My last week on Midway, today is my last Friday and as I count down the final moments in all their glory today I received a small inoculation, a reminder if you will as to what awaits me back in the ER. March has actually been a busy month for me so far, I have almost needed to shake my funk considering in the first nine days of the month I have nearly seen as many patients as I did in all of February, ten.
So the whole drug allergy thing is about as out of control as the pain scale. You know:
Me: “How would you rate your pain on a scale from one to ten, ten being the worst pain you could possible imagine”
Pt: “Oh, it’s at least an eight, no more like a nine…” [Meanwhile pt is currently playing Angry Birds on iPhone, just finished bag of Fritos (+Fritos sign), vitals: BP 115/70, HR 64, RR 12, SpO2 100%RA, T 37°C]
When I was in PA school, having actually had some prior direct patient care experience, I would attract a critical glare on occasion during history taking practicum when I’d bust out with the truism “Well all patients lie…” for instance, or maybe it’s just because I’m a wiseass. At any rate, the point is you have to utilize those critical listening skills, even if the patient isn’t deliberately trying to deceive, which most the times they’re not, they are trying to tell you their story and not what you need to hear to diagnose or exclude disease.
Just revisit my previous example of the pain scale patient, imagine that patient is complaining of abdominal pain, do you think the patient needs an emergent CT scan of their belly and a battery or lab tests before being whisked off to the operating room or can you sit on them a little while?
Another example, and this is what cracked me up today:
More and more commonly patients report being “allergic” to everything: prednisone, aspirin, glucose, epi… (Need I go on?) Sometimes they are talking about an effect (desired) or a side effect (undesired) of the medication. “Um.. yeah I’m allergic to warfarin, it makes me bleed… Morphine makes me really sleepy…” Well I thought I had heard it all until today, Pt just told me: “I’m allergic to all mammal meat…”
Hmm, well, maybe you’re just allergic to myoglobin, in which case you should just fucking explode… Dude, you’re fucking MADE of mammal meat… WTF!?!
Oh, and too bad, I’m sorry you’re having an anaphylactic reaction but all I can do is give you this epinephrine but you’re fucking allergic to that too…