Monday, October 29, 2007

You Heard What?

A patient comes into the ER the other night with complaint of chest pain so I'm called down to do a EKG on the 35 year old with chest pain. I get into the room start to do the EKG and she becomes very shy about me putting on leads. Every lead I put on she quickly pulls up her gown and the lead falls off. "Sorry ma'am I have to get this back on could you please wait until we have the EKG done, I will go as fast as possible." So I finally finish and EKG is showing normal sinus rhythm and she going into this excruciating pain look and perfectly complaining "Owwww it's hurting right over my heart and very heavy right now with the pain going to my jaw and radiating down my arm." So I give the EKG to the Doc and she say this person has been here like 20 times in the last week, she is a nut case. Great so off I go.

35 Minutes later I'm called to come down and do a nebulizer treatment in the ER and when I get there the Doc tells me it's in the same room as the nut case. I ask "Is she short of breath, she didn't seem short when I was in there and didn't complain of that?" Now here is the response I received from the great and powerful doctor, "She is having a slight wheeze with a forceful exhalation, so maybe she has a little asthma component with exertion." Okay key phrase here if you didn't notice it, "With a FORCEFUL exhalation...".

Damn right she does with a FORCEFUL exhalation, so do I watch.....wheeeeezzzzeeeeee....See I can do it also and I have no breathing problems what so ever, and I'm sure you can do it to. The Doc actually told her to breath out as hard as she could, what the *&^%!!!

Well so I didn't actually say all that to the Doc. But I took a peak flow meter in the room with me to check the patient, we use the low flow ones in the ER (don't ask why) but it only goes up to 375. I give the PF to the patient and she all about blows the room off the room with that thing, plus her lungs are clear as a bell. Off I go and let the doctor know my observations and she is stunned and says "Wow maybe I just heard something at the right time, I guess her lungs are good, but lets give the neb anyways because I might soothe the patient a bit." Alright whatever again the nebulizer works as a pacifier.

After the nebulizer the doc then tells me that she is indeed a nut case and a attention seeker and it's thought that she does a bit of research so she can use the correct symptoms of the problem she is seeking help for. Ya have to love these types of patient and how they can just take up your time and run you schedule right into the ground.

Oh well all is life in your friendly community hospital. I work in a small town hospital now instead of the big city one I used to and when you compare the to there is a difference but in a small town one it seems there are a lot of bored people, namely elderly, who just want some attention so they go to the ER. Job security is the way to look at it.

Until next time, don't inhale chasing it with a exhale.


Freadom said...

We have a patient who comes in all the time with an exaggeration of asthma. She breaths normal until you go to listen and, you guessed it, she forcefully exhales to make herself wheeze. I don't even waste my time listening to her anymore. The funny thing is, doctors buy into it and she keeps getting admitted.

I learned a way to tell if someone is faking or if they are really wheezing. You have them exhale through pursed lips. If they are still wheezing, then it's a real wheeze.

Djanvk said...

Good hint, I'm going to have to remember that one, thanks.

Anonymous said...

That is a good hint, Freadom.

It always amazes me that the old forced-exhalation trick still works on nurses and MDs. How is it that a physician can fail to understand the concept of forced exhalation?