Archive for February, 2009

A-Z of Clinical Odours. (Part Two: N-Z).

Posted on February 27, 2009. Filed under: Benign |

Welcome to the second part of my non- exhaustive encyclopedia of Clinical Odours.

N: Nitrous Oxide: Laughing gas. A distinct smell usually tainted by the smell of the rubber mask through which it is inhaled.  Often associated with dislocated bones. (See R: Rugby player).

O: Oxygen/Fresh Air: The general populous may believe that Oxygen does in fact NOT smell, bit if you’ve be stuck in a room full of sweaty trauma nurses mopping up Malaena and then step out into the cold night air the purity of oxygen hits you. 

P: Perfume:  You may think that the smell of perfume is always a good thing, not so.  Haven’t you ever had the urge to say…”Nice perfume, but did you haveto marinade in it?”  I don’t believe you have to spend an absolute fortune on cologne, but I think it should be easy to tell the difference between Eau De Toilet and Odour Toilet.

Q: Quite Unexpected: Some smells you really are not prepared for. The best example I can give was from a patient who set light to himself in the emergency room waiting area.  I suppose if I’d put thought into it I could have predicted the odour, but I just wasn’t expecting it…I was at the other side of the department and couldn’t see what was going on. All I knew was that the fire alarm and emergency buzzers were both ringing, and that I could smell something quite unexpected for an Emergency Department…Honey smoked Bacon!!!

R: Rugby Players: A not strictly unpleasant odour of fresh mud, fresh blood and a tinge of sweat.

S: Sinusitis: A malingering smell of stagnant and stale blood stained snot.  Distinct and definitely unpleasant.  The only bonus is that if you have sinusitis you can’t smell anything else.

T: Terminal Illness: It has to be quite advanced, and I couldn’t describe it, but you can smell it.

Tobacco:Amazingly heavy smokers don’t seem to realise that it smells, in fact they seem positively surprised when you spontaneously ask how much they smoke.  “How DID you know??”  (apart from the smell? The stained fingers and teeth and prune like facial wrinkles give it away).

Tonsillitis:Not dissimilar to sinusitis in quality, but distinct and gives you one of the few occasions to diagnose the cause of a sore throat before you even look inside.

U: Urine: Sometimes it has a faint smell, other times it smells strongly particularly if rife with Nitrites, sweetened by Ketones, or following a meal with asparagus!  Most distinctly when mixed with stale alcohol and soaked onto a pair of dirty trousers.

Ulcers: See Exudate.

V: Vomit: Essentially an acidic smell which can be uniquely combined with stomach content to produce such smell as : Special Brew Vomit, Curry/kebab and Special Brew vomit, Breast Milk vomit (strangely more acceptable than the previous two!) and many more…

W: Washed: Similar to the smell of fresh air.  The smell that the early shift unknowingly fill the emergency department with that only the stale night shift staff can smell. It’s the smell of reinforcements and comparable to the sun soaked fresh spring air after a long hard winter! It’s the smell that tells the night shift it’s nearly time to go home, have Southern Comfort on their porridge and drift off to sleep!

X: x : The unknown quantity. Allowing for the fact that pretty much any of the smells listed can be combined with any number of the other smells listed and create it’s own unique distinctive odour or malodour!

XXX: The smell of condoms, semen, vaginal secretions and sex workers!

Y: YUK!!! See most of the above!

Z:Zzzzzz:The noise of an unconscious first year student nurse after having their first experience with a strong clinical malodour and passing out! 

So there you have it!!  Please add you own and enjoy!!

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A-Z of clinical odours. (part one: A-M)

Posted on February 19, 2009. Filed under: Benign |

I decided to compile this non-exhaustive encyclopedia last week when, within the space of 30 minutes, my room had become temporarily stained by 3 very distinct odours.  Please feel free (as always) to add any comments and additional suggestions.  I may well add the comments into the main text to make it more complete.

A: Alcohol: When you’ve been dragged into the nearest hospital or clinic, staff can immediately smell the cause for your inability to walk, talk or urinate in the right places.   A strange almost rhubarb -like, overtly sweet malodour that can strip wallpaper from 50 paces.  It may be nice to have a single malt or glass of  Shiraz, but when you’ve been pouring vodka and Thunderbird down your throat and it’s odour is coming out in your sweat then maybe you’ve gone a tad too far!

B: BO1: Body Odour: Affecting any member of the public/staff who decided not to wash prior to coming to clinic.  Forgivable late in the day in mid summer or after a long night shift, less forgivable at 09.00 in the morning regardless of shift pattern.

BO2: Bowels Open: Regardless of its Bristol Stool Chart type, it smells!  It’s always bad, but can have factors that make it worse: see “M for Malaena”.

BV/Bacterial Vaginosis: Malodourous vaginal infected discharge. See “K for Kippers”.

C: Cats urine: The smell accompanying the little dishevelled lady who never felt the need to marry or have children.  The drug Parvolex has the same smell and is given to patients who have overdosed on Paracetamol (acetylcysteine).  Ironically some patients take OD’s because they have split up from their loved ones and don’t want to grow old alone smelling of cats… but due to the odourous quality of Parvolex they can smell of cats before they grow old!!

D: Dirt: The general smell of the great unwashed, not a smell specifically of BO1, but just general lack of cleaning. Often associated with a faint rough brown rash that can be removed with vigorous scrubbing with soap.

E: Exudate: It may be rewarding to clean away that sloughy pus, but really did God have to make it smell so bad!  This smell is amplified by “helpful” patients who have decided to self treat their ulcers by wrapping an adhesive bandage straight onto their exudating leg and letting it set into place for a week.

F: Feet: You know it’s going to be bad, several key factors give it away. Firstly the general presentation of the patient, then the condition of their socks, and then the amount of sock fluff…that’s the point you are committed to smelling their odourous feet, the nails might be black, there may be calluses, verrucas and ingrowing toenails..but it’s not what you see that stays in the room for so long that the next three patients all think you have stinky feet!!

G: Gases: See F, N & O – ha! you’ll have to wait a week!

H: Horse: OK, so not many horses come to see non- veterinarian clinicians, but the riders often do. They leave your room smelling like a combination of urine soaked straw and wet animals.  Only comparable to the smell of a school boy who is playing Joseph in the nativity and nervously wets himself  near the straw, when realising their are 200 parents with video cameras watching him.

I: Incense: Nothing says “I’ve been smoking dope” like the smell of sandalwood joss-sticks. Nurses and the like recognise this instantly…mostly due to hazy memories of being a student!

J: Joop:In my experience it’s the only aftershave strong enough to get me through the Friday night shift, without me wanting to puke due to all the other smells.

K: Kippers: Fish smells, some more than others – Kippers being the worst.  See Bacterial Vaginosis.

L: Leather: As worn by bikers, usually smelt in the health care field when associated with big guys (and girls) sobbing.  The sobbing is nothing to do with the potential fractures they’ve sustained from coming off their bike at high speed, but more because the leather smell is being caused by a nurses trauma scissors cutting through their highly expensive leather trousers.

M: Melaena: It’s a distinct smell, essentially it reminds me of cooking liver, (which is why I don’t eat liver).  For those that don’t know…it’s bloody crap…no literally…blood from the bowel and probably one of the most offensive smells in health care.  PLEASE DON’T NAME YOUR CHILDREN “MELAENA”  (or Candida)!

Next time you can look forward to N-Z…and see how I cope with Q, X, Y and Z…oh yes….I’ve already got it sussed!

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Why Adults are better than kids….

Posted on February 11, 2009. Filed under: Benign |

Ladles and Jellyspoons…. I’ve been nagging, pestering and finally dragged out a guest writer…please allow me to introduce the curly haired Practice Nurse Extraordinaire that is….Nurse Rosie.

OK!  So I’ve just finished reading Max’s last post, and normally I agree with every word that flows from his laptop, however….

Have you lost your mind Maxter?? (Urm hello!  I work for the health service…)

Adults are soooo much easier to look after than kids, and not just at home either!  (Rosie’s obviously not met my wife!)

For example, when was the last time you saw an adult with a Go-Go Crazy Bones figure jammed up his nose, for the second time….

(Although I did once syringe the ears of a lady with bilateral garlic cloves in her ears, she’d been told it would cure her tinnitus…..they’d been in there a fortnight, I’ll leave the smell to your imagination…)

When was the last time an adult give you a bloody good kick on the shin for administering a travel vaccine, for a holiday his parents had booked?!

Children come in to my room in ‘hunter-gatherer mode’, anything not nailed down or padlocked shut is apparently fair game. Last week after I’d run out of ‘You’ve been brave’ stickers, sugar free Chupa-Chups, Oh and all the little penguins the nice rep left me for insulin starts, one charming little brat made off with a portion plate and a pedometer…….mind you, his mother might have got some use out of them!

Adults tend to leave the waiting room as they found it, not scattered with a Krypton Factor style maze for our less well sighted members to navigate through, much to the amusement of the ones still waiting….ahem…..

Well I think I’ve made my point, but I’ll be honest with you Max, it wasn’t easy, all the way through this I’ve found myself thinking of lots more incidences why kids are so much easier, funnier and braver than the most adults, maybe you haven’t lost your mind, maybe you just caught some of that dementia from your four year old!

Big thanks to Rosie….It’s put me right off garlic…Apparently Rosie enjoyed it…so maybe we can expect more?!?!  …and as always I look forward to anyone elses imput and posts.

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Why paediatric patients are better than adult patients…

Posted on February 5, 2009. Filed under: Benign |

Now it seems like a bold statement to say that children make better patients than adults, but I can think of several reasons why…and in that way that I do…I shall enlighten those non- believers.  (obviously there are exceptions to the rules).

1: Children tell the truth… sometimes it’s clinically relevant, other times less so…but normally truthful…This morning I was informed…”I’ve got my pants up my bum”.  Adults never tell me these things.

2: Children describe things better, without inhibitions or trying to be “helpful”…

I had two patients last week with odd noises in their ears, the first was a little old lady, who was trying to be helpful by saying; “I can hear my ear wax”. Not actually very helpful…I tried to get her to describe what it sounded like, but she informed me she couldn’t really hear anything, but her hearing was fine, and her ear didn’t hurt.

On examination, she had a little fluid behind her ear drum… had she said what my second patient with odd noises had said it would have been easier… She was a 5 year old who said: “It sounds like a train in my ear”.  Once we had established it wasn’t a tinnitus “toot toot” and more of a “chug, chug” it was fairly easy to realise that she had medial fluid too.

3: Children will say “my willy hurts”  and drop their trousers, before you’ve even said “hello”, rather than mutter for 10 minutes about a “problem down below”, blush and try to reveal the offending body part, without letting you see anything that isn’t directly involved.

4: Children don’t have a hidden agenda…except the occasion Monday morning school belly aches/skivitis.

5: Children tend not to have underlying drug abuse, alcohol or tobacco habits to hide and exacerbate symptoms.

6: Children don’t actually want medication, so they don’t pester for it after you’ve told them they don’t need it, nor do they try to deceive you to try and obtain drugs…. I’ve never heard a four year old say: “Look old man, I just need some Calpol so that I can stop shaking”

7: If children don’t wash, it doesn’t smell half as bad as an unwashed adult!

8: Even really poorly feeling children can clamber onto an examination bed without making as much fuss as an adult.

9: Children naturally won’t eat if they’ve got diarrhoea and vomiting, whereas adults force themselves to and therefore make themselves worse, and children won’t carry on walking on a limb that hurts and then moan about it to you in 8 weeks.

10: They are genuinely smarter and less deceptive than your average adult!

As usual feel free to add your own in the comments box…

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