Every ER doc has a collection of "interesting" xrays featuring a certain foreign object lodged in a bodily orifice, like this one or the one below:
C'mon, admit it! You got 'em. I would bet that Grunt Doc, Trenchy, Scalpel, and Shadowfax have file cabinets full of them. For teaching purposes, of course. ;-) And they certainly can top what I have in my stash, I think, though I would dare say that it'd be pretty damn hard! Here's the lateral view:
Note the dual, size D batteries. In the words of my trusty Irish charge nurse Annie after we pulled this foreign body out, "Holy shiet! That thing is a monster!"
But back to my comment about "Do as I say..." and me looking like a buffoon, the story goes like this:
It had been a quiet opening to the Spring Break season this past weekend. A few non-serious DUI related MVA's, a couple of drunk college kids with minor lac's s/p the usual altercations at the local bars, an uninjured drunk balcony jumper (lucky son of a bitch, fell 3 stories!)...then the "Bat Phone" went off.
"Rescue 3 to Crack City Medical...respiratory arrest...he's clenched down tight, we can't intubate him..."
With Etomidate and Sux drawn up and ready, we patiently awaited EMS arrival.
"Dispatch said he's a Spring Breaker," Annie commented, "We haven't seen a Scooped case in a while. I thought that GHB is out these days."
"Who the hell knows what drugs these kids are into anymore," Tamara, a traveller nurse answered.
(For the uninitiated, "scoop" is the slang term for GHB in these parts. Elsewhere it's also known as liquid ecstacy, Georgia Home Boy, G, Grievous Bodily Harm, battery acid, blue nitro, cherry meth, easy lay, enliven, everclear, fantasy, firewater, G, GH buddy, Gina, goop, jib, liquid G, liquid X, organic Quaalude, remforce, renewtrient, salty war, salty water, serenity, sleep 500, soap, swirl, vita G, water bomb, zonked..." GHB was the rage during the 1990's but its use has since waned and seems to be no longer fashionable after numerous reports of death due to overdose.)
Lights and sirens signaled the ambulance arrival up our ER ramp. The guy's face, neck, and chest were covered in vomitus when he hit our doors. The paramedic at the head of the Stryker gurney was providing bag-valve-mask ventilation on the dude as best as he could.
"He's scooped, doc!" this paramedic reported.
The other paramedic chimed in with more details of the transpiring events.
"20 years old Spring Breaker from University of ______ (Division I). His boyfriend," winked the paramedic, "said that he had drank some GHB. We got 2 large bore IV's. BP's...Pulse...He threw up everywhere, doc. Just hope he hasn't aspirated."
It was quite routine, no biggie. He was an easy intubation after rapid sequence induction by Etomidate and Sux, although we did have to suction out quite a bit of emesis from his oropharynx. The dude was completely apneic upon arrival. His O2sats came up to 100% with bagging and the post-intubation chest xray looked great. Only if it was that easy.
I wrote down some quick orders to appease the nurses and respiratory tech, as a confirmation of the verbal orders that I had given them earlier. They're sticklers for the rules, especially when it comes to verbal orders and things like that. As I was dictating the encounter, I noted that the vital signs were incomplete. I dropped the chart and went up to Tamara and said, "Hey, I need a core temp on the dude."
"Alright, we'll getcha one," she responded.
I waited a while and nothing, so I came back in the room and nagged, "Hey, where's my core temp?"
"I'm having some problem inserting the rectal probe, I'll getcha ya one. Just hold yer horses," she sounded peeved. "He's agitated and bucking the vent, can I give him some ativan?"
I went back to my chair, grabbed the dictaphone and continued, "The temperature will be documented on the chart. The patient was not felt by touch to be hypothermic nor febrile clinically..."
"Hey Doctor_____," Annie interrupted, "The boyfriend (she gestured over-effeminately) of the scooped guy in (Rm) 2 has been clamoring to talk to you. He's outside the lobby jumping up and down saying that he has to talk to you right now. He's been up to the triage desk over a dozen time bothering Liz that he has to tell you something right a way that's very important."
"Alright, put him in the consultation room and I'll be right there."
The boyfriend of the patient was just that, a gay boyfriend. Flaming, in fact.
"We couldn't get it out," he whimpered, "then JJ stop breathing..."
After hearing what important information he had to reveal, I ran into the patient's room, quickly gloved up and squirted a gob of KY onto my finger.... and sure enough...the damn vibrator was still on! GHB and a vibrator, I guess I'll never be able to understand how anyone could derive any pleasure out of such a combination.
At the very top of my blog it says, "Fingers and tubes in every orifice, it is a tenet of critical care medicine..." Damn, even I neglect to practice what I preach, sometimes. Every unresponsive patient need a finger up their ass, no exception.
28 comments:
i want to be you when i grow up.
So, uh, how exactly did you get it out? Did you just use one finger?
That would be so awsome to see, Charity Doc, Trenchy, Grunt Doc, Shadowfax, and Scalpel in a pissing contest to see who has the more bizaare xrays and stories to tell.
Could be a budding diplomat, that one.
Charity's definitely got the best pics and stories. I concede.
I have not, unfortunately, been my compulsive self about recording the xrays of the 'south of the border' foreign bodies, so will reluctantly concede the battle.
However, I have a minor point to make: What he means is every patient needs a Physicians' digit in every orifice, as the nonphysicians and their digits were the proximate cause of this presentation.
Heh.
crud. Last by me.
GruntDoc
Love it.
With our crack city population, how did we ever get to be the superpower of the world.
Anon 2:20
Not everyone in crack city is cracked, I suspect. It's likely a small segment of the population that gets all the attention.
(I would comment but I still can't stop laughing at the sheer SIZE of that gadget up the er...orifice!)
I feel like ShadowFax might be ahead in the running, by just a hair. His last one (which was a while ago) was really fabulous.
I propose a battle of the x-rays.
CharityDoc, I should know this by now, but I'm assuming CCMC is not a teaching program. If you have interns, you never miss a rectal.
OMG. That's a mighty fine detail to omit when you call 911. ROFL.
"Never do anything you wouldn't want to explain to the paramedics."
Yikes! :)
I saw a guy once with the chief complaint of "abdominal pain" who never mentioned he had an extra-large battery-powered screwdriver stuck up his rectum.
Post-op he was the biggest jerk imaginable and each time he bitched and moaned about the care he was receiving I wanted to shake him to remind him that we didn't shove a large power tool up his butt - he did.
Did he want it removed - or just better batteries - move over the Energiser bunny!
Charity Doc-
I enjoy your blog a great deal, and read often. I don't, however, enjoy the not-so subtle homophobia in this post. I hope that you and the nurses who work with you are more professional and respectful when your patients and/or their families are close enough to see and hear you.
koo...moo,
According to the Merriam-Webster Dictionary, homophobia is defined as irrational fear of, aversion to, or discrimination against homosexuality or homosexuals. No where on this post did I find any out right, subtle, or "not-so subtle" disparaging homophobic comments by Charity.
Give me a f'in break. SHEESH, you gay people are too queerly over sensitive!
Anonymous-
Oh, if only you knew me and knew how completely NOT over-sensitive I am...
My objection is to the tone of this post. Hand gestures by nurses, the winking paramedic, etc... are all manifestations of homophobia. I was not criticizing Charity Doc, merely pointing out that if I were a friend or family member of the patient in question, I would hope for slightly more professional behavior. Healthcare workers of ALL types often have to deal with people and situations they find distasteful, but they also have to treat all of their patients without judgement or disrespect. It's one thing to dislike gay people, black people, junkies, whatever. It's another to let that dislike show. As a human being, I'm sensitive about that. It has nothing whatsoever to do with being gay.
P.S. Please try to refrain from making generalized statements like "you gay people are too queerly over sensitive!". Unless you, yourself, are gay you really have no concept of homophobia, regardless of what your dictionary says.
I have to agree with Kookaloomoo --
People of all orientations do stupid things, but making a thing about the orientation, not the stupid action, is homophobia. And comments like "you gay people are too queerly oversensitive" simply reinforce the fact that you are focusing on the fact that the patient is gay. I mean, come on, emergency room physicians have seen plently of straight people stick weird things up their nethers.
I'm not sure how a wink and a hand/wrist gesture can be construed as homophobic or hateful, but then again I'm not gay so I plead ignorance over the matter. I think that all the paramedic and the nurse were trying to do is to convey to me that this patient is gay and has a very worried gay boyfriend out front. This boyfriend is the poster child and epitome of your effeminate type, no doubt about it by his speech, mannerism and appearance. Hence my comment that he was "flaming." Is flaming, too, a derogatory term? Heck, I don't know. Like I said, I'm not gay and am ignorant to the matter. But frankly, on this subject, ignorance to me is bliss because I don't care nor do I have any desire to know unless concrete harm or some criminal action has been done. I personally don't find a gesturing hand, a wink, and referring to someone as flaming gay to be hateful nor harmful. It's admittedly sophomoric and crude, but not criminal. Everyone of us at one time or another in our lives have been singled out and made fun of by insensitive jerks spewing stupid comments about our appearance. I say don't sweat the small stuff and let it roll off. Rise above it and you'll be better off. Jerks will be jerks and there are more of them around than you. Bottom line is that I don't personally find anything criminal or hateful about a harmless wink and gesturing motion of the wrist when referring to a gay person. Maybe the nurse and the paramedic should have just openly say, "his gay boyfriend" instead of gesticulating innuendoes but c'mon, it's "sticks and stones" harmless. On the other hand if any patient in my ED was ever denied proper care because of his/her appearance, sexual orientation, economic status, then I have real issues with that.
Finally, look at the last sentence in the post, it says "Every unresponsive patient..." It didn't say every unresponsive gay patient....See there, I'm an equal opportunity jerk all around.
During my Navy days I was called to an ER to assist with a rectal "impaction." Quite funny since I was with the Bomb Squad . . . It seems that a young Marine had inserted an incadescent light bulb up his rectum but when his friends tried to pull it out they heard a "crack" and became nervous.
We happened to have a special piece of equipment that was used to inject plaster of paris in to time delayed fuzes to gum up the works and stop the mechanism.
The doc's wanted us to inject the POP in the lightbulb and allow it to harden and prevent the light bulb from collapsing on itself.
... just one of my rockin chair memories of Uncle Sam's canoe club.
DocBrayPA
O.k. - I know, obviously, I am naive about this stuff - but HOW does one get a light bulb up there? You mean like the 75 - 100 watt regular size lamp light bulbs?
Scrubs just had a patient who had done the same thing. On the show - they used some kind of balloon device to go up behind it - inflate and pull out - but that was a sitcom.
Seriously?! A thermometer is big. A enema hose is big. A LIGHT BULB???
Then finally - WHY?
Why? A Good Australian phrase is appropriate here.
Buggered if I know.
So to speak.
hey don't knock it till you've tried it doc... uhhhh, i mean, yeah, what a freak!
ps doc, wanna come walk in a smaller town with a fun group?
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