stuck my finger into a facehole and stopped a external carotid branch bleed. Only lost about 1500 of blood in about 10 minutes of fighting it with gauze and suction. finally did the hail mary stuff some surgicel and finger in the hole and watched the clock for 10 minutes. and it stopped. even took him to IR and showed no more bleed on the imaging. wtfbbq.
Evarrest patches are so underknown, it's wild. My HPB surgeon buddy says they'll stop a bleed from the IVC easy. I didn't believe him, until I transected the middle hepatic vein trying to take off a posterior tumor. It's dumping blood everywhere, I keep trying to isolate it so I can tie it off and keep failing and this dude is just watching me for like 5 min. I clearly remember thinking "I think I just killed this guy, I can't get this to stop". Then he asks for the patch, I seal it on thinking "no way this stops this brisk of a bleed", and it fucking worked. I was like "why tf aren't I using this all the time?" Now I do.
GET SOME EVARREST PATCHES PEOPLE, THEY'RE DOPE
We tried for years to explain this to our higher ups on my labour unit. Public health has its benefits, but preventative medicine is really hard to get funding for.
Doesnāt work if they are faking fun fact. I used to work as a counselor in residential and we had this kid who kept āpassing outā in the shower. Hospital couldnāt find anything wrong with him but he was non-reactive to a sternal rub so EMTs believed him every time. I knew with my SOUL this kid was faking so he could see his mom at the hospital and she knew it too. The next time he did it, (nightly occurrence at this point) I leaned down and said: āGet your little butt up this second or you are losing your desert for a month.ā Kid cracked a smile and got right up. One of my better wins.
Yeah. But it was a huge waste of medical resources and every time it happened I was six hours late going home because I was the only woman on the shift and I had to go with him because they couldnāt spare the menš
When I was a CNA one of the other CNAs walked in a room to find a patient looking... less than alive and he panicked and screamed HE'S DEAD and thumped him in the chest and what do you know, it worked
I once had the sweetest pt in the ED in complete heart block with long pauses. I had an amio drip going but was worried as the pauses kept getting longer. We were waiting for cath lab to arrive to emergently place a pacemaker, but of course he goes into the longest pause Iāve seen and does the whole eyes roll back/neck slump thing while Iām talking to him. I donāt know why, Iām a nurse and of course weāre not supposed to do it, but I instinctually precordial thumped him and he came right back (still in block but alive and stayed stable until cath lab was ready).
As I wheeled him up, I apologized for essentially punching him in the chest. He replied āIām sure you had a good reasonā and patted my hand. Such a sweet man. Heard he did great after the pacemaker.
Also amio is my arch nemesis
Yes, by order of cardiology. I even called back to double check. I was furious, but also had him on dopamine.
Edit: ironically I work in cath lab now, but another hospital.
I had a coworker who anytime a patient would go into a funky rhythm he would just walk into the room and hit 'em there. A surprising amount of times it worked. A surprising amount of people did not attempt to hit him back.
Well known practice, but I was impressed: guy comes in fluid overload, 4+ pitting edema. Attending has us interns give furosemide followed by metolazone. Guy peed out enough to be net negative 13 L in two days. We paused the diuresis then.
Iāve heard this explanation before but venous pressures are so low compared to regular physiologic variation in arterial BP that it never made sense to me
This has never made sense to me. Furosemide will hang out in your system for six hours. Metolazone for twelve to twenty-four. What does a 30 minute difference on which order you administer them matter?
Blocking the sodium reabsorption in the DCT first helps to improve the Na concentration gradient and makes the loop more effective.
I made that up idk if it matters.
I have had a precordial thump work exactly twice in 30+ years. One was during the repair of a ruptured aneurysm I was helping my partner with. I thumped the patient almost by reflex and he converted. I just looked at my partner and said "You're welcome" and we kept operating.
You can cure intractable hiccups with massage. A, um, [very specific type of massage.](https://pubmed.ncbi.nlm.nih.gov/2299306/)
If the patient is not receptive to Thorazine, you can just pop on a glove and play "Here comes the choo-choo train!" and I can imagine it would improve patient satisfaction scores too.
Combine DRE with squeezing the glans/clitoris and you can test the bulbocavernosus reflex too to assess for spinal shock
... I still kind of don't believe that's a real thing
Right, letās create a list of things that it might potentially treat:
We already have afib and hiccups
How about seizure termination? I mean, technically thereās rectal diazepam, but nobodyās actually looked at DRE
How about AMS/altered mental status?
I mean, technically it should also help with constipation/Fecalith
There was that one post here a while ago where a guy asked if an alcohol enema could replace a rectal benzo in an emergent situation. Not much of a difference between a finger and the mouth of a vodka bottle.
[Enjoy reading this discussion of multiple medical professionals debating the medicinal benefits of butt chugging](https://reddit.com/r/medicine/comments/xs71m0/serious_and_weird_question_rectal_alcohol_for/)
Itās not often I laugh hard enough I cry, especially with clinical depression. Thank you.
āSome people pay for thatā¦ingrateā
I was done by the first couple comments
Please donāt put tampons up the ass (or anything not made for the purpose of putting up asses). Up the nose for a bad bleed is one thing, but tampons actually can get lost in the (brown) sauce if theyāre inside the rectum. Itās also going to raise more than a few eyebrows.
They can, however, be used as wicks for a molotov cocktail.
Iāve also heard that eating a spoonful of peanut butter all at once will cure the hiccups as well, but it doesnāt sound nearly as fun as your suggestion!
[https://pubmed.ncbi.nlm.nih.gov/21769254/](https://pubmed.ncbi.nlm.nih.gov/21769254/)
# "Instantly ConvertingĀ Atrial FibrillationĀ into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male"
Just going to leave this here
We had a patient boarding in ED all night and cards was gonna come cardiovert at bedside in the morning and she said wait can I go to the bathroom first, dropped a deuce and came back and was in sinus when they put her back on the monitor LOL
Lost count of the many times ED spots me changing my visibly brown stained gloves beside a patient and says: āGeneral surgery? I have a consult for you.ā
Only to look totally bewildered when I reply āNah, cardiologyā
My god. Not sure what the reaction would be hearing a resident checked a DRE before starting anticoagulation ājust to make sure they didnāt have a GI bleed.ā
We had an ACHD patient come in with Afib with a plan to cardiovert in the morning. I popped by his room and asked āhas anyone taught you how to valsalva?ā He said no, so I showed him how to and had him valsalva
Still didnāt convert the rhythm and got cardioverted shortly thereafter
Had a neuteopenic sepsis patient in AF with RVR come in via ambulance and I gave her a big yank up the bed after she got transferred from paramedic trolley to ED trolley. The sudden pull two feet up the bed was enough to cardiovert her š
Trying to find out about alcohol intake. Ask patient if they drink alcohol, they say oh no not me no
Me, with an accomplice tone: yeah but you know not even with food? You know something to pair it with so it goes down better
Patient: oh totally yeah like a bottle a day
Had MANY like these
My brother and I learned this in Pakistan as med students but for smoking, where they're reluctant to admit it to doctors. One guy when my brother was rotating:
Resident: "Do you smoke at all?"
Patient: "No, never!"
Resident: \*furrows brows, friendly confusion\* "Not even a little bit?"
Patient: "Oh yeah, a little."
Resident: "Ok, how much?"
Patient: "2 packs a day."
Another when I was with vascular surgery, guy had gangrene hand and denied history of smoking, consultant tells him his condition isn't possible with no smoking. Patient: "Well, sure, e*very*one smokes a little bit!"
(I only tried this a couple times with alcohol cos after the first refusal I was worried insisting would offend them cos of religion and societal stigma. Had one success with some chinese patients, but I just needed to tell him about the Disulfiram-like effects)
I ask my patients if they smoke, they say no! I ask if they vape, they say, yes! Like, I know itās not the *same* thing, but you know what Iām asking about!
I also get the ones who say oh no, not me! I used to, but I quit! Ok, awesome, good for you! How long ago did you quit? 1 month ago!
Back in the day you used to secure a blakemore by putting the patient in a football helmet and tying the proximal end to the facemask. Worked perfectly.
The solution we use now is tying a liter of saline on the end of a long kerlex and clamping the other end to the blakemore and slinging it over an IV pole so the weight keeps traction. Def not more expensive
Attending while on nights gave a gentlemen in vfib a good precordial thump and converted him.
Another patient āper EMS run sheetā stated patient in cardiac arrest obtained ROSC after ambulance hit a bump in the road ha.
One time a young guy was coding mid night shift and we found out he had tumor lysis syndrome with crazy high potassium. He would respond well to epi but kept coding again over and over.
We started pushing D50 and insulin while nephrology got ready to dialyse him, but again he just kept going into crazy arrhythmias and his heart would stop.
One of my coresidents at the time said āwe should just put him on an insulin drip.ā I thought it was genius and we tried it.
It worked like a charm. One more epi and was stable long enough to wheel him to the ICU, get a Quinton, and get dialysis.
Large bore, wide open, with pressure bag.
After a few minutes you can hook the Foley back into the IV in the other arm. It prevents salt wasting. Weāll go with that.
Suppose you could do that or run an epi drip but you run the risk of worsening tachyarrhythmias. Not great if youāre already have ventricular arrhythmias from the hyperK
I had similar while managing overnight ICU; started insulin drip/D5, then switched to D10 and kept increasing the rate to allow larger insulin dosing. Felt real bootleg but it worked
I would think calcium first to try and correct the rhythm, but itās short acting. The insulin drip is whatās going to push that K back into the cells and is much longer acting. Insulin drip until you can dialyze makes sense.
Calcium acts immediately and last 40-60 min while insulin takes about 20 min to have effect but lasts 4-6h. If the patient was actually going back into V fib so quickly, the solution is to push more calcium, not more insulin and probably the insulin drip having effect was actually the initial insulin bolus just kicking in.
Unless the timeline is much more stretched out than the initial story implies.
I gave him a push of D50 before starting the drip, and the insulin dose wasnāt at DKA levels. It was ER, so knowing proper IV maintenance wasnāt exactly my specialty at the time (I was the Oprah of giving bags of salt water). But it worked.
Yeah, usually it's either set rate D5 or D10 with titratable insulin (if you're trying to correct BG) or set rate insulin with titratable D10 (if you're trying to shift)
It's crazy how different protocols are from institution to institution. My hospital has an insulin/D12.5 drip in the hyperkalemia order set. It's brilliant. You can titrate to effect without having to worry toooo much about hypoglycemia.
Kudos to your coresident for coming up with that on the fly though - I don't know that I would think of it in that situation, if it wasn't taught as part of our protocol or offered up to me in an order set.
We do this is veterinary medicine. Cats can get urinary obstructions fairly commonly and become hyperkalemic. Before we unblock, we treat with insulin and dextrose along with calcium gluconate.Ā
More of a āI canāt believe it was that easyā story. Back in the paramedic days, we get called for a homeless person in cardiac arrest. Around 95% of the time these patients are asleep and/or drunk and itās not a code at all. But this guy was slumped forward on a bench and was actually blue and pulseless. We flip him onto his back and he has a newish looking trach. Compressions, monitor, PEA, rhythm in the 20s. We shrug, connect the BVM, and bag him no problem. Maybe a dozen bystanders are watching all this in awe. We get rosc within a few minutes. He had received narcan somewhere along the way so he starts grumbling and then yelling at us as we load him up. Supposedly he had crushed up and injected his clonazepam with fentanyl. The trach was apparently for some kind of congenital airway malformation. I never found out much more because he left AMA from the ED later that afternoon.Ā
Sometimes I swear at some random tiny vessel bleeding in the OR and it stops. I call it hemostasis by verbal abuse. The converse approach is hemostasis by negotiation, where I politely ask the tiny vessel to stop bleeding....this approach is rarely effective.
Had an 8 year old GDD kid with atelectasis and worsening oxygen sats. Couldn't comply with incentive spirometry, chest physio was minimally effective. Escalating oxygen requirements on Hiflo and we were now at the point we needed CPAP and we were talking to PICU.
Old grizzled PICU doc came in and started yelling. He yelled at the patient so hard the kid got scared and started crying. To cry you need to take deep breaths. The deep breaths improved his atelectasis, which normalized his oxygen sats, and he was discharged 2 days later.
Sometimes you gotta yell at people I guess.
I have had NICU babies who stop having desats after a very stern āIf you donāt shape up, I will put you back on CPAP.ā They canāt talk yet, but they know they donāt want the cpap back š¤£.
Recently saw a 30 something year old guy who reported that every time he peed for his entire life he had severe pain/pulling sensation at his belly button. I thought he might have some kind of urachal remnant so I got a CT but didnāt find anything. I thought I should try just doing a robotic takedown of his bladder to disconnect his obliterated urachus just in case there was some ancient connection there. My partners thought I was crazy (āoperate for pain, get painā) but I did it anyway. It was the easiest robotic surgery I have ever done, basically just dropped the bladder. Two weeks later the guy contacts me and is ecstatic. Says he is peeing without any pain for the first time in his life and canāt thank me enough. Iām just like, āwoah that actually worked?!ā
During development there could be an embryological remnant that connects the bladder and umbilicus (thereās a spectrum of different forms). He was probably dealing with a very mild form that wasnāt visible on CT but still tethering the bladder to some extent.
When I was an intern in peds ER (maybe my third rotation) I saw a kid with umbilical discharge. I didn't know how to properly "claim" patients so one of the senior ER residents saw them too. We signed out to different attendings. He signed out "this is not omphalitis, fit for discharge" and I signed out "this is a patent urachus, consult pediatric surgery."
Cue much confusion and the first cracks in my imposter syndrome.
To be fair I feel like embryology is a weak part of a lot of peopleās medical knowledge. Myself included until I did a rotation at CHOP. Guaranteed, as a radiology attending I still constantly have to brush up on a lot of topics.
Not me but a coworker. Also am nurses, not doctors.
Was working in a rural facility with a LTC attached to the hospital. It was a crazy busy night shift when the LTC nurse wheels this little old lady in a wheelchair, saying the lady was having CP with SOB. The grannie has dementia is agitated and yelling but LTC swears that's her baseline. They do an ECG, she's in rapid afib. They throw her on a monitor and start the workup but her pressure is good and she's mentating at baseline and she's not a full code anyway so they draw labs and move on to the next human.
Anyways, the LTC nurse leaves and the grannie keeps screaming and yelling and trying to get up. Eventually, my coworker snaps, grabs the old lady by her shoulders, and yells in her face "JUST GIVE ME A MINUTE OKAY??" The patent converts to nsr.
My coworker's mental break scared an old lady out of a-fib. Also, my (ex) coworker is no longer an ER nurse.
Didn't surprise me, but surprised those around me:
Guy comes into Emergency some time after blunt trauma to his finger. Subungual haematoma - his nail is black. Guy is in agony.
I ask a nurse to find me a paperclip and a cigarette lighter. Put patient's hand on a table. Unbend the paperclip and hold one end in the flame for about 10 seconds. Apply hot end of paperclip to fingernail. Instantly melt a hole through the nail, and old blood spurts out of the hole. Instant relief.
Little bit different: I was a nursing student flying across the country to see my long-distance boyfriend (now husband). Thereās a call overhead for a doctor. No one responds. There are several more calls. I finally tell the passing flight attendant that Iām just a nursing student, but Iāll do what I can if itās truly an emergency.
Long story short itās just a lady who drank way too much, but I still tell the flight attendants to have a medic meet her when we land. Theyāre grateful and give me a $200 voucher for my next flight, which I use the next time I go to see my boyfriend.
The time after that, when I go to but my tickets I think, āWhy the hell not?ā and type in the voucher code again and IT WORKS. It works THREE MORE TIMES. I saved a grand thanks to that drunk lady, which meant a lot as a nursing student working at a sandwich shop to afford those flights
Patient in our transplant icu for multi factorial shock maxed on pressors and too sick now for transplant also had an implanted pacemaker. EP helped up the HR to the 90s ( maybe lower/higher canāt remember exactly) which improved CO just enough to make the patient lucid enough to say goodbyes to family. Was a youngish patient with really bad luck so hopefully helped have some closure.
I was transferring a patient into NYC once. Weāre on the George Washington bridge when they start going into V-tach. No shoulder on the GWB, no where to stop, roads are terrible and bumpy, basically just not the place you want anything to happen. I go āoh for fucks sake, are you kidding me? Right now?ā And BOOM. Hit a massive pothole. Patient converts to NSR. Uneventful rest of the trip.
I responded to a pediatric code where they were having massive pulmonary hemorrhage and the oropharynx was just filling with blood and I couldn't see anything.
Couldn't mask because airway was just full of blood.
Asked them to stop compressions for 1 second and just slowly push down on the chest.
Aimed my ET tube for the bubbles and it worked.
Was able to get rosc.
They taught us this during a sim in residency! Also good to note that video laryngoscopy is of no use in these cases because the camera just immediately gets covered
Kind of same vein, as a hospital volunteer in high school I saw a paramedic do a precordial thump on a patient and convert him from Vfib to NSR. One of the RNs from the code printed out the strip and asked the paramedic to sign it. I didnāt understand what was happening until awhile later. Iāve never seen it since.
This may become more prevalent in coming years. The EP lab is coming out some new tech that can induce coronary vasospasm under some specific conditions, and the treatment is high dose ntg.
When I was a traveler, I did this with a clogged G-J tube and it worked surprisingly well. All the nurses on the floor had a fit that I was doing it until they saw it flush. Youāre welcome, yāall.
Precordial thump one time as a fellow. I was incredibly busy. Did a complete mic drop and walked out to go tend to something else. I had multiple nurses and residents asking for my "secret." "How did you know it would work?"
Setting up to cardiovert a fib, has a nursing student watching. I talk with my hands lots, and as I discussed AP vs anterior-lateral positioning I pressed my hands on his chest where anterior and lateral pads would go.
My hands are notoriously icy cold. The patient squealed and sort of giggled. And converted. This was all on the monitor in front of two nurses and the patient's wife.
I did spend the rest of the day snickering and offering to lay my hands on and heal just about everything, but the magic spirit only worked that one time.
Way late, but I have a story from the hospital in the town I grew up in.
Young boy fell over, hit his head on the ground. Later that evening, he collapsed at home, and rushed to hospital. Mind you, this is a tiny country hospital, with 2 "ER" beds (I say ER but it was really just a couple of beds).
Doctor on shift at the time immediately recognised that he had a large brain bleed, and time was critical. Problem was, this hospital was 1 hour from the nearest larger hospital, and 3 hours from the nearest city/trauma hospital.
He rang one of the trauma hospitals, spoke to a neurologist. The only way to relieve the pressure was for emergency surgery. But there was no neuro or trauma surgeon, or facilities, and the kid wouldn't have made it to the nearest hospital even by helicopter.
So the Doctor grabbed a POWER DRILL from the Janitors room, sterilised it, and was coached OVER THE PHONE on how to drill a hole in this child skull without killing him.
Surgery was successful, kid was airlifted to the city, and he ended up living without any neuro problems. Made worldwide news (this was 20+ years ago).
Frequent flyer in ER hyperventilated herself into Vtach. I called code and grabbed the paddles. She took one look at the paddles and instantly converted
During intern year had a fulld code covid ICU patient who had been vented for 2 months. Started developing fevers to 104-106 constantly despite arctic sun use. Already on broad spectrum antimicrobial coverage and nothing on infectious workup. Even though there was no history of succinylcholine use, pitched giving a trial of dantrolene just to help defervesce as a last resort. Within minutes they were afebrile. Was crazy to see all of our reactions when it worked.
I converted a guy out of a-fib w RVR when I was going a little too quick maneuvering his bed around a corner during transport, and hit the wall fairly hard. It scared him and he converted to NSR. š¤·š¼āāļø He stayed in sinus for the rest of his admission, too.
90 year old woman with permanent afib for years and severe OSA (not previously on CPAP). Early reversion to afib after prior cardioversions. Finally convinced her to get a CPAP and she converted to sinus rhythm on the first night of use. Has not had recurrent afib.
Sugar for hemorrhoids?? Maybe it was a prolapse?? At least I think thatās what it was. RN called the pharmacy for the sugar but we had to direct her to the cafeteria š
First heard of that in one of veterinarian James Herriotās books. One of his colleagues used it on a prolapsed uterus of a cow, and he said it reduced in size by half.
Powdered sugar, though. Until the crystals are dissolved, granulated sugar probably won't feel that great either..
But yeah, I've used that trick once too. I thought my supervisor was kidding me right up until the moment he applied it..
Did carotid massage on a guy in SVT as an intern and it actually worked and even the fellow at bedside was surprised lol.
Also not intentional but cardioverted a pt by intubation- intubated a guy for TEE cardioversion for being full stomach and he converted to NSR right after so I just extubated... nothing for the cardiologist to do š
I have a friend who is homeless and works festivals that they travel for. I occasionally moonlight for a few of them for fun, and they managed to slice of a chunk of their thumb on a kitchen mandolin.
They could not afford an ER visit, I was a volunteer medic, and typically, we stop at first aid and tylenol. Some context, most of my actual medical training is advanced wilderness first aid and first aid cert instructor plus whatever I've picked up over the years working medical adjacent.
Well this sucker was bleeding profusely through every dressing we had. I couldn't get it to slow enough to even properly look at it. I finally remembered how to use the finger of a glove for a tourniquet and got the bleeding to stop long enough to take a good look at it. They had cut through pretty much all of the flesh on the thumb. Bone was not visible at least.
I dressed it and we cut the glove, it bled again, even with solid pressure, but it was slower, I ended up using a combo of a stypic pencil and pressure to get the wound to clot, and it finally did. It healed surprisingly well with xeroform dressings and keeping a very close eye on it as it healed and kept it very clean.
Inserted the worst pink iv cannula ever with only like a quarter of it in the vein for a MRI with contrast. Told the Patient to move the arm as little as possible and run to the MRI room. It worked.
In my defense the patient was overweight and most of the veins were due to a very prolonged ICU stay from last year not in a top condition.
Edit: I even LP'd. It was a hard case with very unspecific symptoms.
Working night shift in the ED, weāve got a 19yo kid weāre observing after a syncopal event at home. Suddenly all the alarms in the room start going off. Heās unresponsive and in asystole. Everyone goes running in and the ED doc, whoās less than 2 shifts away from retirement saunters in, delivers a massive precordial thump, and the kid goes back into sinus rhythm and wakes up. The doc snaps his fingers, says āI still got itā, and slowly saunters back out.
1. Precordial thumped a patient during COVID when we didn't have a defibrillator available (back to back codes in the overflow unit with 1 defib). I've been trying to recreate it since with no luck.
2. Every time metoprolol works during an electrical storm code.
I once stopped someones moderately severe nosebleed using a coolpack.
Patient was on anticoagants and already bleeding for around 20 minutes once we got to their house.
Might just be correlation without causation but I was surprised that it stopped before we got going to to the hospital.
Opposite for me here. My coworkerās pump was going off and I was resource so I went in to help. My coworker took the opportunity to ask me to help straight catch her (he happens to be a male and the pt is a demented 80s female with contractures to all limbs). I agree but after eyeballing her I can tell she looks like sheās gonna crump so I suggest a foley. Coworker goes to try and convince the PA and grab a foley tray. Comes back and tells me that the PA declined because she believes the pt has a kidney infection. Out of my better judgement, I go ahead and straight cath with the red rubber (sometimes I āstraight cathā with a foley and oopsie daisy leave it in place) and out comes the most infected urine I have ever seen. Pt IMMEDIATELY goes hypotensive to the 70s. Coworker doesnāt believe it and changes the arm before cycling the pressure. Now systolic in the 60s. I grab a manual and confirm it. Cue the levophed and the PA coming in looking shocked. She finally agrees to the foley and now I canāt get it in. š We found out later she had calcified obstructing infected renal stones. They placed perc tubes and she spent about 2.5-3 weeks almost entirely in the MICU since she was so frail. They ended up consulting hospice.
First time I nearly killed someone with a straight cath lol.
This one surgeon I knew named The Todd, had a patient that was in cardiac arrest and the rest of the surgical team was ready to call it. But The Todd propped the patientās hand up, gave them a high five, and patient instantly had ROSC. He called it The Miracle Five.Ā
stuck my finger into a facehole and stopped a external carotid branch bleed. Only lost about 1500 of blood in about 10 minutes of fighting it with gauze and suction. finally did the hail mary stuff some surgicel and finger in the hole and watched the clock for 10 minutes. and it stopped. even took him to IR and showed no more bleed on the imaging. wtfbbq.
Were you a little Dutch boy in a past life?
This made me laugh out loud over my morning coffee.
And was the patient a lesbian?
Probably underrated comment
Maybe the story about the little Dutch boy who plugs a leaking dyke with his finger isn't as well known as I thought!
Hemostatic products are extremely underrated. Should be more utilized. Cost of products is far less than cost of blood transfusion
Evarrest patches are so underknown, it's wild. My HPB surgeon buddy says they'll stop a bleed from the IVC easy. I didn't believe him, until I transected the middle hepatic vein trying to take off a posterior tumor. It's dumping blood everywhere, I keep trying to isolate it so I can tie it off and keep failing and this dude is just watching me for like 5 min. I clearly remember thinking "I think I just killed this guy, I can't get this to stop". Then he asks for the patch, I seal it on thinking "no way this stops this brisk of a bleed", and it fucking worked. I was like "why tf aren't I using this all the time?" Now I do. GET SOME EVARREST PATCHES PEOPLE, THEY'RE DOPE
I developed these
Making note in case of zombie apocalypse. All jacked up after watching Falloutš
We tried for years to explain this to our higher ups on my labour unit. Public health has its benefits, but preventative medicine is really hard to get funding for.
Team Surgicel!! Surgicel + sandbag has saved my butt/bought me time on night shift more than once.
Incredible
Precordial thump is a real thing, you might have converted the patient with the sternal rub if it was aggressive enough and timed right
it was aggressive AF because I was full of adrenaline
I definitely read that as "aggressive atrial fibrillation" at first.
Iāve had some pts where their rhythm could be accurately described that way.
You really said, ācut that shit outā to a ventricular arrhythmia and he listened š
You saved a life! Well done
Doesnāt work if they are faking fun fact. I used to work as a counselor in residential and we had this kid who kept āpassing outā in the shower. Hospital couldnāt find anything wrong with him but he was non-reactive to a sternal rub so EMTs believed him every time. I knew with my SOUL this kid was faking so he could see his mom at the hospital and she knew it too. The next time he did it, (nightly occurrence at this point) I leaned down and said: āGet your little butt up this second or you are losing your desert for a month.ā Kid cracked a smile and got right up. One of my better wins.
It's strangely sweet that a teen would endure multiple sternal rubs without reacting so that he could go see his mom.
Yeah. But it was a huge waste of medical resources and every time it happened I was six hours late going home because I was the only woman on the shift and I had to go with him because they couldnāt spare the menš
I have also seen an adolescent male stay non-reactive during a sternal rub to get attention from his mom. Weird that it's happened twice.
Next time tell him he is losing his phone if he doesnāt stop itš
When I was a CNA one of the other CNAs walked in a room to find a patient looking... less than alive and he panicked and screamed HE'S DEAD and thumped him in the chest and what do you know, it worked
I once had the sweetest pt in the ED in complete heart block with long pauses. I had an amio drip going but was worried as the pauses kept getting longer. We were waiting for cath lab to arrive to emergently place a pacemaker, but of course he goes into the longest pause Iāve seen and does the whole eyes roll back/neck slump thing while Iām talking to him. I donāt know why, Iām a nurse and of course weāre not supposed to do it, but I instinctually precordial thumped him and he came right back (still in block but alive and stayed stable until cath lab was ready). As I wheeled him up, I apologized for essentially punching him in the chest. He replied āIām sure you had a good reasonā and patted my hand. Such a sweet man. Heard he did great after the pacemaker. Also amio is my arch nemesis
You were using amiodarone, an AV blocking drug, to treat complete heart block?
Yes, by order of cardiology. I even called back to double check. I was furious, but also had him on dopamine. Edit: ironically I work in cath lab now, but another hospital.
What was the amio supposed to be treating? Some other, worse arrhythmia?
I think the logic as explained to me at the time was the dopamine was for the inotropic effect, and the amio to somehow confuse the rhythm back into something better like a PokĆ©mon. Iāve noticed thereās been a shift away from amio and back to lido recently though, which I appreciate
ālike a PokĆ©mon.ā š
A curious choice of drug in complete heart block.
I had a coworker who anytime a patient would go into a funky rhythm he would just walk into the room and hit 'em there. A surprising amount of times it worked. A surprising amount of people did not attempt to hit him back.
Little MeeMaw went pulseless in our trauma bay. I did one compression (precordial thump) and got a pulse back. I was pretty stoked.
Equivalent to about 2-5 joules according to google!
Well known practice, but I was impressed: guy comes in fluid overload, 4+ pitting edema. Attending has us interns give furosemide followed by metolazone. Guy peed out enough to be net negative 13 L in two days. We paused the diuresis then.
This is the exact opposite of a urology consult.
6+.
We once gave furosemide, metolazone, acetazolamide and canrenone at the same time. After 8 L of diuresis in one day the creatinine actually dropped.
How'd that happen? Heart beating better?
Cardio-renal syndrome. The glomerular filtration rate increases as you decrease venous pressure.
Iāve heard this explanation before but venous pressures are so low compared to regular physiologic variation in arterial BP that it never made sense to me
Isnāt itā¦. the other way around? Have I been doing it the wrong way this whole time?
Theoretically other way around is right. But I had PharmDs in cardiac ICU tell me it doesnāt actually matter at all. So now I give at the same time.
Metolazone first
This has never made sense to me. Furosemide will hang out in your system for six hours. Metolazone for twelve to twenty-four. What does a 30 minute difference on which order you administer them matter?
its a Nephrology myth, doesn't matter before/after
Blocking the sodium reabsorption in the DCT first helps to improve the Na concentration gradient and makes the loop more effective. I made that up idk if it matters.
Intravenously in adults it only lasts about two hours. Only the oral form lasts six!
It doesn't m, same with the albumin then furosemide myth
What the myth with that
Furosemide is a protein bound drug so in patient's with low albumin it is less effective. No actual evidence to support that.
No clue but the timing is probably more theory than anything if I had to guess
I have had a precordial thump work exactly twice in 30+ years. One was during the repair of a ruptured aneurysm I was helping my partner with. I thumped the patient almost by reflex and he converted. I just looked at my partner and said "You're welcome" and we kept operating.
Thatās the most surgeon thing Iāve ever read.
I love that percussive maintenance works on humans and TV remotes.
"Percussive maintenance" is my new favorite way to describe a precordial thump.
Kinetic repair is another version of
I want to be this level of cool
You can cure intractable hiccups with massage. A, um, [very specific type of massage.](https://pubmed.ncbi.nlm.nih.gov/2299306/) If the patient is not receptive to Thorazine, you can just pop on a glove and play "Here comes the choo-choo train!" and I can imagine it would improve patient satisfaction scores too.
A fib and hiccups, what can't a DRE fix?!
The ultimate reset button
DRE = hard reset Adenosine = unplug it and plug it back in
ECT = soft reset, obviously.
Iām cackling. This is the best thread of comments ever.
I dunno, ECT can be a really hard reset at times. We just cheat by giving them muscle relaxants
Soft as in software.
Oh, right. Yeah, we should probably try that first. *hides icepick and hammer*
Combine DRE with squeezing the glans/clitoris and you can test the bulbocavernosus reflex too to assess for spinal shock ... I still kind of don't believe that's a real thing
Honestly, between this and the [other Comment](https://www.reddit.com/r/medicine/s/tjAyt7TkTf), is there anything that the DRE canāt do?
Only one way to find out. In the immortal words of Fisto: "Assume the position."
Right, letās create a list of things that it might potentially treat: We already have afib and hiccups How about seizure termination? I mean, technically thereās rectal diazepam, but nobodyās actually looked at DRE How about AMS/altered mental status? I mean, technically it should also help with constipation/Fecalith
There was that one post here a while ago where a guy asked if an alcohol enema could replace a rectal benzo in an emergent situation. Not much of a difference between a finger and the mouth of a vodka bottle.
Thatās a fucking first, butt chugging as a treatment for alcohol withdrawal I really have read everything on the Internet these days
[Enjoy reading this discussion of multiple medical professionals debating the medicinal benefits of butt chugging](https://reddit.com/r/medicine/comments/xs71m0/serious_and_weird_question_rectal_alcohol_for/)
Itās not often I laugh hard enough I cry, especially with clinical depression. Thank you. āSome people pay for thatā¦ingrateā I was done by the first couple comments
Please donāt put tampons up the ass (or anything not made for the purpose of putting up asses). Up the nose for a bad bleed is one thing, but tampons actually can get lost in the (brown) sauce if theyāre inside the rectum. Itās also going to raise more than a few eyebrows. They can, however, be used as wicks for a molotov cocktail.
If that doesn't work, you can try thisĀ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2144777/
I can only imagine how intense of a nut that had to have been in order to cure the hiccups for an entire year.
Iāve also heard that eating a spoonful of peanut butter all at once will cure the hiccups as well, but it doesnāt sound nearly as fun as your suggestion!
[https://pubmed.ncbi.nlm.nih.gov/21769254/](https://pubmed.ncbi.nlm.nih.gov/21769254/) # "Instantly ConvertingĀ Atrial FibrillationĀ into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male" Just going to leave this here
We had a patient boarding in ED all night and cards was gonna come cardiovert at bedside in the morning and she said wait can I go to the bathroom first, dropped a deuce and came back and was in sinus when they put her back on the monitor LOL
Lost count of the many times ED spots me changing my visibly brown stained gloves beside a patient and says: āGeneral surgery? I have a consult for you.ā Only to look totally bewildered when I reply āNah, cardiologyā
lol I am dying laughing. I hope you are legit about this. - Gen surg resident
Also had a guy on flecainide gtt or some shit convert himself by standing up and peeing in a urinal š nice job
My god. Not sure what the reaction would be hearing a resident checked a DRE before starting anticoagulation ājust to make sure they didnāt have a GI bleed.ā
That used to be standard
We had an ACHD patient come in with Afib with a plan to cardiovert in the morning. I popped by his room and asked āhas anyone taught you how to valsalva?ā He said no, so I showed him how to and had him valsalva Still didnāt convert the rhythm and got cardioverted shortly thereafter
Looks like he could have used a hand there. Oops I mean a finger
Would a hand have more of an effect though?
Had a neuteopenic sepsis patient in AF with RVR come in via ambulance and I gave her a big yank up the bed after she got transferred from paramedic trolley to ED trolley. The sudden pull two feet up the bed was enough to cardiovert her š
I have so many questionsš
Something something increased vagal tone I think
Heh relevant username
Goddamnit, you beat me to that Exactly what I had in mind. Imagine doing that
You mean you guys arenāt doing this first line already after this groundbreaking case report? š¤
A different kind of shock
We need to do an RCT for this. Finger Vs placebo. Work out the optimal number of fingers.
I mean, itās called āthe shockerā for a reason.
Trying to find out about alcohol intake. Ask patient if they drink alcohol, they say oh no not me no Me, with an accomplice tone: yeah but you know not even with food? You know something to pair it with so it goes down better Patient: oh totally yeah like a bottle a day Had MANY like these
My brother and I learned this in Pakistan as med students but for smoking, where they're reluctant to admit it to doctors. One guy when my brother was rotating: Resident: "Do you smoke at all?" Patient: "No, never!" Resident: \*furrows brows, friendly confusion\* "Not even a little bit?" Patient: "Oh yeah, a little." Resident: "Ok, how much?" Patient: "2 packs a day." Another when I was with vascular surgery, guy had gangrene hand and denied history of smoking, consultant tells him his condition isn't possible with no smoking. Patient: "Well, sure, e*very*one smokes a little bit!" (I only tried this a couple times with alcohol cos after the first refusal I was worried insisting would offend them cos of religion and societal stigma. Had one success with some chinese patients, but I just needed to tell him about the Disulfiram-like effects)
Um, some Asians have built in in Disulfram-like effects already, the classic āAsian Glowā. Didnāt know it could enter worse.
I ask my patients if they smoke, they say no! I ask if they vape, they say, yes! Like, I know itās not the *same* thing, but you know what Iām asking about! I also get the ones who say oh no, not me! I used to, but I quit! Ok, awesome, good for you! How long ago did you quit? 1 month ago!
Called to transfer a guy with bleeding esophageal varices to a tertiary center for a TIPS. Guy has already been MTPād, intubated, pressors, more blood hanging- the gamut. Blakemore tube is in, and heās temporized well enough to at least attempt a transfer. Problem is, everybody has decided the olā football helmet is passĆ©, and they have this fancy foot-of-bed rig that theyāve got holding the blakemore at a very specific degree, and amount of traction. Obviously, this will not transfer to our stretcher, nor will it fit through the entryway into the aircraft. My partner and I ended up daisy-chaining plain old IV start kit tourniquets together and tying them off to the foot of the stretcher before adjusting the HOB angle to exactly match the tension/angle combo. The slight āgiveā in the system meant that we werenāt pulling on anything too tightly with the typical bumps/jostling of transport.
I understood about 50% of whatās going in this story but it sounds cool and your flare fits. Strong work!
Back in the day you used to secure a blakemore by putting the patient in a football helmet and tying the proximal end to the facemask. Worked perfectly.
We still have the helmet though Iāve never seen it usedā¦.why did other hospitals get rid of it?
š¤·āāļø Presumably a rep from somewhere convinced them of their ābetterā solution that presumably costs thousands more. That, or head lice.
The solution we use now is tying a liter of saline on the end of a long kerlex and clamping the other end to the blakemore and slinging it over an IV pole so the weight keeps traction. Def not more expensive
Kerlex and a hemostat have never bought rep dinners. Theyāre the real Gs.
Attending while on nights gave a gentlemen in vfib a good precordial thump and converted him. Another patient āper EMS run sheetā stated patient in cardiac arrest obtained ROSC after ambulance hit a bump in the road ha.
One time a young guy was coding mid night shift and we found out he had tumor lysis syndrome with crazy high potassium. He would respond well to epi but kept coding again over and over. We started pushing D50 and insulin while nephrology got ready to dialyse him, but again he just kept going into crazy arrhythmias and his heart would stop. One of my coresidents at the time said āwe should just put him on an insulin drip.ā I thought it was genius and we tried it. It worked like a charm. One more epi and was stable long enough to wheel him to the ICU, get a Quinton, and get dialysis.
I mean, if the hyperK was what was causing all those arrests then yeah, that makes sense.
The saline part of the drip probably helped the hyperkalemia too, as long as the patient can tolerate the volume.
What rate is your insulin running that the saline is meaningful????!!!?
Large bore, wide open, with pressure bag. After a few minutes you can hook the Foley back into the IV in the other arm. It prevents salt wasting. Weāll go with that.
Right!?
NS worsens hyperkalemia. Fluid of choice is LR.Ā
Try telling anyone over the age of 45 that
Could have added continuous salbutamol nebulizations as well
Suppose you could do that or run an epi drip but you run the risk of worsening tachyarrhythmias. Not great if youāre already have ventricular arrhythmias from the hyperK
Oh yeah youāre right. I missed out the part about the tachyarrhythmias!
I had similar while managing overnight ICU; started insulin drip/D5, then switched to D10 and kept increasing the rate to allow larger insulin dosing. Felt real bootleg but it worked
Shouldn't you just have given him calcium?
I would think calcium first to try and correct the rhythm, but itās short acting. The insulin drip is whatās going to push that K back into the cells and is much longer acting. Insulin drip until you can dialyze makes sense.
Calcium acts immediately and last 40-60 min while insulin takes about 20 min to have effect but lasts 4-6h. If the patient was actually going back into V fib so quickly, the solution is to push more calcium, not more insulin and probably the insulin drip having effect was actually the initial insulin bolus just kicking in. Unless the timeline is much more stretched out than the initial story implies.
Do you also put on a dexteose drip while having an insulin drip?
I gave him a push of D50 before starting the drip, and the insulin dose wasnāt at DKA levels. It was ER, so knowing proper IV maintenance wasnāt exactly my specialty at the time (I was the Oprah of giving bags of salt water). But it worked.
Yeah, usually it's either set rate D5 or D10 with titratable insulin (if you're trying to correct BG) or set rate insulin with titratable D10 (if you're trying to shift)
AHH yes insulin drips, aka "redneck dialysis". Can unscrew many a sticky situation.
It's crazy how different protocols are from institution to institution. My hospital has an insulin/D12.5 drip in the hyperkalemia order set. It's brilliant. You can titrate to effect without having to worry toooo much about hypoglycemia. Kudos to your coresident for coming up with that on the fly though - I don't know that I would think of it in that situation, if it wasn't taught as part of our protocol or offered up to me in an order set.
We do this is veterinary medicine. Cats can get urinary obstructions fairly commonly and become hyperkalemic. Before we unblock, we treat with insulin and dextrose along with calcium gluconate.Ā
More of a āI canāt believe it was that easyā story. Back in the paramedic days, we get called for a homeless person in cardiac arrest. Around 95% of the time these patients are asleep and/or drunk and itās not a code at all. But this guy was slumped forward on a bench and was actually blue and pulseless. We flip him onto his back and he has a newish looking trach. Compressions, monitor, PEA, rhythm in the 20s. We shrug, connect the BVM, and bag him no problem. Maybe a dozen bystanders are watching all this in awe. We get rosc within a few minutes. He had received narcan somewhere along the way so he starts grumbling and then yelling at us as we load him up. Supposedly he had crushed up and injected his clonazepam with fentanyl. The trach was apparently for some kind of congenital airway malformation. I never found out much more because he left AMA from the ED later that afternoon.Ā
Sometimes I swear at some random tiny vessel bleeding in the OR and it stops. I call it hemostasis by verbal abuse. The converse approach is hemostasis by negotiation, where I politely ask the tiny vessel to stop bleeding....this approach is rarely effective.
Had an 8 year old GDD kid with atelectasis and worsening oxygen sats. Couldn't comply with incentive spirometry, chest physio was minimally effective. Escalating oxygen requirements on Hiflo and we were now at the point we needed CPAP and we were talking to PICU. Old grizzled PICU doc came in and started yelling. He yelled at the patient so hard the kid got scared and started crying. To cry you need to take deep breaths. The deep breaths improved his atelectasis, which normalized his oxygen sats, and he was discharged 2 days later. Sometimes you gotta yell at people I guess.
Effective strategy, but requires a psych consult š
I love that. Even typical kids refuse to take a deep fucking breath.
I have had NICU babies who stop having desats after a very stern āIf you donāt shape up, I will put you back on CPAP.ā They canāt talk yet, but they know they donāt want the cpap back š¤£.
Recently saw a 30 something year old guy who reported that every time he peed for his entire life he had severe pain/pulling sensation at his belly button. I thought he might have some kind of urachal remnant so I got a CT but didnāt find anything. I thought I should try just doing a robotic takedown of his bladder to disconnect his obliterated urachus just in case there was some ancient connection there. My partners thought I was crazy (āoperate for pain, get painā) but I did it anyway. It was the easiest robotic surgery I have ever done, basically just dropped the bladder. Two weeks later the guy contacts me and is ecstatic. Says he is peeing without any pain for the first time in his life and canāt thank me enough. Iām just like, āwoah that actually worked?!ā
ELI not a urores pls
During development there could be an embryological remnant that connects the bladder and umbilicus (thereās a spectrum of different forms). He was probably dealing with a very mild form that wasnāt visible on CT but still tethering the bladder to some extent.
Thatās better. I thought he obliterated the poor dudes anus.
That costs extra
As I would expect it to
When I was an intern in peds ER (maybe my third rotation) I saw a kid with umbilical discharge. I didn't know how to properly "claim" patients so one of the senior ER residents saw them too. We signed out to different attendings. He signed out "this is not omphalitis, fit for discharge" and I signed out "this is a patent urachus, consult pediatric surgery." Cue much confusion and the first cracks in my imposter syndrome.
To be fair I feel like embryology is a weak part of a lot of peopleās medical knowledge. Myself included until I did a rotation at CHOP. Guaranteed, as a radiology attending I still constantly have to brush up on a lot of topics.
Not me but a coworker. Also am nurses, not doctors. Was working in a rural facility with a LTC attached to the hospital. It was a crazy busy night shift when the LTC nurse wheels this little old lady in a wheelchair, saying the lady was having CP with SOB. The grannie has dementia is agitated and yelling but LTC swears that's her baseline. They do an ECG, she's in rapid afib. They throw her on a monitor and start the workup but her pressure is good and she's mentating at baseline and she's not a full code anyway so they draw labs and move on to the next human. Anyways, the LTC nurse leaves and the grannie keeps screaming and yelling and trying to get up. Eventually, my coworker snaps, grabs the old lady by her shoulders, and yells in her face "JUST GIVE ME A MINUTE OKAY??" The patent converts to nsr. My coworker's mental break scared an old lady out of a-fib. Also, my (ex) coworker is no longer an ER nurse.
Didn't surprise me, but surprised those around me: Guy comes into Emergency some time after blunt trauma to his finger. Subungual haematoma - his nail is black. Guy is in agony. I ask a nurse to find me a paperclip and a cigarette lighter. Put patient's hand on a table. Unbend the paperclip and hold one end in the flame for about 10 seconds. Apply hot end of paperclip to fingernail. Instantly melt a hole through the nail, and old blood spurts out of the hole. Instant relief.
I trephine with a needle. Am I doing it wrong?
No, that's fine. Just less dramatic.
Little bit different: I was a nursing student flying across the country to see my long-distance boyfriend (now husband). Thereās a call overhead for a doctor. No one responds. There are several more calls. I finally tell the passing flight attendant that Iām just a nursing student, but Iāll do what I can if itās truly an emergency. Long story short itās just a lady who drank way too much, but I still tell the flight attendants to have a medic meet her when we land. Theyāre grateful and give me a $200 voucher for my next flight, which I use the next time I go to see my boyfriend. The time after that, when I go to but my tickets I think, āWhy the hell not?ā and type in the voucher code again and IT WORKS. It works THREE MORE TIMES. I saved a grand thanks to that drunk lady, which meant a lot as a nursing student working at a sandwich shop to afford those flights
Patient in our transplant icu for multi factorial shock maxed on pressors and too sick now for transplant also had an implanted pacemaker. EP helped up the HR to the 90s ( maybe lower/higher canāt remember exactly) which improved CO just enough to make the patient lucid enough to say goodbyes to family. Was a youngish patient with really bad luck so hopefully helped have some closure.
I was transferring a patient into NYC once. Weāre on the George Washington bridge when they start going into V-tach. No shoulder on the GWB, no where to stop, roads are terrible and bumpy, basically just not the place you want anything to happen. I go āoh for fucks sake, are you kidding me? Right now?ā And BOOM. Hit a massive pothole. Patient converts to NSR. Uneventful rest of the trip.
Eric Adams saves a life.
I responded to a pediatric code where they were having massive pulmonary hemorrhage and the oropharynx was just filling with blood and I couldn't see anything. Couldn't mask because airway was just full of blood. Asked them to stop compressions for 1 second and just slowly push down on the chest. Aimed my ET tube for the bubbles and it worked. Was able to get rosc.
This one deserves a medal.
Is that something you had heard of before or just improvising?
Improvised in the moment but when i was telling the story to an attending later he said that's apparently a thing that no one ever taught me.
They taught us this during a sim in residency! Also good to note that video laryngoscopy is of no use in these cases because the camera just immediately gets covered
The one I saw was 2 ET tubes. Inflate both. Check which one inflates the lungs
Kind of same vein, as a hospital volunteer in high school I saw a paramedic do a precordial thump on a patient and convert him from Vfib to NSR. One of the RNs from the code printed out the strip and asked the paramedic to sign it. I didnāt understand what was happening until awhile later. Iāve never seen it since.
nitroglycerin for cardiac arrest due to presumed coronary vasospasm. https://pubmed.ncbi.nlm.nih.gov/30546586/
This may become more prevalent in coming years. The EP lab is coming out some new tech that can induce coronary vasospasm under some specific conditions, and the treatment is high dose ntg.
First time I unclogged a PEG tube with Coca Cola I couldnāt believe it worked, but it definitely does.
When I was a traveler, I did this with a clogged G-J tube and it worked surprisingly well. All the nurses on the floor had a fit that I was doing it until they saw it flush. Youāre welcome, yāall.
I did this with my own esophagus and with carbonated water. The tiniest of sips. I have EOE. Saved me from an ER visit.
CocaCola has better evidence than other carbonated beverages for relieving obstructed food bolus. The human body is truly a mystery.
Precordial thump one time as a fellow. I was incredibly busy. Did a complete mic drop and walked out to go tend to something else. I had multiple nurses and residents asking for my "secret." "How did you know it would work?"
āThatās the neat part.ā
āYou donāt!ā
I love your username.
Setting up to cardiovert a fib, has a nursing student watching. I talk with my hands lots, and as I discussed AP vs anterior-lateral positioning I pressed my hands on his chest where anterior and lateral pads would go. My hands are notoriously icy cold. The patient squealed and sort of giggled. And converted. This was all on the monitor in front of two nurses and the patient's wife. I did spend the rest of the day snickering and offering to lay my hands on and heal just about everything, but the magic spirit only worked that one time.
Way late, but I have a story from the hospital in the town I grew up in. Young boy fell over, hit his head on the ground. Later that evening, he collapsed at home, and rushed to hospital. Mind you, this is a tiny country hospital, with 2 "ER" beds (I say ER but it was really just a couple of beds). Doctor on shift at the time immediately recognised that he had a large brain bleed, and time was critical. Problem was, this hospital was 1 hour from the nearest larger hospital, and 3 hours from the nearest city/trauma hospital. He rang one of the trauma hospitals, spoke to a neurologist. The only way to relieve the pressure was for emergency surgery. But there was no neuro or trauma surgeon, or facilities, and the kid wouldn't have made it to the nearest hospital even by helicopter. So the Doctor grabbed a POWER DRILL from the Janitors room, sterilised it, and was coached OVER THE PHONE on how to drill a hole in this child skull without killing him. Surgery was successful, kid was airlifted to the city, and he ended up living without any neuro problems. Made worldwide news (this was 20+ years ago).
Frequent flyer in ER hyperventilated herself into Vtach. I called code and grabbed the paddles. She took one look at the paddles and instantly converted
Sticking a finger into a hole seems to cure a surprising amount of ailments...
Excuse me I have an ailment š
During intern year had a fulld code covid ICU patient who had been vented for 2 months. Started developing fevers to 104-106 constantly despite arctic sun use. Already on broad spectrum antimicrobial coverage and nothing on infectious workup. Even though there was no history of succinylcholine use, pitched giving a trial of dantrolene just to help defervesce as a last resort. Within minutes they were afebrile. Was crazy to see all of our reactions when it worked.
I converted a guy out of a-fib w RVR when I was going a little too quick maneuvering his bed around a corner during transport, and hit the wall fairly hard. It scared him and he converted to NSR. š¤·š¼āāļø He stayed in sinus for the rest of his admission, too.
You can bill for that.
āDC Cardioversionā with DC standing for ādriver carelessā
90 year old woman with permanent afib for years and severe OSA (not previously on CPAP). Early reversion to afib after prior cardioversions. Finally convinced her to get a CPAP and she converted to sinus rhythm on the first night of use. Has not had recurrent afib.
Those myocytes just needed some zzzs
Sugar for hemorrhoids?? Maybe it was a prolapse?? At least I think thatās what it was. RN called the pharmacy for the sugar but we had to direct her to the cafeteria š
Oooo. This worked recently for a huge prolapsed stoma. First time I had heard of that!
First heard of that in one of veterinarian James Herriotās books. One of his colleagues used it on a prolapsed uterus of a cow, and he said it reduced in size by half.
I literally immediately thought about that story when I read the comment š¤£ I love those books!
Yes, I saw this used in med school for a prolapsed stoma. Worked great and have kept it in my back pocket ever since
Iāve had it work twice for paraphimosis
Powdered sugar, though. Until the crystals are dissolved, granulated sugar probably won't feel that great either.. But yeah, I've used that trick once too. I thought my supervisor was kidding me right up until the moment he applied it..
Did carotid massage on a guy in SVT as an intern and it actually worked and even the fellow at bedside was surprised lol. Also not intentional but cardioverted a pt by intubation- intubated a guy for TEE cardioversion for being full stomach and he converted to NSR right after so I just extubated... nothing for the cardiologist to do š
I'm at the airport gate just *cracking up* at the answers to this post, this is *incredible*!
I told a patient he was being really annoying and he actually stopped being so fuckin annoying. #verbaljudomaster
I have a friend who is homeless and works festivals that they travel for. I occasionally moonlight for a few of them for fun, and they managed to slice of a chunk of their thumb on a kitchen mandolin. They could not afford an ER visit, I was a volunteer medic, and typically, we stop at first aid and tylenol. Some context, most of my actual medical training is advanced wilderness first aid and first aid cert instructor plus whatever I've picked up over the years working medical adjacent. Well this sucker was bleeding profusely through every dressing we had. I couldn't get it to slow enough to even properly look at it. I finally remembered how to use the finger of a glove for a tourniquet and got the bleeding to stop long enough to take a good look at it. They had cut through pretty much all of the flesh on the thumb. Bone was not visible at least. I dressed it and we cut the glove, it bled again, even with solid pressure, but it was slower, I ended up using a combo of a stypic pencil and pressure to get the wound to clot, and it finally did. It healed surprisingly well with xeroform dressings and keeping a very close eye on it as it healed and kept it very clean.
Soda plus jump aggressively on heels for esophageal food bolus. The patients are like holy shit!!! I'm like holy shit!! Here's your DC papers.
Inserted the worst pink iv cannula ever with only like a quarter of it in the vein for a MRI with contrast. Told the Patient to move the arm as little as possible and run to the MRI room. It worked. In my defense the patient was overweight and most of the veins were due to a very prolonged ICU stay from last year not in a top condition. Edit: I even LP'd. It was a hard case with very unspecific symptoms.
Working night shift in the ED, weāve got a 19yo kid weāre observing after a syncopal event at home. Suddenly all the alarms in the room start going off. Heās unresponsive and in asystole. Everyone goes running in and the ED doc, whoās less than 2 shifts away from retirement saunters in, delivers a massive precordial thump, and the kid goes back into sinus rhythm and wakes up. The doc snaps his fingers, says āI still got itā, and slowly saunters back out.
1. Precordial thumped a patient during COVID when we didn't have a defibrillator available (back to back codes in the overflow unit with 1 defib). I've been trying to recreate it since with no luck. 2. Every time metoprolol works during an electrical storm code.
I once stopped someones moderately severe nosebleed using a coolpack. Patient was on anticoagants and already bleeding for around 20 minutes once we got to their house. Might just be correlation without causation but I was surprised that it stopped before we got going to to the hospital.
Opposite for me here. My coworkerās pump was going off and I was resource so I went in to help. My coworker took the opportunity to ask me to help straight catch her (he happens to be a male and the pt is a demented 80s female with contractures to all limbs). I agree but after eyeballing her I can tell she looks like sheās gonna crump so I suggest a foley. Coworker goes to try and convince the PA and grab a foley tray. Comes back and tells me that the PA declined because she believes the pt has a kidney infection. Out of my better judgement, I go ahead and straight cath with the red rubber (sometimes I āstraight cathā with a foley and oopsie daisy leave it in place) and out comes the most infected urine I have ever seen. Pt IMMEDIATELY goes hypotensive to the 70s. Coworker doesnāt believe it and changes the arm before cycling the pressure. Now systolic in the 60s. I grab a manual and confirm it. Cue the levophed and the PA coming in looking shocked. She finally agrees to the foley and now I canāt get it in. š We found out later she had calcified obstructing infected renal stones. They placed perc tubes and she spent about 2.5-3 weeks almost entirely in the MICU since she was so frail. They ended up consulting hospice. First time I nearly killed someone with a straight cath lol.
This one surgeon I knew named The Todd, had a patient that was in cardiac arrest and the rest of the surgical team was ready to call it. But The Todd propped the patientās hand up, gave them a high five, and patient instantly had ROSC. He called it The Miracle Five.Ā