.

Q

 

[kungfufishing]

For me personally I think the ice skating rink sign would probably be a fracture of my distal radius...

 

[Jeff698]

For me personally I think the ice skating rink sign would probably be a fracture of my distal radius...

proximal radius in my wife's case.

Take care,
Jeff

 

[trkd]

What's the "Ice skating rink" sign? I can imagine repeated abrasions from an FB under the lid resembling unZambonied ice, but I've never heard of it.

I think the "unzambonied sign" is better name... and much cooler.

 

[beyond all hope]

Having been on the sending and recieving end of transfers, they can be silly. A lot of times you sound like an idiot when you're trying to transfer a patient out because you're tired and you have thirteen other things going on. However, I've heard even more idiocy than I can credit for business.

Attending ER physicians who transfer in burns. I ask them to describe the burn and they say 'It looks bad'.

ER transfers are usually less silly than PCP transfers. The primaries can be absurd. R/o hypertension. Although I had one PMD who sent a pt in for r/o appy having done an outpt CT that was positive! I was impressed and somewhat appalled. Surgery repeated the CT, which was positive, and took him to the OR after at least 18 hours of WU between us and the PMD. Lucky it didn't rupture.