ER Hall of Fame

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Tas said:
I'm not a doctor, i work for ems - but I wondered if anyone has had a blood glucose under 7 (he lived)?
Click to expand...

On my sub-I I had a guy come in, awake, respiratory distress, disoriented...blood sugar came back on fingerstick too low to measure, got official read from lab with the Chem 7, BS was 1...guy lived
Members don't see this ad.
 
Cr of 25.23 (BUN 153)
I was wondering why it was taking so long for the lab to give me the results so I called down and was told they were re-running it. Turns out it was true.

37 yo M with "32 days of vomiting and constipation," per the triage note. I must admit I went in thinking how fast can I get this guy out. Needless to say, we put in a dialysis catheter before he got admitted.
 
Cr 41.8 BUN 230s(i think) K 8.7 without ECG changes
guy who had been sick for weeks ended up having goodpasture's
 
Members don't see this ad :)
Rectal Temp 109.4!

Patient apparently (pt wasn't talking obviously) took a pretty big benzo OD and then passed out outside in June in Vegas. Patient wasn't in the sun (no sunburn) but ambient temp was ~111. Pt found to be in rhabdo, ATN, hyperkalemia, etc. Came in with a heart rate of 170 and BP 60/p.

Of note cooling went really well with IVF via a Level 1 infuser (heater off of course), ice packs, wet sheets, fans, cooling blanket and bladder irrigation. Temp was 101 within about 45 min and HR down to 110 and BP up over 100.

The initial temp of 109.4 was in the ED after the patient had 1 L of cool NS enroute during her 15 transport in an airconditioned ambulance. I'd love to know what it was on scene.
 
I did a consult yesterday on a head bleed. He was found down on the asphalt and they estimated 10-15 minutes down at most.

He had second degree burns on his legs and back. Curiously enough this was through a heavy workshirt and jeans.

That means the ground was pretty hot, right?
 
This one's kind of rude... during my Sub-I, a man came who was "jumped by 5 guys in a van" who "shoved something up my butt", the patient reported. On x-ray there was a large vibrator impacted in his rectum. You could see the circuits and batteries and all, clear as day. Apparently this gentleman had a prior history of losing items up his rectum according to records. He was the toast of the ED for the rest of the shift.

I wish I had printed that one out to add to my growing collection of swallowed objects, gruesome compound fractures, are other interesting x-rays! :D
 
This thread has higher, but I'm throwing this out there because of the mystery aspect.

Blood glucose >1400, lab can't do higher. 20 of insulin didn't touch it (we gave that working from a meter which maxes out at 600). A1C 14.7 Surprisingly, anion gap was only about 18.

Also had a BP of 270/120... lady was perfectly coherent. This is the 5th time we'd seen her and it was never lower than 220/100.

This was just in a day with family medicine, but I figured it fit better here than the FM forum.
 
PT>200,INR>20 (both maxed out lab values), AST/ALT in low 20,000s.

Now that was fulminant liver failure.
 
Rendar5 said:
PT>200,INR>20 (both maxed out lab values), AST/ALT in low 20,000s.

Now that was fulminant liver failure.
Click to expand...

highest INR I have seen(around 10 yrs ago)=41
didn't do well....coumadin is a fairly effective drug with which to kill oneself....
 
emedpa said:
highest INR I have seen(around 10 yrs ago)=41
didn't do well....coumadin is a fairly effective drug with which to kill oneself....
Click to expand...

lol, dedicated lab to wait that long to see the blood clot =)
 
Members don't see this ad :)
had this abg today: pH 6.707/ co2 38/o2 129/hco3 5
-about 15 minutes before flat line...
...lactate 9.8
 
Had a pH of 6.66 once that, as predicted by the ominous numbers, did very poorly.
 
Na 108 (Glucose was 1100 though)....unfortunately on my uncle, came to ED c/o SOB, up walking and coherent, but looked sick. Coded 12 hours later. Poopy shift. :(

BNP 31,182.... CHF exac, lasix worked wonders. too bad EF was <10%
 
I saw this patient twice in 2 weeks. First Glucose was 1600. Second was 2400.
 
I didn't know there were any machines that bothered to register over 1200 or so... That's ridiculous.
 
ours reads that high, with the electrolyte set...I specifically told her to start using her insulin, and to cease smoking crack, but I suppose that didn't take.
 
BUN 269
Cr 35
K 7.5
Bicarb 3
AG 55
pH 7.1
One week of being unable to pee, and breathing fast. Tubed later, dialyzed.
 
Serum ferritin = 15,000

The patient is the previously healthy 75 yo father of a friend, who brought her dad's lab report to the bar for me to look at. Next morning she took her dad to hospital, where the ER docs said they'd never seen anything like it.

On Dec. 23rd, he was found to have extensive melanoma, and is now in palliative.
 
Lactate 20.9

Pt is clinically doing well and is off his pressors

Update: incredibly, a day later is still in the land of the living and off his pressors; BP doing fine. Still on A/C vent of course. Looks like they took off his bicarb drip.
 
Last edited:
I hope you'll let me play, even though I work with horses (pre-vet, vet tech type).

Personal "bests":

High PCV:
Saw a horse a couple weeks ago that came in with a PCV 78% on machine, >80% hand spun. HR=100 -- normal for an adult horse is 30-45. C/O colic symptoms, moderate amount of reflux with NGT. Went to sx (can't use CT/MRI except on limbs in horses) -- nothing found except ugly looking colon. After 6L plasma and 50L fluids the PCV was down to 48%. He lived about a week; when they euthanized him and opened him up, his entire colon was necrotic.

Low PCV: 10% Horse was on fluids and bleeding for about 6 days post-sx due to long-term NSAID's. It's not common to store whole blood or pRBC's in horses -- you have to do a crossmatch and bleed a donor horse on the spot, making it impractical to just pour blood in. The horse got about 50L of blood during that week and slowly stopped oozing.

Low HCO3 -- saw a foal with diarrhea of unknown origin with a bicarb of 5, K+ < 2.0 (machine wouldn't read lower). Took several days to get his electrolyte status stable, but he made it (kicked several people for the effort, too).
 
Had a patient come in the other day with an Hgb of 0.3 and Hct of 0.6. Thats a new record for me.
 
35 yo F with h/o CP c/o abdominal distention/pain.

Dx: FOS.

Ct findings: Rectum: 21 cm in diameter. Colon fine per rads, which made it more of a "toxic megarectum." Looked 8 months pregnant. Was one of the most impressive scans I've ever seen. Called her PCP, said that I the standard "enemas until clear" protocol wasn't going to cut it.


And had an honorable mention of PCO2 173 last night. Mostly obtunded, nursing home said her sats were "low." Maybe it was the guppy breathing that tipped them off. She was DNR/DNI, so we let her keep strolling towards the light.
 
devlyyn said:
Had a patient come in the other day with an Hgb of 0.3 and Hct of 0.6. Thats a new record for me.
Click to expand...

:eek:

I've seen a Hct of 7...and that was plenty low.
 
dchristismi said:
35 yo F with h/o CP c/o abdominal distention/pain.

Dx: FOS.

Ct findings: Rectum: 21 cm in diameter. Colon fine per rads, which made it more of a "toxic megarectum." Looked 8 months pregnant. Was one of the most impressive scans I've ever seen. Called her PCP, said that I the standard "enemas until clear" protocol wasn't going to cut it.


And had an honorable mention of PCO2 173 last night. Mostly obtunded, nursing home said her sats were "low." Maybe it was the guppy breathing that tipped them off. She was DNR/DNI, so we let her keep strolling towards the light.
Click to expand...

Hope you had a med student for the manual disempaction! :idea::laugh:
 
dchristismi said:
And had an honorable mention of PCO2 173 last night. Mostly obtunded, nursing home said her sats were "low." Maybe it was the guppy breathing that tipped them off. She was DNR/DNI, so we let her keep strolling towards the light.
Click to expand...

Update:

I had her on Bipap, mostly because we figured we had to do "something."

She woke up a couple hours later after ventilating off most of that CO2. I heard about it a few weeks later when she came back to the ED again.
 
Following up on a microcytic anemia with some iron studies.

Ferritin 0.3

... First time I've ever had one reported with a decimal.
 
Most money found on homeless pt: $ 3200 in cash and tickets.

I'm sure DocB and GeneralVeers can beat me on this one
 
We often have a little of that "Vegas cash" here in Connecticut. i have had a couple of elderly people who have rolled in carrying a few thousand dollars. Where were they prior to arrival? Foxwoods or Mohegan Sun. Kinda sucks to hit it big at the casino and then crash your car driving home.
 
One of the most impressive ODs I've seen in a while.

Pt took 220 TylenolPMs based on the bottles and the 30 leftover pills. They were 500/25s so that's 110 grams of APAP and 5.5 grams of benadryl.

Initial APAP was 414.

Four hour APAP was 274.

Pt was severely altered, agitated, tachycardic on presentation. Intubated and put on diprivan and versed so never seized.
 
I wonder what the APAP would have been without the huge dose of anticholinergic. In residency I had a Chinese take-out driver (who only spoke Mandarin) involved in an MVC carrying >$12k. We had to get his boss to translate, and I am certain the first couple of minutes of their conversation had nothing to do with the driver's medical history.


Also, yesterday we broke our record for most strippers in the ED because of psychiatric problems at one time. Two.
 
When I was a medical student in Ireland I saw a woman in clinic who had a total cholesterol of 120 mmol/L. She had some kind of pregnancy induced dyslipidaemia that they were treating with fish oils (because she was pregnant). They had managed to get it down to 25mmol/L as of the end of the pregnancy. I'm not sure what that is in mg/dL - if the conversion factor in Pepid is correct it comes to 4633.20mg/dL initially, coming down to 965.25, which seems a little high. Mind you, a normal cholesterol in mmol/L is around 5...
 
  • Like
Reactions: 1 user
Thank you for that mmol translation, because, you're right, it doesn't compute (which is ironic when the unit to which we are accustomed here is mg/dL!).

Cholesterol that high should have made her blood look like a milkshake!
 
Apollyon said:
Thank you for that mmol translation, because, you're right, it doesn't compute (which is ironic when the unit to which we are accustomed here is mg/dL!).

Cholesterol that high should have made her blood look like a milkshake!
Click to expand...

I didn't get to see her blood, but I would imagine it was pretty gross looking indeed. This was her second pregnancy and on the first she only :)laugh:) went up to 80 or so. After the child was delivered she went back to her baseline, which was pretty low as I recall, somewhere around 3.5 for total cholesterol. Last I heard the consultant cardiologist was trying to get a paper out of her. Cheers,
M
 
Guy came into clinic today for a regularly scheduled appointment, said his elbow had been hurting on and off. Has a history of gout. Elbow was tapped in clinic, synovial fluid looked a little green..


Synovial WBC: 1,400,000
Birefringent crystals crowding the field
Synovial glucose: 110
Serum WBC: 9,700

Double and triple-checked by the lab. Yep- it was right. That's one gouty joint!!
 
You must log in or register to reply here.
Next unread thread

Similar threads

B
Milwaukie ER overdose death
2
Replies
80
Views
5K
TooMuchResearch
T
Groove
"I'm A Doctor: Corporate Greed Is Killing Your ER"
Replies
32
Views
3K
cyanide12345678
cyanide12345678
thegenius
How to Fix ER Overcrowding
Replies
48
Views
2K
Birdstrike
Birdstrike
thegenius
I wish patients knew what the ER was for
2 3 4 5
Replies
210
Views
11K
gruemd
G
cyanide12345678
ER Dumping
Replies
12
Views
2K
cyanide12345678
cyanide12345678
Top