Orange and Blue Bags This Week

Written by Tad. Posted in Trauma Strap Bags

I spent some spare time the last couple of weeks making these bags. My wife asked me why I made seven and I told her it was because that is how many bottoms could be cut out of the material. Doing seven at a time makes me more efficient but at times I do feel like I am in a sweat shop. I crammed them in my locker at work and they are gone already!

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You Swallowed What?

Written by Tad. Posted in Kooks

Here are four stories of crazy things crazy people said they swallowed.

A 38-year-old man came in complaining of heavy salivation and pain in the abdomen and throat after drinking a cup of someone else’s urine a day earlier. He wouldn’t say why he did this but said he had been drinking a lot of liquids recently in order to flush out his system.

 

A middle-aged lady had been having abdominal pains, which were worse after eating. She had schizophrenia and was very obese. After talking with her, I was worried she might have gallstones since gallstones are more likely to be painful after eating, especially after meals of fatty or greasy food.

I ordered some pain medicine and blood tests. When I went back to see how she was doing, she was eating a huge chocolate bar and washing it down with a pint of half and half! When I asked her about it, she told me her mom always told her to drink milk to coat her stomach when she had a stomachache. She didn’t seem to think it was at all weird to drink half and half, which she repeatedly referred to as “milk.”

 

A 44-year-old man with a history of schizophrenia came in saying he was having a lot of problems caused by a cigarette lighter he swallowed years ago. He was sure it was stuck in his rectum. It was causing his stools to be grooved and was giving him prolonged erections and “terrific ejaculations” like he had not had since he was 30. The lighter was pressing forward against his prostate and he could feel it when he pinched his anal sphincter. He had seen multiple doctors for this and no one was able to find the lighter.

I did a rectal exam and an x-ray and was also unable to identify the cause of his symptoms.

 

A 41-year-old man was brought in from jail. He said he was brushing his teeth at 2:00 in the morning when the toothbrush broke off in his mouth, cutting his gums. This caused him to vomit. During the vomiting spell, he swallowed the head of the toothbrush. He subsequently passed blood and “stuff that looked like cow liver” from his rectum.

He arrived in the emergency department complaining of discomfort in his throat and abdomen. A check of his old records showed he had recently been seen for swallowing a coin.

On his examination there was no evidence of any injury or blood in his mouth or rectum.

As a test to make sure he was OK, we gave him some crackers and orange juice, which he ate without any problem. Afterwards, he said that when he was not observed, he vomited up the toothbrush but then he swallowed it again before he could get it out of his mouth.

He was sent back to jail.

A New Button

Written by Tad. Posted in Uncategorized

My web Guru and son-in-law, Taylor, made a cool change to the the web page today. He added a button titled “ER Stories.” It is on the right, just under the “Cookie Recipes” button. You can click it and see the whole list of crazy stories from the emergency department. Check it out!

Three Trauma Cases

Written by Tad. Posted in Kooks

Ride Motorcycles, Not Fences

A 27-year-old man lost control of his motorcycle and ran up against a three-foot-tall chain link fence. He was brought in by ambulance complaining of severe groin pain from having been dragged along the top of the fence. The medics reported that his testicle had been amputated. They said they picked it off the fence and had it in a plastic bag. What I found in the bag was a large piece of scrotal skin. I found the testicle hanging back between his legs, attached only by the spermatic cord.

The urologist took him to the operating room to finish removing the testicle and repair the injury.

 

Dangerous Summersault

My patient was a 22-year-old female who was playing on the floor with her niece and nephew. She tried to do a forward roll or summersault. She didn’t roll over enough and came straight down on her head. This caused sudden onset of severe neck pain as her neck twisted underneath her. This was associated with numbness in her right arm that quickly went away.

My first reaction was, “No one can break her neck doing a summersault on the living room floor” but x-rays showed two fractures of the second vertebra. She was admitted to the hospital for placement of a halo brace. Here is a simple explanation of what this is: http://kidshealth.org/parent/question/medical/halo_brace.html

 

Ice Avalanche

A young man was transferred to the emergency department from a nearby chicken processing plant. He had been working in a giant room where they stored huge amounts of crushed ice used in processing the chicken. He had been assigned to break down a large amount of ice that had formed against one of the walls of the room. As he chipped away at the wall of ice, it suddenly collapsed, burying him under a huge mound of crushed ice. The paramedics reported that coworkers were able to quickly uncover his head, allowing him to breath, but it took approximately thirty minutes to free him from the ice.

On arrival in the emergency department, he was found to be hypothermic and have several minor injuries.

 

 

Banner Bag

Written by Tad. Posted in Trauma Strap Bags

When shopping at RAFT, I am always on the prowl for something that would make a cool bag. When we saw two huge banners with lots of black and orange, I bought them. I have had them rolled up under the bed for months until, on Friday night, I woke up at 2:00 and was unable to go back to sleep. It was tricky to sew the plasticized material but I was pleased with the result. The bag folds flat but unfolds to form a rectangular bottom that stands up well. Here are some pictures.

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This is what the banner looked like. I took the upper left part for my bag.

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Here is the bag with the bottom folded flat. The trauma straps cover the word “Microsemi” that was on the banner.

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Here it is with the bottom unfolded.

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Back.

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Sides.

Customer Service 2

Written by Tad. Posted in Kooks

Customer Service 2

Last week, I posted about a man who complained to Customer Service after being refused intravenous morphine. Today I will share with you another noteworthy complaint.

A middle-aged woman came to the emergency department with many complaints. From the time she arrived, the staff found her to be difficult to deal with. She was seen walking around the department in no obvious distress. Yet, she was so uncooperative that every attempt to care for her was met with disregard for the staff’s effort to address her needs.

When she decided she was going to leave, she asked that she be provided by a taxi voucher to pay for her ride home. When she was told that would not be possible, she threw herself onto the floor in the waiting room, screaming and making a huge scene. She later wrote a letter of complaint about her care.

I was Chairman of our department at that time and it fell on me to respond to her complaint. I never saw this patient but I had to review her complaint and respond to Customer Service. I wish I had her original letter but I do have the memo I wrote to Customer Service in response to her letter. I will share it with you. This is another example that shows how hard it is to make the patient a customer with a motto: “The customer is always right.”

 

To:            Customer Service

From:                        Dr. Tad, M.D.

Subject:            Patient Complaint

I have reviewed the letter of complaint and medical record of this patient. Her long letter outlines many complaints against the emergency department staff. Here is a partial list:

  1. She saw many seriously injured people getting no attention.
  2. She saw staff eating donuts.
  3. She saw staff laughing and giving each other “high-fives.”
  4. It took thirty minutes and four nurses to get her initial care.
  5. It took ninety more minutes to get the next episode of care.
  6. She was in the hospital three hours before she was diagnosed.
  7. She was told to get pain medication from Long’s Drugs.
  8. She was forced to sign the Leaving Against Medical Advise form.
  9. She was treated “without any concerns or sympathy.”
  10. She “fell unconscious at the foot of my bed” and “saw my face hitting the cold floor.”
  11. She was not allowed to make a phone call for help.
  12. She was stuck outside in the cold, unable to get up because the wheel chair was locked.
  13. She was treated with “disregard and carelessness.”
  14. She was not given a cab voucher.
  15. She was not treated for asthma.
  16. She was not “emotionally comforted.”
  17. The nurses and receptionists were having a picnic of chips and soda.
  18. Her “intelligence has been insulted and (her) private rights have been violated.”

Interestingly, she also admits in the last paragraph of her complaint that she behaved “impudently” and apologizes for her “peculiar impoliteness that evening.” Impudent is defined as “marked by contemptuous or cocky boldness or disregard for others.” I have talked to several of the people who had opportunity to care for this patient that night. From all accounts, it sounds like she has used the appropriate word in describing her behavior. The staff saw her walking around the department in no obvious distress. Yet, she was so uncooperative that every attempt to care for her was met with contemptuous boldness and disregard for the staff’s effort to address her needs.

The episode where she describes going to the ground was seen by the staff to occur when she threw herself on the floor when she was told that there was no taxi voucher for her.

The staff attempted to provide her with an appropriate exam and treatment. They tried to help her get a ride home. They were insulted and rebuffed at every attempt to help her. She signed out against medical advice rather than accept any appropriate evaluation and care in the emergency department.

It is clear this lady was not happy with our care but it is also probably true that her expectations were unrealistic. It is very clear from talking with the staff that her impudent behavior was responsible for a good part of her unpleasant experience here.

Thank you very much.

Dinner from Manu

Written by Tad. Posted in Uncategorized

On June 17th, I posted a picture of the bag I man for Manu, one of our registration staff. I was really surprised when he came in one morning with a bag full of food he had prepared, as a thank you for the bag. We made a complete, gourmet dinner. We started with an appetizer of  toasted, crustless bread spread with cream cheese, and pesto then topped with cucumber and red bell pepper. Then we had perfectly cooked tri-tip and mashed potatoes flavored with onion and cayenne. It was amazing and very much appreciated.

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Copyright © 2014 Bad Tad, MD