Curbside Consult Thread

[doctorcoug]

A 20 something year old admitted to inpatient psychiatry who was suicidal and with unusual cognitive presentation. Neuropsych testing from a few years ago was completely normal. Now, his response time for even the most basic closed question is several questions. Brain is completely fried. Likely going to need nursing home care. The cause: less than a year of huffing.

Inhalants are bad news.

Bath salts are the new drug that is causing the most crazy mental status changes. The patients come in doing some wild crap.

[risicam]

Bath salts are the new drug that is causing the most crazy mental status changes. The patients come in doing some wild crap.

BATH SALTS?!

[doctorcoug]

I've got a shit for brains intern on-call with me tonight and I should have been asleep an hour ago. He hasn't learned how to manage a simple MI by now; grrr.

His responses:

Patient has chest pain, call cardiology

Patient has dizziness, order stat CT head and call neuro

Patient has ureteral stone, call urology

Patient has fever, order BMP and give Vanc, rocephin, and Zithromax and call ID

Patient has cough, call it pneumonia and call pulm.

I've had to evaluate all the patients tonight. Man, I'm pissed.

[wuapinmon]

I've got a shit for brains intern on-call with me tonight and I should have been asleep an hour ago. He hasn't learned how to manage a simple MI by now; grrr.

His responses:

Patient has chest pain, call cardiology

Patient has dizziness, order stat CT head and call neuro

Patient has ureteral stone, call urology

Patient has fever, order BMP and give Vanc, rocephin, and Zithromax and call ID

Patient has cough, call it pneumonia and call pulm.

I've had to evaluate all the patients tonight. Man, I'm pissed.

In that hour of dread and blurred light,
his eyes lingered on his Golem.
Who will tell us, what did God feel,
looking upon His rabbi in Prague?

evermore

[doctorcoug]

Saw something very similar to this in a mono di with twin twin transfusion syndrome with subsequent ruptured intertwin membrane and donor fetal demise. Near amputation of four toes and less extensive banding of the wrist.

[San Juan Sun]

So I just finished an endoscopy month. It was incredibly frustrating. The endoscopy department is notoriously slow, routinely taking hours to get started with the first schedule appointments of the day. They also routinely sabotage the doctors schedule so that they can leave early. They try to get cases cancelled by anesthesia, or they delay cases until they have to be postponed until the next day.

(Imagine you had rectal bleeding, were admitted to the hospital, and started the prep for a colonosopy on Sunday. You had nothing to eat on Monday, had pooped your brains out all night, and then get told late Monday afternoon that your case would be moved to Tuesday due to "scheduling issues". So you can have some clear liquids Monday night, and then sit around all day Tuesday waiting for your added on procedure to get an open time slot in a room. If that were you or me, we'd hit the roof with anger. This happens routinely here. It's appalling.)

A few weeks ago, I could take it no longer and at the request of my boss I started taking pictures of the department. On multiple days in the mid-morning, with full schedules, I photodocumented all the procedure rooms empty, with the anesthesia and endoscopy staff sitting around visiting. In one photo, I got eight people in one shot sitting around doing nothing.

My boss had me present the photos to some of the senior administrators, and we were told that "this will be addressed today." Emergency meetings are underway as we speak.

[DU Ute]

So I just finished an endoscopy month. It was incredibly frustrating. The endoscopy department is notoriously slow, routinely taking hours to get started with the first schedule appointments of the day. They also routinely sabotage the doctors schedule so that they can leave early. They try to get cases cancelled by anesthesia, or they delay cases until they have to be postponed until the next day.

(Imagine you had rectal bleeding, were admitted to the hospital, and started the prep for a colonosopy on Sunday. You had nothing to eat on Monday, had pooped your brains out all night, and then get told late Monday afternoon that your case would be moved to Tuesday due to "scheduling issues". So you can have some clear liquids Monday night, and then sit around all day Tuesday waiting for your added on procedure to get an open time slot in a room. If that were you or me, we'd hit the roof with anger. This happens routinely here. It's appalling.)

A few weeks ago, I could take it no longer and at the request of my boss I started taking pictures of the department. On multiple days in the mid-morning, with full schedules, I photodocumented all the procedure rooms empty, with the anesthesia and endoscopy staff sitting around visiting. In one photo, I got eight people in one shot sitting around doing nothing.

My boss had me present the photos to some of the senior administrators, and we were told that "this will be addressed today." Emergency meetings are underway as we speak.

Narc

[San Juan Sun]

Narc

I prefer the term whistleblower.

[San Juan Sun]

Two from last night:

Guy on branch trimming crew is drunk. He climbs 12-14 feet up in tree and sits on branch. He uses saw to cut the very branch he's sitting on, and falls Elmer Fudd-style to the earth, hitting his head. He has bleeding on his brain and in now in our ICU.

Husband/wife owners of jewelry store living in city. Reasonably successful and probably should have moved out years ago, but hey, they love their community despite several robberies over the years. Early this AM as the guy was leaving the house to go to work, a couple of young guy jump him as he open's the door and force their way into his home. A scuffle ensues, and thugs unload their handguns into him as he attempts to shield his wife from gunfire. He is shot all over, including the head, and dies on the scene. His wife is shot in the arm, overed in his blood, and is brought to our ER. Awful story.

[ERCougar]

Two from last night:

Guy on branch trimming crew is drunk. He climbs 12-14 feet up in tree and sits on branch. He uses saw to cut the very branch he's sitting on, and falls Elmer Fudd-style to the earth, hitting his head. He has bleeding on his brain and in now in our ICU.

Husband/wife owners of jewelry store living in city. Reasonably successful and probably should have moved out years ago, but hey, they love their community despite several robberies over the years. Early this AM as the guy was leaving the house to go to work, a couple of young guy jump him as he open's the door and force their way into his home. A scuffle ensues, and thugs unload their handguns into him as he attempts to shield his wife from gunfire. He is shot all over, including the head, and dies on the scene. His wife is shot in the arm, overed in his blood, and is brought to our ER. Awful story.

I've seen the drunk tree trimmer before! Several times. The drunk hunter in the tree stand is a more common, and only slightly less stupid variation. Alcohol is job security.

That's an awful story about the jeweler. Detroit is in a deep pit. I hope it ever makes it out.

My weekend story
Sunday morning, 6 am. Guy comes in and asks for help bringing his friend in from his truck who 'isn't acting right'. I go out with a nurse and it turns out that 'isn't acting right' means gray and unresponsive. As I'm straddled over this guy in the passenger seat of a truck doing CPR, I find out that it's been about 30 minutes driving down the canyon since his friend has said a word. No complaint, nothing. Just died right next to him. Pretty nonchalant about the whole thing too.
Whole thing was just surreal.

[San Juan Sun]

Took out a gallbladder on Monday. Patient did well and had no issues aside from being crazy. She wanted to stay in the hospital until "after the weekend" and asked if we would fill out disability paperwork for her.

(FYI: these demands only helped her get discharged a little faster on Tuesday morning).

Anyways, my boss just texted me. After she left us, she went and got admitted at another hospital, was discharged, and went to yet another hospital. At hospital #3 she was admitted by a nonsurgeon who consulted my boss... the person who took out her gallbladder in the first place. (My boss is on staff at several places.) My boss went to see the patient. I just got this text:

"ABSOLUTELY NORMAL!!! Still crazy"

I'm going to text her back and have her make sure to get the disability paperwork filled out.

[Commando]

BATH SALTS?!

That's the street name for a new synthetic drug that has the effects of meth and ecstasy combined, but also causes drug-induced paranoid schizophrenia. It circumvented fda scrutiny by being sold in head shops as "bath salts."

It was just barely made illegal in AZ like 6 months ago.

I have a cousin that was battling meth addiction, came to AZ to get away from that scene and ended up getting into bath salts. I wish she was just into meth at this point. It's so fkd up

[ERCougar]

That's the street name for a new synthetic drug that has the effects of meth and ecstasy combined, but also causes drug-induced paranoid schizophrenia. It circumvented fda scrutiny by being sold in head shops as "bath salts."

It was just barely made illegal in AZ like 6 months ago.

I have a cousin that was battling meth addiction, came to AZ to get away from that scene and ended up getting into bath salts. I wish she was just into meth at this point. It's so fkd up

It wasn't just sold under that name. People really did start doing actual bath salts. I think they've reformulated the non-illicit ones since then.

I wish these people would direct their talents towards something useful. If I had a nickel for every time I've thought "WTF?" at some new abused substance or some new creative concoction that I've seen in the ER...

[doctorcoug]

Took out a gallbladder on Monday. Patient did well and had no issues aside from being crazy. She wanted to stay in the hospital until "after the weekend" and asked if we would fill out disability paperwork for her.

(FYI: these demands only helped her get discharged a little faster on Tuesday morning).

Anyways, my boss just texted me. After she left us, she went and got admitted at another hospital, was discharged, and went to yet another hospital. At hospital #3 she was admitted by a nonsurgeon who consulted my boss... the person who took out her gallbladder in the first place. (My boss is on staff at several places.) My boss went to see the patient. I just got this text:

"ABSOLUTELY NORMAL!!! Still crazy"

I'm going to text her back and have her make sure to get the disability paperwork filled out.

Why was she admitted in the first place? I'm not questioning you...it sounds like there is more to this story, which could be interesting.

[TexTechCoug]

Took out a gallbladder on Monday. Patient did well and had no issues aside from being crazy. She wanted to stay in the hospital until "after the weekend" and asked if we would fill out disability paperwork for her.

(FYI: these demands only helped her get discharged a little faster on Tuesday morning).


I'm going to text her back and have her make sure to get the disability paperwork filled out.

Do you think there would be less crazy if SS disability didn't exist. Number one reason not to be a pain doctor, crazy folk trying to get on disability.