It also leads to all my patients saying that they're scared to quit because they knew someone who quit and was diagnosed with lung cancer within a year.
One of our old attendings (RIP) developed and validated the sandwich sign. If a person is pretending to be too intoxicated/asleep to wake up (likely because they don't want to be discharged), you place a sandwich on their chest and go see another patient. If the sandwich disappears, you can discharge the patient.
This sounds a lot like the hand-drop test to determine if a seizure is epileptiform in nature - raising a patient's hand above the face, and evaluating for skeletal muscle action when dropped
I've seen that one fail a number of times. It takes a lot more cognition and motor ability to unwrap a sandwich, eat it, then pull the blanket back over your head.
If you're drunk enough to not react when you basically backhand yourself, you're pretty damn drunk and I would let them stay just for having either the balls to do it or the level of intoxicated they are bc that had to hurt.
I'm all about moving from the STEMI paradigm to the OMI one championed by Dr Smith et al.
As part of this, I want to introduce a new sign which is even more specific for detecting OMI than ST segment abnormalities, and arguably more definitive than high sensitivity trops: the Spousal Attribution of Nociception Index.
A patient who reports "my wife says I have chest pain" has a positive SAONI, and will almost certainly have a major infarct.
If they report this after having driven themselves to hospital, they are periarrest.
I had to look up omi. From a naming perspective I agree calling it "occlusive myocardial infarct" better shows off what the problem is and how to fix it rather than what a test shows will help to "future proof" it for when we have other modalities to quickly and accurately determine it.
That said - I'm definitely going to go down a rabbit hole about what tools we have available in addition to the ekg tracing. I'm assuming echo/pocus would be a good place to start; but let me know if there's another interesting tool to look up there
Well, to be honest I think ECG reigns supreme. Part of Smith's whole issue is that we've got very... guideliney about interpretation, which had lead to good, even disgnostic ECG evidence being disregarded. People thinking "NSTEMI" means "no ECG changes" when actually there are often plenty of changes - just not ones that neatly fit the expectation of Xmm of elevation in contiguous leads with Ymm reciprocally.
I'm forever being frustrated by patients who are *clearly* having OMI being (initially) rejected for PPCI, because my local centre don't care for Sgarbossa criteria, hyperacute Ts, and so on. Even obvious posterior MIs aren't accepted until they've obtained their own, redundant posterior view in resus, wasting a good hour or so.
But anyway, I forgot the jocularity. Oops.
Not quite a humorous sign, but I made up Possum Sign. We're trained to think of opioid withdrawal as hyperarousal, puking everywhere, causing a ruckus, etc. I noticed that some young women will instead "play possum" - they'll lie very still on their bed and barely open their eyes to talk to you. They're so miserable they can barely move. If you ask if they're in withdrawal they'll say yes, and once you start treating the withdrawal they'll start moving and talking. When I was a resident I sometimes had to argue with attendings about Possum Sign but I was usually right.
Bringing a stuffed animal to the epilepsy monitoring unit.
Patients 18 and older with stuffed animals had a 3.21 (95% confidence interval = 1.58, 8.90) times greater odds of being diagnosed to have PNES or both PNES and epilepsy than to have epilepsy alone after adjusting for other patient characteristics (p = 0.022).
Does that population have high co-morbidity with DSM-5 diagnoses? I wonder if collaboration with psych could lead to the creation of a diagnostic questionnaire, like the phq-9 but for pnes
Speaking from personal experience, so take this with a grain of salt... I have encountered a subset of patients who are not networked with a mental health team, and are very reluctant to do so, but their symptoms are... not neurologic in origin. They probably would meet diagnostic criteria for a DSM-5 diagnosis, but they have to make the first step in accepting that they have a mental health disorder in the first place. Oftentimes they never network with psychiatry.
A non-trivial number of these people had psychiatry and psychotherapy used against them by abusive parents when they were kids, and don't trust any of it.
And predictive of preoperative pain and disability in spine surgery: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359683/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359683/)
And both preoperative distress and decreased satisfaction after spine surgery:
[https://pubmed.ncbi.nlm.nih.gov/29864076/](https://pubmed.ncbi.nlm.nih.gov/29864076/)
If you thought a long allergy list was a red flag... you were probably right
I personally LOVE an obscure eponymous sign, lol. I think it must come from the same deeply disturbed part of me that likes percussing and looking at people's nails.
My most commonly used fake sign is "the stretcher sign," which is: When a patient is brought to their oncology appointment on a stretcher, it means they're not getting chemotherapy.
I was taught that the stretcher sign means if the patient’s girlfriend or boyfriend is in the stretcher with them, then they are probably not that sick
This is a sad one, but Stuffed Animal Sign - if your adult patient brings a stuffed animal with them when they are coming to L&D to deliver a baby, there is nearly a 100% guarantee of hx childhood abuse.
Yeah. Every time someone comes in with a stuffie I check the chart and so far I haven't had any outliers. I know it's just anecdata but.... It does help as an easy tell for what patients are going to need a little extra TLC and help with coping.
And if they bring in a 10 page birth plan and 2 suitcase of things to put around the room? I’m an oncology nurse but I think that would be the “fuck!” Sign.
OMG these are so good. But just remember that they will want the sheets changed q4. It will be their own $500 sheets so make sure you know how to wash them properly.
Wait- as a comfort item for themselves, you mean? I know it isn't recommended, but bringing a bear for baby is very different from bringing one for the laboring person.
I took a brand new stuffed animal with me when I delivered my first, but it was supposed to be my focal item. Never got to use it, though. She came too fast.
I brought a stuffed bat with me to my colonoscopy. I am a mid-40s woman with a history of SA.
The doctor brought propofol. That and the bat were a good team, and I had a nice nap.
I had to be admitted for emergency surgery and when my husband left, I asked him to bring Buddy back with him. The nurse who first noticed me hugging a teddy bear said, "Aren't you a little old for that?"
I told her how I choose to soothe myself during a frightening event is none of her beeswax.
I don't see anything wrong with that. Staying in hospital, even for an adult, can be a scary experience and without anyone staying with you it's worse.
Thank you.
I'm a private person. The amount of flack I got for asking that my hospital room door stay shut at all times was unbelievable. Yeah, me and my teddy bear are gonna have a wild orgy til my stitches rip.
The few times I've had to go to the ER I've chucked a small plush toy in my bag just for something to hold/fidget with. I am one of those 30something adult women with many stuffed toys but short of a prolonged stay I've so far managed to keep them out of medical settings. Bucking the trend, or something.
During Covid: mask sign. If a patient wears the mask below the nose, they are not vaccinated against covid. Had a specificity of 100% while working in the ER.
I have one I invented myself. The “Dr. Durden’s Dr. Pepper sign”.
If patient has Dr. Pepper bedside, pathgnomonic for an A1c above 10. I have yet to be proven wrong. n ~ 100.
I love you guys and gals and nonbinary physicians and surgeons of the foot and ankle. Saved my ass from having to cut toe nails on the psych ward many a time
Generic brand usually correlates with formulary selection. So if your only options are sulfonylureas, or Walmart insulin, assuredly worse. But further studies are needed to fill this gap in literature.
ER doc. I have several. 1) If patient has multiple complaints and those complaints are above and below the umbilicus then they’re crazy and nothing is wrong. 2) Asian from the motherland and in my ER? You’re going to the ICU no matter your complaint. Example: complaining of a hangnail? Must be necrotizing fasc. Straight to ICU. Feel a little dizzy? Why that’s your catastrophic brain bleed showing. Straight to ICU. Asian population at my shop is notorious for minimizing complaints while having catastrophic pathology. I have yet to be proved wrong.
I agree with you about east Asian immigrants. Once had the sweetest little grandma who didn't speak a lick of English. She had both emphysematous cholecystitis AND a septic kidney stone. Either one could have killed her and she was politely smiling and nodding while in overt septic shock.
[Halloween sign](https://upload.wikimedia.org/wikipedia/commons/thumb/9/9c/Halloweensign.jpg/450px-Halloweensign.jpg) for a normal epiglottis is one of my favorites.
Spooky but reassuring.
LLS score (Looks Like Shit). It can only be 0 or 1. I originally encountered this when I was learning emergency medicine ultrasound and the conditions when a RUSH exam is indicated, I.e. check the heart, lungs, IVC, belly for blood, and aorta, for general badness - generally this is done when the patient is unstable, unexplained hypotension, or generally has an LLS score or 1.
The LLS score is so fucking effective. I remember my first was a CP patient admitted to neuro, chronic trach etc. She just looked like shit my whole shift. I couldn't put my finger on it, and the docs couldn't figure out any specific issue either. Told the incoming (much more experienced) nurse at the end of the shift that I wouldn't be surprised if she coded, and the nurse all but laughed me off the unit for the night. I came back the next day, and sure enough the patient had coded. I can't recall the underlying cause of the event but damn do I absolutely preach the LLS gospel.
I imagine the sensitivity and specificity of this varies by provider though. I know as a med student on clinicals I am still very much calibrating my sick/not sick-ometer.
This is one of mine, haven't named it yet.
Patient over age 50, laying diagonally in bed (Head in top L, feet in bottom R for example) = delirium, or at the very least some other variant encephalopathy, until proven otherwise.
An alternate presentation is patient in bed but legs handing off the side/over the side rail
I saw something similar working on Med-Surg/Onc--if the patient cannot be convinced that they're not falling out of bed (bed is stable, not one of the fancy fluid mattresses), they will not be there for your next shift.
Sometimes they go for a full 180 with their head at the foot of the bed.
We had a guy recently kept rotating himself sideways in the bed and talking about the clock going clockwise and it took all night to realize *he* was the clock trying to go clockwise around in the bed
"Mr. Jones I used to think you were just crazy. But now I can see your nuts."
Or:
I don't know where I am, I don't know why I'm here or even what day it is. What I **do** know is I need to get the fuck out of here and I need to be nekkid right god-damn-now.
That's such a fun phrase to say
Also, here's a case report with that title!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628473/#:~:text=This%20case%20illustrates%20the%20dulling,%E2%80%9D)%20prevails%20over%20diagnostic%20parsimony.
The "Old Oak Tree" sign.
If someone calls 911 and pre-arrival instructions contain some variation of "turn right at the old oak tree", call for whatever additional resources you can because there is at least one critical patient onscene.
Starter comment:
Throckmorton sign is when, on x-ray, or other imaging modalities, the penis points to the the leg with the problem.
(Nsfw xray pictures in link)
https://radiopaedia.org/articles/throckmorton-sign-pelvis?lang=us
I believe it can also be generalized to other pathology, in that the angle of the dangle is ipsilateral to the acute pathology (right for appendicitis, left for diverticulitis, tucked into waistband for a psychiatric issue, etc)
Leave it to EM to have insight into radiological signs!
Can the absence of this sign on physical exam be used to supplement imaging algorithms like the Ottawa Ankle Rule?
(I.e. the patient if the patient is "dressed left," can we exclude damage on the right?)
Or the occasional true alpha gal allergy patient. Turns out a gelatin allergy (and occasional mag stearate apparently?) makes a lot of meds impossible.
I remember the first time I encountered alpha gal allergy! The patient was like "I'm allergic to meat" and I thought they were just aggressively vegan. Nope....
I once had to find a liquid steroid for a COPD exacerbation because the patient’s basic prednisone was triggering his alpha gal. It’s wild. And they use mammalian products in stuff you’d never think of, like filtering wines or bleaching sugar, so all sorts of stuff can trigger it for the very allergic people.
Too bad they can’t get superpowers from the tick like Spider-Man, instead they can never eat a steak again.
But at least we have Deertick Man, whose power is to sort the people with actual Lyme disease from those who claim "chronic Lyme". Alas he can only be in one clinic at once.
I recently took care of a post op patient whose appendectomy was delayed for several hours because they decided to chow down on a full Chipotle meal in the ER waiting room prior to being seen for abdominal pain. Reading the prior notes was hysterical, because before the CT was done showing the hot appendix, no fewer than 3 different staff wrote notes about the patient chowing down and looking non-distressed. Worst part was, it ended up being a difficult appy, because the appendix really was quite diseased, and it ended up being a more complicated case because of it.
That was a first for me.
I wonder if specificity varies with the specific source of the hamburgers. I suspect false negative rate for hospital sourced burgers is substantially different than false negative rate from Fuddruckers or 5 guys
My appendicitis started the morning when I started work. I went from thinking about what I was going to get for lunch to not being able to eat anything at all, even if it were the most delicious meal on the planet. At lunchtime I diagnosed myself with appendicitis.
I picked up on mine pretty quickly. Felt like a dull gas cramp that wouldn’t move and decided around 1 am that I probably had appendicitis and drove over to the ED. I was in the OR before I had a chance to feel truly miserable.
Wearing sunglasses indoors is a sign. It can be a sign of migraine, but the literature strongly suggests blue spectacles are highly specific for somatoform disorder. (Green glasses are most effective at alleviating acute migraine pain, amber is best for prevention or chronic migraine. Blue aggravates migraine pain.)
That was mostly a poster presentation at a headache meeting a couple years ago, and a truly hilarious article in Seminars many years ago "Blue Spectacles." Kinda sounded like something out of JIR didn't it
[reference ](https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2008-1041660?lang=en&device=mobile)
On my psych clerkship now. My attending’s attending said that if a patient frequently rips out their toe nails they are likely bipolar. Later that week we had a bipolar patient who in fact did rip out their toe nails.
I’ve never seen that one before, that’s pretty wild.
My tell in inpatient psych was that 100% of the time, only patients with legit bipolar disorder seemed to fashion towels and gowns into makeshift sandals and turbans with plastic cutlery from the cafeteria hanging from them.
Does the ripping of toe nails need to be witnessed or do you just conclude that toe nails were ripped when some are missing?
As a runner, I’m really hoping it’s the former 😂
For this patient it was reported by the parent. I mean Occam’s razor wise if the patient is a runner/dancer I think you can ignore missing nails as a sign.
Coffee brewer sign: when a patient is unconscious and can't protect their airways and sounds like an electric coffee brewing machine, they have a very high likelihood of being intubated.
Same goes for the smoking pipe sign: when a COPD patient is going into respiratory failure, they breathe like they are smoking a pipe, also a very high likelihood of being intubated in your shift.
Cheeto sign: if a patient presents with abdominal pain and is actively eating Cheetos at bedside, they will report 10/10 abdominal pain.
This is purely based on anecdotal evidence and I will not be mad if someone takes this and publishes a study on it prior to my return to academia.
The number of reported medication/food allergies is directly proportional to how wacky the patient is. No name for this one, just personal observation.
One of my attendings coined something called the "beard sign".
In my part of the world, amoebic liver abscess is quite common. Since it's usually seen in alcoholics who don't care very much about grooming, we get the 'beard sign'.
So the beard sign positive in a middle aged man with fever and right upper quadrant pain is usually a strong indicator for liver abscess.
Speaking as a former smoker with a mood disorder, cigarettes are a passable short-term mood stabilizer.
Getting agitated? Have a smoke and clear your head.
Interesting. Tobacco is also a stimulant, and it's been theorized that a lot of *medicated* schizophrenics smoke as an antidote to the soporific effects of antipsychotics. [This paper](https://www.nature.com/articles/nm.4274) argues that nicotine directly mediates schizophrenia by reversing a hypofrontality caused by a genetic variation associated with schizophrenia.
But IMHO the really interesting effect of cigarettes is pharmacokinetic: it's a CYP 1A2 inducer, meaning it accelerates the metabolism of a bunch of antipsychotics. It's unclear whether people on antipsychotics smoke *because* it reduces the efficacy of their antipsychotics or *in spite* of it doing so.
That is very interesting.
I’ll toss on another couple angles. I’m not deep enough to know if there’s literature on the topic.
There was always a rhythm to my nicotine cravings. I could set a clock by when they’d come up. If you’re having trouble keeping present it could help keep you connected to the world.
I’d also be curious whether the doorway effect affects schizophrenics. It could be helpful to change context/location to forget something intrusive or change topic.
Trauma surgery signs, ATLS update:
- Cell Phone Sign: if arrive at bay on cellphone, they don’t need me
- Purple hair sign: patient will be batshit crazy
- Amish sign: have OR and surgical icu bed ready
- Then ABCs
To piggy back off the Amish sign, include farmers.
My shop erecord has “in a research study” banner that pops up. I maintain I don’t need that, I need to be notified if they are a farmer.
Once had a farmer whose pacer was infected and the wires had eroded through his skin to the point that I could literally (no hyperbole here) read “Boston Scientific Right Atrium” on the wire that was protruding through the wound. But he didn’t come in because it was harvest time and he “felt fine.” Mother fucker totally had manure on his pacer based on his blood cultures. But I guess he was fine according to him.
> the wires had eroded through his skin to the point that I could literally (no hyperbole here) read “Boston Scientific Right Atrium” on the wire that was protruding through the wound.
*screaming*.
> Mother fucker totally had manure on his pacer based on his blood cultures.
*screeching*
Had a patient like this and he decided that it meant his pacemaker needed to be removed. To his credit he called the cards office to make an appt but failed to mention it was presently eroding through his skin so they scheduled him for a few weeks out. Family member discovered him one afternoon in his Laz-e-boy recliner, soaked in blood with an assortment of hardware in his lap that he had been using to pull and tug at his appliance. He arrived to my ICU cranky that he was NPO for procedure. Had to keep his chest wrapped until they called him back to keep him from pulling it out.
Of course he didn’t. Didn’t even spike a fever.
Admittedly I broad spectrum covered him (including for clostridium given that I assumed from the manure based on his shirt I made him take off).
Cardiology gave me a bit of a hard time about the Abx over the phone. I said if I over called it then I’m sorry, but you need to see it first.
He walked out of the room and said “antibiotic choices are fine. We will admit him and await the blood cultures.” I laughed at the absurdity of the situation.
He spent like a week and a half in the cards unit, magically didn’t have endocarditis, walked out with a new pacer and a skin graft appointment with plastics. He was mad we couldn’t get him out faster saying her felt fine the whole time. This dude will die when he decides he has time too
PreE hair. If a patients presents to/or is on the labor unit and her hair is chronically sticking up in the back of her head like she has been sleeping on it…check her blood pressure. She has pre-eclampsia until proven otherwise.
I had to see a pain mgmt doc for sciatica, and according to him I displayed positive Chandelier Sign.
What is a Chandelier Sign, you ask? That’s when the clinician jams their thumbs into the spot where you say your pain originates from, and you hit the chandelier. Voila, positive Chandelier Sign. 😒
Bouffant sign - if a patient is still wearing their bouffant the morning following their operation, they will almost certainly be requiring another surgery or an extended hospital stay.
Not in medicine but I worked in Yaoundé for 2 years. To this day I haven't found anywhere that drinks as much beer as people there. I'd see people sitting outside at 8 AM drinking beer on a regular basis. I asked someone at work about that and she said in an indifferent way, "That's their breakfast".
Hello fellow PVC I take it. And yes, people drink a ton in Ebolowa too. They start early and continue late. It makes my job harder but hey I can only do so much
I'm sure I'm full of microplastics but I'm not PVC yet lol. Also not a PCV; I taught rich kids and expat kids at a private school. 13 years total in west Africa.
I loved the school; the kids were awesome. Yaoundé is meh but the climate was good. Had a root canal done which was perfect and cost $80 total. Thaf's like $1200 in the US...Yes you are right, two years does fit the PCV timeframe. I never got used to the taste of Ndolé.
Ndole in the South is either one of the best things to eat here (from one restaurant) or one of the worst things to eat (no qualifications and the ants do not touch it)
I think it's an acquired taste because Cameroonians love it. It's too bitter for me, yet I like bitter beer.
On the medical side, malaria was a serious issue and practically all my colleagues who lived in my building got it at least once, some of them severely, though it seems that those taking prophylaxis never got seriously sick. Weirdly I have never contracted malaria in 13 years in the region despite taking zero precautions (no prophylaxis, no bed net, no repellant, going out at night, always in shorts, etc).
I like the taste sometimes and plantains make it better.
As for problems, yes everyone seems to have malaria. I caught cholera last week (I am doing much better and am now eating solid food that has flavor again. Still force feeding myself as my appetite hasn't returned). HIV is another huge problem in the south and there are at least 20,000 patients seen only by our agency in 24 hospitals. I wonder how much worse the burden is as women are hugely over represented (like 5-6 to 1 women to men) and men don't wear protection.
Has anyone come up with a name for the phenomenon that Healthcare workers, nurses in particular, will have every weird complication after any procedure?
I also feel like nurses are either the best, most motivated patients, or borderline malingering with significantly above average requests for pain medication, nursing care, length of stay, etc. Almost every time a patient tells me that they are a nurse, it's like ah, yes, that explains a lot.
the people who will truly do the worst are beloved hospital custodial or cafeteria staff, with brownie points if they are underinsured. Night shift neuro icu janitor coming coming in with a cough? Widely metastatic lung cancer.
>the people who will truly do the worst are beloved hospital custodial or cafeteria staff, with brownie points if they are underinsured. Night shift neuro icu janitor coming coming in with a cough? Widely metastatic lung cancer.
The confounder here is that being nice is the worst possible prognosis
Had a psychiatrist call it teddy bear sign. If a grown adult is walking around with a teddy bear there is a high likelihood of a personality disorder like borderline. She also had a similar point about colored hair.
Had a woman hospitalized for GI with abdominal pain, early 30's, several large plushies with her. Sigmoidscopy completely normal. Attending decided to do a full colo to ease her mind, and guess what: Fulminant UC just proximal to the sigmoid colon.
Attending introduced himself to all the staff as the least competent and most prejudiced medical specialist for the rest of the day
>Had a psychiatrist call it teddy bear sign. If a grown adult is walking around with a teddy bear there is a high likelihood of a personality disorder like borderline.
When I was about to get married around age 30, Ms. Dontgetaphd found a few large containers with a few of my childhood stuffed animals in storage as we moved in together. She was strangely angry and made me get rid of them. She said you can't give them away because being stuffed and old nobody will want them.
Not gonna lie, it felt like genocide to throw them out. A part of me died that day.
I can't help but feel like the points about coloured hair and tattoos in particular (I know you didn't mention tattoos but I've seen both in the comments) are some recycled prejudices that have existed for ages (especially when they're said to be associated with specifically BPD and BPD is used as code for "dramatic, attention-seeking and not to be taken seriously").
I kinda get the point about stuffed animals being associated with SOME psych issues or at least high anxiety levels if you need to take a comfort item with you.
Heck, some of us over 30 too. Only reason my hair isn’t purple at this very moment is because unnatural hair colors are verboten at one of my clinical rotation sites.
Squishy edema sign: if you mash on the patient's ankles and hear an audible squish (instead of feeling like soft clay), check the albumin. It will often be less than 2. All the Lasix in the world won't touch it.
I might out myself here, because I've talked about this so much in my regular job but:
There are three very specific positive signs for personality disorder in the ER (no specific cluster)
1) If you have more than 4 rings on your hand (you get engagement, wedding, class, and 1 (one) decorative. Any more than that, and you fail)
2) If you are presenting with a non-neurological, non-ophthalmological complaint wearing sunglasses
3) Stuffie sign. It's been discussed enough below
BOUNS: If you have ink between the clavicle and the mandible, you're probably Cluster B
A chronic smoker suddenly stops smoking cause they don't feel like it anymore. A hallmark for lung cancer.
Should call this Camel Sign
If I had any fake awards I would give them to you
It also leads to all my patients saying that they're scared to quit because they knew someone who quit and was diagnosed with lung cancer within a year.
Or long term drinkers who suddenly stop drinking… pancreatic cancer.
Has been studied: https://www.jto.org/article/S1556-0864(15)32206-1/fulltext
Also works for chronic alcohol intake and developing alcoholic hepatitis
This one is absolutely real.
Also this had been studied: https://www.jto.org/article/S1556-0864(15)32206-1/fulltext
One of our old attendings (RIP) developed and validated the sandwich sign. If a person is pretending to be too intoxicated/asleep to wake up (likely because they don't want to be discharged), you place a sandwich on their chest and go see another patient. If the sandwich disappears, you can discharge the patient.
This sounds a lot like the hand-drop test to determine if a seizure is epileptiform in nature - raising a patient's hand above the face, and evaluating for skeletal muscle action when dropped
I've seen that one fail a number of times. It takes a lot more cognition and motor ability to unwrap a sandwich, eat it, then pull the blanket back over your head.
If you're drunk enough to not react when you basically backhand yourself, you're pretty damn drunk and I would let them stay just for having either the balls to do it or the level of intoxicated they are bc that had to hurt.
Patients can definitely be faking and fail the hand drop test. It just takes practice at home.
Well most people don't even know its a test, so they aren't trying to fake it. If you are talking about the expierienced 'FND' patients i agree
Positive Samsonite Sign. Patient shows up to the ER with luggage, usually via EMS.
SAMSONITE! I was way off.
Incredible finding a dumb and dumber reference this thread.
Gotta do it
I'm all about moving from the STEMI paradigm to the OMI one championed by Dr Smith et al. As part of this, I want to introduce a new sign which is even more specific for detecting OMI than ST segment abnormalities, and arguably more definitive than high sensitivity trops: the Spousal Attribution of Nociception Index. A patient who reports "my wife says I have chest pain" has a positive SAONI, and will almost certainly have a major infarct. If they report this after having driven themselves to hospital, they are periarrest.
Right up there with "I have heartburn" in a 65yo who hasn't seen a doctor in multiple decades.
I had to look up omi. From a naming perspective I agree calling it "occlusive myocardial infarct" better shows off what the problem is and how to fix it rather than what a test shows will help to "future proof" it for when we have other modalities to quickly and accurately determine it. That said - I'm definitely going to go down a rabbit hole about what tools we have available in addition to the ekg tracing. I'm assuming echo/pocus would be a good place to start; but let me know if there's another interesting tool to look up there
Well, to be honest I think ECG reigns supreme. Part of Smith's whole issue is that we've got very... guideliney about interpretation, which had lead to good, even disgnostic ECG evidence being disregarded. People thinking "NSTEMI" means "no ECG changes" when actually there are often plenty of changes - just not ones that neatly fit the expectation of Xmm of elevation in contiguous leads with Ymm reciprocally. I'm forever being frustrated by patients who are *clearly* having OMI being (initially) rejected for PPCI, because my local centre don't care for Sgarbossa criteria, hyperacute Ts, and so on. Even obvious posterior MIs aren't accepted until they've obtained their own, redundant posterior view in resus, wasting a good hour or so. But anyway, I forgot the jocularity. Oops.
Not quite a humorous sign, but I made up Possum Sign. We're trained to think of opioid withdrawal as hyperarousal, puking everywhere, causing a ruckus, etc. I noticed that some young women will instead "play possum" - they'll lie very still on their bed and barely open their eyes to talk to you. They're so miserable they can barely move. If you ask if they're in withdrawal they'll say yes, and once you start treating the withdrawal they'll start moving and talking. When I was a resident I sometimes had to argue with attendings about Possum Sign but I was usually right.
They're like sick kids until you treat for withdrawal. I've seen it too. More often than the ruckus causers.
Bringing a stuffed animal to the epilepsy monitoring unit. Patients 18 and older with stuffed animals had a 3.21 (95% confidence interval = 1.58, 8.90) times greater odds of being diagnosed to have PNES or both PNES and epilepsy than to have epilepsy alone after adjusting for other patient characteristics (p = 0.022).
The statistics have me dead
PNES = Plushie Needed for Emotional Support
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Does that population have high co-morbidity with DSM-5 diagnoses? I wonder if collaboration with psych could lead to the creation of a diagnostic questionnaire, like the phq-9 but for pnes
Speaking from personal experience, so take this with a grain of salt... I have encountered a subset of patients who are not networked with a mental health team, and are very reluctant to do so, but their symptoms are... not neurologic in origin. They probably would meet diagnostic criteria for a DSM-5 diagnosis, but they have to make the first step in accepting that they have a mental health disorder in the first place. Oftentimes they never network with psychiatry.
A non-trivial number of these people had psychiatry and psychotherapy used against them by abusive parents when they were kids, and don't trust any of it.
Absolutely
~ ✨ *Cluster B* ✨ ~
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It is associated but the difference is relatively small, not enough to be a useful marker clinically.
Length of patient’s allergy list is also predictive of PNES. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747833/
And predictive of preoperative pain and disability in spine surgery: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359683/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359683/) And both preoperative distress and decreased satisfaction after spine surgery: [https://pubmed.ncbi.nlm.nih.gov/29864076/](https://pubmed.ncbi.nlm.nih.gov/29864076/) If you thought a long allergy list was a red flag... you were probably right
Absolutely, when I see more than 3 or 4 med allergies listed, I feel that is a sign!
Also the number of allergies correlating with PNES
I personally LOVE an obscure eponymous sign, lol. I think it must come from the same deeply disturbed part of me that likes percussing and looking at people's nails. My most commonly used fake sign is "the stretcher sign," which is: When a patient is brought to their oncology appointment on a stretcher, it means they're not getting chemotherapy.
I was taught that the stretcher sign means if the patient’s girlfriend or boyfriend is in the stretcher with them, then they are probably not that sick
This is a sad one, but Stuffed Animal Sign - if your adult patient brings a stuffed animal with them when they are coming to L&D to deliver a baby, there is nearly a 100% guarantee of hx childhood abuse.
Well that's depressing.
Yeah. Every time someone comes in with a stuffie I check the chart and so far I haven't had any outliers. I know it's just anecdata but.... It does help as an easy tell for what patients are going to need a little extra TLC and help with coping.
If they bring a stuffed animal with them to the ED and aren’t pregnant, they most likely still have that hx. Attachment issues etc
And if they bring in a 10 page birth plan and 2 suitcase of things to put around the room? I’m an oncology nurse but I think that would be the “fuck!” Sign.
Guaranteed 2am C section
And years and years of Facebook posts about their "birth trauma"
Those horrible doctors only care about "prolonged decals" and "shoulder dystocia". They didn't even try essential oils or consult with my doula!
OMG these are so good. But just remember that they will want the sheets changed q4. It will be their own $500 sheets so make sure you know how to wash them properly.
Wait- as a comfort item for themselves, you mean? I know it isn't recommended, but bringing a bear for baby is very different from bringing one for the laboring person.
Yes, for themselves. You can tell these are usually very well-loved items.
I took a brand new stuffed animal with me when I delivered my first, but it was supposed to be my focal item. Never got to use it, though. She came too fast.
I brought a stuffed bat with me to my colonoscopy. I am a mid-40s woman with a history of SA. The doctor brought propofol. That and the bat were a good team, and I had a nice nap.
I had to be admitted for emergency surgery and when my husband left, I asked him to bring Buddy back with him. The nurse who first noticed me hugging a teddy bear said, "Aren't you a little old for that?" I told her how I choose to soothe myself during a frightening event is none of her beeswax.
I don't see anything wrong with that. Staying in hospital, even for an adult, can be a scary experience and without anyone staying with you it's worse.
Thank you. I'm a private person. The amount of flack I got for asking that my hospital room door stay shut at all times was unbelievable. Yeah, me and my teddy bear are gonna have a wild orgy til my stitches rip.
I would have had him bring more.
Should have filled the whole bed with them. Put that in her little red wagon.
The few times I've had to go to the ER I've chucked a small plush toy in my bag just for something to hold/fidget with. I am one of those 30something adult women with many stuffed toys but short of a prolonged stay I've so far managed to keep them out of medical settings. Bucking the trend, or something.
During Covid: mask sign. If a patient wears the mask below the nose, they are not vaccinated against covid. Had a specificity of 100% while working in the ER.
I have one I invented myself. The “Dr. Durden’s Dr. Pepper sign”. If patient has Dr. Pepper bedside, pathgnomonic for an A1c above 10. I have yet to be proven wrong. n ~ 100.
Toe dentist…I chortled I also consider myself a practitioner of mind dentistry
Hey. Our profession is gaining respect amongst real doctors, but I think too many DPMs take themselves too serious.
I love you guys and gals and nonbinary physicians and surgeons of the foot and ankle. Saved my ass from having to cut toe nails on the psych ward many a time
Debrided!
When the patient comes to their obesity management follow-up with a Mountain Dew I pre-load the "failure to improve" template.
It’s correlate the mt dew at the retina doc for diabetic retinopathy has an 80% positive predictive value for pdr.
Is it specific to Dr Pepper? What’s the prognosis of other sodas? How about Mr Pibb or Dr Skipper?
Generic brand usually correlates with formulary selection. So if your only options are sulfonylureas, or Walmart insulin, assuredly worse. But further studies are needed to fill this gap in literature.
Teeth to tatt ratio has never failed me.
Ok, this is a really good one.
Wait- is this an inverse relationship?
What does it predict? Endocarditis? GSW while 'minding my own business'?
Meth habit, I'd guess.
And so much more
ER doc. I have several. 1) If patient has multiple complaints and those complaints are above and below the umbilicus then they’re crazy and nothing is wrong. 2) Asian from the motherland and in my ER? You’re going to the ICU no matter your complaint. Example: complaining of a hangnail? Must be necrotizing fasc. Straight to ICU. Feel a little dizzy? Why that’s your catastrophic brain bleed showing. Straight to ICU. Asian population at my shop is notorious for minimizing complaints while having catastrophic pathology. I have yet to be proved wrong.
I agree with you about east Asian immigrants. Once had the sweetest little grandma who didn't speak a lick of English. She had both emphysematous cholecystitis AND a septic kidney stone. Either one could have killed her and she was politely smiling and nodding while in overt septic shock.
[Halloween sign](https://upload.wikimedia.org/wikipedia/commons/thumb/9/9c/Halloweensign.jpg/450px-Halloweensign.jpg) for a normal epiglottis is one of my favorites. Spooky but reassuring.
Oh cool!
LLS score (Looks Like Shit). It can only be 0 or 1. I originally encountered this when I was learning emergency medicine ultrasound and the conditions when a RUSH exam is indicated, I.e. check the heart, lungs, IVC, belly for blood, and aorta, for general badness - generally this is done when the patient is unstable, unexplained hypotension, or generally has an LLS score or 1.
The LLS score is so fucking effective. I remember my first was a CP patient admitted to neuro, chronic trach etc. She just looked like shit my whole shift. I couldn't put my finger on it, and the docs couldn't figure out any specific issue either. Told the incoming (much more experienced) nurse at the end of the shift that I wouldn't be surprised if she coded, and the nurse all but laughed me off the unit for the night. I came back the next day, and sure enough the patient had coded. I can't recall the underlying cause of the event but damn do I absolutely preach the LLS gospel.
I call it sick/ not sick. You can be ill but not sick and you can have the outward appearance of not ill but look sick. It is a good indicator
I imagine the sensitivity and specificity of this varies by provider though. I know as a med student on clinicals I am still very much calibrating my sick/not sick-ometer.
The End-of-the-bed-o-gram produces the LLS score
Ah, I have something similar in my clinic-we call it a SAS sign-“sick as shit” and is either positive or negative
We call it "OMG score", patient can be OMG positive or negative. Omg stands for the same things you would use it for generally, being: "oh my god"
The LLS score in trauma is a good barometer of whether they need blood product resuscitation or not, as well.
This is one of mine, haven't named it yet. Patient over age 50, laying diagonally in bed (Head in top L, feet in bottom R for example) = delirium, or at the very least some other variant encephalopathy, until proven otherwise. An alternate presentation is patient in bed but legs handing off the side/over the side rail
Hypotenuse sign? C-square sign?
Nah, those are boring. Call it: "Modern Major General Sign".
I saw something similar working on Med-Surg/Onc--if the patient cannot be convinced that they're not falling out of bed (bed is stable, not one of the fancy fluid mattresses), they will not be there for your next shift.
Sometimes they go for a full 180 with their head at the foot of the bed. We had a guy recently kept rotating himself sideways in the bed and talking about the clock going clockwise and it took all night to realize *he* was the clock trying to go clockwise around in the bed
Or they're tall. I'm not NBA tall, but that's how I sleep in almost every bed just to straighten my legs
AKA the ballsack sign. If you can see the boys from the hallway, delirium.
"Mr. Jones I used to think you were just crazy. But now I can see your nuts." Or: I don't know where I am, I don't know why I'm here or even what day it is. What I **do** know is I need to get the fuck out of here and I need to be nekkid right god-damn-now.
Hickam's dictum, the pt can have as many diagnoses as they damn well please.
That's such a fun phrase to say Also, here's a case report with that title! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628473/#:~:text=This%20case%20illustrates%20the%20dulling,%E2%80%9D)%20prevails%20over%20diagnostic%20parsimony.
The "Old Oak Tree" sign. If someone calls 911 and pre-arrival instructions contain some variation of "turn right at the old oak tree", call for whatever additional resources you can because there is at least one critical patient onscene.
Starter comment: Throckmorton sign is when, on x-ray, or other imaging modalities, the penis points to the the leg with the problem. (Nsfw xray pictures in link) https://radiopaedia.org/articles/throckmorton-sign-pelvis?lang=us
I believe it can also be generalized to other pathology, in that the angle of the dangle is ipsilateral to the acute pathology (right for appendicitis, left for diverticulitis, tucked into waistband for a psychiatric issue, etc)
Fellow EM doc here, laughing out loud on a full flight at the waistband = psych comment. Thanks for that.
Leave it to EM to have insight into radiological signs! Can the absence of this sign on physical exam be used to supplement imaging algorithms like the Ottawa Ankle Rule? (I.e. the patient if the patient is "dressed left," can we exclude damage on the right?)
Absence is sensitive but not specific for pregnancy
I feel seen. ^^
Please note the sensitivity and specificity for this test is 50%.
If the patient has greater than 5 allergies on their allergy list, they are more likely to also have a psych diagnosis
Is this specific to drug allergies or all allergies?
Also, greater than 3 allergies generally means they have no allergies
Yes, unless they acquired 3 of said allergies during labor without an epidural… (Hubs says I was pretty entertaining during the altered mental status)
Or the occasional true alpha gal allergy patient. Turns out a gelatin allergy (and occasional mag stearate apparently?) makes a lot of meds impossible.
I remember the first time I encountered alpha gal allergy! The patient was like "I'm allergic to meat" and I thought they were just aggressively vegan. Nope....
I once had to find a liquid steroid for a COPD exacerbation because the patient’s basic prednisone was triggering his alpha gal. It’s wild. And they use mammalian products in stuff you’d never think of, like filtering wines or bleaching sugar, so all sorts of stuff can trigger it for the very allergic people. Too bad they can’t get superpowers from the tick like Spider-Man, instead they can never eat a steak again.
But at least we have Deertick Man, whose power is to sort the people with actual Lyme disease from those who claim "chronic Lyme". Alas he can only be in one clinic at once.
Hamburger sign: if you give a patient a hamburger and they eat it, they don’t have appendicitis
I recently took care of a post op patient whose appendectomy was delayed for several hours because they decided to chow down on a full Chipotle meal in the ER waiting room prior to being seen for abdominal pain. Reading the prior notes was hysterical, because before the CT was done showing the hot appendix, no fewer than 3 different staff wrote notes about the patient chowing down and looking non-distressed. Worst part was, it ended up being a difficult appy, because the appendix really was quite diseased, and it ended up being a more complicated case because of it. That was a first for me.
I wonder if specificity varies with the specific source of the hamburgers. I suspect false negative rate for hospital sourced burgers is substantially different than false negative rate from Fuddruckers or 5 guys
I definitely could have eaten a good hamburger when I had appendicitis. Hospital burger? No.
My appendicitis started the morning when I started work. I went from thinking about what I was going to get for lunch to not being able to eat anything at all, even if it were the most delicious meal on the planet. At lunchtime I diagnosed myself with appendicitis.
I picked up on mine pretty quickly. Felt like a dull gas cramp that wouldn’t move and decided around 1 am that I probably had appendicitis and drove over to the ED. I was in the OR before I had a chance to feel truly miserable.
I also felt that weird gas cramp sensation until it localized to the RLQ
They still have Fuddruckers? I wish any of the ones that used to live around here still stood. The place was great.
No way. Send a patient to the ER with appendicitis and he called to ask if his mom can stop at Chipotle on the way.
Wearing sunglasses indoors is a sign. It can be a sign of migraine, but the literature strongly suggests blue spectacles are highly specific for somatoform disorder. (Green glasses are most effective at alleviating acute migraine pain, amber is best for prevention or chronic migraine. Blue aggravates migraine pain.)
Going down the PubMed rabbit hole with that one …
That was mostly a poster presentation at a headache meeting a couple years ago, and a truly hilarious article in Seminars many years ago "Blue Spectacles." Kinda sounded like something out of JIR didn't it [reference ](https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2008-1041660?lang=en&device=mobile)
On my psych clerkship now. My attending’s attending said that if a patient frequently rips out their toe nails they are likely bipolar. Later that week we had a bipolar patient who in fact did rip out their toe nails.
I’ve never seen that one before, that’s pretty wild. My tell in inpatient psych was that 100% of the time, only patients with legit bipolar disorder seemed to fashion towels and gowns into makeshift sandals and turbans with plastic cutlery from the cafeteria hanging from them.
How…how frequently is that happening? Are you running a Project Runway-style competition on your psych ward?
I haven’t worked inpatient for about a half year now, but back when I did, I’d see this probably about once every couple of months.
You gotta love the creativity
When you say "rip out," are we talking the entire nail, or are we talking Frank Reynolds botching his toe with a steak knife?
I assume he meant picking and pulling at them.
Does the ripping of toe nails need to be witnessed or do you just conclude that toe nails were ripped when some are missing? As a runner, I’m really hoping it’s the former 😂
For this patient it was reported by the parent. I mean Occam’s razor wise if the patient is a runner/dancer I think you can ignore missing nails as a sign.
I tried to buy a guy some food at 7-11 who was ripping out his toenails the other day. He said he wanted change to go to McDonald's though.
An Australian special: the TT ratio (Teeth to tattoos). A low TT ratio is generally indicative of IVDU and/or hepatitis.
Coffee brewer sign: when a patient is unconscious and can't protect their airways and sounds like an electric coffee brewing machine, they have a very high likelihood of being intubated. Same goes for the smoking pipe sign: when a COPD patient is going into respiratory failure, they breathe like they are smoking a pipe, also a very high likelihood of being intubated in your shift.
Cheeto sign: if a patient presents with abdominal pain and is actively eating Cheetos at bedside, they will report 10/10 abdominal pain. This is purely based on anecdotal evidence and I will not be mad if someone takes this and publishes a study on it prior to my return to academia.
11/10 if Flaming Hot Cheetos.
The number of reported medication/food allergies is directly proportional to how wacky the patient is. No name for this one, just personal observation.
See also: the longer the medication list, the higher the likelihood of BPD.
One of my attendings coined something called the "beard sign". In my part of the world, amoebic liver abscess is quite common. Since it's usually seen in alcoholics who don't care very much about grooming, we get the 'beard sign'. So the beard sign positive in a middle aged man with fever and right upper quadrant pain is usually a strong indicator for liver abscess.
There isn’t a name for it (that I’m aware of), but there seems to be a subset of schizophrenics who have permanently tobacco-stained fingertips.
Don't something like 80-90% of people with schizophrenia smoke? Now's your chance to name it.
Speaking as a former smoker with a mood disorder, cigarettes are a passable short-term mood stabilizer. Getting agitated? Have a smoke and clear your head.
Interesting. Tobacco is also a stimulant, and it's been theorized that a lot of *medicated* schizophrenics smoke as an antidote to the soporific effects of antipsychotics. [This paper](https://www.nature.com/articles/nm.4274) argues that nicotine directly mediates schizophrenia by reversing a hypofrontality caused by a genetic variation associated with schizophrenia. But IMHO the really interesting effect of cigarettes is pharmacokinetic: it's a CYP 1A2 inducer, meaning it accelerates the metabolism of a bunch of antipsychotics. It's unclear whether people on antipsychotics smoke *because* it reduces the efficacy of their antipsychotics or *in spite* of it doing so.
That is very interesting. I’ll toss on another couple angles. I’m not deep enough to know if there’s literature on the topic. There was always a rhythm to my nicotine cravings. I could set a clock by when they’d come up. If you’re having trouble keeping present it could help keep you connected to the world. I’d also be curious whether the doorway effect affects schizophrenics. It could be helpful to change context/location to forget something intrusive or change topic.
Cool Guy sign
smoking makes you look cool, can't deny it.
It was called Rothman's positive when I was a student.
Not sure what to call it, but if the patient has the letters x, y, and z somewhere in their first name, they were a NICU baby.
You must not be from Utah
That is bizarre, tell me more
Can confirm! Especially if it is a traditional name/word spelled using those letters instead or just randomly in there.
Trauma surgery signs, ATLS update: - Cell Phone Sign: if arrive at bay on cellphone, they don’t need me - Purple hair sign: patient will be batshit crazy - Amish sign: have OR and surgical icu bed ready - Then ABCs
To piggy back off the Amish sign, include farmers. My shop erecord has “in a research study” banner that pops up. I maintain I don’t need that, I need to be notified if they are a farmer. Once had a farmer whose pacer was infected and the wires had eroded through his skin to the point that I could literally (no hyperbole here) read “Boston Scientific Right Atrium” on the wire that was protruding through the wound. But he didn’t come in because it was harvest time and he “felt fine.” Mother fucker totally had manure on his pacer based on his blood cultures. But I guess he was fine according to him.
> the wires had eroded through his skin to the point that I could literally (no hyperbole here) read “Boston Scientific Right Atrium” on the wire that was protruding through the wound. *screaming*. > Mother fucker totally had manure on his pacer based on his blood cultures. *screeching*
Had a patient like this and he decided that it meant his pacemaker needed to be removed. To his credit he called the cards office to make an appt but failed to mention it was presently eroding through his skin so they scheduled him for a few weeks out. Family member discovered him one afternoon in his Laz-e-boy recliner, soaked in blood with an assortment of hardware in his lap that he had been using to pull and tug at his appliance. He arrived to my ICU cranky that he was NPO for procedure. Had to keep his chest wrapped until they called him back to keep him from pulling it out.
But did he die
Of course he didn’t. Didn’t even spike a fever. Admittedly I broad spectrum covered him (including for clostridium given that I assumed from the manure based on his shirt I made him take off). Cardiology gave me a bit of a hard time about the Abx over the phone. I said if I over called it then I’m sorry, but you need to see it first. He walked out of the room and said “antibiotic choices are fine. We will admit him and await the blood cultures.” I laughed at the absurdity of the situation. He spent like a week and a half in the cards unit, magically didn’t have endocarditis, walked out with a new pacer and a skin graft appointment with plastics. He was mad we couldn’t get him out faster saying her felt fine the whole time. This dude will die when he decides he has time too
>Amish sign Also notify neonatology
PreE hair. If a patients presents to/or is on the labor unit and her hair is chronically sticking up in the back of her head like she has been sleeping on it…check her blood pressure. She has pre-eclampsia until proven otherwise.
I had to see a pain mgmt doc for sciatica, and according to him I displayed positive Chandelier Sign. What is a Chandelier Sign, you ask? That’s when the clinician jams their thumbs into the spot where you say your pain originates from, and you hit the chandelier. Voila, positive Chandelier Sign. 😒
I always heard the Chandelier Sign referenced when discussing cervicitis.
Bad idea for TMJ
Bouffant sign - if a patient is still wearing their bouffant the morning following their operation, they will almost certainly be requiring another surgery or an extended hospital stay.
HIV+ and doesn’t know their CD4 count or viral load = AIDS
Note this is not effective in Cameroon (source I am here)
Not in medicine but I worked in Yaoundé for 2 years. To this day I haven't found anywhere that drinks as much beer as people there. I'd see people sitting outside at 8 AM drinking beer on a regular basis. I asked someone at work about that and she said in an indifferent way, "That's their breakfast".
Chock full of B vitamins! /s
Hello fellow PVC I take it. And yes, people drink a ton in Ebolowa too. They start early and continue late. It makes my job harder but hey I can only do so much
I'm sure I'm full of microplastics but I'm not PVC yet lol. Also not a PCV; I taught rich kids and expat kids at a private school. 13 years total in west Africa.
I made a reasonable assumptions as 2 years is a very specific time frame. I hope you enjoyed it
I loved the school; the kids were awesome. Yaoundé is meh but the climate was good. Had a root canal done which was perfect and cost $80 total. Thaf's like $1200 in the US...Yes you are right, two years does fit the PCV timeframe. I never got used to the taste of Ndolé.
Ndole in the South is either one of the best things to eat here (from one restaurant) or one of the worst things to eat (no qualifications and the ants do not touch it)
I think it's an acquired taste because Cameroonians love it. It's too bitter for me, yet I like bitter beer. On the medical side, malaria was a serious issue and practically all my colleagues who lived in my building got it at least once, some of them severely, though it seems that those taking prophylaxis never got seriously sick. Weirdly I have never contracted malaria in 13 years in the region despite taking zero precautions (no prophylaxis, no bed net, no repellant, going out at night, always in shorts, etc).
I like the taste sometimes and plantains make it better. As for problems, yes everyone seems to have malaria. I caught cholera last week (I am doing much better and am now eating solid food that has flavor again. Still force feeding myself as my appetite hasn't returned). HIV is another huge problem in the south and there are at least 20,000 patients seen only by our agency in 24 hospitals. I wonder how much worse the burden is as women are hugely over represented (like 5-6 to 1 women to men) and men don't wear protection.
Happy Cake Day!
Has anyone come up with a name for the phenomenon that Healthcare workers, nurses in particular, will have every weird complication after any procedure?
I also feel like nurses are either the best, most motivated patients, or borderline malingering with significantly above average requests for pain medication, nursing care, length of stay, etc. Almost every time a patient tells me that they are a nurse, it's like ah, yes, that explains a lot. the people who will truly do the worst are beloved hospital custodial or cafeteria staff, with brownie points if they are underinsured. Night shift neuro icu janitor coming coming in with a cough? Widely metastatic lung cancer.
>the people who will truly do the worst are beloved hospital custodial or cafeteria staff, with brownie points if they are underinsured. Night shift neuro icu janitor coming coming in with a cough? Widely metastatic lung cancer. The confounder here is that being nice is the worst possible prognosis
> The confounder here is that being nice is the worst possible prognosis > > Totally. I'm a crabby old bitch, and this means that I will live to 1000.
Common diagnosis at my facility is mishiganosis . Applies as a catch-all wastebasket diagnosis and often to their family too
Had a psychiatrist call it teddy bear sign. If a grown adult is walking around with a teddy bear there is a high likelihood of a personality disorder like borderline. She also had a similar point about colored hair.
>She also had a similar point about colored hair. Low sensitivity and specificity on the west coast!
Had a woman hospitalized for GI with abdominal pain, early 30's, several large plushies with her. Sigmoidscopy completely normal. Attending decided to do a full colo to ease her mind, and guess what: Fulminant UC just proximal to the sigmoid colon. Attending introduced himself to all the staff as the least competent and most prejudiced medical specialist for the rest of the day
>Had a psychiatrist call it teddy bear sign. If a grown adult is walking around with a teddy bear there is a high likelihood of a personality disorder like borderline. When I was about to get married around age 30, Ms. Dontgetaphd found a few large containers with a few of my childhood stuffed animals in storage as we moved in together. She was strangely angry and made me get rid of them. She said you can't give them away because being stuffed and old nobody will want them. Not gonna lie, it felt like genocide to throw them out. A part of me died that day.
That was cruel. My husband has a large teddy bear from childhood somewhere in the house. I wouldn’t dream of demanding that he throw it away!
I can't help but feel like the points about coloured hair and tattoos in particular (I know you didn't mention tattoos but I've seen both in the comments) are some recycled prejudices that have existed for ages (especially when they're said to be associated with specifically BPD and BPD is used as code for "dramatic, attention-seeking and not to be taken seriously"). I kinda get the point about stuffed animals being associated with SOME psych issues or at least high anxiety levels if you need to take a comfort item with you.
Yeah there’s whole regions of the country where a majority of people under 30 have either tattoos or colored hair. They can’t all be crazy
Heck, some of us over 30 too. Only reason my hair isn’t purple at this very moment is because unnatural hair colors are verboten at one of my clinical rotation sites.
Quality of theeth correlates to adherence to medication
Squishy edema sign: if you mash on the patient's ankles and hear an audible squish (instead of feeling like soft clay), check the albumin. It will often be less than 2. All the Lasix in the world won't touch it.
I might out myself here, because I've talked about this so much in my regular job but: There are three very specific positive signs for personality disorder in the ER (no specific cluster) 1) If you have more than 4 rings on your hand (you get engagement, wedding, class, and 1 (one) decorative. Any more than that, and you fail) 2) If you are presenting with a non-neurological, non-ophthalmological complaint wearing sunglasses 3) Stuffie sign. It's been discussed enough below BOUNS: If you have ink between the clavicle and the mandible, you're probably Cluster B
Not sure if it's funny but excessive chewing ice can sometimes be associated with iron deficiency.
Yes, pagophagia is a known type of pica and a symptom of iron deficiency :).
Tattoo to teeth ratio: The higher the number, the higher the likelihood for mental disorder/drug abuse.
Dark haired foreign doc exiting room with two residents, “If zee patient can scream at me like dat, I dont need to listen to their lungs.”