beer bottle Christmas

this male, 53+ y/o arrived via ambulance on Christmas eve. i asked him what happened and he told me, "my girlfriend and i got drunk and she got a little carried away."

Hx of Szr

there were so many things wrong with this incident that i will prolly end up writing several articles about the difference between taxis and ambulances, pt.s faking seizures to get attention, and pt.s that try to dictate their care.

Diluadid Deficiency

taken from http://tinyurl.com/6skm3mr

The symptoms can vary but include:

1. Chest pain that is difficult to describe that radiates through your back, down your flank, to your left ankle, and back up your right leg to your neck, and back to your back.
2. Often times, the pain may radiate from the chest through the outer layers of your scalp to the other side of your neck.
3. The pain may also not be described as a "chest pain", but rather a non-descript "pressure" sensation that does not match any physiological or anatomical possibilities.
4. The patient will usually say that the pain is similar to a previous episode of DDA chest pain that was only relieved by diluadid.
5. Patients will also state that the oral/pill form of diluadid has not worked in the past and that they need large IV doses.
6. Patients normally know the exact dose that would relieve their pain.
7. Patients may appear comfortable and not distressed, but as soon as a nurse or physician walks by, the pain becomes excruciating and the patient may writhe and scream in pain. You don't want to miss this finding, similar to white coat hypertension. But it's white coat DDA.

i've seen scrubs on TV

i often hear pts dropping "key words/phrases" i suppose they think that if they know the lingo we will press the magic button that allows them fast an helpful service. unfortunately the misuse of medical terminology usually delays care; also it makes them look foolish. once i had a pt comment on my use of a sphygmomanometer, i told her, "in the real world, we call this a blood pressure cuff".

I'm not sure what it's called something like...Dilaudid

i also like it when the pt is bent over in pain during the initial assessment, can't ambulate and screaming in pain who then storm out after realizing we aren't going to give them a narcotic script.