Gravity works inside the body as well as outside. That low spot on your driveway or sidewalk stays wet even after the rain stops because the water seeks the lowest level. Your lawnmower ends up in the mud and chopping through thick wet grass for the same reason. Inside the body is no different. After the storm (i.e., the injury), things will settle before they subside.
Two of the most common ways this plays out in the ER are a medical condition (e.g., heart failure) and trauma or surgery. (Surgery is akin to controlled trauma under sterile conditions.)
Pain is a frequent complaint that brings patients to the ER. Abdominal and chest pain are some of the most common. I often get asked by patients, usually at the end of a negative abdominal or chest pain workup, when they should come back.
This is difficult to answer. The older the patient and the more chronic medical problems they have, the higher the chance that something significant is causing their symptoms. The younger and healthier they are, the lower the chance, but diseases and disasters don’t exclude anyone 100%. Everyone knows a story of someone, often young, dropping dead with no warning. Is it likely when you are young and healthy that you can ignore most symptoms? Yes, but there are no guarantees.
More than one patient has come to the ER with blue, purplish, or black skin. At first glance, it appears that there is a lack of blood flow and it’s obviously very disconcerting. My colleague recently had a young lady like this who was rushed from triage to a critical care area as it appeared her legs did not have any blood flow. They were blue.
Google blue or purple skin and you will be hit with all kinds of scary information that makes you think you are on the verge of death. But it turns out, context matters.
A 21-year-old male came to the ER with right-sided chest pain. He described his pain as “a needle being stabbed into a vein in my heart.” He used that same phrase a few times during our conversation. Fortunately for him, he did not actually have any problems with his heart or otherwise that we could diagnose. We looked for the usual causes of dangerous chest pain and found none. He likely had acid reflux from his steady diet of Taco Bell where he worked. As he explained to me, he’s poor and the food is free despite him calling it “shit from a tube.” Presumably referring to the plastic packaging the “meat” comes from.
My father passed away from dementia in 2022. My mother is still alive and in the early stages of it. Most likely Alzheimer’s for both, as that is the most common form of dementia. There are others, but that type accounts for the majority of cases.
I see a lot of dementia in the ER and virtually never actually diagnose it.
Things like episodes of confusion, short-term memory loss, forgetfulness, wandering away from home, getting lost while driving, forgetting how to do something, difficulty with simple tasks, poor judgment, changes in mood, and trouble with communication… These are all signs of dementia. And most often they are not the result of any other acute condition.
Patients come to the ER for work notes, and I wish they would just be honest upfront about it rather than concoct complaints and then slip in a comment about a work note. It’s frustrating to do all the song and dance about some potential problem they have that they often have difficulty describing. Their answers to my line of questioning about symptoms sometimes don’t make sense, and I’m left scratching my head, sometimes worried there is really something sinister going on. In reality, they are only halfway paying attention because the goal is the work note, nothing more.
The first thing to know about coming to the ER with a bloody nose is that it will stop. (In fact, the only guarantee in medicine is that all bleeding stops eventually.) And the second thing to know is that you will likely be very unsatisfied with the visit.
A couple things to know about bloody noses, referred to medically as epistaxis. The bleeding is most often from small veins along the septum of the nose. The septum is the middle part of the nose that divides your nasal passages in half. These veins are close to the surface of the mucosa/skin that lines the septum and when they get disrupted or irritated, they can bleed.
Varicose veins are the superficial veins in your legs that return blood to the heart. (They can appear in other places, but they are most commonly in the legs.) Some people don’t have any, some have a few, and some have a lot. Occasionally, they bleed. And they can bleed a lot!
The most important thing to do is to put direct pressure on the bleeding. Most often, literally putting a finger on it stops the bleeding. They are not under high pressure like arteries. This doesn’t require someone kneeling on your leg like the junctional arterial bleeding in the movie Black Hawk Down. This is more like putting your finger in a dike to stop a steady but low-pressure water leak.
This year marks 20 years of CrossFit for me. I was fortunate enough to discover it in the Navy while at Dive School. This year marks 20 years of CrossFit for me. I was fortunate enough to discover it in the Navy while at Dive School. My fitness has been steadily improving ever since. Age is catching up with me like everyone else, but I’m far more capable—and more useful—than I was in my 20s.
The features of metabolic syndrome have been defined since 1988 by Gerald Reaven. The 5 features include hypertension (HTN), elevated blood sugar (prediabetes or diabetes), abdominal obesity, high triglycerides (TG), and low HDL. Having any combination of 2 or more of these things significantly increases your risk of cardiovascular disease.
Unfortunately, in my experience, these things are often ignored by primary care. There has been a decades-long push to solve for LDL and more recently ApoB. The long-standing belief is that LDL/ApoB causes heart disease. Conveniently for Big Pharma, they make a class of drug that has been worth billions that lowers LDL. These are called “statins” because the end of the generic name always ends with “-statin,” commonly known as Lipitor and Crestor among others. (Interestingly, LDL has never been a defining feature of metabolic syndrome.)