All-Star Chief Complaints

[BoardingDoc]

update: turns out she couldn't find underwear and got angry. Then she decided she wanted to come here afterwards. I dont know what I was expecting, but it was all right there on the chief complaint.

What did she want you to do?

I ask all these people point blank what they were hoping would happen when they came to the ER. Trying to organically figure that out with someone who has demonstrated themselves to be bats*** insane is almost universally a waste of time.

---

Members don't see this ad.

 

[DocEspana]

What did she want you to do?

I ask all these people point blank what they were hoping would happen when they came to the ER. Trying to organically figure that out with someone who has demonstrated themselves to be bats*** insane is almost universally a waste of time.

A refill on the psychiatric medicine that she had not taken for about 6 months.

Apparently becoming irrationally angry because she couldn't find underwear. Was actually a wake-up call to go back on medicine and she had really good insight that that was not a normal reaction.

 

[The Knife & Gun Club]

A refill on the psychiatric medicine that she had not taken for about 6 months.

Apparently becoming irrationally angry because she couldn't find underwear. Was actually a wake-up call to go back on medicine and she had really good insight that that was not a normal reaction.

What did she want you to do?

I ask all these people point blank what they were hoping would happen when they came to the ER. Trying to organically figure that out with someone who has demonstrated themselves to be bats*** insane is almost universally a waste of time.

“What we’re you hoping we’d be able to do for you today”

And

“What made you decide today is the day to get this checked out”

Are probably my two favorite questions of all time to ask patients. You can get 90% of the info you need using these two questions.

Or at least determine if you have a meaningful pretest probability of something bad actually going on.

 

[CajunMedic]

“What we’re you hoping we’d be able to do for you today”

And

“What made you decide today is the day to get this checked out”

Are probably my two favorite questions of all time to ask patients. You can get 90% of the info you need using these two questions.

Or at least determine if you have a meaningful pretest probability of something bad actually going on.

Same here. I usually say "What changed after x number of months, weeks, etc, to make it an emergency today?"

 

[BoardingDoc]

A refill on the psychiatric medicine that she had not taken for about 6 months.

Apparently becoming irrationally angry because she couldn't find underwear. Was actually a wake-up call to go back on medicine and she had really good insight that that was not a normal reaction.

Wow. That's actually really refreshing. I essentially never refill any outpatient meds, but depending on what she was on, I'd probably actually oblige that request with a few weeks of it.

 

[dozitgetchahi]

Some legendary/memorable CCs from my month in the ER as an IM resident:

“Massive, unbelievable, gut wrenching farts” - guy ate a full 6 pack of Fiber One bars, which it turns out lead to massive amounts of gas (if you eat just one). He was visibly bloated. The guy demoed one of his farts for us, and it was indeed the second longest/loudest fart I’ve ever heard in my life (the longest being when I pushed neostigmine for an intestinal pseudo-obstruction).

“Fell asleep on railroad tracks” - that one was sad, homeless drunk guy passed out on railroad tracks and got a b/l BKA courtesy of the local Amtrak train.

“My belly is swollen” - woman in her 30s presents with what looks just like a pregnant abdomen. Everyone kept asking her if she was pregnant…it was a massive uterine fibroid.

 

[thegenius]

neostigmine for an intestinal pseudo-obstruction?

I'm so stupid I can't even remember this crap anymore.

 

[RustedFox]

neostigmine for an intestinal pseudo-obstruction?

I'm so stupid I can't even remember this crap anymore.

No.
You're not.
I only heard of this thru @dchristismi .

 

[Apollyon]

I gave it once for a guy who didn't decompress after his colonoscopy. It was remarkable watching his abdomen just deflate.

 

[Arcan57]

Not quite the same but I got woken up by an off service intern while on call in the ICU recently:

“Hey I think we need to call a stroke alert on bed 1, he has new left sided weakness”

- oh absolutely thanks for letting me know call the stroke alert right away I’ll be right there.

…brain starts to turn on from being asleep for the last 3 hours…

- wait, how does he have new weakness??? Bed 1 is horrific TBI with an Atlanto-occipital dislocation and complete transection of the spinal cord. He’s comatose, GCS3, and quadriplegic.

“Well he’s just like slumped to the left”

- does he have like, a pillow or anything behind him?

*hears russeling in the background*

“Oh yea man just a pillow under his butt he’s sitting normally now!”

🫠

I had a case early in my career where a guy with a pre-existing near complete mid C-spine injury brought in by his brother for a chief complaint of weakness and being less chatty during the game then usual. Dx: locked in from basilar artery thrombus. Thank God for triage ordered cross-sectional imaging.

 

[Apollyon]

Locked in? Ugh. Kill me. 100% serious.

 

[The Knife & Gun Club]

Locked in? Ugh. Kill me. 100% serious.

I had a guy with that actually. Internal Decapitation and locked in but AO3/GCS15 after being hit by a rented street racing sports car while crossing the road on south beach.

He blinked out that he wanted palliative extubation and to donate his organs. Ethics, palliative, everyone got together and decided he had capacity and if he wanted to be extubated that was within his rights.

So organ procurement typed him, found organ recipients, and I rolled with him to the OR at 3am for the procurement. Confirmed one final time that I’m going to take the tube out and he blinked “Yes”. I had had a 250 mL bag of 1 mg/mL morphine from pharmacy.

We pulled the tube, and he looked me right in the damn eyes the entire time as his sat drifted down. I just kept pushing morphine 10 mg at a time (for air hunger) until he closed his eyes and drifted off. I remember really distinctly just saying “AGAIN” over and over as the anesthesia tech passed me the morphine syringes. PEA—>asystole on the monitor a moment later, I called time of death, and the transplant surgeons flooded his body with iced saline and went to work for the procurement.

Then I walked out of the OR and sobbed like a freakin baby.

That crap was the bravest thing I’ve ever seen a patient do.

 

[DocEspana]

I had a guy with that actually. Internal Decapitation and locked in but AO3/GCS15 after being hit by a rented street racing sports car while crossing the road on south beach.

He blinked out that he wanted palliative extubation and to donate his organs. Ethics, palliative, everyone got together and decided he had capacity and if he wanted to be extubated that was within his rights.

So organ procurement typed him, found organ recipients, and I rolled with him to the OR at 3am for the procurement. Confirmed one final time that I’m going to take the tube out and he blinked “Yes”. I had had a 250 mL bag of 1 mg/mL morphine from pharmacy.

We pulled the tube, and he looked me right in the damn eyes the entire time as his sat drifted down. I just kept pushing morphine 10 mg at a time (for air hunger) until he closed his eyes and drifted off. I remember really distinctly just saying “AGAIN” over and over as the anesthesia tech passed me the morphine syringes. PEA—>asystole on the monitor a moment later, I called time of death, and the transplant surgeons flooded his body with iced saline and went to work for the procurement.

Then I walked out of the OR and sobbed like a freakin baby.

That crap was the bravest thing I’ve ever seen a patient do.

I'm not crying, you're crying!

 

[Porfirio]

Cc: pt states he was watching TV and started hallucinating, smoked a cigarette and tasted “crawfish, peni$, and seamen”

 

[DocEspana]

Cc: pt reports that she took her nightly meds with hot tea instead of cold water and now she feels like she is flying. Thinks the heat changed the meds.

 

[Apollyon]

Cc: pt reports that she took her nightly meds with hot tea instead of cold water and now she feels like she is flying. Thinks the heat changed the meds.

Well, it's possible...

 

[Porfirio]

Cc: +SI; denies plan, states “I just want to die. It seems like that’s the only way to stop it”; denies VH/AH; +HI “my OCD makes me think I’m a pedifile (spelled this way)”; pt crying