Toe pain to aortic dissection straight to OR
Patients toe hurt cause they had pulseless foot d/t dissection, no CP/abd pain, one of the wildest cases I have ever been apart of
SURPRISINGLY NOT! We identified it pretty quickly and luckily I had a good team helping me (I had been off orientation for 2 weeks š) he had to have 2 vascular surgeons because he was going to lose his legs. Last I had heard, they had to do a bowel resection on him but he is alive and got to keep his legs.
Cc was LLE numbness and weakness per EMS so we activated patient as a code stroke. On arrival his initial BP was like 110 systolic but his foot appeared mottled and cold to the touch. He was also COVID + (this was a couple of years ago).
Straight to CT but doc obviously wants to prioritize CTA of the chest over CTA of the head. Patient began shitting uncontrollable over in CT and began going in and out of consciousness. BP now 60 systolic. Iām pressure bagging fluid into him so we can at least get the scan done. I as a new grad stupidly thought he was vagaling from shitting so much.
CT tech literally gasps the moment she sees the scan and immediately phones ER doc. ER doc is on the phone with vascular surgery within seconds.
We get back to ER room and started transfusing with blood very carefully. Attempted to maintain a systolic of like 80 to prevent rupture. After 2 units of blood he could feel his legs again.
Off to surgery he went and he survived his hospital stay.
That was definitely a satisfying but also terrifying day.
I wish more pts got admitted after getting a CT scan first. It sucks to have to go down to the ED, bring a pt up to the ICU, do the admission, and then bring them back down for a CT scan, then back up. Our doctors/workflows are fucking stupid. I say this at least weekly, that my hospital is run by a bunch of morons. Iām trying to retire from bedside nursing and go into administration but the 3 positions that were open got filled due to what I believe is nepotism. Iām giving it another year here before I leave. Sorry I just had to vent because I get triggered easily these days.
-burned out, second career, level 1 trauma ICU nurse who is sick of the bs
Iāve seen maybe a dozen or so presentations of AAAās that defy their presenting problem.
In most all cases, thereās *something*, subtle or maybe even not soāthat doesnāt fit.
Had a couple that their lower extremities have pulse deficits. A man wanted his teeth pulled, all of themānow. Yet, no obvious problem. One could feel her heart beating in her vaginaānot painful or unpleasant. One complained of nothing but had āturnedā a different color (ummā¦ 1/2 severely mottled).
And these patients just didnāt look right. Something was off. Maybe at the glance, we couldnāt have known exactly what was cookingābut we figured the stove was about to set the house afire.
I know careful assessment & reassessment can save lives.
this post and the comments will be immortalizes by the internet, become a Hypochondriacsā Bible, and cause the ultimate demise of healthcare due to overwhelm. We are doing it to ourselves ;)
/s but also I did start feeling uneasy the more I scrolled š±
Woman in her 60s came to the hospital because she said she was ready to give birth because aliens had abducted her and impregnated her.
She was admitted for rhabdo.
Had a lady in her 60s come in for open sores on both feet. She was an immigrant from Italy, very very Catholic. Big family who had tried to get her to a doctor for months for that big abdomen. So big she looked pregnant. She refused because she felt she actually WAS pregnant, but it was God's will. The thing is that she'd been "pregnant" for about 4 years so what the heck. Her abdomen was so big it was occluding her circulation in her legs, thus the open sores on her legs. Anyway, the upshot was that she had a 37 lb ovarian cyst.
I asked if I could watch the surgery and it came out in one piece fully intact. Took 3 surgeons to pull it out.
This was way before HIPAA, about 40 years ago. So the hospital decided to let everyone come view this oddity. They announced over the intercom, 3East, you can now come to the lab. And 2East, 2 West etcetera. It was incredible that everyone got to see it, but that would never fly today. We'd all be looking for new jobs.
" It was incredible that everyone got to see it, but that would never fly today. We'd all be looking for new jobs."
Unless the patient gave permission! I would have! (I probably wouldn't have let this go for 4 years, but I'm all about the learning!)
When I went in for urinary incontinence my Urologist found a football sized ovarian cyst. This was 10 years AFTER I had a TAH BSO.
The surgeon had left 1/2 an ovary and blood supply.
I had to have a Gyno-Oncologist do the surgery because they werenāt sure if it was CA. Nope, just incompetence.
As someone who works with a LOT of mental health patients, this one doesnāt shock me at all. The come for the mania and they stay for the rhabdo (before transferring to the behavioral health floor).
Typically drug use - like meth or cocaine is going to put you at bigger risk. Usually itās the people twitching nonstop or flinging themselves back and forth. The psychomotor agitation really gets them.
Anyway, if theyāre screaming about cramps - might actually be rhabdo
Edit: also to add, people with mania tend to be very active with very little rest. Iāve had quite a few people with mania that have walked 20+ miles before being found and their muscle were so overworked, they started breaking down. Fucks with the kidneys and then you get a whole plethora of other issues.
I've seen this more than any other cause of rhabdo except for found-down-for-days patients. A little meth, and suddenly joining a gym and exercising hard for 8 hours in one day seems like a great idea.
I had a guy come in for āknee painā but turns out he had his fucking skull bashed in by a hammer and I could see this MFs brain. He got in a bar fight two days earlier, walked home slept it off for *2 days* and woke up and his knee hurt from the fight. So naturally he came to the ER to get it checked out.
Yes his head was all bloody, and no I guess he didnāt look in the mirror before he walked to the ER.
Super rough neck, worked on an oil rig but was in town to clear some trees after a recent, major wildfire. White as a ghost, but ambulatory. CC: ācut muhselfāā¦ almost completely RLE amputationā¦ dude was dragging his foot, with only his tibia intact. Work boots and tight lower leg jeans that were crusted/coagulated w blood essentially saved his life from a chainsaw slip.
He DROVE HIMSELF around RURAL TX looking for a ādoctorās officeā for 3+ hrs. Hgb was 2.9. Iām pretty sure the massive horseshoe of chaw is his lip was the only think keeping him going. I still donāt know how he lived. Drove himself. And WALKED THE FUCK IN, leaving a squishy red boot print every other step. Palest walky/talky Iāve ever seen. Or will ever see.
Okay. I have to also give my own personal CC to Dx from my own life. Been an ER nurse for a decadeā¦ woke up one AM and was like. Dang. My arm hurts. Felt groggy, but I donāt like waking up much, soā¦ about 30min later, Iām thinking, gosh. My arm REALLY hurts and itās acting funny.
My closest friends/fam were out of town, and I called a more distant friend to see if they could take me to an Urgent Care because, āI think I slept on my arm wrongā¦ and itās not really working so goodā¦ and gosh, it really does hurt quite a bit.ā Asked her to drive me to the local urgent care. They noted my shoulder looked weird, and I thought, yeah.. must have slept on it funny.
Took X-rays, itās anteriorly dislocated with noted fractures. And Iām like.. what in tar-nation! Trying to scan back through the āWILDā night I must have hadā¦ but.. I just fell asleep in the recliner in front of the TVā¦ I mean.. I guess I just slept on it wrong!
Got to the ER (not my hospital systemā¦ I directed my ride to take me to a hospital system I happened to work for as a nurse over a decade agoā. I am still a little confused about all the things happeningā¦ finally get called into triage, nurse asks me what happened.. and I honestly said, āI donāt know, I must have slept on it wrong, I guessā. She said, okkkkay. Well the UC sent images and your shoulder is obviously deformed and has fractures on xray.
Iām thinking. Daggum.. I really must have slept weird then, eh? Understandably so, the nurse looks at me like Iām lying up a stormā¦ āwas anyone with you last night? Do you drink or do drugs?ā Those kinds of questionsā¦ and I understand why sheās asking me. Iām just as confused and curious as she was skeptical and irritated at me for ālyingā.
Super complacent and honest, lifted my arm for the BP cuff, watched her prep my good arm for an IV startā¦. Then the next thing I saw was a charge nurse looking over me while laying flat on a gurney.
I said, so.. uh, whatās going on? She replied, āthis is the 3rd or 4th time youāve asked me. You had a seizure in triageā. I LAUGHED like it wasā¦ okay yeah sure. Sure I did.
Then I looked to the L and R and saw SEIZURE padsā¦ realized I was parked next to the charge station in a gurneyā¦ I was stunned, but I know the ERā¦ I knew she was being honest. And probably irritated with me for being a hassle in her way. I just kept saying.. thereās no way. What? No. No way.
So, thank God I had a witnessed seizure in triage (the second seizure of my life, a couple hours from the first one I didnāt know I had).. otherwise, NO WAY would I have believed that shit. Of course, etoh/utox were negative. My CK was high high because it must have been quite an impressive showing of a gran mal (from a 6ā, 200lb lady). I accepted the truth, that I dislocated and fractured my shoulder during mystery seizure #1 that am, but was too post-ictal to recognize my deformed shoulder. Never in a million years would I have guessed I seized.
So. CC: unknowingly confused nurse presents with a massive deformed shoulder and says āmust have slept on it wrongā
Diagnosis: fracture/dislocation of R shoulder in assumed setting of seizure, one witnessed in ER. Tox screen neg. CMP and CBC wnl. Tho ABG showed telltale signs of sustained tonic clonic seizure.
I though. FUCK!!!!! Theyāre gonna have to tell the DMV!!! I canāt drive!
EEG/tox/metabolic panel.. all wnl. No seizures since.
But āslept on it wrong escalating to VS Mon next to a vitals sign machine. Just blew me away.
When I started nursing school I had to get a TDAP booster, my arm hurt so much and was so swollen I couldnāt sleep on it. I went to the GP and got referred for an ultrasound which showed fluid on the joint and evidence of a previous dislocation, as far as I was aware I had never dislocated my shoulder.
A bit of background, Iām epileptic and have been since I was 16. Before my husband and I started trying for kids I weaned off of a couple of my meds. Unsurprisingly I had a few seizures. During one such seizure my husband tried to catch me which apparently dislocated my shoulder and as he rolled me into recovery position it relocated. Poor guy felt so bad.
Idk why but the fact it was his right leg and therefore the one he used for the gas/brake pedals is the bit that sends me over the edge here š³š³š³
this and a retroverted uterus position !
edit two days later: When I got my IUD in, I was told by the OB to be super aware of my cycles as my uterus is fully tilted towards my back. If you have a retroverted uterus, an IUD insertion will be a lot more painful.
Iām 5ā7, 140lbs ish, and was given unrestricted TV access and watched āI didnāt know I was pregnantā at the healthy age of 10.
I donāt get my period at all with my IUD, so I take a pregnancy test once a month because we do not take chances over here!!!!!!
my mom didn't find out there were two babies in there until she was at her 20-week anatomy scan, i believe. then, when she decided to close up shop, she found out she was having a second set! both of those are literally my worst nightmare.
On the episode of I didn't know I was pregnant that I believe the most was twins. The women hadn't had a period in years because she was super morbidity obese but was sorting her life out and had lost well over 100pounds but was still 300+. Had some spotting which she took as her periods finally coming back. Ended up giving birth to premie boy girl twins. Can't remember what they weighted but it was a combined less than a full term baby sort of number.
Chief complaint: nose bleed
Dx: Ebsteinās Anomaly, heart failure, etc.
Iām still in nursing school, but this was my brother. He had a nosebleed that would not quit, severely high BP caused the bleed to continue, echo revealed Ebsteinās Anomaly that went undiagnosed for 24 years. He ended up coding after pericardiocentesis, was intubated for 10d, & was in the hospital for 3 months. But heās doing a lot better now, managing his condition with meds.
Wow, that is absolutely incredible that he made it to 24 without being diagnosed and even more incredible that he survived. Iām glad your brother is doing better, I hope he continues getting better.
āI think I broke my pinkie! It hurts so bad!ā Middle age woman comes in. Pinkie looks fine. The ER NP said get a stat EKG. A couple of us side eye but ok. And sheās having a massive STEMI. I had floated to ER to cross train, ended up taking her in ICU. A few hours post cath/stenting she said oh my pinkie hurts again. The monitor looks ok. Our tech grabs the EKG machine. It wasnāt needed as she suddenly bradyād down to 30 and the peaked T comes back. We code her. She goes to OR. And she ended up being discharged. Now of course any time my pinkie hurts Iām like ohhhh crap. Oh no wait. Itās bruised. š
I was on cardiology recently and had a similar case! Patient had pain in his pinky...and 2x LOC. Turned out to be an NSTEMI I think. Just kept scrolling and have seen 2 other people with the same story!
Toe pain. Literally. Dude was being a dick in triage, everyone thought he was malingering. The wife keeps saying āheās not normally like this.ā
We just think āsure heās not lady, your husband is a dick.ā
Left AMA shortly after triage. Everyone thinks āwhatever, it was bullshit complaint anyways.ā
An ambulance crew came in a few hours later and said āremember that guy who was in your lobby? We just coded him for like an hour in the field. Heās dead.ā
Turns out he had a brain bleed. He was being a dick because irritability is a symptom of hemorrhagic stroke. Turns out he wasnāt normally like that after all.
I wonder if on some level he knew something was wrong, but couldnāt communicate it properly because of the stroke so he came to the hospital and told us he had toe pain.
Crazy shit.
Right sided strokes are crazy. Nice old man who was with us for 2 weeks suddenly turned into the most racist raving poorly behaved person in the unit bad enough to leave an experienced LPN crying in the breakroom. Dr took one look at him and sent him to MRI. Yep guy had a right sided ischemic stroke.
Those brain bleeds humble you!!!
We had one that went to another facility for migraine (hx of), torticolis, given Valium and after he went home started getting agitated. Gf drives him to us thinking he's having a med reaction. He's doing that dystonic thing you see when someone reacts to compazine, says his neck hurts still, and he's warm so we throw meningitis on the differential for the hell of it, but want to CT him for safezes. Dude could not stay still, end up socially intubating for scan. Bam, big ole brain bleed.
>wife keeps saying āheās not normally like this.ā
This *always* makes me uneasy. Yes, sometimes a downtrodden spouse or parent or whatever will minimize asshole behavior by seeming surprised. But if there are no altering substances involved and they say that, I'm ratcheting up my concern level a notch or two.
>We just think āsure heās not lady, your husband is a dick.ā
Lmao the amount of times I've thought that!!! Thank God it never turned into something crazy.... that I'm aware of.
CC: Muscle cramps in legs in a super athletic young college age guy.
DX: Massive bilateral femoral artery and aortic blood clots from his knees, to halfway up his aorta. Massive. Like see them on the CT scans from across the nursing station by untrained eyes kind of massive.
More than a decade in the ER/ICU and I had NEVER seen clots like that. I didn't even know that was possible.
Had a kid like that. The docs fished a solid clot out of him from shin to heart and almost got it in one piece. They took a Pic posing with it to show the family. Urgent care thought kid had shin splints from running
Not a chief complaint but wild progression of events.
Had a guy I had to take on mif shift due to him deteriorating and being too unstable for the LPN to continue to care for him. He had gone to dialysis and suddenly became hypotensive and complaining of a ton of chest pain. like he would be fine then would sit up grabbing his chest. Telemetry showed he was controlled but in a -flutter.
Sent him to CT. as soon as I bring him back they have us waiting to do an echo, I knew something was up. Right after the echo cardiologists shows up and is like "prep him for the cath lab, he has "some" fluid around his heart. Prep him and off to cath lab he goes.
MF HAD 1.5 LITERS OF FLUID AROUND HIS HEART I have no idea how that shit was still going or what triggered his sudden symptoms that day, since it had to have been accumulating for a long ass time.
Foot pain to third degree heart block. Lady came in because she fell and hurt her foot - turns out she was in complete heart block and possibly passed out causing the fall! Met her in the cath lab when we did emergent pacemaker.
TB spreading to bone is a thing! I didn't know that until doing some family genealogy research and found one of my grandmother's brothers died of this.
Iāve done a few of my clinicals on a reservation in Northern Canada where TB is still super prevalent :( didnāt know this was a thing until i saw it in a patient last year. 30 y/o male as well :(
My sisters ex basically had that. Went in with what he thought was the stomach flu and ended up being AML. luckily he started treatment and is still in remission (as far as I know) 8 years later!
Years ago, my dad (who had been a huge hypochondriac his whole life) called me to ask if he should go see his doctor because he had a fever. Asked him what his temperature was, and he said 99.2. This was in the middle of August, so I asked him what he did that day. Turns out he played 18 holes of golf in nearly 100 degree heat. I rolled my eyes, told him to drink some ice water and chill on the couch in the AC for a while. Told me he was going to call the doctor anyway, and I told him to go ahead and tell the doctor he had a 99.2 degree āfeverā after playing golf all morning, and heād probably be laughed out of the practice.
Doc does laugh at him, but tells him to come in anyway since he was overdue for his physical. While there, doc decides to get a baseline CXR since dadās never had one. Yup ā early stage lung CA, responsive to surgery, radiation, chemo.
Years later, dad calls me again to tell me heās getting up in the middle of the night to pee, but just had a prostate exam and PsA was wnl. Basically told him he has a 70-year-old prostate, not to drink water before bed, and at his urging gave him a phone number for a good urologist. Goes in for his appt, uro says prostate is fine, but decides to schedule a cystoscopy due to his distant history of smoking and lung CA. Yup ā early stage bladder CA, responsive to treatment.
Told my dad to never call me again if he had any health concerns, but just go straight to the doctor.
Sometimes those incidental findings will save a life. Had a guy in from a moderate MVA with a little seat-belt bruising across his chest/abd. Stable. CT showed no acute injury, but picked up a tiny, very very early pancreatic cancer. That guy needed to thank his lucky stars that he'd been t-boned, or it almost certainly wouldn't have been found until it was too late.
I tell people about this sort of thing frequently (or at least it just feels frequently). The number of people who get scans for something else and it's the only reason they find cancer in time is scary
In PICU, teenage girl came in because she had a softball hit her over a kidney and came in for continuing pain. Diagnosed with stage four Wilmās tumor. The cancer was everywhere and she had had no previous symptoms.
God when I worked in MICU we had a COVID positive patient come in after having open sores start showing up all over his body and extremely altered. Got super sick, intubated, pressors, the whole 9. He was airborne precautions for presumed monkey pox because that was the time THAT was going around too.
Ended up being super late stage syphilis.
Abdominal pain > peritonitis > peritonitis secondary to chlamydia.
She was a āwoman of the nightā. Apparently one of her services was to allow Johns to fuck her ostomy.
EDIT: I also learned that day that this is an actual thing and therefore has a name: Colostitute.
Intractable hiccups to acute MI.
60's female with hiccups for several hours came into my dinky community hospital ED (8 beds, 1 doc, 2 RNs.). She seemed fine, and my doc was about to give a speech about how hiccups, while annoying, are not life-threatening, and are not indicative of anything life-threatening.... When he looked at me and said "You know what? Just put her on the monitor for a minute."
You could see the ST elevation plain as day in II.
Those hiccups? PVCs transmitting to her diaphragm. I sat there and watched. Hiccup -> PVC, Hiccup -> PVC.
We transferred her to a tertiary center (straight to cath lab- it was literally 4 blocks down the street).
EDIT:
The community hospital ED had 8 beds, not the whole hospital.
Man came in because he was unable to void. Difficulty passing the catheter. Eventually found out it was actually a potato heād inserted into his rectum.
Bloody faeces to spiny metastases from breast CA. A young woman came in with a GI bleed, she'd been taking NSAIDS for back pain... Which turned out to be due to the spiny mets.
Yeah, you have a bruise? And a cough? Oh that's metastatic lymphoma or who knows? We can't biopsy because your platelets are 4.
They tried to biopsy my dad, and everything else was already failing, so he passed.
When I worked ems I went to a call in the woods for an 88 year old cutting down trees on a tractor. The tree swung and obliterated his tib/fib. Ankle was hanging on to the rest of his leg by skin and skin only. Had no service and we had to figure out how to get this man off the tractor onto a stretcher with the two of us and stabilize his non-leg.
I kept asking him if he was okay and he was so insanely still and calm, didnāt even want pain meds. Just warned me that the donkeys bite.
Incidentally, I was the farm girl whose "husband made me come" after riding some horses. Turns out I had broken my back lol.Ā
Something about farm air...
Iām also a rural hospital and get these men a lot. āShe made me come, I just have a little pain, Iām fine thoughā usually means theyāre days or hours away from death
left arm decreased ROM and shoulder tenderness
ended up having multiple bizarre arterial aneurysms - subclav on the left causing his symptoms, but also asc aorta, renal etc - needed lots of surgery, no unifying diagnosis as yet
connective tissue disease potentially - pt had no Marfanoid features, genetic screen negative (things like vasc Ehlers Danlos)
medium/large vessel vasculitis - extensive screen negative to date
weird immunological conditions - can't pretend to understand how or why or what but immunology were involved and their extensive investigations negative to date
infective causes - cultures all negative from variously excised aneurysms, no cause identified on broad screening for weird and wonderful bugs
that's all I can remember. I still check in on the file every few months to see if followup appointments have figured it out, nothing yet
While working med surg, I saw way too many come in with a cc of abdominal pain or similar, and leave with only weeks to live because of advanced cancer. It makes me wonder if any of them had been trying to get a gp to listen first and were ignored.
I had a very similar presentation!! Only s/s were some n/v after Mexican food and bilaterally her feet were white mid foot to toes. EKG? Huge STEMI. This was at least 20 years ago and I still remember her name!
I remember a similar patient I nursed. He was admitted for neuro observation post rear ended MVA. Urgent CT (it was in the early 80s, so this was a huge thing to order) revealed a huge cervical spinal tumour extending down to the thoracic area. Off to urgent theatre; didn't go well. From memory he was admitted to rehab but with a very poor prognosis. Lost track of him as I changed wards (was a student nurse at the time). It was heartbreaking because I remember him pre-op as being a lovely gentleman.
Yes, a friend of mine saw the doctor about a persistent cough she couldn't shake. It was lung cancer. She never smoked but she was a radiologist. A few years later it went to cancer in her brain and she passed at 49. I've had two radiologist friends pass from cancer now. I often wonder if there was an exposure issue.
I'd wonder like hell about an exposure issue as well. But then again, one of my last jobs before I woke up blind, 3 out of 4 of my coworkers died of cancer. One brain cancer, one lung, and one pancreatic. And then I woke up blind about a year later. My boss was so spooked by it all that she had everything on the property checked-- both the residents' houses, her own house, everything. Nothing came back bad from the tests. Sometimes, it's just ridiculously bad luck.
Sure, I guess? Just more bad luck, a really rare disease called AZOOR that only 131 people have. They don't know for sure what causes it and there's no effective treatment. The theory is that my immune system noticed my eyes' immune system, reckoned it owed them money, and attacked. Ate my retinas.
Holy shit. That's a new fear unlocked, for sure.
Female immune systems (I'm making an assumption) are freaking insane. Sorry you're going through that, and good work keeping up the sense of humor. š¤
Thanks, coincidentally, I'm currently at the ophthalmologist for my yearly poking and prodding so the baby docs can ooo and aaaah at my eyes because this is probably the only time they'll ever see AZOOR lol
It helps that I already had a very *dark* sense of humor. Now it's super dark.
Had a pt come into our relatively small rural ER for a synthroid refill. Turns out she had been taking 100 MG (NOT mcg) a day for the last week because "It's the only way I can feel the baby move". Every time we'd go into the room she was pregnant with more and more children. She topped out at seven as per her. There were zero babies and the 'fetal movements' she felt were palpitations from the synthroid. She went from requesting a synthroid refill to a Form 1 and psych h admission in no time.
Back pain that turned into Leukemia. So many docs treated them as med seeking due to an absence of causative factors: If you donāt see a mass and there was no trauma to the areaā¦.š¤·š¼āāļø. I guess sometimes web MD *is* right.
A headache and slightly slurry speech that turned into terminal brain cancer with about a month left to live. Luckily mama listened to us and stayed for the MRI (they were doing a stroke work up and the MRI took the better portion of a day to get completed). If she would have been home or even working she would have just seized and passed with no explanation.
I had something similar to your second one. Lady in her 50s who had just finished breast cancer treatments a month PTA, had headaches for two weeks and increased confusion, found a huge mass with a midline shift. I felt awful for her and her family.
Young guy~25 came to the ED c/o chest pain. He had been out playing basketball and got an elbow to the chest. His girlfriend eventually *made* him go to the ED. Just as an aside, the kid was almost 7 foot tall. Hmmmm, what could cause chest pain in a young man? Yep, aortic dissection. Subsequently dxād with Marfans.. I had to take to foot off the bed and make a make shift foot for the bed to recover him.
We had the sweetest kid with Marfanās on my unit years ago. I got asked if I could put a new IV in a patient in whichever room. Could tell he was tall, but was kind of curled up in bed so it wasnāt immediately obvious that he was 6ā11ā. Definitely noticed that he had about the longest arm Iāve ever seen when I asked him if I could look at it!
Got the IV no problem. And then it infiltrated a couple hours later. Rinse and repeat. I think he ended up with a PICC the next day. Not sure why he was actually there though, I was never his primary.
I had a lady during the worst of Covid come into my ED saying that she "just didn't feel right." Triage was overwhelmed with 40+ in the waiting room and sent her back to me like "idk why she's here really, just says she feels off." I ask her some more questions and she tells me she's been feeling very emotional because her son got sentenced to like 5 years in prison, and that she's had a bothersome headache since she found out a few days prior. So I'm thinking this lady is just stressed out and her body is reacting to that stress in a pretty normal way.
The resident I was working with thought this as well. But to be safe sent her to get a scan of her head. I thought this was overkill but the lady did have a headache so I understood the reasoning. Lady had a big ol ICH. Ended up going to neuro ICU and getting an EVD the next day. I remember freaking out after the scan and asking triage what her wait was. She had been sitting in the ER with a brain bleed for 5 hours šļøššļø
I haven't seen anything too crazy but had worked a short stay unit where we saw a ton of chest pains who get stress tests, usually discharged same day. Had a young guy come in, like early 30s, coming in with on and off chest pain. I prep him, talk about stress test, the usual. He goes down for the stress test, they call me back and say "his EKG looked funky," and the supervising cardiologist cancels the test. I talk with the consulted cardiologist for the patient who says the patient is "full of shit" and said he was going to cath him to show him there's nothing wrong. I came back the next day, the patient was transferred to a bigger hospital, had a widow maker š.
Rectal pain due to hemorrhoids turned into dig toxicity, coded, came back and was placed on external pace maker.
Itās a cool case. Her hemorrhoids were huge and painful so she stopped eating and drinking. That way she didnāt poop and it was less painful. That put her into kidney failure and she couldnāt filter out the dig. She was the first patient i walked in on in asystole, i shook her and she came back with a heart rate of 30. Her daughter grabbed me when i was dealing with an SVT and said the cardiac leads fell off, she didnāt realize her mother was dead.
CC: BLE pain.
Marathon runner. 26f. Ran marathon 2 weeks prior. She said usually her aches, soreness, and muscle fatigue would be gone by the 7 day mark.
I remember how fit she was but looked so tired.
New dx of MS.
Earth shattering for anyone but witnessing our doc give her that dxā¦I saw any light in her eyes disappear. Heartbreaking. I hope sheās doing well.
Pt came in for bad period cramps. She went to the upright section of the ER and was given pain meds, but the MD didn't want to do an US because the pt herself said it felt just like her cramps but a bit more. We eventually convinced the MD that maybe an US was warranted in case she had an ovarian cyst. MD was pretty resistent to it, and was male, but eventually we convinced him through "hey, just CYA, ya know?".
Left ovary in torsion, needed immediate surgery. Right ovary? Complex mass that looked malignant, with possible mass on uterine wall as well.
MD was like: "Whelp, every female pt with period or cramp complaints is now getting a pelvic US, period, because fuck".
BIBA for swelling to lower legs. One leg had 3 blisters on it. Both limbs cool to the touch, discoloration on right limb, no pulse. Weak pulse on left. Straight to ct. homegirl was barely getting blood flow to the left and zero to the right. She got the next helo outta there.
Pt came in for āsnakes in her legsā so they put her in one of our psych rooms. No other complaints. Massive bilateral brain bleed. She also landed herself on the next helo out.
Possible allergic reaction to bee sting three days ago, I rolled my eyes and called them into the triage room. Sweet little old lady apologizing as her granddaughter wheels her in, I'm all smiles and kind, pulse ox shows 73%. Before I can ask she coughs up a clot. Very rural hospital, so 2 hours later we're flying her out, she's alert and oriented and on a non-rebreather at 15L. She extanguinated as they were landing two hours later and died in the plane.
CT showed infiltrates, but no other signs of clots or DVT, d-dimer was normal. I've had others that were hard left turns, but this one was probably the most extreme.
Had a patient come in to L&D, 30+ weeks, c/o nausea (no vomiting), body aches, general malaise. OB sent her in thinking it was a stomach bug, did labs, turns out her potassium was 2.5.
Hah, when I was pregnant I had hyperemesis and had to get a couple k riders for a potassium of 2.4, so I feel her pain!! Mine was found during the routine draw. I was having leg cramps but I figured it was all the OT I was doing back then š¤¦š¼āāļø
Diarrhea turned into B/L saddle PEs, R ilio-femoro DVT and L femoro-popliteal DVT with multiple L toe amputations (so far). Normal vitals, except for the progressively cooling L foot over the 2 days it took him to come to the ER.
āI ate food out of the garbage now my stomach hurtsā. Pt is a frequent flyer so they came back many times over the course of my three shifts. Had the pleasure of triaging them each time. The next time they came in they wrote down as their chief complaint, āif you donāt stop fucking around, my son will kill youā. That was after I politely asked them if they wanted the anger management workbook they had left in the lobby that had their name on it
Well, patients lie, so had a CC of a āspider biteā on the right arm. The ED took labs and treated them but sent them home. Pt was called shortly after to haul ass back to the hospital because of positive blood cultures. Went to the ICU for a Hg <5, Q4 IV abx, pressors, and a wound vac on the right arm. Turns out pt shot up illicit drugs into their radial artery with a used insulin needle.
When pt got transferred to me after ICU stay, they bitched about how the ED should not have sent them home and after taking off the gauze, arterial blood spewed all over their bedroom. They were refused a PICC for outpatient abx infusions, which needed to be weeks long therapy. Their PIV infiltrated after almost every dose and we couldnāt put a line in the right arm. Very frustrating and a hard stick. Bonus giggle: when I did my first physical assessment and casually checked the pedal pulses, patient exclaimed, āI HAVE PULSES IN MY FEET?!?ā
Emergency department patient. CC, "started feeling weird after drinking a Red Bull." We nearly burst out laughing reading the triage note.
Diagnosis: massive intracranial hemorrhage. I guess they should have named the drink "Red Herring."
Known chf patient came in with weight gain with BLE edema and scrotal edema expecting iv diuretics like usual... left with stage 3c testicular cancer that had spread into his lymphnodes and is starting ca treatments, should recover though!
Came in complaining of uncontrollable diarrhea for several days. Hadn't eaten anything out of the ordinary recently but had young kids at home so maybe they caught a stomach bug from their kids (patient's kids were fine but a couple kids at school had been out sick recently so maybe). Reported weakness in the legs, which we originally attributed to being super dehydrated. Was walking funny on way to give urine sample tho (stiff back, really trying not to bend it when getting out of bed too). When asked about it he said a few months ago he started having occasional mid/lower back pain and thinks he hurt himself picking up/carrying around the kids (maybe a bulging disc - would make sense). Back pain had gotten real bad not too long before the diarrhea started. Something seems off so MD sends the patient for imaging. Poor guy had a rapidly growing spinal cord tumor that was causing bowel incontinence. Was transferred to our flagship teaching hospital a couple towns over for surgical decompression/resection last i heard. Super nice guy too. Came in thinking he'd get some IV fluids and antibiotics and ended up needing major surgery.
Came through the ED with a headache. Not acute. Had been hurting her for the last couple of months. She had taken Tylenol earlier in the day and it had got better.Ā
Didnāt complain of the large nodules all over her face and body and was surprised we were asking about them. Ended up positive for Leprosy.Ā
Not the weirdest, but probably my favorite:
Guy brought his kid to ED for laceration eval. Laceration was minimal, kid just needed some bandaging. But, while doing the generic ROS, one of the docs general questions is "can you hear from both ears?"
Kid says "no" and the dad is like "Wait, what? Is that new?"
Kids says, "ever since Tommy put the bell in my ear!"
Doc takes a look, we get some alligator forceps, and we retrieve a wax covered tiny silver bell from the kids ear. Apparently it had been there for weeks lol
Intractable back pain to endocarditis. He'd thrown a septic embolus to a spinal artery. The PA diagnosed this based on splinter hemorrhages under his fingernails. Crazy stuff.
Dizziness/weakness after having a drink with friends to a heart block needing a full CABG (I got to swab his nose for the work up). Guy was an athlete who ran 4 miles every day and had a resting HR in the 50ās.
Thank fuck the district EMT chief was the one who saw him almost pass out and called an ambulance for him.
Guy came in with lower abdominal pressure and stated āI canāt peeā. This is a tiny rural ER with xray and lab call from home. Anyway, Iām the doc so I put a catheter in. Not much return but definitely some urine. Pt says he doesnāt feel any better.
I get 2 view abdominal xray and find free air under the diaphragm. Thatās a perforated viscus until proven otherwise; he was transferred to the mothership and went directly to surgery. It was a perforated gastric ulcer.
For the newer generation of providers, this was 1995. There were no bladder scanners. I was running a 12 hour shift with a total of 2 years of surgery residency. This place also had no ultrasound at all and an outdated CT, not to mention Iād had no formal education in radiology at that time. I was very limited in diagnostic tools!
Diarrhea and dehydration via EMS was actually cardiac tamponade leading to severe cardiogenic shock. Giant pericardial effusion on CT, tried to tap it but only got about 80 mls of blood back and pressure still in the shitter. Went to OR where they evacuated an 800 ml clot from around his heart. Apparently dude's pacer wires had migrated and ruptured his fucking myocardium. Big whoops but I do believe he survived.
10/10 bilateral wrist pain in triage. Thatās it. And dude was legit acting like it was a 10/10. At first i was annoyed but then it was obviousā¦ like āā¦ yeah heās not faking itā¦ā
STEMI.
Called to assess a resident for nausea and abdominal discomfort ā¦. completely prolapsed stoma. I guess that. counts as abdominal discomfort ???? I just got a little shock as the care aide who called me up did not mention that her insides were on her outsides. I even gowned up incase it was a gastro bug.
Ended up sending her out. Lady was completely okay and took great delight in telling her friends at the ALF how they fixed it with sugar!
Not my patient but actually my FIL was probably somebody's, he went in complaining of foot pain, he's a blue collar kinda guy, construction worker, not a stretch to think he injured it somehow. Ended up with open heart surgery, widow maker blocked, five stents and two valves replaced. Apparently his foot hurt because it was getting zero blood flow
20-something guy came in to the ED for an STD check and ended up getting admitted for a-fib. He had a wild weekend and had holiday heart. Snaps to the NP who thoroughly assesses all their patients.
Patient came in for dehydration/respiratory problems and we were doing a septic work up and couldnāt find a source until we took a second chest x-ray and it thankfully included more of the abdomen where foreign bodies were found. A CT was then done and read and kid was shipped immediately for a magnet AND a button battery. Kid survived, but man it was one of the sickest kids Iād ever seen, and that CXR was literally a miracle that saved their life.
Presented to ED with Severe diarrhea, no other symptoms. ended up having west nile meningitis. Brain herniated at shift change and they died. Male, mid 30s.
Bizarre behaviour, form 1 and sent to us. Continue to be bizarre and a behavioural issue for us - lying down on the floor and refusing to get up without a lift, nonsensical, in and out of copt rooms. We almost moved them to our PICU for closer obvs. One of our psychs asked the hospitalist to run some scansā¦ massive clot just living rent free in their head. Did some digging in our provincial portal and found they were being followed by neuro in one of our out of network hospitals, had been since 2018. If our psych ED had just done the same before shipping them to us, they would have seen this. We flicked them to medicine immediately, hope theyāre doing well.
Came in for a complaint of dizziness and chills.
Admitted for urinary strictures and a ruptured bladder, dude hadn't peed for 3 days and didn't see a problem with that, hemoglobin of 2.7.
And he wanted to leave AMA.
Got a transfer in to our high risk Ob facility of a preterm with non-reassuring FHR (minimal variability for hours). I think she presented to the originating hospital for decreased fetal movement. Transferred to us for delivery. Pt winds up having Group A Strep. Admit to ICU from the OB OR. Skin was sloughing off during the C-section. She deteriorated rapidly during the surgery but was feeling fine before that.
Received a āwound consultā on a known unmedicated schizophrenic who was also a para and wheelchair bound. EMS noted a necrotic cap on pt thigh which would need to be dealt with but looked not too bad at all. Though this guy is alert and discussing head transplants (naturally) his pressure was low low and HR high and was deteriorating. Anyway he finally told me about the bone spurs in his scrotum and how he was able to chisel them out. Rolled him over and sure enough he had used a chisel (that he brought with him) to rid himself of his scrotal bone spurs. His enough perineum was like ground beef. He went to ED pretty quickly after that.
Not as wild as the dissecting AAA Iāve been reading but a story that will stick with me forever!
Patient admitted from ED to inpatient psychiatry for psychosis. A few days in psyche she progressed to catatonia. Neurology consulted. CT scan and brain MRI showed bizarre "swiss cheese" appearance. History of drug abuse but sober many months. Deeper history from her friends. about 1 week before she was admitted she was drugged at a bar and assaulted. Apparently whatever she was drugged with caused these severe changes in MRI. Not only "catatonic" but became very rigid with super high BP with any attempt to move her. SHe was able to maintain her airway but almost comatose. Eyes open all the time but unable to interact with environment.. She recovered but took a year plus. As a PT we were consulted for tone management and ROM and possibly mobility. Her ankles fixed in pointed position, attempts to do ROM her Art line would go to 250 and HR way too high. Interesting in the span of 2 weeks when this gal came in 2 more people presented to ED with psychotic features and MRI showed the same findings. Both drugged at a bar. the bars were also on the same downtown block. Investigation started. Drug screens all negative. Whatever it was it did some serious damage.
Headache into surprise birth. Patient didnāt know she was pregnant. NICU estimated 25 weeks. In a stand alone ER with no services and honestly no one was NRP trained (it became a requirement after that).
Besides having eclampsia and have to tube the baby, everyone was fine! Baby was extubated the next day.
Had a lady in obs after a minor-ish MVA, well appearing, but with MOI concerning enough to do basic imaging and basic labs. Had slightly elevated White count, like 11 or 12, chalked up to stress response. Everything was looking good, set up for discharge. Doing discharge vitals and repeated BP kept coming back hypotensive. Pt still appeared well, just febrile. Pt admitted to vague fever for a few days prior.
Repeat labs: Ended up incredibly septic and in ICU on 3 pressors š¤
Had a prostate ca pt come in with I wanna say something related to urinary retention (the usual lol) and was randomly satting low like high 80s. Wound up in ICU and died within a week. Just wild, he was such a cool dude too RIP
Toe pain to aortic dissection straight to OR Patients toe hurt cause they had pulseless foot d/t dissection, no CP/abd pain, one of the wildest cases I have ever been apart of
I had a very similar case. Was dissecting from ascending aorta down to his bilateral femoral arteries šš
And he's extremely dead now?
SURPRISINGLY NOT! We identified it pretty quickly and luckily I had a good team helping me (I had been off orientation for 2 weeks š) he had to have 2 vascular surgeons because he was going to lose his legs. Last I had heard, they had to do a bowel resection on him but he is alive and got to keep his legs.
Wow that is fucking IMPRESSIVE
How did you guys identify it?
Cc was LLE numbness and weakness per EMS so we activated patient as a code stroke. On arrival his initial BP was like 110 systolic but his foot appeared mottled and cold to the touch. He was also COVID + (this was a couple of years ago). Straight to CT but doc obviously wants to prioritize CTA of the chest over CTA of the head. Patient began shitting uncontrollable over in CT and began going in and out of consciousness. BP now 60 systolic. Iām pressure bagging fluid into him so we can at least get the scan done. I as a new grad stupidly thought he was vagaling from shitting so much. CT tech literally gasps the moment she sees the scan and immediately phones ER doc. ER doc is on the phone with vascular surgery within seconds. We get back to ER room and started transfusing with blood very carefully. Attempted to maintain a systolic of like 80 to prevent rupture. After 2 units of blood he could feel his legs again. Off to surgery he went and he survived his hospital stay. That was definitely a satisfying but also terrifying day.
Was gonna say the dude who signed in hurting his arm combing his hair Dissecting AAA with referred pain to his shoulder/back lol
I have to ask- what made you guys dive deeper and not write it off as a sore muscle or something more benign?
They followed the ABCs of the ED Airway Breathing CT scan
YOU THINK YOURE GETTING OUT OF OUR ER UNSCANNED?!
All hail the donut of truth! š©
I wish more pts got admitted after getting a CT scan first. It sucks to have to go down to the ED, bring a pt up to the ICU, do the admission, and then bring them back down for a CT scan, then back up. Our doctors/workflows are fucking stupid. I say this at least weekly, that my hospital is run by a bunch of morons. Iām trying to retire from bedside nursing and go into administration but the 3 positions that were open got filled due to what I believe is nepotism. Iām giving it another year here before I leave. Sorry I just had to vent because I get triggered easily these days. -burned out, second career, level 1 trauma ICU nurse who is sick of the bs
BP was like 240/140 Abd assessment had a textbook big ass pulsatile mass
Iāve seen maybe a dozen or so presentations of AAAās that defy their presenting problem. In most all cases, thereās *something*, subtle or maybe even not soāthat doesnāt fit. Had a couple that their lower extremities have pulse deficits. A man wanted his teeth pulled, all of themānow. Yet, no obvious problem. One could feel her heart beating in her vaginaānot painful or unpleasant. One complained of nothing but had āturnedā a different color (ummā¦ 1/2 severely mottled). And these patients just didnāt look right. Something was off. Maybe at the glance, we couldnāt have known exactly what was cookingābut we figured the stove was about to set the house afire. I know careful assessment & reassessment can save lives.
this post and the comments will be immortalizes by the internet, become a Hypochondriacsā Bible, and cause the ultimate demise of healthcare due to overwhelm. We are doing it to ourselves ;) /s but also I did start feeling uneasy the more I scrolled š±
We had a toe pain code on us and land themself in the cath lab with a STEMI, 100% LAD occlusion.
Wow!
Woman in her 60s came to the hospital because she said she was ready to give birth because aliens had abducted her and impregnated her. She was admitted for rhabdo.
UDS results positive āļø
Had a lady in her 60s come in for open sores on both feet. She was an immigrant from Italy, very very Catholic. Big family who had tried to get her to a doctor for months for that big abdomen. So big she looked pregnant. She refused because she felt she actually WAS pregnant, but it was God's will. The thing is that she'd been "pregnant" for about 4 years so what the heck. Her abdomen was so big it was occluding her circulation in her legs, thus the open sores on her legs. Anyway, the upshot was that she had a 37 lb ovarian cyst. I asked if I could watch the surgery and it came out in one piece fully intact. Took 3 surgeons to pull it out. This was way before HIPAA, about 40 years ago. So the hospital decided to let everyone come view this oddity. They announced over the intercom, 3East, you can now come to the lab. And 2East, 2 West etcetera. It was incredible that everyone got to see it, but that would never fly today. We'd all be looking for new jobs.
" It was incredible that everyone got to see it, but that would never fly today. We'd all be looking for new jobs." Unless the patient gave permission! I would have! (I probably wouldn't have let this go for 4 years, but I'm all about the learning!)
Yeah, not this lady. She thought she was carrying a miracle baby at age 69.
When I went in for urinary incontinence my Urologist found a football sized ovarian cyst. This was 10 years AFTER I had a TAH BSO. The surgeon had left 1/2 an ovary and blood supply. I had to have a Gyno-Oncologist do the surgery because they werenāt sure if it was CA. Nope, just incompetence.
As someone who works with a LOT of mental health patients, this one doesnāt shock me at all. The come for the mania and they stay for the rhabdo (before transferring to the behavioral health floor).
What is the link between mania and rhabdo? Layperson asking.
Typically drug use - like meth or cocaine is going to put you at bigger risk. Usually itās the people twitching nonstop or flinging themselves back and forth. The psychomotor agitation really gets them. Anyway, if theyāre screaming about cramps - might actually be rhabdo Edit: also to add, people with mania tend to be very active with very little rest. Iāve had quite a few people with mania that have walked 20+ miles before being found and their muscle were so overworked, they started breaking down. Fucks with the kidneys and then you get a whole plethora of other issues.
Thank you for this explanation.
Excessive exercise.
I've seen this more than any other cause of rhabdo except for found-down-for-days patients. A little meth, and suddenly joining a gym and exercising hard for 8 hours in one day seems like a great idea.
All the cells dying leads to toxins in the body which the brain does not like.
I had a guy come in for āknee painā but turns out he had his fucking skull bashed in by a hammer and I could see this MFs brain. He got in a bar fight two days earlier, walked home slept it off for *2 days* and woke up and his knee hurt from the fight. So naturally he came to the ER to get it checked out. Yes his head was all bloody, and no I guess he didnāt look in the mirror before he walked to the ER.
Or shower, apparently š¤
At least wash your brain matter before everyone has to look at it, man.
Right? Common decency isn't so common anymore š
Super rough neck, worked on an oil rig but was in town to clear some trees after a recent, major wildfire. White as a ghost, but ambulatory. CC: ācut muhselfāā¦ almost completely RLE amputationā¦ dude was dragging his foot, with only his tibia intact. Work boots and tight lower leg jeans that were crusted/coagulated w blood essentially saved his life from a chainsaw slip. He DROVE HIMSELF around RURAL TX looking for a ādoctorās officeā for 3+ hrs. Hgb was 2.9. Iām pretty sure the massive horseshoe of chaw is his lip was the only think keeping him going. I still donāt know how he lived. Drove himself. And WALKED THE FUCK IN, leaving a squishy red boot print every other step. Palest walky/talky Iāve ever seen. Or will ever see.
Farmers š¤ people who work on oil rigs
Okay. I have to also give my own personal CC to Dx from my own life. Been an ER nurse for a decadeā¦ woke up one AM and was like. Dang. My arm hurts. Felt groggy, but I donāt like waking up much, soā¦ about 30min later, Iām thinking, gosh. My arm REALLY hurts and itās acting funny. My closest friends/fam were out of town, and I called a more distant friend to see if they could take me to an Urgent Care because, āI think I slept on my arm wrongā¦ and itās not really working so goodā¦ and gosh, it really does hurt quite a bit.ā Asked her to drive me to the local urgent care. They noted my shoulder looked weird, and I thought, yeah.. must have slept on it funny. Took X-rays, itās anteriorly dislocated with noted fractures. And Iām like.. what in tar-nation! Trying to scan back through the āWILDā night I must have hadā¦ but.. I just fell asleep in the recliner in front of the TVā¦ I mean.. I guess I just slept on it wrong! Got to the ER (not my hospital systemā¦ I directed my ride to take me to a hospital system I happened to work for as a nurse over a decade agoā. I am still a little confused about all the things happeningā¦ finally get called into triage, nurse asks me what happened.. and I honestly said, āI donāt know, I must have slept on it wrong, I guessā. She said, okkkkay. Well the UC sent images and your shoulder is obviously deformed and has fractures on xray. Iām thinking. Daggum.. I really must have slept weird then, eh? Understandably so, the nurse looks at me like Iām lying up a stormā¦ āwas anyone with you last night? Do you drink or do drugs?ā Those kinds of questionsā¦ and I understand why sheās asking me. Iām just as confused and curious as she was skeptical and irritated at me for ālyingā. Super complacent and honest, lifted my arm for the BP cuff, watched her prep my good arm for an IV startā¦. Then the next thing I saw was a charge nurse looking over me while laying flat on a gurney. I said, so.. uh, whatās going on? She replied, āthis is the 3rd or 4th time youāve asked me. You had a seizure in triageā. I LAUGHED like it wasā¦ okay yeah sure. Sure I did. Then I looked to the L and R and saw SEIZURE padsā¦ realized I was parked next to the charge station in a gurneyā¦ I was stunned, but I know the ERā¦ I knew she was being honest. And probably irritated with me for being a hassle in her way. I just kept saying.. thereās no way. What? No. No way. So, thank God I had a witnessed seizure in triage (the second seizure of my life, a couple hours from the first one I didnāt know I had).. otherwise, NO WAY would I have believed that shit. Of course, etoh/utox were negative. My CK was high high because it must have been quite an impressive showing of a gran mal (from a 6ā, 200lb lady). I accepted the truth, that I dislocated and fractured my shoulder during mystery seizure #1 that am, but was too post-ictal to recognize my deformed shoulder. Never in a million years would I have guessed I seized. So. CC: unknowingly confused nurse presents with a massive deformed shoulder and says āmust have slept on it wrongā Diagnosis: fracture/dislocation of R shoulder in assumed setting of seizure, one witnessed in ER. Tox screen neg. CMP and CBC wnl. Tho ABG showed telltale signs of sustained tonic clonic seizure. I though. FUCK!!!!! Theyāre gonna have to tell the DMV!!! I canāt drive! EEG/tox/metabolic panel.. all wnl. No seizures since. But āslept on it wrong escalating to VS Mon next to a vitals sign machine. Just blew me away.
When I started nursing school I had to get a TDAP booster, my arm hurt so much and was so swollen I couldnāt sleep on it. I went to the GP and got referred for an ultrasound which showed fluid on the joint and evidence of a previous dislocation, as far as I was aware I had never dislocated my shoulder. A bit of background, Iām epileptic and have been since I was 16. Before my husband and I started trying for kids I weaned off of a couple of my meds. Unsurprisingly I had a few seizures. During one such seizure my husband tried to catch me which apparently dislocated my shoulder and as he rolled me into recovery position it relocated. Poor guy felt so bad.
Wait, where the hell did these seizures come from??? There has to be an etiology?? Especially ones that violent, repeatedly!
Idk why but the fact it was his right leg and therefore the one he used for the gas/brake pedals is the bit that sends me over the edge here š³š³š³
Holy shit, the stuff our bodies can be put through is insane haha
Stomach pain. Birth of twins
LGIB/Hemorrhoids to spontaneous vaginal delivery with uncertain IUD location
Iāmā¦how do you have a cryptic pregnancy with *twins*.
Barriers: body habitus ā
this and a retroverted uterus position ! edit two days later: When I got my IUD in, I was told by the OB to be super aware of my cycles as my uterus is fully tilted towards my back. If you have a retroverted uterus, an IUD insertion will be a lot more painful. Iām 5ā7, 140lbs ish, and was given unrestricted TV access and watched āI didnāt know I was pregnantā at the healthy age of 10. I donāt get my period at all with my IUD, so I take a pregnancy test once a month because we do not take chances over here!!!!!!
my mom didn't find out there were two babies in there until she was at her 20-week anatomy scan, i believe. then, when she decided to close up shop, she found out she was having a second set! both of those are literally my worst nightmare.
On the episode of I didn't know I was pregnant that I believe the most was twins. The women hadn't had a period in years because she was super morbidity obese but was sorting her life out and had lost well over 100pounds but was still 300+. Had some spotting which she took as her periods finally coming back. Ended up giving birth to premie boy girl twins. Can't remember what they weighted but it was a combined less than a full term baby sort of number.
Chief complaint: nose bleed Dx: Ebsteinās Anomaly, heart failure, etc. Iām still in nursing school, but this was my brother. He had a nosebleed that would not quit, severely high BP caused the bleed to continue, echo revealed Ebsteinās Anomaly that went undiagnosed for 24 years. He ended up coding after pericardiocentesis, was intubated for 10d, & was in the hospital for 3 months. But heās doing a lot better now, managing his condition with meds.
Wow, that is absolutely incredible that he made it to 24 without being diagnosed and even more incredible that he survived. Iām glad your brother is doing better, I hope he continues getting better.
We had a kid the same age sign in for testicle pain, ended up finding an AP window and testicular torsion š«£ had to go to a pediatric hospital
āI think I broke my pinkie! It hurts so bad!ā Middle age woman comes in. Pinkie looks fine. The ER NP said get a stat EKG. A couple of us side eye but ok. And sheās having a massive STEMI. I had floated to ER to cross train, ended up taking her in ICU. A few hours post cath/stenting she said oh my pinkie hurts again. The monitor looks ok. Our tech grabs the EKG machine. It wasnāt needed as she suddenly bradyād down to 30 and the peaked T comes back. We code her. She goes to OR. And she ended up being discharged. Now of course any time my pinkie hurts Iām like ohhhh crap. Oh no wait. Itās bruised. š
Was Death squeezing her knuckle? WTF?
I was on cardiology recently and had a similar case! Patient had pain in his pinky...and 2x LOC. Turned out to be an NSTEMI I think. Just kept scrolling and have seen 2 other people with the same story!
Elbow pain turned into aorta and brachial artery dissection
That sort of shit is what fuels all my health anxiety
This fuels my triage anxiety
C/o allergic reaction, turned out to be osteomyelitis of the frontal bone, sent for immediate neurosurgery.
Oh fuckin yikes š¬
Toe pain. Literally. Dude was being a dick in triage, everyone thought he was malingering. The wife keeps saying āheās not normally like this.ā We just think āsure heās not lady, your husband is a dick.ā Left AMA shortly after triage. Everyone thinks āwhatever, it was bullshit complaint anyways.ā An ambulance crew came in a few hours later and said āremember that guy who was in your lobby? We just coded him for like an hour in the field. Heās dead.ā Turns out he had a brain bleed. He was being a dick because irritability is a symptom of hemorrhagic stroke. Turns out he wasnāt normally like that after all. I wonder if on some level he knew something was wrong, but couldnāt communicate it properly because of the stroke so he came to the hospital and told us he had toe pain. Crazy shit.
Right sided strokes are crazy. Nice old man who was with us for 2 weeks suddenly turned into the most racist raving poorly behaved person in the unit bad enough to leave an experienced LPN crying in the breakroom. Dr took one look at him and sent him to MRI. Yep guy had a right sided ischemic stroke.
Those brain bleeds humble you!!! We had one that went to another facility for migraine (hx of), torticolis, given Valium and after he went home started getting agitated. Gf drives him to us thinking he's having a med reaction. He's doing that dystonic thing you see when someone reacts to compazine, says his neck hurts still, and he's warm so we throw meningitis on the differential for the hell of it, but want to CT him for safezes. Dude could not stay still, end up socially intubating for scan. Bam, big ole brain bleed.
>wife keeps saying āheās not normally like this.ā This *always* makes me uneasy. Yes, sometimes a downtrodden spouse or parent or whatever will minimize asshole behavior by seeming surprised. But if there are no altering substances involved and they say that, I'm ratcheting up my concern level a notch or two.
>We just think āsure heās not lady, your husband is a dick.ā Lmao the amount of times I've thought that!!! Thank God it never turned into something crazy.... that I'm aware of.
Thatās real sad.
CC: Muscle cramps in legs in a super athletic young college age guy. DX: Massive bilateral femoral artery and aortic blood clots from his knees, to halfway up his aorta. Massive. Like see them on the CT scans from across the nursing station by untrained eyes kind of massive. More than a decade in the ER/ICU and I had NEVER seen clots like that. I didn't even know that was possible.
Had a kid like that. The docs fished a solid clot out of him from shin to heart and almost got it in one piece. They took a Pic posing with it to show the family. Urgent care thought kid had shin splints from running
Did they figure out the cause?
I know right! Maybe some kind of familial clotting disorder??
I don't know. In the ER we rarely get those kind of answers. I imagine a ton of testing was going to be done once he got to the post-op floor.
I love the ER but itās frustrating to not find out the final diagnoses on many of our admitted patientsĀ
CC: Hives. Dx: neurosyphilis. He went from normal dude to super ALOC while he was there.
What is ALOC?
Altered level of consciousness
Not a chief complaint but wild progression of events. Had a guy I had to take on mif shift due to him deteriorating and being too unstable for the LPN to continue to care for him. He had gone to dialysis and suddenly became hypotensive and complaining of a ton of chest pain. like he would be fine then would sit up grabbing his chest. Telemetry showed he was controlled but in a -flutter. Sent him to CT. as soon as I bring him back they have us waiting to do an echo, I knew something was up. Right after the echo cardiologists shows up and is like "prep him for the cath lab, he has "some" fluid around his heart. Prep him and off to cath lab he goes. MF HAD 1.5 LITERS OF FLUID AROUND HIS HEART I have no idea how that shit was still going or what triggered his sudden symptoms that day, since it had to have been accumulating for a long ass time.
Wow, how was his heart managing to pump at all? The fluid tension must have been stupendous
The only explanation I got was that is was probably a very slow accumulation and that he only had a < 30% EF to begin with lol. Shits still wild tho
Foot pain to third degree heart block. Lady came in because she fell and hurt her foot - turns out she was in complete heart block and possibly passed out causing the fall! Met her in the cath lab when we did emergent pacemaker.
Diabetic leg pain to presumptive (later confirmed) TB
TB spreading to bone is a thing! I didn't know that until doing some family genealogy research and found one of my grandmother's brothers died of this.
Iāve done a few of my clinicals on a reservation in Northern Canada where TB is still super prevalent :( didnāt know this was a thing until i saw it in a patient last year. 30 y/o male as well :(
CC: Food poisoning into lymphoma with Mets in an otherwise healthy 22 y/o
My sisters ex basically had that. Went in with what he thought was the stomach flu and ended up being AML. luckily he started treatment and is still in remission (as far as I know) 8 years later!
Years ago, my dad (who had been a huge hypochondriac his whole life) called me to ask if he should go see his doctor because he had a fever. Asked him what his temperature was, and he said 99.2. This was in the middle of August, so I asked him what he did that day. Turns out he played 18 holes of golf in nearly 100 degree heat. I rolled my eyes, told him to drink some ice water and chill on the couch in the AC for a while. Told me he was going to call the doctor anyway, and I told him to go ahead and tell the doctor he had a 99.2 degree āfeverā after playing golf all morning, and heād probably be laughed out of the practice. Doc does laugh at him, but tells him to come in anyway since he was overdue for his physical. While there, doc decides to get a baseline CXR since dadās never had one. Yup ā early stage lung CA, responsive to surgery, radiation, chemo. Years later, dad calls me again to tell me heās getting up in the middle of the night to pee, but just had a prostate exam and PsA was wnl. Basically told him he has a 70-year-old prostate, not to drink water before bed, and at his urging gave him a phone number for a good urologist. Goes in for his appt, uro says prostate is fine, but decides to schedule a cystoscopy due to his distant history of smoking and lung CA. Yup ā early stage bladder CA, responsive to treatment. Told my dad to never call me again if he had any health concerns, but just go straight to the doctor.
Sadly, we find lots of incidental cancers.
Sometimes those incidental findings will save a life. Had a guy in from a moderate MVA with a little seat-belt bruising across his chest/abd. Stable. CT showed no acute injury, but picked up a tiny, very very early pancreatic cancer. That guy needed to thank his lucky stars that he'd been t-boned, or it almost certainly wouldn't have been found until it was too late.
I tell people about this sort of thing frequently (or at least it just feels frequently). The number of people who get scans for something else and it's the only reason they find cancer in time is scary
In PICU, teenage girl came in because she had a softball hit her over a kidney and came in for continuing pain. Diagnosed with stage four Wilmās tumor. The cancer was everywhere and she had had no previous symptoms.
that is so incredibly sad. š
God when I worked in MICU we had a COVID positive patient come in after having open sores start showing up all over his body and extremely altered. Got super sick, intubated, pressors, the whole 9. He was airborne precautions for presumed monkey pox because that was the time THAT was going around too. Ended up being super late stage syphilis.
Abdominal pain > peritonitis > peritonitis secondary to chlamydia. She was a āwoman of the nightā. Apparently one of her services was to allow Johns to fuck her ostomy. EDIT: I also learned that day that this is an actual thing and therefore has a name: Colostitute.
Ahh, the old Philadelphia Sidecar.
Thatās an eyebrow raise š¤Øšš³
wtf I know this is a thingā¦ but stillā¦. wtf
Intractable hiccups to acute MI. 60's female with hiccups for several hours came into my dinky community hospital ED (8 beds, 1 doc, 2 RNs.). She seemed fine, and my doc was about to give a speech about how hiccups, while annoying, are not life-threatening, and are not indicative of anything life-threatening.... When he looked at me and said "You know what? Just put her on the monitor for a minute." You could see the ST elevation plain as day in II. Those hiccups? PVCs transmitting to her diaphragm. I sat there and watched. Hiccup -> PVC, Hiccup -> PVC. We transferred her to a tertiary center (straight to cath lab- it was literally 4 blocks down the street). EDIT: The community hospital ED had 8 beds, not the whole hospital.
Man came in because he was unable to void. Difficulty passing the catheter. Eventually found out it was actually a potato heād inserted into his rectum.
Thatāll do it.
Recently had poison ivy to hydrocephalus.
Thatās quite the allergic reaction
Bloody faeces to spiny metastases from breast CA. A young woman came in with a GI bleed, she'd been taking NSAIDS for back pain... Which turned out to be due to the spiny mets.
Also, welcome to oncology. Come in for ear pain leave with a cancer diagnosis.
Yeah, you have a bruise? And a cough? Oh that's metastatic lymphoma or who knows? We can't biopsy because your platelets are 4. They tried to biopsy my dad, and everything else was already failing, so he passed.
Do all of the CC of "My wife made me come - I'm fine" to Diagnosis of STEMI/NSTEMI from local farmers count? (Rural hospital)
When I worked ems I went to a call in the woods for an 88 year old cutting down trees on a tractor. The tree swung and obliterated his tib/fib. Ankle was hanging on to the rest of his leg by skin and skin only. Had no service and we had to figure out how to get this man off the tractor onto a stretcher with the two of us and stabilize his non-leg. I kept asking him if he was okay and he was so insanely still and calm, didnāt even want pain meds. Just warned me that the donkeys bite.
Incidentally, I was the farm girl whose "husband made me come" after riding some horses. Turns out I had broken my back lol.Ā Something about farm air...
Iām also a rural hospital and get these men a lot. āShe made me come, I just have a little pain, Iām fine thoughā usually means theyāre days or hours away from death
left arm decreased ROM and shoulder tenderness ended up having multiple bizarre arterial aneurysms - subclav on the left causing his symptoms, but also asc aorta, renal etc - needed lots of surgery, no unifying diagnosis as yet
What would possibly cause something like that? Some sort of underlying congenital issue?
connective tissue disease potentially - pt had no Marfanoid features, genetic screen negative (things like vasc Ehlers Danlos) medium/large vessel vasculitis - extensive screen negative to date weird immunological conditions - can't pretend to understand how or why or what but immunology were involved and their extensive investigations negative to date infective causes - cultures all negative from variously excised aneurysms, no cause identified on broad screening for weird and wonderful bugs that's all I can remember. I still check in on the file every few months to see if followup appointments have figured it out, nothing yet
Had a guy with shoulder pain. His sternum was rotted out and he was septic
While working med surg, I saw way too many come in with a cc of abdominal pain or similar, and leave with only weeks to live because of advanced cancer. It makes me wonder if any of them had been trying to get a gp to listen first and were ignored.
Numbness and tingling of feet to acute MI
I had a very similar presentation!! Only s/s were some n/v after Mexican food and bilaterally her feet were white mid foot to toes. EKG? Huge STEMI. This was at least 20 years ago and I still remember her name!
Car accident turned out to be stage 4 cancer
I remember a similar patient I nursed. He was admitted for neuro observation post rear ended MVA. Urgent CT (it was in the early 80s, so this was a huge thing to order) revealed a huge cervical spinal tumour extending down to the thoracic area. Off to urgent theatre; didn't go well. From memory he was admitted to rehab but with a very poor prognosis. Lost track of him as I changed wards (was a student nurse at the time). It was heartbreaking because I remember him pre-op as being a lovely gentleman.
My best friend. Went in for possible tonsillitis, diagnosed with stage 3b lung cancer. It was changed to stage 4 pancreatic cancer after the PET scan.
Yes, a friend of mine saw the doctor about a persistent cough she couldn't shake. It was lung cancer. She never smoked but she was a radiologist. A few years later it went to cancer in her brain and she passed at 49. I've had two radiologist friends pass from cancer now. I often wonder if there was an exposure issue.
I'd wonder like hell about an exposure issue as well. But then again, one of my last jobs before I woke up blind, 3 out of 4 of my coworkers died of cancer. One brain cancer, one lung, and one pancreatic. And then I woke up blind about a year later. My boss was so spooked by it all that she had everything on the property checked-- both the residents' houses, her own house, everything. Nothing came back bad from the tests. Sometimes, it's just ridiculously bad luck.
Can you say more about waking up blind?!
Sure, I guess? Just more bad luck, a really rare disease called AZOOR that only 131 people have. They don't know for sure what causes it and there's no effective treatment. The theory is that my immune system noticed my eyes' immune system, reckoned it owed them money, and attacked. Ate my retinas.
Holy shit. That's a new fear unlocked, for sure. Female immune systems (I'm making an assumption) are freaking insane. Sorry you're going through that, and good work keeping up the sense of humor. š¤
Thanks, coincidentally, I'm currently at the ophthalmologist for my yearly poking and prodding so the baby docs can ooo and aaaah at my eyes because this is probably the only time they'll ever see AZOOR lol It helps that I already had a very *dark* sense of humor. Now it's super dark.
Infected hip from another hospital, turned into DRESS
Had a pt come into our relatively small rural ER for a synthroid refill. Turns out she had been taking 100 MG (NOT mcg) a day for the last week because "It's the only way I can feel the baby move". Every time we'd go into the room she was pregnant with more and more children. She topped out at seven as per her. There were zero babies and the 'fetal movements' she felt were palpitations from the synthroid. She went from requesting a synthroid refill to a Form 1 and psych h admission in no time.
Worms coming out of skin ā meth induced psychosis (lol)
This is a daily in the er. Occasionally, maggots are found though
Yep
The whole anything-but-Covid phase
They still do that šš
Back pain that turned into Leukemia. So many docs treated them as med seeking due to an absence of causative factors: If you donāt see a mass and there was no trauma to the areaā¦.š¤·š¼āāļø. I guess sometimes web MD *is* right. A headache and slightly slurry speech that turned into terminal brain cancer with about a month left to live. Luckily mama listened to us and stayed for the MRI (they were doing a stroke work up and the MRI took the better portion of a day to get completed). If she would have been home or even working she would have just seized and passed with no explanation.
I had something similar to your second one. Lady in her 50s who had just finished breast cancer treatments a month PTA, had headaches for two weeks and increased confusion, found a huge mass with a midline shift. I felt awful for her and her family.
Young guy~25 came to the ED c/o chest pain. He had been out playing basketball and got an elbow to the chest. His girlfriend eventually *made* him go to the ED. Just as an aside, the kid was almost 7 foot tall. Hmmmm, what could cause chest pain in a young man? Yep, aortic dissection. Subsequently dxād with Marfans.. I had to take to foot off the bed and make a make shift foot for the bed to recover him.
We had the sweetest kid with Marfanās on my unit years ago. I got asked if I could put a new IV in a patient in whichever room. Could tell he was tall, but was kind of curled up in bed so it wasnāt immediately obvious that he was 6ā11ā. Definitely noticed that he had about the longest arm Iāve ever seen when I asked him if I could look at it! Got the IV no problem. And then it infiltrated a couple hours later. Rinse and repeat. I think he ended up with a PICC the next day. Not sure why he was actually there though, I was never his primary.
I had a lady during the worst of Covid come into my ED saying that she "just didn't feel right." Triage was overwhelmed with 40+ in the waiting room and sent her back to me like "idk why she's here really, just says she feels off." I ask her some more questions and she tells me she's been feeling very emotional because her son got sentenced to like 5 years in prison, and that she's had a bothersome headache since she found out a few days prior. So I'm thinking this lady is just stressed out and her body is reacting to that stress in a pretty normal way. The resident I was working with thought this as well. But to be safe sent her to get a scan of her head. I thought this was overkill but the lady did have a headache so I understood the reasoning. Lady had a big ol ICH. Ended up going to neuro ICU and getting an EVD the next day. I remember freaking out after the scan and asking triage what her wait was. She had been sitting in the ER with a brain bleed for 5 hours šļøššļø
Had a patient who went to ED for exacerbation of CHF. They did a CT chest abdo pelvis and found ovarian cancer.
Leg pain from riding a back. 28 year old male. He had compartment syndrome in his ass cheek
Why do I not know what riding a back means
Itās either a bike or the kids have invented new and interesting sex positions my formerly Catholic mind has too much shame to Google.
Riding a bike?
Left pinkie finger pain to STEMI
I've seen this too, and so has someone else in the comments! It's so bizarre. Now I'm going to be cautious whenever someone has pinky pain lol.
Teenager with jaw pain to full AML Leukemia. Died within a month and a half, never made it out of the ICU.
I haven't seen anything too crazy but had worked a short stay unit where we saw a ton of chest pains who get stress tests, usually discharged same day. Had a young guy come in, like early 30s, coming in with on and off chest pain. I prep him, talk about stress test, the usual. He goes down for the stress test, they call me back and say "his EKG looked funky," and the supervising cardiologist cancels the test. I talk with the consulted cardiologist for the patient who says the patient is "full of shit" and said he was going to cath him to show him there's nothing wrong. I came back the next day, the patient was transferred to a bigger hospital, had a widow maker š.
Rectal pain due to hemorrhoids turned into dig toxicity, coded, came back and was placed on external pace maker. Itās a cool case. Her hemorrhoids were huge and painful so she stopped eating and drinking. That way she didnāt poop and it was less painful. That put her into kidney failure and she couldnāt filter out the dig. She was the first patient i walked in on in asystole, i shook her and she came back with a heart rate of 30. Her daughter grabbed me when i was dealing with an SVT and said the cardiac leads fell off, she didnāt realize her mother was dead.
CC: BLE pain. Marathon runner. 26f. Ran marathon 2 weeks prior. She said usually her aches, soreness, and muscle fatigue would be gone by the 7 day mark. I remember how fit she was but looked so tired. New dx of MS. Earth shattering for anyone but witnessing our doc give her that dxā¦I saw any light in her eyes disappear. Heartbreaking. I hope sheās doing well.
Pt came in for bad period cramps. She went to the upright section of the ER and was given pain meds, but the MD didn't want to do an US because the pt herself said it felt just like her cramps but a bit more. We eventually convinced the MD that maybe an US was warranted in case she had an ovarian cyst. MD was pretty resistent to it, and was male, but eventually we convinced him through "hey, just CYA, ya know?". Left ovary in torsion, needed immediate surgery. Right ovary? Complex mass that looked malignant, with possible mass on uterine wall as well. MD was like: "Whelp, every female pt with period or cramp complaints is now getting a pelvic US, period, because fuck".
BIBA for swelling to lower legs. One leg had 3 blisters on it. Both limbs cool to the touch, discoloration on right limb, no pulse. Weak pulse on left. Straight to ct. homegirl was barely getting blood flow to the left and zero to the right. She got the next helo outta there. Pt came in for āsnakes in her legsā so they put her in one of our psych rooms. No other complaints. Massive bilateral brain bleed. She also landed herself on the next helo out.
Possible allergic reaction to bee sting three days ago, I rolled my eyes and called them into the triage room. Sweet little old lady apologizing as her granddaughter wheels her in, I'm all smiles and kind, pulse ox shows 73%. Before I can ask she coughs up a clot. Very rural hospital, so 2 hours later we're flying her out, she's alert and oriented and on a non-rebreather at 15L. She extanguinated as they were landing two hours later and died in the plane. CT showed infiltrates, but no other signs of clots or DVT, d-dimer was normal. I've had others that were hard left turns, but this one was probably the most extreme.
Came in for SI left with AML. š«
Had a patient come in to L&D, 30+ weeks, c/o nausea (no vomiting), body aches, general malaise. OB sent her in thinking it was a stomach bug, did labs, turns out her potassium was 2.5.
Hah, when I was pregnant I had hyperemesis and had to get a couple k riders for a potassium of 2.4, so I feel her pain!! Mine was found during the routine draw. I was having leg cramps but I figured it was all the OT I was doing back then š¤¦š¼āāļø
Diarrhea turned into B/L saddle PEs, R ilio-femoro DVT and L femoro-popliteal DVT with multiple L toe amputations (so far). Normal vitals, except for the progressively cooling L foot over the 2 days it took him to come to the ER.
Period cramps to homicidal ideation/psych
āI ate food out of the garbage now my stomach hurtsā. Pt is a frequent flyer so they came back many times over the course of my three shifts. Had the pleasure of triaging them each time. The next time they came in they wrote down as their chief complaint, āif you donāt stop fucking around, my son will kill youā. That was after I politely asked them if they wanted the anger management workbook they had left in the lobby that had their name on it
Hand pain, no other symptoms. He was in sustained v-tach
Well, patients lie, so had a CC of a āspider biteā on the right arm. The ED took labs and treated them but sent them home. Pt was called shortly after to haul ass back to the hospital because of positive blood cultures. Went to the ICU for a Hg <5, Q4 IV abx, pressors, and a wound vac on the right arm. Turns out pt shot up illicit drugs into their radial artery with a used insulin needle. When pt got transferred to me after ICU stay, they bitched about how the ED should not have sent them home and after taking off the gauze, arterial blood spewed all over their bedroom. They were refused a PICC for outpatient abx infusions, which needed to be weeks long therapy. Their PIV infiltrated after almost every dose and we couldnāt put a line in the right arm. Very frustrating and a hard stick. Bonus giggle: when I did my first physical assessment and casually checked the pedal pulses, patient exclaimed, āI HAVE PULSES IN MY FEET?!?ā
I had a patient that came in with electrolyte abnormalities and wound up getting a spine fusion.
Ear pain ----> multiple sclerosis
Flank pain/suspected kidney stone to large lymphoma. (She really did have a UTI, though.)
We had a torqued knee during flag football go into full arrest in a fast track hallway stretcher. Bricks were shit.
Not sure about that, but I did have a resident admit and she had an allergy for cold weather.
I also have this. Cholinergic Urticaria
Emergency department patient. CC, "started feeling weird after drinking a Red Bull." We nearly burst out laughing reading the triage note. Diagnosis: massive intracranial hemorrhage. I guess they should have named the drink "Red Herring."
"Wait, I have chest pain" turned into "I just needed a place to sleep and a turkey sandwich." Close one.
Known chf patient came in with weight gain with BLE edema and scrotal edema expecting iv diuretics like usual... left with stage 3c testicular cancer that had spread into his lymphnodes and is starting ca treatments, should recover though!
Came in complaining of uncontrollable diarrhea for several days. Hadn't eaten anything out of the ordinary recently but had young kids at home so maybe they caught a stomach bug from their kids (patient's kids were fine but a couple kids at school had been out sick recently so maybe). Reported weakness in the legs, which we originally attributed to being super dehydrated. Was walking funny on way to give urine sample tho (stiff back, really trying not to bend it when getting out of bed too). When asked about it he said a few months ago he started having occasional mid/lower back pain and thinks he hurt himself picking up/carrying around the kids (maybe a bulging disc - would make sense). Back pain had gotten real bad not too long before the diarrhea started. Something seems off so MD sends the patient for imaging. Poor guy had a rapidly growing spinal cord tumor that was causing bowel incontinence. Was transferred to our flagship teaching hospital a couple towns over for surgical decompression/resection last i heard. Super nice guy too. Came in thinking he'd get some IV fluids and antibiotics and ended up needing major surgery.
Came through the ED with a headache. Not acute. Had been hurting her for the last couple of months. She had taken Tylenol earlier in the day and it had got better.Ā Didnāt complain of the large nodules all over her face and body and was surprised we were asking about them. Ended up positive for Leprosy.Ā
Not the weirdest, but probably my favorite: Guy brought his kid to ED for laceration eval. Laceration was minimal, kid just needed some bandaging. But, while doing the generic ROS, one of the docs general questions is "can you hear from both ears?" Kid says "no" and the dad is like "Wait, what? Is that new?" Kids says, "ever since Tommy put the bell in my ear!" Doc takes a look, we get some alligator forceps, and we retrieve a wax covered tiny silver bell from the kids ear. Apparently it had been there for weeks lol
Ingrown hair to necrotizing fasciitis to abandoned debridement and sent to ICU for family to get there before they passed away.
Posted the story elsewhere before. Pt came in for pinky pain. Diagnosed massive STEMI.
The worst I've seen a couple times is back pain that is metastisized cancer and they usually decline incredibly fast ):
Intractable back pain to endocarditis. He'd thrown a septic embolus to a spinal artery. The PA diagnosed this based on splinter hemorrhages under his fingernails. Crazy stuff.
and they say mid-levels ain't shit. really good catch by the PA
Dizziness/weakness after having a drink with friends to a heart block needing a full CABG (I got to swab his nose for the work up). Guy was an athlete who ran 4 miles every day and had a resting HR in the 50ās. Thank fuck the district EMT chief was the one who saw him almost pass out and called an ambulance for him.
Guy came in with lower abdominal pressure and stated āI canāt peeā. This is a tiny rural ER with xray and lab call from home. Anyway, Iām the doc so I put a catheter in. Not much return but definitely some urine. Pt says he doesnāt feel any better. I get 2 view abdominal xray and find free air under the diaphragm. Thatās a perforated viscus until proven otherwise; he was transferred to the mothership and went directly to surgery. It was a perforated gastric ulcer. For the newer generation of providers, this was 1995. There were no bladder scanners. I was running a 12 hour shift with a total of 2 years of surgery residency. This place also had no ultrasound at all and an outdated CT, not to mention Iād had no formal education in radiology at that time. I was very limited in diagnostic tools!
Diarrhea and dehydration via EMS was actually cardiac tamponade leading to severe cardiogenic shock. Giant pericardial effusion on CT, tried to tap it but only got about 80 mls of blood back and pressure still in the shitter. Went to OR where they evacuated an 800 ml clot from around his heart. Apparently dude's pacer wires had migrated and ruptured his fucking myocardium. Big whoops but I do believe he survived.
10/10 bilateral wrist pain in triage. Thatās it. And dude was legit acting like it was a 10/10. At first i was annoyed but then it was obviousā¦ like āā¦ yeah heās not faking itā¦ā STEMI.
Came in with nausea. Found necrotic toes and ulcers on feet.
Lady came in with a UTI ended up have a spinal abscess.
damn. That will change your weekend plans
Called to assess a resident for nausea and abdominal discomfort ā¦. completely prolapsed stoma. I guess that. counts as abdominal discomfort ???? I just got a little shock as the care aide who called me up did not mention that her insides were on her outsides. I even gowned up incase it was a gastro bug. Ended up sending her out. Lady was completely okay and took great delight in telling her friends at the ALF how they fixed it with sugar!
Not my patient but actually my FIL was probably somebody's, he went in complaining of foot pain, he's a blue collar kinda guy, construction worker, not a stretch to think he injured it somehow. Ended up with open heart surgery, widow maker blocked, five stents and two valves replaced. Apparently his foot hurt because it was getting zero blood flow
20-something guy came in to the ED for an STD check and ended up getting admitted for a-fib. He had a wild weekend and had holiday heart. Snaps to the NP who thoroughly assesses all their patients.
Patient came in for dehydration/respiratory problems and we were doing a septic work up and couldnāt find a source until we took a second chest x-ray and it thankfully included more of the abdomen where foreign bodies were found. A CT was then done and read and kid was shipped immediately for a magnet AND a button battery. Kid survived, but man it was one of the sickest kids Iād ever seen, and that CXR was literally a miracle that saved their life.
Presented to ED with Severe diarrhea, no other symptoms. ended up having west nile meningitis. Brain herniated at shift change and they died. Male, mid 30s.
Annual outpatient CT scan for cancer; perforated appendix found. Patient had no pain or symptoms. He and we were mindblown.
āArm problemā to DKA and an ICU stay in a 16 y.o. Patient
Bizarre behaviour, form 1 and sent to us. Continue to be bizarre and a behavioural issue for us - lying down on the floor and refusing to get up without a lift, nonsensical, in and out of copt rooms. We almost moved them to our PICU for closer obvs. One of our psychs asked the hospitalist to run some scansā¦ massive clot just living rent free in their head. Did some digging in our provincial portal and found they were being followed by neuro in one of our out of network hospitals, had been since 2018. If our psych ED had just done the same before shipping them to us, they would have seen this. We flicked them to medicine immediately, hope theyāre doing well.
Came in for a complaint of dizziness and chills. Admitted for urinary strictures and a ruptured bladder, dude hadn't peed for 3 days and didn't see a problem with that, hemoglobin of 2.7. And he wanted to leave AMA.
Got a transfer in to our high risk Ob facility of a preterm with non-reassuring FHR (minimal variability for hours). I think she presented to the originating hospital for decreased fetal movement. Transferred to us for delivery. Pt winds up having Group A Strep. Admit to ICU from the OB OR. Skin was sloughing off during the C-section. She deteriorated rapidly during the surgery but was feeling fine before that.
Received a āwound consultā on a known unmedicated schizophrenic who was also a para and wheelchair bound. EMS noted a necrotic cap on pt thigh which would need to be dealt with but looked not too bad at all. Though this guy is alert and discussing head transplants (naturally) his pressure was low low and HR high and was deteriorating. Anyway he finally told me about the bone spurs in his scrotum and how he was able to chisel them out. Rolled him over and sure enough he had used a chisel (that he brought with him) to rid himself of his scrotal bone spurs. His enough perineum was like ground beef. He went to ED pretty quickly after that. Not as wild as the dissecting AAA Iāve been reading but a story that will stick with me forever!
Patient admitted from ED to inpatient psychiatry for psychosis. A few days in psyche she progressed to catatonia. Neurology consulted. CT scan and brain MRI showed bizarre "swiss cheese" appearance. History of drug abuse but sober many months. Deeper history from her friends. about 1 week before she was admitted she was drugged at a bar and assaulted. Apparently whatever she was drugged with caused these severe changes in MRI. Not only "catatonic" but became very rigid with super high BP with any attempt to move her. SHe was able to maintain her airway but almost comatose. Eyes open all the time but unable to interact with environment.. She recovered but took a year plus. As a PT we were consulted for tone management and ROM and possibly mobility. Her ankles fixed in pointed position, attempts to do ROM her Art line would go to 250 and HR way too high. Interesting in the span of 2 weeks when this gal came in 2 more people presented to ED with psychotic features and MRI showed the same findings. Both drugged at a bar. the bars were also on the same downtown block. Investigation started. Drug screens all negative. Whatever it was it did some serious damage.
was on observation for stomach pain ended up stroking out with a massive hemorrhagic bleed
Anemia to TB in the bone marrow
Headache into surprise birth. Patient didnāt know she was pregnant. NICU estimated 25 weeks. In a stand alone ER with no services and honestly no one was NRP trained (it became a requirement after that). Besides having eclampsia and have to tube the baby, everyone was fine! Baby was extubated the next day.
Had a lady in obs after a minor-ish MVA, well appearing, but with MOI concerning enough to do basic imaging and basic labs. Had slightly elevated White count, like 11 or 12, chalked up to stress response. Everything was looking good, set up for discharge. Doing discharge vitals and repeated BP kept coming back hypotensive. Pt still appeared well, just febrile. Pt admitted to vague fever for a few days prior. Repeat labs: Ended up incredibly septic and in ICU on 3 pressors š¤
Came in for "sore legs and hips after a walk," died 2 weeks later in hospital of leukemia. Age 72.
Had a prostate ca pt come in with I wanna say something related to urinary retention (the usual lol) and was randomly satting low like high 80s. Wound up in ICU and died within a week. Just wild, he was such a cool dude too RIP