Foreign Bodies

Tree! Mend us!

Posted on April 16, 2009. Filed under: Apply topically, Foreign Bodies |

A fantastic story in this weeks news about a 28 year old Russian man called Artyom Sidorkin.  Who presented to Doctors with chest pains, he was sent for X-ray.   The X-ray showed a large shadow and Doctors told Mr Sidorkin that they feared he had lung cancer.

Presumably with a previously healthy young man with a lung shadow, they wasted no time taking him to surgery, on opening him up they found…he didn’t have cancer. So what was causing the shadow??? A 5cm fir tree! I’m not teasing!  It’s in the papers and the news.

Watch carefully I’ll be asking questions afterwards.

 OK so you’ve seen the report, here are your questions…. 

1: How many people where required to remove the small fir tree??

One?  Two? or Tree fellers?

2:  Did they get the thoracic surgeon to operate, or did they call a tree surgeon?

3: If it had grown bigger would they have to tear him limb from limb or just operate on his trunk?

Enough puns questions, I’ll leaf it there for today!

…and now for something completely different….for anyone who’s ever loved a doctor!  (I’ve only ever dated a Doctor’s daughter…trivial but no punch line!!)

 

 

I tried to put Julie Andrews in here, but it wouldn’t let me imbed her (oo-er) so you’ll have to settle for the rather wacky Janet Klein (I’ll be returning her to Nurse Ratcheds care).

 Toodle pip!!

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Mechanism of Injury…

Posted on July 10, 2008. Filed under: Benign, Foreign Bodies |

The mechanism of injury is an important part of history taking when finding out about an injured patient.  You can tell a lot about the injury when you can visualise what actually happened.

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If a patient states “I had a car crash”, the mechanism of injury allows us to find out speed, airbag activation, seat belt impact, position in vehicle, direction of impact et cetera, et cetera and take into account the clinical implications. Often it is fairly mundane stuff: “I slipped on the bottom step and my foot went inward” – OK so I know before I examine which ligaments are likely to be sore and which less so.  But sometimes it can be a little more wacky!!

Here is my chance to vent some of my favourites…and yes groovers these are all straight from my patients mouth, please feel free to add your own…although there are plenty of urban legends out there (some involving being naked while using vacuum cleaners).

Curious design for a ride on vacuum!

Busy Night shift in the Emergency Department…

A young lady presents with atypical lacerations to her back. She is embarrassed and not giving the doctors a good history. So I change my name to “Frank” and bluntly ask her what actually happened, because… “what your telling us doesn’t fit the injury”.  

It turns out she and her boyfriend were in bed, they had a glass of wine which she’d place on the floor. They were (hmm… how shall I phrase this without getting an adult rating…ok…) pretending to be dogs, when he decided to step things up a notch(….hmm too cryptic), shove it in a different orifice (that should do!).  She (understandably in my mind) objected and turned round sharply to get him off...(hmmm, that needs rephrasing too!!) tell him she wasn’t happy about his decision making.

Consequently she lost her balance and fell off the bed, landing on top of the wine glass, which obviously broke and subsequently caused the laceration.  She  ended up with several pricks in her back when we sutured her up, so a no win situation for her.

Next…

2 adult males presenting with rope burns to the neck.  This story is summarised as it all got a bit “Jerry Springer”:

 Basically to male friends had found out that one woman was seeing both of them…clear so far.   They were upset, they had both been lied to, they decided to commit suicide together.  (Nutty). They had one piece of rope and tied a noose in both ends, and climbed onto a big tree branch. The plan was they’d jump together (off opposite sides of the branch obviously) and hang together to teach her a lesson!!! (Don’t go out with nutters..perhaps?)

So there they are in the department with rope burns, but not broken necks…something else broke….that’s right….the branch snapped!

It all ended happily when the girl came to the department and she decided what to do.  They left a threesome!!

   I doubt they got married though!

As I right this I realise how absolutely absurd this sounds. I’m not sure I would believe me…but it’s true!

Next…

Kid with saucepan on his head…a stereotypical presentation. But I’ve only seen it once. Mechanism of Injury….Dad put it on his “Little solider!” Can’t even blame the kid!

So remember if you are going to do something stupid, and you might get injured, be prepared to share you idiocy with the emergency department staff, they won’t laugh…(in your face).

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Strange FB’s again

Posted on March 7, 2007. Filed under: Foreign Bodies |

This is quite bizarre, and a little bit legendary in my neck of the woods, so I was slightly reserved against sharing it as it may give away my alter ego identity, (but I’m not too worried).

Are you sitting comfortably?  Then I shall begin…

It was a couple of years ago, when I was a fresh faced NP student. My next patient on  the computer screen was listed with the PC of “bleeding tummy button”.  The patient was an adult female, so my usual guesstimate of what I’m going to see was limited, some kind of grossly ruptured hernia perhaps???

As the patient entered my room, it was apparent that she was more than a few kilos over weight.  She gave a history that she had noticed a small amount of dried blood near her belly button, but was otherwise asymptomatic.

So we took a look, she popped onto the couch and there was a tiny amount of red goo on her skin, nothing gross.  At this point I should have said:

“Oh, probably just a scratch, go home and return if you have any further problems”

But no, not I – this phenomenon needed further investigation, (prompted partially by a slight malodour coming from the deep dark depths of her umbilical region)

So first I try a separate the skin as much as possible, and with the light beaming behind me, have a look. There I see something! I get a cotton bud and delve further into the cavern before me and with a nice scoop action remove the foreign body….

One dead moth….

So my patient is embarrassed, but goes away happy in the knowledge there is no surgical emergency, but from that day to this I have one question…

Surely it didn’t fly in there, so did it go in as a Caterpillar?

The moral of the story -  never forget the importance of good umbilical hygiene.

Kim’s been busy again with another:

changeofshift

but make sure you take your tissues, the first few links are real weapy, nursey stuff (You’ve been warned)

http://www.emergiblog.com/2007/03/change-of-shift-volume-one-number-nineteen.html

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Foreign Bodies

Posted on March 2, 2007. Filed under: Foreign Bodies |

I suppose my first thought goes back to a trip as a student nurse to one of the London Hospital museums. I remember lots of glass cabinets filled with kidney stones, a massive ball of hair retrieved from a womans stomach and an Alka Seltzers bottle, these are other peoples stories…
So in my working time I have removed more beads, buttons and sweets from childrens noses and tips of cotton buds from peoples ears than I would ever want to recall, however occasional something atypical makes you want to stop and think “ooooh, but why?”
As a student nurse doing paediatrics I remember a girl being admitted for what we jokingly referred to as a Dolphinectomy.  Apparently she had sat on her toy wind up dolphin in the bath and had somehow managed its way past her sphincter – (likely story) Xray showed the metal of the wind up mechanism just inside her descending colon.  Thankfully she managed to save herself from said Dolphinectomy by one rather painful bowel motion. (Whether or not the dolphin swam out to sea or ended up in a museum is unknown to me – hopefully it is not back in her bath!)

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