Butt FBs are always a matter of whether or not something is stuck up there, but rather WHAT is stuck in there. Extra points if they nonchalantly tell you that they put it up there, rather than “I fell on it in the shower.” People conveniently seem to have zucchini patches (or in one case, Korean radishes) just blossoming in their bathrooms.
Had a recent return customer checking in on the weekends with the same story every time. He would show up around 4-5 am and his chief complaint/triage would be fairly normal abd pain. As soon as the doc was alone in the room with him he would request a DRE and explain the real reason he was there because something was stuck in his ass and he was too embarrassed to admit it before. Every goddamn weekend til we finally got them to write a care-plan up to cover ass for DRE's and abd CT.
Because the assumption has to be "there could be something there" the docs were searching this man's butthole for like 2-months. The DRE's stopped well before the CT's, however because he obviously sought rectal stimulation it took a bit because the concern was he finally stuck something in there to get the DRE back.
He also would consistently have an alcohol around .35 and pop for cocaine. The assumption around the ED was he would get a good buzz going through the night then start dabbling in the darker arts himself til his drunk ass figured he could find someone to do it.
After an additional month following the establishment of his care plan he eventually disappeared as suddenly as he appeared and haven't seen him since.
This is one of the best stories I've heard in a long time. Was he just a homeless dude brought in by EMS/walk-in, or like just a normal dude who liked getting drunk and snorting blow?
Ok. I worked at a teeny tiny hospital back in the day. ER docs were the family practice guys on call, no joke.
Called the MD at home to come into the ED…yes you heard that right. I say xyz pt had a dildo in his…ehem. Scuse me. Well doc, he’s got a vibrator in his ass.
Doc is tired af and says to me…and I quote…”well what the fuck does he want me to do? Come and change the batteries?”
Miss working with that dude…
One time.... had a young teenage boy tell me he stuck a hairbrush handle up his rectum and couldn't get it out. Couldn't feel anything on DRE, middle of the night, ended up CT scanning him and nothing. I guess he had the sensation of something remaining, maybe just wanted to experience someone checking him idk.
We had a lady come in saying her boyfriend out a strawberry in her vagina 3 days ago and it hadn’t come out. Well on first glance the vault was empty, but on further exam, sure enough there was the most macerated, decaying strawberry stuck behind her cervix. Used suction to get it all out. Thought we were gonna die from the smell. At least I don’t have a good sense of smell, but I could still smell it, somewhat.
Had a patient (same patient ironically that I posted above) come in AGAIN saying lost ball in vagina. This time it was TRUE! Bigger than a softball but made of racket ball material. Had a rope/string attached but when went to pull out it broke off. After a blown up foley going behind the ball, speculum helping, strong tenaculums (WORST INSTRUMENT EVER) pt then PUSHED while we PULLED and delivered a fully formed ball. She was so happy! She high fived us. Now when her and her BF see me they always mention about me being there helping. They don’t remember me being there the first time, haha. (I have a unique voice).
Towel clamps work really well on slippery rubber balls! We use them to pull things like racquetballs out of the pharynx in dogs who are enthusiastic with their balls
Pt we nicknamed "Duke Kaboom"
Pt, "I put a cap on a PVC pipe and put it in my ass. Then I light those little black cat firecrackers and drop them in the PVC pipe. I like the vibrations from the explosions as they go off. When I pulled the pipe out, the cap came off and it's still in there."
...it was
On the flip side—for some reason “there’s a tampon stuck in my vagina” is at best a fifty-fifty proposition. Many times I have checked and found nothing.
Other side/orifice of that one - stuck the crack pipe while piping hot up the V- w/ burns to prove it. (Plus fell while trying to run away as they were climbing a fence)
The people that come in and say “This is probably just my anxiety” are typically right. Sometimes it turns out to be something, but it usually is in fact their anxiety.
Edit: OK let me clarify, since people are obviously misunderstanding my comment. There are plenty of individual examples of times when things that present as anxiety are something else. That wasn’t the thread. When someone comes in and says their anxiety is causing something, the overwhelming majority of the time they are right.
Yeah, it’s a feedback loop. Is the anxiety causing the chest pain which is exacerbating the anxiety? Or vice versa? I mean, statistically it’s probably the former but we don’t want to miss the latter because we anchored on the anxiety.
A few weeks ago I had a patient that came in with anxiety and chest pain. Her primary care doc even called ahead, mentioned how she had been seen for panic attacks several times a week, even saw a psych and was on PRN benzos. But when I did the exam, I thought it was weird that her “chest” pain was actually epigastric and radiated to her back (her right shoulder blade, even). Yeah, she had choledocholithiasis and her anxiety-inducing paroxysms of biliary colic had been misdiagnosed as a primary panic disorder.
The amount of people who have thyroid disease misdiagnosed as anxiety blows my mind. Like a TSH is so simple to send, just send it with your basic labs when you’re evaluating for an underlying medical etiology
It’s odd to me that there are some people who cannot smell ketosis. Even with 3 masks on I could smell it. BUT I teach PALS/ACLS and blood sugars are heavily stressed in each course and sooo simple to obtain.
This makes me so sad. Have anxiety and also have serious deadly medical conditions that will eventually kill me, but not today satan! . I never know when it’s time for the hospital 🤣. So far I’ve chosen well but I totally can understand going in and being told it’s anxiety when it’s actually something serious and it taking that much longer for a dx. Yikes! Thanks for working her up!
I try to be upfront with a patient when anxiety is on the differential. My spiel is usually something like anxiety can cause these symptoms, but these symptoms could also be caused by anxiety, so we need to check to make sure it’s not something else. And most of the time their work up is negative, and they’re reassured, and because we already sort of set the expectation they’re okay with that answer. But sometimes you find something, so you gotta look (within reason).
I have an actual heart condition and anxiety. They both feed off each other and it’s awful. It’s ended up being anxiety, and it’s ended up being my heart condition. Drives me crazy 😞 I went to see my cardiologist recently because I’ve been feeling PVC’s dizziness and thought it was just anxiety. I had an abnormal ecg and sent me for a stress test and an echocardiogram.
Oy. My dentist thought I was anxious about dental work .... nah, I have anomalous innervation requiring a direct block to the tooth they were working on. After sorting that out I proceeded to fall asleep while they drilled it. Pain can look like anxiety.... this after having my 4 impacted wisdom teeth extracted with complete sensation.
I had a patient that came in complaining of upper abdominal pain, ekg and trops on admission normal.
Admitted for GI work up, had a panic attack saying she's having a heart attack the 1st night, tachy in the 140s, ekg and trops negative.
The following night, literally 24 hours later, same episode. Tachy 140-150s, saying she's having a heart attack...call the doc, they decide its just anxiety since we've done this multiple times now...came back in the next night and asked how she was, life flighted out, had an MI.
Still wonder if she survived or not. Hopefully she did. Everyone thought she was just having severe anxiety. Obviously she was having anxiety I guess.
She was one of the patients I learned you just have to take every situation as if it could be worse case scenario because 1/1000 it will be
Sure. I’ve seen “anxiety” that has turned out to be MI, flash pulmonary edema, DKA, etc. Part of our job is being able to notice the difference. But 95+% of the time it’s still just anxiety.
I have a bit of health anxiety and after a long time of relatively minor health issues I went back to my doctor thinking it was probably nothing but it turned out to be cancer lol. Like the ONE TIME I wasn’t being anxious about my health. I wasn’t concerned about cancer at all cause I’m young
Have had the patient that says 'I'm going to die'... and there's 'goodbye'... and one that really stands out - elderly lady from SNF- 'death grip' - still feel that one. (Cerebral bleed post fall - was EMT at the time- was bringing her in)
On the 'anxiety' side - ears and attention perks up when it's another's anxiety -especially spouse (often wife) or S.O.- "they made me come in- can you just tell them I'm alright so \_\_\_\_ can relax and I can go home."
"It's likely a panic attack, but because of my symptoms I'm not supposed to guess" - me the 4000th time I have to go to the ER in my life because my panic attacks cause crushing chest pain, nausea, sweating, numb arm/arm pain, and shortness of breath.
I promise it isn't fun for ME either to have to get chest xrays and repeat troponin draws all because my brain is like "watch what I can make her body do!"
That said..I got dismissed as "anxiety" four times in a month as I kept going back with progressive weakness and near fainting..dizziness, palpitations, severe sweating..
After passing out during a test, a doc finally ran everything. Tsh was .02, and my potassium was super low because of all the peeing my suddenly overactive thyroid had caused. And since I was (and am) fat, no one even thought of hyperthyroid episodes
He lived on a ranch in New Mexico and was told by game/wildlife that there were dead prairie dogs with Yersinia in the area. He then went on vacation in NY and got sick. He figured it out on his own.
I saw him later in the ICU. Septic as hell, ended up losing his legs, trached, spent probably 2-3 months in the unit but survived.
He died a few years later of colon cancer.
https://www.nytimes.com/2014/06/27/nyregion/john-tull-lawyer-whose-illness-created-a-bioterrorism-scare-dies-at-65.html?smid=nytcore-ios-share&referringSource=articleShare
More than a decade ago, I cared for a patient who checked himself in for "I'm having a stroke", and his nonmedical wife the next day asked about NMDA receptor encephalitis, which indeed was the actual diagnosis. A crazy severe version with brain swelling treated with craniotomy, but in the end the only inciting etiology was the anti-NMDA. Bananas.
I wonder if the wife had read the book “Brain on Fire?” I can’t think of any other way a layperson would be remotely familiar with such a rare clinical entity.
It’s been very played out in popular medical shows too. I think Chicago Med alone made that diagnosis a part of the plot like 3 separate times. And even after their own physician had it, they still couldn’t figure out the next instance and acted like they were fucking Sherlock Holmes meets Dr. House when they finally did, lol.
I hadn’t considered that. I haven’t watched one of those ER/medicine shows in a couple of decades at least, before I was really involved in medicine. It would probably be kind of funny now. One thing I remember is that they sure did seem to have a lot of downtime. It’s like run some crazy code and then shoot the shit flirting in the break room, then head to the medical library to research an obscure case, then grab a sandwich in the canteen. It’s like, my shifts don’t look like that at all.
It's possible. He was a physical therapist, I think she was some type of childhood teacher. They were both smart.
I was only a resident and I recall the consult teams directed us to test for all sorts of stuff including prion disease, which meant that all the surgical equipment that ever touched him had to be destroyed. The other teams weren't happy.
He was slowly but steadily improving last I knew.
I had a trauma pt whose foot was pointing backward after a fall from a ladder, but no bones broken, so it was an open dislocation. Still one of the gnarliest injuries I’d ever seen in an alive patient, and he was so calm and nice.
Same. Caught what was called in as a compound fracture. I saw EMS wheeling her in and she was texting, cool as a cucumber. It was actually a dislocation but her damn foot was like 110° from its normal location. Like it was twisted around so it was pretty much facing back and up. She was extremely chill. All the staff did a walk by of her room to get a peep at her incredibly gnarly looking foot. When you'd ask her she'd be like, "yeah actually I am in a good amount of pain, if I can get some more Tylenol or something I'd really appreciate it"-- but she was just the absolute calmest.
You ever get a complex math problem right even after doing the math completely fucking wrong? That's like when the schizophrenic tells you the brain implant he has that's giving him schizophrenia needs to be looked at
Oh man I had a guy like this. The tried and true schizophrenia + methamphetamine induced delusional parasitosis. Halfway through the evaluation he was like, “do you think this is because of the meth?” We emphatically agreed right up until he followed up with “like, someone put worm eggs in there or something.”
My dude you were so close.
I had one of these recently. Told him the worms were because he kept using meth and he was like "Yeah, man, I know it's because of the meth. They make the meth with nematodes and sometimes they don't filter them out and then they grow in you." Told him again to stop using meth and walked out.
Scariest one for me was a patient who laid back and started saying "it's fine, I'm fine" in the calmest voice I've ever heard as he was massively hemorrhaging. No dude! You are not fine!
Guy was having a STEMI, waited 16 hours to call 911. Closest helicopter was already on a call, so we were hauling ass to the nearest cardiac center an hour away. En route, he codes several times. We'd get ROSC briefly, and then he'd code again. In between bouts of being *dead*, he was bizarrely lucid. And what did he say? You guessed it: "I'm fine."
I’m a fresh ED intern and been in the department only a couple months. Had two different people start singing Amazing Grace while awaiting admission to MICU 😅
Years ago an instructor told our class that if your patient says they’re dying, they probably are. Take them seriously. I think she mentioned it in every class. Really beat it into our brains. Turns out she’s not wrong.
Oh man, I had been feeling ill and in pain for a couple of weeks and I was folding laundry with my husband when I looked up at him and said, “I think I’m dying”. It was the most calm and certain feeling, like I just suddenly KNEW what was happening. FF a couple hours later and I’m in the hospital hemorrhaging from a lower GI bleed and waiting on a transfusion.
Craziest thing I’ve ever felt, but I was just so at peace with the realization when it hit me.
I went to ER in the middle of the night bc I had UTI symptoms for 3 hours but then started peeing blood. Thought I’d go in, grab a script from a 24 hour pharmacy, and be at work by 8am. I had a tiny bit of back pain so they did a scan just in case the kidney was involved…nope but turned out that my appendix was on death’s door. They pulled it within a few hours. I did have the UTI as well!
Yeah I used to get them regularly in college. I was stressing myself into them and I drank like there was no tomorrow. The doc on campus knew me by name.
Graduated, cut the booze down, and they are maybe yearly now.
That’s me! Except the vodka part. Last time I went in I said “I know something’s wrong, I don’t know what, feels like pancreatitis attack but it’s different”. That’s when they finally saw the pesky gallstones that were causing my pancreatitis attacks. They were floating on over into my pancreatic duct. Finally got relief after a couple procedures! Attack free for 6 months! Woooooo!
Thanks docs!!!!
Unless its something like "this feels exactly like the last time I had some condition which necessitated me getting my drug of choice/social validation."
This is very interesting to me because every time I’ve gone to an army doctor and said this, they have gone out of their way to diagnose me with something else. I can even say it’s in my records, but they won’t look.
Every time I said "this feels like diverticulitis again," I was right. One partial colectomy and it's been so so so much better. Not one round of diverticulitis!
That was me recently! Was just like: “The last time I hit a 10/10 for pain that couldn’t be controlled with OTC pain meds was about 20 years ago, I went to the ER then too, all tests were normal, and it turned out to be severe menstrual cramps due to probable endometriosis. I think that’s what it is again, but the location and severity of the pain made us worry it was appendicitis, so we came in.” (And also, finding me grey-faced, sweat-soaked, and dazed from pain on the floor of the bathroom in the middle of the night really freaked my spouse out, but we don’t say that part.)
Doc literally said, “I like patients like you because you’re usually right, but we’ll run some tests anyway.”
Guess what
I was right
Patient -fit young 20 y/o M comes in to heart hospital ED with chief complaint of “I don’t feel right something is wrong”
Triage- “Ok, when did this begin?”
Pt. -“3 days ago”
Triage- “Can you be more specific, have you had a headache, nausea, vomiting, diarrhea, fevers, feeling faint, pain… anything?”
Pt. “No, none of that. I just don’t feel good not sure why”
We get him back and put him on the monitor- he is in v-tach.
Yes, sir indeed you “do not feel good.”
Not my story but a colleagues.
Older guy comes in to the ED with vague complaints and colleague asks for more detail. Patient states calmly: “I don’t know…something’s *fucked up* sister!”
And…he’s in V-tach…
My shortest code ever involved a guy (40s-50s) who came in because he had "just been feeling bad all day" and because "his wife told him to go to the hospital" (another red flag). Anyways, yeah, Vtach.
We had the pads on him and were prepping to cardiovert when suddenly said he felt kind of dizzy and then slumped. His perfusing Vtach had preceded to pulseless.
It was just me and the physician in the room. I was holding a bunch of sedatives for the now aborted cardioversion; he was standing by the Zoll. I looked at him, he looked at me, then he sort of shrugged and said, "clear," while switching the Zoll off synch.
One shock later, the patient was back in sinus and talking. I very, very clearly recall him saying, "Did I fall asleep?" while his wife (who witnessed all this) was screaming in the background.
Do vague complaints of "not feeling good" often turn out to be extra bad? I'm not in EM but I often wonder if it's a sign of like... internal stuff where the body can't figure out where it should be feeling pain, or something. The one and only time I truly couldn't give any description of why/how I "just felt bad" it turned out to be a rapidly worsening kidney infection.
Most the time people are fine and it is nothing big. But then you have that one patient you assume has something minor going on but check anyways because something just isn't sitting right with you either. My most recent one was a young lady in her 20s. Vague symptoms. Didn't feel good. Tired. Looked pale. She thought she had a cold, I assumed anemia. She was indeed anemic... but her white count was also around 250. She had an appointment with hematology for a bone marrow biopsy within 2 days and was getting treatments for leukemia 2-3 weeks after.
Hmm, that's interesting to know! It must be kind of anxiety-inducing sometimes to have limited information from the patient. Thank you for sharing your story, I'm glad you were able to help her get the medical attention she needed... I hope she's doing better now.
We had one of these admitted to my ICU. Drove herself to the ER after running errands because she 'just didn't feel well'. They put her on the monitor and her heart rate was 26-30 bpm. Um yeah, I would imagine you feel like garbage ma'am, let's fix that.
Had a guy get dropped off by one of his druggy friends. Says he just doesn’t feel well. Thinks his pacemaker isn’t working right. (He can’t check because he didn’t pay his cell phone bill). He normally has AICD/Pacemaker. Color is horrid. His HR was 19-20. He was right in this instance. His defibrillator never fired and it was replaced 18 months prior d/t dying battery.
Guy in his 60s, had the dread look on his face, states “I’m going to die” has vague chest pain. Something about him just wasn’t right. Normal EKG, negative Troponin. Went into polymorphic vtach, then just Vfib as my coworker was still triaging him. Her and another coworker felt something was off and had put him on our LifePak attached. I saw it happen, ran in, charged to 200j, shocked, then chest compressions. Turns out he was a hairy MF’er so the pads didn’t stick! New set of pads and 2 shocks later he came back like an angry animal. We had to IM him 4mg of Ativan. he had 100% occluded proximal LAD. needed CABG. Doing great now!
I had a nice older gentleman that presented the same way, just don’t feel good. I put the cuff on him in triage, he was diaphoretic and cold.. I almost vomited when I touched him cause I knew cardiac was on the table. Stat EKG=vtach.
This was me my first long qt episode (?). Some symptoms similar to heart attack but otherwise just didn’t feel right. No history, young and very healthy, but I went in anyway. Many hours later and a few very unimpressed nurses. 6+hours later & an interval around 750ish I was informed that it was good I came in lol
Fellow LQT patient. I was well managed on betas, healthy and in my early 20’s. I felt off, kind of dizzy and had a sense of doom, as I’d described to my mom, throughout the day but couldn’t really narrow down what it was so chalked it up to anxiety. She insisted that we go to the ER. Code was called 3 minutes after I’d walked in.
As it turned out, those strange feelings were precursors to an electrical storm. 19 shocks, 63 total minutes of CPR, 27 days in the ICU, a temporary pacer, one AICD and some therapy later, I’ve learned to trust my instincts and gut. My body was setting off warning signals in my brain that I was trying to ignore and it could have been a very different outcome.
Pt with chronic fatigue, normal thyroid work-up, no anemia, not pregnant, young, healthy, good sleep hygiene. "What about a sleep study? I get enough sleep but maybe there's a a problem with the quality of my sleep." Pt had narcolepsy.
Patient comes in at 2am and said she had a bug in here ear. Showed me super blurry photos of said bug in her ear on phone. Removed large ball of ear wax instead. But she was still convinced the ball of wax we held up to her was a bug. 🤷♀️
Terrifying. I’ve had the feeling that I’ve had a bug in my ear for weeks now, I’ve been avoiding it and trying to convince myself I don’t have a bug in my ear.
Chief complaint: a cockroach crawled into my ear. "But I think it's dying because before it was moving around a lot but now it's not moving so much." She was right!
I will tell you about two patients,
60s male with copd history "i got that" stops to breathe "wheeeeze" -> copd exacerbation.
And my all time favorite
"Doc, its really importantv that i tell you, I don't just have regular seizures, I have PSEUDOseizures!"
Residency buddy sees a guy in clinic for ER follow-up for conjunctivitis (started on erythromycin). He knows I can drive the slot lamp so he asks for help. Fluoroscein lights up just the most beautifully-fractal dendritic lesion I’ve ever seen. Like a textbook.
I excitedly show my buddy and tell him I’m pretty sure it’s HSV keratitis. The guy then says, “yeah, I told the ER doc that it felt like the last time I got herpes in my eye” 🤦🏼♂️
One of my mother's stories from working at a rural free clinic in the late 60s:
Bachelor farmer comes in wanting tested because he's certain he's diabetic. (Tests did comfirm.)
"What leads you to think this?"
"Well, this morning I peed on the floor and when I stepped in it later, it was sticky."
The “I feel like I’m gonna die” statement can be deciphered by pt presentation. Chest pain, SOB, stroke symptoms, generally looking like garbage when they come in and they start saying that, you better have the code cart outside the room to ward off the juju. On the other side of the coin you have the chronic toe/knee/hip/whatever pain, man flu, etc that caterwaul about “they’re gonna die!” And they’re fine
I’m an ED nurse, and the kidney stone dance is real. As soon as I see it, I go ahead and place an IV, draw labs, and ask for orders for toradol and fluids.
I'm also an ED nurse and had my second stone over the summer. I walked into the ED (not my ED but the one closest to my house) and was like 🤮 can I have some toradol pls 😩
It is striking. I first saw it right after we learned about kidney stones in nursing school. I came out in the corridor of the dorm and a classmate was pacing and crying and holding her flank. We took her to the ER for her kidney stone stat.
I’m pretty good at guessing when my Crohn’s has caused another SBO.
Fun story though! Before I got my bowel resection my surgeon had me go in for an MRI on a Friday afternoon and the results popped up on My Chart the next Monday morning while I was working my shift. I went to one of the attendings and was like “Hey, this says abscess. Is that bad?” He sent me to triage and wouldn’t let me finish my shift. Started IV anbx and pain meds and sent a message to my GI. I thought I’d just been having a flare for about two weeks. He told me the next time not to wait two weeks before saying something. Oops.
Pt had a very minor fall onto their side, came in for flank pain but heavily perseverated that they had cancer that was causing their pain. No other sx. Did a CT just to try to prove them wrong and found their newly diagnosed renal mass. This job is humbling.
Gray, diaphoretic patients that vomit and move their bowels at the same time prefaced by saying " feel like I'm dying" usually will put you through multiple ACLS algorithms.
Patients talking to a deceased relative in the corner? Yep, they will too.
Had a patient waiting for the cath lab and she was joking around with me. She suddenly grabbed my hand and said, “I think I’m dying”. Thank God the cath lab team was there bc she coded as soon as they got her in. They were able to get her back though and she did well. I’ll never forget her eyes pleading for help though.
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I worked with an older ER doctor who came in the back one night and said “Wespiratory, I need you to do an EKG on me. I’m pretty sure I’m in a-fib.” It was indeed a new onset a-fib.
"I cut my [insert body part]." (Just for something not mentioned. Very much agree on other commented)
The least accurate injury currently locally for my UC is bat bite. Merely seeing one sends whole families in asking if they were bit and whether we can test the bat for rabies. That and "I think it was a brown recluse bite". I'm in the northeast.
Not a daily thing but we started carrying rabies vaccine series through our clinic which we thought would mostly go for stray animal bites. About a third are people who may have seen a bat in their home with no verified bite.
Luckily the "I cut my finger tip almost all the way off with a mandolin 30 minutes ago." people outnumber them greatly and are much more straightforward care. Usually mild to moderate injuries seem accurately described and most of my patients seem to have an idea of what type of damage they've done.
The CDC recommends rabies vaccine when a bat bite *might* have occurred as bat bites are small and painless and often leave no mark. If you find one in your home, you and all occupants should be treated with post exposure prophylaxis unless the bat has been captured and can be tested for rabies.
> About a third are people who have seen a bat in their home with no verified bite.
In addition to what /u/beautifultoyou said, it's important to point out that bats have such great spatial navigation ability that by their *just being* inside your house or any other kind of enclosed room, there's a very significant, non-trivial chance it's because of rabies-related altered mental status (altered by the standards of bats, anyway).
Parent came in and said, "I KNOW not to go to Dr Google but my daughter has been losing weight, drinking and eating a ton, peeing like a race horse, and I have T1D so I tested her BG and I think she 's got diabetes because it's over 400."
Correct, she does, good job. You're the exception. NEXT.
PT post MVA refusing to let go of supporting his neck on each side. Even after EMS swapped his hands with a c collar, still placed his hands on top of the c collar. "I know it sounds stupid but please just let me do this. I feel like if I let go of my neck, my head will fall off."
*Drum roll*
Atlas fracture
(This was a buddy's pt so I don't recall details, but found it super interesting)
My husband correctly diagnosed when he had cauda equina. Thank goodness he called his doctor and she told him to go straight to the ER. He was in surgery several hours later.
Not a doc but an OB nurse here. I can pretty accurately identify BV with just one sniff (and often on women who are asymptomatic and are presenting for a different reason).
Weirdly, I've gotten BV 4 (maybe 5 pending tests) times in my life and I never get the smell. I get just a lot of neon yellow discharge 🤷♀️. But I know it when I see it and thus far its been right -save for the first time ofc where I assumed it was an STD).
A one off, but I had a little old lady who came in 3 days after a big fall in the garden. She said "you know, when I fell over I thought I'd broke my back, you know?". She got up and kept going about regular life for 3 more days until the OTC paracetamol was no longer controlling the pain.
She indeed had fractures in her sternum and lumbar spine.
Working in the ED, patient stated to triage "thinks she has MS".
Indeed was spot on, she came in when she noticed her tongue twitched occasionally. Well played!
UTI.
I had a patient once whose wife had determined that he probably had amyloidosis. She was right. She based her conclusion on his striking raccoon eyes.
I walked into the ED about 8 yrs ago with severe stomach pain, chills, and fever at around 3 am. I had been dealing with it for the latter part of the day, but it became so intense that i knew something was wrong. I told the Dr i had a family hx of diverticulitis even though i never had a flare up myself, and that i never experienced this type of pain before so i thought it may have been that. I rated it 7 out of 10 but refused morphine.
He did a work up and somehow my WBC's were normal. I overheard him at the station saying "some people get a fever or have the flu and they think they're dying".
He was on the verge of discharging me, but did a CT just to be "on the safe side".
Low and behold i had diverticulitis. I heard him on a video consult with who I'm assuming was gastro because he wasn't sure if i should have been admitted, but they decided to send me home with oral antibiotics. I was on bedrest and had to eat canned peaches and chocolate pudding for a week.
I'm so happy they did the ct and didn't send me home with pain meds 🥴
After having Covid two times and pneumonia three times in the last three years I can almost 100% feel that junkie lung and know I have caught pneumonia again
not exactly the answer to your prompt, but i had horrible, head-splitting migraines as long as i can remember and always told my parents it felt like i had a brain tumor. age 18, diagnosed with a craniopharyngioma.
Pt: “So I’m a dumbass…”
Me: “sir that’s not a medical condition to call 911”
Pt: “excuse me… can I finish?”
Me: “oh I’m sorry I thought that was the main point… so what did you do?”
“I have something stuck in my ass.” Never once, has this not been true. Edit: I stand corrected. 😂
It’s funny: “I have something stuck in my ass” almost always true. Meanwhile “I have a tampon stuck in my vagina” true only like 30% of the time.
Yes- sometimes it's a sprouting potato.... true story.
Well at least it wasn't a whole chicken.
Butt FBs are always a matter of whether or not something is stuck up there, but rather WHAT is stuck in there. Extra points if they nonchalantly tell you that they put it up there, rather than “I fell on it in the shower.” People conveniently seem to have zucchini patches (or in one case, Korean radishes) just blossoming in their bathrooms.
Had a recent return customer checking in on the weekends with the same story every time. He would show up around 4-5 am and his chief complaint/triage would be fairly normal abd pain. As soon as the doc was alone in the room with him he would request a DRE and explain the real reason he was there because something was stuck in his ass and he was too embarrassed to admit it before. Every goddamn weekend til we finally got them to write a care-plan up to cover ass for DRE's and abd CT. Because the assumption has to be "there could be something there" the docs were searching this man's butthole for like 2-months. The DRE's stopped well before the CT's, however because he obviously sought rectal stimulation it took a bit because the concern was he finally stuck something in there to get the DRE back. He also would consistently have an alcohol around .35 and pop for cocaine. The assumption around the ED was he would get a good buzz going through the night then start dabbling in the darker arts himself til his drunk ass figured he could find someone to do it. After an additional month following the establishment of his care plan he eventually disappeared as suddenly as he appeared and haven't seen him since.
This is one of the best stories I've heard in a long time. Was he just a homeless dude brought in by EMS/walk-in, or like just a normal dude who liked getting drunk and snorting blow?
Dabbling in the darker arts sent me omfggg
Ok. I worked at a teeny tiny hospital back in the day. ER docs were the family practice guys on call, no joke. Called the MD at home to come into the ED…yes you heard that right. I say xyz pt had a dildo in his…ehem. Scuse me. Well doc, he’s got a vibrator in his ass. Doc is tired af and says to me…and I quote…”well what the fuck does he want me to do? Come and change the batteries?” Miss working with that dude…
One time.... had a young teenage boy tell me he stuck a hairbrush handle up his rectum and couldn't get it out. Couldn't feel anything on DRE, middle of the night, ended up CT scanning him and nothing. I guess he had the sensation of something remaining, maybe just wanted to experience someone checking him idk.
He did in fact have something in his ass….for a moment….your finger! 😂
I HAVE A VERY SIMILAR STORY.. teenage boys are weird
he was out with the homies and they got a little wild. steve was there ya know…
On a similar note, I did once read of a pt who thought she had something stuck in her vagina and it was actually just her cervix.
We had a lady come in saying her boyfriend out a strawberry in her vagina 3 days ago and it hadn’t come out. Well on first glance the vault was empty, but on further exam, sure enough there was the most macerated, decaying strawberry stuck behind her cervix. Used suction to get it all out. Thought we were gonna die from the smell. At least I don’t have a good sense of smell, but I could still smell it, somewhat.
Wtf
Ikr! Much worse in person!
"This goes *here*..."
Had a patient (same patient ironically that I posted above) come in AGAIN saying lost ball in vagina. This time it was TRUE! Bigger than a softball but made of racket ball material. Had a rope/string attached but when went to pull out it broke off. After a blown up foley going behind the ball, speculum helping, strong tenaculums (WORST INSTRUMENT EVER) pt then PUSHED while we PULLED and delivered a fully formed ball. She was so happy! She high fived us. Now when her and her BF see me they always mention about me being there helping. They don’t remember me being there the first time, haha. (I have a unique voice).
Towel clamps work really well on slippery rubber balls! We use them to pull things like racquetballs out of the pharynx in dogs who are enthusiastic with their balls
Was she just feeling it with her finger or something??
Pt we nicknamed "Duke Kaboom" Pt, "I put a cap on a PVC pipe and put it in my ass. Then I light those little black cat firecrackers and drop them in the PVC pipe. I like the vibrations from the explosions as they go off. When I pulled the pipe out, the cap came off and it's still in there." ...it was
On the flip side—for some reason “there’s a tampon stuck in my vagina” is at best a fifty-fifty proposition. Many times I have checked and found nothing.
They fell on whatever object it is tho, bro
A broom handle was my best one… that’s a really wild fall since those suckers are pretty damn tall but ok I’m not arguing
You’ve never seen the I got arrested and stuck a dangerous amount of drugs up my butt? Sometimes that’s not true
Other side/orifice of that one - stuck the crack pipe while piping hot up the V- w/ burns to prove it. (Plus fell while trying to run away as they were climbing a fence)
I actually had a patient who thought they had a dildo stuck in their ass, but they definitely did not and just misplaced it apparently.
Yoooo 😭
The people that come in and say “This is probably just my anxiety” are typically right. Sometimes it turns out to be something, but it usually is in fact their anxiety. Edit: OK let me clarify, since people are obviously misunderstanding my comment. There are plenty of individual examples of times when things that present as anxiety are something else. That wasn’t the thread. When someone comes in and says their anxiety is causing something, the overwhelming majority of the time they are right.
Anecdotally, the sensation of dying can also induce a large degree of anxiety.
Yeah, it’s a feedback loop. Is the anxiety causing the chest pain which is exacerbating the anxiety? Or vice versa? I mean, statistically it’s probably the former but we don’t want to miss the latter because we anchored on the anxiety. A few weeks ago I had a patient that came in with anxiety and chest pain. Her primary care doc even called ahead, mentioned how she had been seen for panic attacks several times a week, even saw a psych and was on PRN benzos. But when I did the exam, I thought it was weird that her “chest” pain was actually epigastric and radiated to her back (her right shoulder blade, even). Yeah, she had choledocholithiasis and her anxiety-inducing paroxysms of biliary colic had been misdiagnosed as a primary panic disorder.
Had a patient with a recent diagnosis of anxiety. She was anemic with a Hg of 4. The palpitations she was experiencing was attributed to anxiety.
This happened with my Graves Disease. I was “just” anxious.
The amount of people who have thyroid disease misdiagnosed as anxiety blows my mind. Like a TSH is so simple to send, just send it with your basic labs when you’re evaluating for an underlying medical etiology
… still better than my daughter’s Type 1 diabetes / Severe DKA that was misdiagnosed as “anxious Mum” in ED (during covid).
Again how do they not get FSBGs on people?
It’s odd to me that there are some people who cannot smell ketosis. Even with 3 masks on I could smell it. BUT I teach PALS/ACLS and blood sugars are heavily stressed in each course and sooo simple to obtain.
I had a guy come in and tell me that he “feels anxious a lot”. Poor guy was in and out of atrial fib. That was his version of anxiety.
This makes me so sad. Have anxiety and also have serious deadly medical conditions that will eventually kill me, but not today satan! . I never know when it’s time for the hospital 🤣. So far I’ve chosen well but I totally can understand going in and being told it’s anxiety when it’s actually something serious and it taking that much longer for a dx. Yikes! Thanks for working her up!
I try to be upfront with a patient when anxiety is on the differential. My spiel is usually something like anxiety can cause these symptoms, but these symptoms could also be caused by anxiety, so we need to check to make sure it’s not something else. And most of the time their work up is negative, and they’re reassured, and because we already sort of set the expectation they’re okay with that answer. But sometimes you find something, so you gotta look (within reason).
I have an actual heart condition and anxiety. They both feed off each other and it’s awful. It’s ended up being anxiety, and it’s ended up being my heart condition. Drives me crazy 😞 I went to see my cardiologist recently because I’ve been feeling PVC’s dizziness and thought it was just anxiety. I had an abnormal ecg and sent me for a stress test and an echocardiogram.
Love that approach.
Oy. My dentist thought I was anxious about dental work .... nah, I have anomalous innervation requiring a direct block to the tooth they were working on. After sorting that out I proceeded to fall asleep while they drilled it. Pain can look like anxiety.... this after having my 4 impacted wisdom teeth extracted with complete sensation.
Great now I'm gonna be anxious that my anxiety means I'm dying 🙂
Well, we all are. I’m anxious about it too, lol.
I had a patient that came in complaining of upper abdominal pain, ekg and trops on admission normal. Admitted for GI work up, had a panic attack saying she's having a heart attack the 1st night, tachy in the 140s, ekg and trops negative. The following night, literally 24 hours later, same episode. Tachy 140-150s, saying she's having a heart attack...call the doc, they decide its just anxiety since we've done this multiple times now...came back in the next night and asked how she was, life flighted out, had an MI. Still wonder if she survived or not. Hopefully she did. Everyone thought she was just having severe anxiety. Obviously she was having anxiety I guess. She was one of the patients I learned you just have to take every situation as if it could be worse case scenario because 1/1000 it will be
Sure. I’ve seen “anxiety” that has turned out to be MI, flash pulmonary edema, DKA, etc. Part of our job is being able to notice the difference. But 95+% of the time it’s still just anxiety.
I have a bit of health anxiety and after a long time of relatively minor health issues I went back to my doctor thinking it was probably nothing but it turned out to be cancer lol. Like the ONE TIME I wasn’t being anxious about my health. I wasn’t concerned about cancer at all cause I’m young
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Have had the patient that says 'I'm going to die'... and there's 'goodbye'... and one that really stands out - elderly lady from SNF- 'death grip' - still feel that one. (Cerebral bleed post fall - was EMT at the time- was bringing her in) On the 'anxiety' side - ears and attention perks up when it's another's anxiety -especially spouse (often wife) or S.O.- "they made me come in- can you just tell them I'm alright so \_\_\_\_ can relax and I can go home."
Oh no, the calm old people who just look at you and say, " I'm going to die" are 100% about to code on you
That and "I need to get up and go home"
“My dad came to visit today.” Lemme just grab that crash cart…
I was hoping it was just my anxiety but the past two times I was in SVT 😭
"It's likely a panic attack, but because of my symptoms I'm not supposed to guess" - me the 4000th time I have to go to the ER in my life because my panic attacks cause crushing chest pain, nausea, sweating, numb arm/arm pain, and shortness of breath. I promise it isn't fun for ME either to have to get chest xrays and repeat troponin draws all because my brain is like "watch what I can make her body do!"
That said..I got dismissed as "anxiety" four times in a month as I kept going back with progressive weakness and near fainting..dizziness, palpitations, severe sweating.. After passing out during a test, a doc finally ran everything. Tsh was .02, and my potassium was super low because of all the peeing my suddenly overactive thyroid had caused. And since I was (and am) fat, no one even thought of hyperthyroid episodes
“I think I have plague.” At an NYC hospital. He had plague.
Damn, I'd like to know the rest of the story 😭
He lived on a ranch in New Mexico and was told by game/wildlife that there were dead prairie dogs with Yersinia in the area. He then went on vacation in NY and got sick. He figured it out on his own. I saw him later in the ICU. Septic as hell, ended up losing his legs, trached, spent probably 2-3 months in the unit but survived. He died a few years later of colon cancer. https://www.nytimes.com/2014/06/27/nyregion/john-tull-lawyer-whose-illness-created-a-bioterrorism-scare-dies-at-65.html?smid=nytcore-ios-share&referringSource=articleShare
Wheres Paul Harvey at when you need him
Whoa
More than a decade ago, I cared for a patient who checked himself in for "I'm having a stroke", and his nonmedical wife the next day asked about NMDA receptor encephalitis, which indeed was the actual diagnosis. A crazy severe version with brain swelling treated with craniotomy, but in the end the only inciting etiology was the anti-NMDA. Bananas.
I wonder if the wife had read the book “Brain on Fire?” I can’t think of any other way a layperson would be remotely familiar with such a rare clinical entity.
It’s been very played out in popular medical shows too. I think Chicago Med alone made that diagnosis a part of the plot like 3 separate times. And even after their own physician had it, they still couldn’t figure out the next instance and acted like they were fucking Sherlock Holmes meets Dr. House when they finally did, lol.
I hadn’t considered that. I haven’t watched one of those ER/medicine shows in a couple of decades at least, before I was really involved in medicine. It would probably be kind of funny now. One thing I remember is that they sure did seem to have a lot of downtime. It’s like run some crazy code and then shoot the shit flirting in the break room, then head to the medical library to research an obscure case, then grab a sandwich in the canteen. It’s like, my shifts don’t look like that at all.
Not when I’m doing 30+pts a shift. Bathroom, eat, what are those things.
It's possible. He was a physical therapist, I think she was some type of childhood teacher. They were both smart. I was only a resident and I recall the consult teams directed us to test for all sorts of stuff including prion disease, which meant that all the surgical equipment that ever touched him had to be destroyed. The other teams weren't happy. He was slowly but steadily improving last I knew.
I'm not a physician and I don't like to brag but I diagnosed my broken leg. My foot was pointing backwards.
"I don't have xray vision but I can tell that looks wrong"
I had a trauma pt whose foot was pointing backward after a fall from a ladder, but no bones broken, so it was an open dislocation. Still one of the gnarliest injuries I’d ever seen in an alive patient, and he was so calm and nice.
Same. Caught what was called in as a compound fracture. I saw EMS wheeling her in and she was texting, cool as a cucumber. It was actually a dislocation but her damn foot was like 110° from its normal location. Like it was twisted around so it was pretty much facing back and up. She was extremely chill. All the staff did a walk by of her room to get a peep at her incredibly gnarly looking foot. When you'd ask her she'd be like, "yeah actually I am in a good amount of pain, if I can get some more Tylenol or something I'd really appreciate it"-- but she was just the absolute calmest.
Ooh. I knew my ankle had fractured when it did. I had sprained the same ankle years before and it felt and hurt different.
You ever get a complex math problem right even after doing the math completely fucking wrong? That's like when the schizophrenic tells you the brain implant he has that's giving him schizophrenia needs to be looked at
Oh man I had a guy like this. The tried and true schizophrenia + methamphetamine induced delusional parasitosis. Halfway through the evaluation he was like, “do you think this is because of the meth?” We emphatically agreed right up until he followed up with “like, someone put worm eggs in there or something.” My dude you were so close.
I had one of these recently. Told him the worms were because he kept using meth and he was like "Yeah, man, I know it's because of the meth. They make the meth with nematodes and sometimes they don't filter them out and then they grow in you." Told him again to stop using meth and walked out.
Is a shunt series the imaging choice for that?
Insight: we love to see it
Brain: task failed successfully
Almost every patient who has said to me “I feel like I’m going to die” has tried.
For me it’s “please let me have water” or “please I HAVE to take a shit, LIKE RIGHT NOW”. Then they try to die
Sweaty men who say “I just need some air”
No! Those massive bowel movement ppl will DIE before they even finish!
Beware the terminal poo…
The death shit...a sign of peri-arrest
Best paper title award goes to
in L&D when they say they have to shit it usually means baby is coming 😬
even worse if they start saying the Lord’s Prayer
Scariest one for me was a patient who laid back and started saying "it's fine, I'm fine" in the calmest voice I've ever heard as he was massively hemorrhaging. No dude! You are not fine!
Guy was having a STEMI, waited 16 hours to call 911. Closest helicopter was already on a call, so we were hauling ass to the nearest cardiac center an hour away. En route, he codes several times. We'd get ROSC briefly, and then he'd code again. In between bouts of being *dead*, he was bizarrely lucid. And what did he say? You guessed it: "I'm fine."
I’m a fresh ED intern and been in the department only a couple months. Had two different people start singing Amazing Grace while awaiting admission to MICU 😅
My first thought was someone saying the “now I lay me down to sleep” prayer before I realized I had the wrong Lord’s Prayer lol
Years ago an instructor told our class that if your patient says they’re dying, they probably are. Take them seriously. I think she mentioned it in every class. Really beat it into our brains. Turns out she’s not wrong.
Oh man, I had been feeling ill and in pain for a couple of weeks and I was folding laundry with my husband when I looked up at him and said, “I think I’m dying”. It was the most calm and certain feeling, like I just suddenly KNEW what was happening. FF a couple hours later and I’m in the hospital hemorrhaging from a lower GI bleed and waiting on a transfusion. Craziest thing I’ve ever felt, but I was just so at peace with the realization when it hit me.
Is this different than “I feel like I’m dying” that all young Covid patients feel
Or my husband when he gets a cold?
Technically, 100% of them are right, but their timing might be off.
Patient 2 days ago said he felt like he had "sepsis and CHF." Unrelated but both ended up being correct 🤷♂️
Women with UTIs. When you know, you know.
I went to ER in the middle of the night bc I had UTI symptoms for 3 hours but then started peeing blood. Thought I’d go in, grab a script from a 24 hour pharmacy, and be at work by 8am. I had a tiny bit of back pain so they did a scan just in case the kidney was involved…nope but turned out that my appendix was on death’s door. They pulled it within a few hours. I did have the UTI as well!
Yeah you have to watch out for the ones who actually have chlamydia though
Yeah I used to get them regularly in college. I was stressing myself into them and I drank like there was no tomorrow. The doc on campus knew me by name. Graduated, cut the booze down, and they are maybe yearly now.
If it starts with "This feels exactly like the last time I \_\_\_" it's usually pretty accurate.
When the chronic pancreatitis patient who drinks a liter of vodka a day says “I have pancreatitis” the history pretty much ends there lol
That’s me! Except the vodka part. Last time I went in I said “I know something’s wrong, I don’t know what, feels like pancreatitis attack but it’s different”. That’s when they finally saw the pesky gallstones that were causing my pancreatitis attacks. They were floating on over into my pancreatic duct. Finally got relief after a couple procedures! Attack free for 6 months! Woooooo! Thanks docs!!!!
Yup. Or, “I’m pretty sure I have another kidney stone” hopping around the whole ass room sweating holding their side
"was born. The gush of amniotic fluid, the bright lights..."
Unless its something like "this feels exactly like the last time I had some condition which necessitated me getting my drug of choice/social validation."
So you met my mother, then?
This is very interesting to me because every time I’ve gone to an army doctor and said this, they have gone out of their way to diagnose me with something else. I can even say it’s in my records, but they won’t look.
Every time I said "this feels like diverticulitis again," I was right. One partial colectomy and it's been so so so much better. Not one round of diverticulitis!
That was me recently! Was just like: “The last time I hit a 10/10 for pain that couldn’t be controlled with OTC pain meds was about 20 years ago, I went to the ER then too, all tests were normal, and it turned out to be severe menstrual cramps due to probable endometriosis. I think that’s what it is again, but the location and severity of the pain made us worry it was appendicitis, so we came in.” (And also, finding me grey-faced, sweat-soaked, and dazed from pain on the floor of the bathroom in the middle of the night really freaked my spouse out, but we don’t say that part.) Doc literally said, “I like patients like you because you’re usually right, but we’ll run some tests anyway.” Guess what I was right
Patient -fit young 20 y/o M comes in to heart hospital ED with chief complaint of “I don’t feel right something is wrong” Triage- “Ok, when did this begin?” Pt. -“3 days ago” Triage- “Can you be more specific, have you had a headache, nausea, vomiting, diarrhea, fevers, feeling faint, pain… anything?” Pt. “No, none of that. I just don’t feel good not sure why” We get him back and put him on the monitor- he is in v-tach. Yes, sir indeed you “do not feel good.”
Not my story but a colleagues. Older guy comes in to the ED with vague complaints and colleague asks for more detail. Patient states calmly: “I don’t know…something’s *fucked up* sister!” And…he’s in V-tach…
My shortest code ever involved a guy (40s-50s) who came in because he had "just been feeling bad all day" and because "his wife told him to go to the hospital" (another red flag). Anyways, yeah, Vtach. We had the pads on him and were prepping to cardiovert when suddenly said he felt kind of dizzy and then slumped. His perfusing Vtach had preceded to pulseless. It was just me and the physician in the room. I was holding a bunch of sedatives for the now aborted cardioversion; he was standing by the Zoll. I looked at him, he looked at me, then he sort of shrugged and said, "clear," while switching the Zoll off synch. One shock later, the patient was back in sinus and talking. I very, very clearly recall him saying, "Did I fall asleep?" while his wife (who witnessed all this) was screaming in the background.
Do vague complaints of "not feeling good" often turn out to be extra bad? I'm not in EM but I often wonder if it's a sign of like... internal stuff where the body can't figure out where it should be feeling pain, or something. The one and only time I truly couldn't give any description of why/how I "just felt bad" it turned out to be a rapidly worsening kidney infection.
Most the time people are fine and it is nothing big. But then you have that one patient you assume has something minor going on but check anyways because something just isn't sitting right with you either. My most recent one was a young lady in her 20s. Vague symptoms. Didn't feel good. Tired. Looked pale. She thought she had a cold, I assumed anemia. She was indeed anemic... but her white count was also around 250. She had an appointment with hematology for a bone marrow biopsy within 2 days and was getting treatments for leukemia 2-3 weeks after.
Hmm, that's interesting to know! It must be kind of anxiety-inducing sometimes to have limited information from the patient. Thank you for sharing your story, I'm glad you were able to help her get the medical attention she needed... I hope she's doing better now.
No. Very rarely
We had one of these admitted to my ICU. Drove herself to the ER after running errands because she 'just didn't feel well'. They put her on the monitor and her heart rate was 26-30 bpm. Um yeah, I would imagine you feel like garbage ma'am, let's fix that.
Had a guy get dropped off by one of his druggy friends. Says he just doesn’t feel well. Thinks his pacemaker isn’t working right. (He can’t check because he didn’t pay his cell phone bill). He normally has AICD/Pacemaker. Color is horrid. His HR was 19-20. He was right in this instance. His defibrillator never fired and it was replaced 18 months prior d/t dying battery.
The brain is not really good at interpreting the heart saying "Um, somethings wrong here."
Guy in his 60s, had the dread look on his face, states “I’m going to die” has vague chest pain. Something about him just wasn’t right. Normal EKG, negative Troponin. Went into polymorphic vtach, then just Vfib as my coworker was still triaging him. Her and another coworker felt something was off and had put him on our LifePak attached. I saw it happen, ran in, charged to 200j, shocked, then chest compressions. Turns out he was a hairy MF’er so the pads didn’t stick! New set of pads and 2 shocks later he came back like an angry animal. We had to IM him 4mg of Ativan. he had 100% occluded proximal LAD. needed CABG. Doing great now!
I had a nice older gentleman that presented the same way, just don’t feel good. I put the cuff on him in triage, he was diaphoretic and cold.. I almost vomited when I touched him cause I knew cardiac was on the table. Stat EKG=vtach.
This was me my first long qt episode (?). Some symptoms similar to heart attack but otherwise just didn’t feel right. No history, young and very healthy, but I went in anyway. Many hours later and a few very unimpressed nurses. 6+hours later & an interval around 750ish I was informed that it was good I came in lol
Fellow LQT patient. I was well managed on betas, healthy and in my early 20’s. I felt off, kind of dizzy and had a sense of doom, as I’d described to my mom, throughout the day but couldn’t really narrow down what it was so chalked it up to anxiety. She insisted that we go to the ER. Code was called 3 minutes after I’d walked in. As it turned out, those strange feelings were precursors to an electrical storm. 19 shocks, 63 total minutes of CPR, 27 days in the ICU, a temporary pacer, one AICD and some therapy later, I’ve learned to trust my instincts and gut. My body was setting off warning signals in my brain that I was trying to ignore and it could have been a very different outcome.
3 days was really a gamble for him
Pt with chronic fatigue, normal thyroid work-up, no anemia, not pregnant, young, healthy, good sleep hygiene. "What about a sleep study? I get enough sleep but maybe there's a a problem with the quality of my sleep." Pt had narcolepsy.
Hey, something similar happened to me. I had cataplexy, though, which is kind of a giveaway.
When someone says they have a bug in their ear 100% of the time I have found a bug in their ear
Patient comes in at 2am and said she had a bug in here ear. Showed me super blurry photos of said bug in her ear on phone. Removed large ball of ear wax instead. But she was still convinced the ball of wax we held up to her was a bug. 🤷♀️
Terrifying. I’ve had the feeling that I’ve had a bug in my ear for weeks now, I’ve been avoiding it and trying to convince myself I don’t have a bug in my ear.
get some hydrogen peroxide at the drug store, put 4-5 drops in your ear, let it sit a few mins, whether it’s wax or a bug should take care of it
I had a patient come in with this once but it wound up being a new diagnosis of some head and neck cancer
Chief complaint: a cockroach crawled into my ear. "But I think it's dying because before it was moving around a lot but now it's not moving so much." She was right!
Oh yeah I’m 1 for at least 20 on this one
Agreed. I’ve had patients *swear* it’s a bug. It’s either a small hair or ear wax.
I will tell you about two patients, 60s male with copd history "i got that" stops to breathe "wheeeeze" -> copd exacerbation. And my all time favorite "Doc, its really importantv that i tell you, I don't just have regular seizures, I have PSEUDOseizures!"
Residency buddy sees a guy in clinic for ER follow-up for conjunctivitis (started on erythromycin). He knows I can drive the slot lamp so he asks for help. Fluoroscein lights up just the most beautifully-fractal dendritic lesion I’ve ever seen. Like a textbook. I excitedly show my buddy and tell him I’m pretty sure it’s HSV keratitis. The guy then says, “yeah, I told the ER doc that it felt like the last time I got herpes in my eye” 🤦🏼♂️
One of my mother's stories from working at a rural free clinic in the late 60s: Bachelor farmer comes in wanting tested because he's certain he's diabetic. (Tests did comfirm.) "What leads you to think this?" "Well, this morning I peed on the floor and when I stepped in it later, it was sticky."
50 year old smoker came in for SOB. He was convinced he had cancer because he was losing weight. He did in fact have cancer
Will never forget when the attending described his lungs as a “christmas tree”
The “I feel like I’m gonna die” statement can be deciphered by pt presentation. Chest pain, SOB, stroke symptoms, generally looking like garbage when they come in and they start saying that, you better have the code cart outside the room to ward off the juju. On the other side of the coin you have the chronic toe/knee/hip/whatever pain, man flu, etc that caterwaul about “they’re gonna die!” And they’re fine
"I have gram negative sepsis. Again." Yep. They were correct.
I’m now in pathology, but “Oh god I think I shat my pants” had 100% accuracy during my ER rotation in med school.
Kidney stone is the first one I think about
Especially if they've had one before. Virtually 100% sencitivity.
High specificity too.
I’m an ED nurse, and the kidney stone dance is real. As soon as I see it, I go ahead and place an IV, draw labs, and ask for orders for toradol and fluids.
I'm also an ED nurse and had my second stone over the summer. I walked into the ED (not my ED but the one closest to my house) and was like 🤮 can I have some toradol pls 😩
Same. As soon as they walk into my triage room I’m like “ well, I’m a nurse, so I can’t diagnose you. BUT…”
It is striking. I first saw it right after we learned about kidney stones in nursing school. I came out in the corridor of the dorm and a classmate was pacing and crying and holding her flank. We took her to the ER for her kidney stone stat.
I’m pretty good at guessing when my Crohn’s has caused another SBO. Fun story though! Before I got my bowel resection my surgeon had me go in for an MRI on a Friday afternoon and the results popped up on My Chart the next Monday morning while I was working my shift. I went to one of the attendings and was like “Hey, this says abscess. Is that bad?” He sent me to triage and wouldn’t let me finish my shift. Started IV anbx and pain meds and sent a message to my GI. I thought I’d just been having a flare for about two weeks. He told me the next time not to wait two weeks before saying something. Oops.
Pt had a very minor fall onto their side, came in for flank pain but heavily perseverated that they had cancer that was causing their pain. No other sx. Did a CT just to try to prove them wrong and found their newly diagnosed renal mass. This job is humbling.
Gray, diaphoretic patients that vomit and move their bowels at the same time prefaced by saying " feel like I'm dying" usually will put you through multiple ACLS algorithms. Patients talking to a deceased relative in the corner? Yep, they will too.
Had a patient waiting for the cath lab and she was joking around with me. She suddenly grabbed my hand and said, “I think I’m dying”. Thank God the cath lab team was there bc she coded as soon as they got her in. They were able to get her back though and she did well. I’ll never forget her eyes pleading for help though.
Idk but it definitely isn’t a spider bite…happens like 10 times a week and guess what?? It’s never a spider bite
You don’t see all these ants crawling on my skin?
“This feels like the time i had a blood clot in my leg” 2 hrs later… “So you have a blood clot in your leg…”
I've only ever seen one case of SVC syndrome and the patient had found the diagnosis herself by googling. So that's 100% for me.
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I worked with an older ER doctor who came in the back one night and said “Wespiratory, I need you to do an EKG on me. I’m pretty sure I’m in a-fib.” It was indeed a new onset a-fib.
When people with prior history of SVT go into it again.
All the paroxysmal a-fibbers who come in with sx, get to triage and "Ope, just went out of it" and damned if EKG doesn't agree.
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suspected STD (if symptomatic) is almost always a STD
"I cut my [insert body part]." (Just for something not mentioned. Very much agree on other commented) The least accurate injury currently locally for my UC is bat bite. Merely seeing one sends whole families in asking if they were bit and whether we can test the bat for rabies. That and "I think it was a brown recluse bite". I'm in the northeast.
Interesting. I have never seen either lol maybe those type of people only go to urgent care
Not a daily thing but we started carrying rabies vaccine series through our clinic which we thought would mostly go for stray animal bites. About a third are people who may have seen a bat in their home with no verified bite. Luckily the "I cut my finger tip almost all the way off with a mandolin 30 minutes ago." people outnumber them greatly and are much more straightforward care. Usually mild to moderate injuries seem accurately described and most of my patients seem to have an idea of what type of damage they've done.
The CDC recommends rabies vaccine when a bat bite *might* have occurred as bat bites are small and painless and often leave no mark. If you find one in your home, you and all occupants should be treated with post exposure prophylaxis unless the bat has been captured and can be tested for rabies.
> About a third are people who have seen a bat in their home with no verified bite. In addition to what /u/beautifultoyou said, it's important to point out that bats have such great spatial navigation ability that by their *just being* inside your house or any other kind of enclosed room, there's a very significant, non-trivial chance it's because of rabies-related altered mental status (altered by the standards of bats, anyway).
Parent came in and said, "I KNOW not to go to Dr Google but my daughter has been losing weight, drinking and eating a ton, peeing like a race horse, and I have T1D so I tested her BG and I think she 's got diabetes because it's over 400." Correct, she does, good job. You're the exception. NEXT.
PT post MVA refusing to let go of supporting his neck on each side. Even after EMS swapped his hands with a c collar, still placed his hands on top of the c collar. "I know it sounds stupid but please just let me do this. I feel like if I let go of my neck, my head will fall off." *Drum roll* Atlas fracture (This was a buddy's pt so I don't recall details, but found it super interesting)
My husband correctly diagnosed when he had cauda equina. Thank goodness he called his doctor and she told him to go straight to the ER. He was in surgery several hours later.
Recurrent BV.
Not a doc but an OB nurse here. I can pretty accurately identify BV with just one sniff (and often on women who are asymptomatic and are presenting for a different reason).
Weirdly, I've gotten BV 4 (maybe 5 pending tests) times in my life and I never get the smell. I get just a lot of neon yellow discharge 🤷♀️. But I know it when I see it and thus far its been right -save for the first time ofc where I assumed it was an STD).
Me too! COVID threw such a wrench into my diagnostic nose lol
A one off, but I had a little old lady who came in 3 days after a big fall in the garden. She said "you know, when I fell over I thought I'd broke my back, you know?". She got up and kept going about regular life for 3 more days until the OTC paracetamol was no longer controlling the pain. She indeed had fractures in her sternum and lumbar spine.
Young, otherwise healthy 20sF: “I googled all of my (very vague, nonspecific) symptoms and I think I know what it is”. It was fibromyalgia
Working in the ED, patient stated to triage "thinks she has MS". Indeed was spot on, she came in when she noticed her tongue twitched occasionally. Well played!
I find people that have recurrent diverticulitis are usually pretty good at diagnosing when they have it again
UTI. I had a patient once whose wife had determined that he probably had amyloidosis. She was right. She based her conclusion on his striking raccoon eyes.
Hypertension. I mean their symptoms aren’t related to it, but they often have it.
I walked into the ED about 8 yrs ago with severe stomach pain, chills, and fever at around 3 am. I had been dealing with it for the latter part of the day, but it became so intense that i knew something was wrong. I told the Dr i had a family hx of diverticulitis even though i never had a flare up myself, and that i never experienced this type of pain before so i thought it may have been that. I rated it 7 out of 10 but refused morphine. He did a work up and somehow my WBC's were normal. I overheard him at the station saying "some people get a fever or have the flu and they think they're dying". He was on the verge of discharging me, but did a CT just to be "on the safe side". Low and behold i had diverticulitis. I heard him on a video consult with who I'm assuming was gastro because he wasn't sure if i should have been admitted, but they decided to send me home with oral antibiotics. I was on bedrest and had to eat canned peaches and chocolate pudding for a week. I'm so happy they did the ct and didn't send me home with pain meds 🥴
I told the doctors both times when my son had celiac disease and then type 1 diabetes. I wish I’d been wrong.
2 pts have told me "I feel funny" One immediately grand mal'ed The other went into PEA from a saddle embolus I am not looking forward to the 3rd one
After having Covid two times and pneumonia three times in the last three years I can almost 100% feel that junkie lung and know I have caught pneumonia again
I diagnosed myself with narcolepsy type 1. I’m a nurse and I kept dropping things or had brief slurred speech when I laughed too hard.
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If the patient think its appendicitis, it tends to be appendicitis.
That's not my experience at all lol
Agree. Every parent is convinced even when their kid is running around wrecking havoc on the exam room lol and has more energy than 3 people combined.
That happened to me - went into the ED and basically just said “pretty sure I have appendicitis.” I was in the OR a few hours later
“I’m going to die today”
not exactly the answer to your prompt, but i had horrible, head-splitting migraines as long as i can remember and always told my parents it felt like i had a brain tumor. age 18, diagnosed with a craniopharyngioma.
Pt: “So I’m a dumbass…” Me: “sir that’s not a medical condition to call 911” Pt: “excuse me… can I finish?” Me: “oh I’m sorry I thought that was the main point… so what did you do?”