14 May 2010

Friday Flashback - That which does not kill me...

Only postpones the inevitable.

I spent a lot of time postponing the inevitable last night. It seemed like every patient was a severely demented octogenarian, non-verbal and non-ambulatory, either septic or with a lower extremity long-bone fracture. (Or, in some cases, both!) Blessedly, most came in with valid DNR papers, so I did not have to pursue heroic measures, but (as I have had to explain to several hospitalists) "Do Not Resuscitate" does not mean "Do Not Treat." So I went and tanked them up with fluids, cultured them from stem to stern, poured in gorilla-cillin and got the relevant consults, all the while shaking my head at the sheer futility of it all. It could have been worse -- the families were all either absent or present and realistic -- no frantic insistence upon unreasonable interventions. But it seems like even the most reasonable families still have a problem withholding antibiotics. They're down with the notion of "no life support" but "just let Granny die" seems too cold for them, especially when contrasted with the seemingly non-invasive IV fluids and antibiotics.

I was lucky, though, that admidst the wreckage there was one beautiful shiny satisfying "Emergency Medicine" case. As good as a Nursemaid's Elbow. Healthy, happy patient, grateful parents, ER doc looking like a hero.Yes, she swallowed a dime. No, she's going to be fine -- 99% of them pass within the week. If you like you can examine her stool, but realistically, you can do nothing at all as long as she has no symptoms. If you like you can follow up for a repeat x-ray at her pediatrician's office in a week, but even that is not necessary in the absence of symptoms.

That case put the smile on my face to get me through the rest of the shift.

Originally Published 25 June 2007


  1. FYI, the Nursemaid's Elbow link requires a password.

  2. Just as a tangent...

    Prior to medical school, I was in practice as a veterinarian.

    From this perspective, my first immediate reaction to this x-ray was a bit less relaxed. U.S. pennies minted after the early 80's have a high percentage of zinc.

    Zinc is very toxic in dogs and parrots and ingesing a penny can be fatal in them.

    In dogs, the zinc causes an often fatal hemolytic anemia.

    It's been well over a decade since I was in veterinary practice, so I will qualify all the above comments with the observation that my memory of exact details may be a bit off.

    IIRC pennies can cause problems in kids too, but it is due to local gastric irritation from the zinc, rather than a systemic toxicity, unless a large number of pennies are swallowed.

    Anyway, this was a dime, which is better than a penny in more ways than one.


  3. So, all you have to do is watch, and see if there's any change? :)

  4. any idea what happened to cranky prof? I hope there's no problem... miss reading her though...

  5. My husband's comment-When they fart, do they make change?


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