42 y/o M c EtOHism admitted for R femur fx d/t MVA, s/p ORIF POD#3, now complaining of AVH and c HTN + tachycardia on vitals.
42 year old male with alcoholism (EtOHism) admitted to the hospital for a right (R) femur (thigh bone) fracture caused by (due to) a motor vehicle accident (MVA—a car crash), status post (s/p) open reduction, internal fixation (ORIF), post-operative day (POD) #3, now complaining of audio-visual hallucinations (AVH) and also has high blood pressure (HTN—hypertension) and tachycardia that was detected during a vital sign check.
In a Nutshell:
This alcoholic got into a car wreck and broke his right thigh bone. The orthopedic surgeon (bone surgeon) took him to the operating room and performed an open reduction, internal fixation – a surgery that requires cutting open the patient’s thigh and/or hip, repositioning the broken thigh bone, and then hammering a rod into the soft marrow cavity of the bone that will act as a support strut for the bone as it heals (see the X-ray below). It is now three days from the operation and the patient is going into alcohol withdrawal, a potentially fatal condition that can cause hallucinations, high blood pressure, tachycardia (fast heart rate), and seizures. This post-operative sequel could have been avoided by monitoring the patient for signs of withdrawal more closely and by treating him with benzodiazepines, a group of medications that include Xanax, Klonopin, and Ativan and which are similar to alcohol in some respects (both alcohol and the benzodiazepines activate GABA receptors in the brain) and which are useful in both preventing and in treating alcohol withdrawal.
18 y/o F c IDA, N/V/D, poor dentition, and amenorrhea x1yr. Pt BIBA to ED after parents found pt lying on the floor of the bathroom with AMS (mild) next to an empty bottle of MoM – suspect acute dehydration and underlying supratentorial etiology. BMI 18.
18 year old female with iron deficiency anemia (IDA), nausea, vomiting, diarrhea (N/V/D), and one year of amenorrhea (lack of menstruation) who was brought in by ambulance (BIBA) to the emergency department after her parents found the patient (pt) lying on the floor of the bathroom next to a bottle of the laxative Milk of Magnesia (MoM). Apparently the patient was confused or acting strangely (mild AMS—altered mental status). The doctor thinks that the patient is dehydrated due to her vomiting and diarrhea and that there is ultimately an underlying psychiatric etiology (cause) of her condition. The patient’s body mass index (BMI) is 18, which is very low (<20 = underweight; 20-25 is normal).
In a Nutshell:
This girl has an eating disorder. Her BMI of 18 suggests that she is anorexic (starves herself) while her purging behavior with laxatives suggests that she also has bulimic behavior (classically binging followed by purging, but sometimes just purging in anorexics who also have bulimic behavior). A lack of iron in the diet has caused this girl to develop iron deficiency anemia and her low BMI has resulted in hormonal abnormalities that have caused her to stop menstruating. Eating disorders are extremely serious and they are the psychiatric condition with the highest mortality. If you have an eating disorder your chance of dying from your disease if it is untreated is higher than the risk of death in even the most serious mood and psychotic disorders, e.g. bipolar disorder and schizophrenia. Unfortunately, some people with eating disorders consider this serious disease to be a “lifestyle choice”—shown below is a “Pro-Ana” bracelet in support of the anorexic lifestyle. It is common on pro-eating disorder websites for anorexia to be referred to as “my friend Ana” and for bulimia to be referred to as “my friend Mia.” Bulimics have a bracelet too by the way. Most people afflicted with eating disorders have both anorexic and bulimic behaviors, e.g. they usually have symptoms of both disorders.
21 y/o M with acute MDMA intox, admitted for GI pain 2/2 obstipation, now c BRBPR s/p self-removal of FB while being transported back from X-ray.
21 year old male with acute MDMA (Ecstasy) intoxication, admitted for gastrointestinal (“stomach”) pain secondary to (2/2) obstipation (inability to pass gas or to have a bowel movement), now with bright red blood per rectum (BRBPR) status post (s/p) self-removal of a foreign body (FB) while being transported back from X-ray.
In a Nutshell:
This guy is high on ecstasy, stuck (or had stuck) a flashlight up his butt, and then had the great idea to yank it out while the poor ER staff was wheeling him back to his room after he got his X-ray. Now he’s bleeding and will probably need an exploratory surgery if the bleeding doesn’t stop on its own in the very near future. Rectal foreign bodies are very common in the emergency department—they are also a source of amusement for radiologists, who usually have a rather boring (albeit important) job. While rectal foreign bodies are embarrassing (don’t stick it up there, genius), they are also a serious medical problem and a potentially fatal cause of bowel obstruction and infection (due to disruption of the rectal /colon wall). If you ever have the misfortune of having this problem, go to the ER! Your doctor and the ER staff are required by law to keep their mouth shut about it and you can (and should) sue the heck out of them if they gossip (of course, the ideal way to prevent this problem is not to stick things up your butt).
Dr. Leonardo Noto
Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis –> (Click on the book covers on the right to check out my books!).
Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).
Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!
Open Reduction, Internal Fixation. Courtesy of Wikipedia. www.wikipedia.org.
Rectal Foreign Body. Courtesy of Wikimedia Commons. http://commons.wikimedia.org.
Pro-Ana Bracelet. Courtesy of the Producer (Open Source Image).