I have had this post on my mind for quite some time but it has come to the forefront due to some of my recent patient encounters. There are certain things in Emergency Medicine which are so strange and become even stranger because of the fact that it seems they are found in all other emergency rooms. Its kind of like someone getting a 1500 calorie fastfood meal and then ordering a diet coke – it doesn’t make sense and yet people everywhere seem to do it.
The first type of patient that causes many of us to just wonder – sometimes out loud – people with multiple tattoos, usually very large ones at that and often with the added variety of body piercings, who refuse to get a shot. Why you might wonder? Because they say they don’t like needles. It makes us wonder if their tattoos were painted on with a brush or maybe the kind you get out of a bubble gum machine. Piercings though – that’s like having a 10 guage needle stuck in you repeatedly – and often in some very sensitive areas as well. For the non-medical out there, we use needles that are at least half that size and sometimes only one third.
The second patient group that leaves us scratching are heads are those that come in with “vomiting”. This group is often divided into two categories: the truly sick and those who aren’t. Those who aren’t sick baffle us because they routinely insist on vomiting on the floor even though typically the waste basket or vomit-bin/bag/etc is literally within easy reach. I used to think that such people would never do such a thing at home, but after doing some EMS ride alongs and seeing some of the conditions that some people live in, I understand that they probably just vomit on their own floors/couches/chairs/etc as well.
As for those who aren’t so sick, its amazing how often they come in complaining of nausea while they munch on Doritos and drink some nasty grape soda or other carbonated sugar poison. One day I’m just going to lose it and tell them that maybe if they weren’t treating their stomachs like toxic waste dumps that they wouldn’t be nauseated. But usually, I just take the polite road and encourage them to do a bland diet for a few days and that they will likely feel better.
The last group that comes to mind – although their are a few others out there deserving of mention – are those that come in with a complaint that just started. “I have a sore throat”. How long have you had it? “Oh, it just started about 30 minutes ago”. Or, “my child has a fever”. When did it start? “I just checked their forehead 20 minutes ago and it felt hot so I rushed him in”. Granted if the patient has some extreme history, like they had epiglottitis or febrile seizure, I would certainly understand and do my best to reassure them – but come on.