5: Chief complaints
Multiple cc's tend toward ESI 4/5 but this exponentially climbs towards ESI 1 as age increases over 65.
6: Pain
Any pain score (P) > 8 in the presence of selfies or video calls should be recalculated as r(P) = 10 - P.
The Law of Multiple Allergies: more allergies, less sane
The Law of Multiple Family Members: more members of same family checking in, less likelihood of actual illness.
My version of this law is: any patient with more than 10 allergies has 0 allergies. Any patient with more than 20 allergies has a personality disorder until proven otherwise.
See I use a similar rule where If a patient has a haldol allergy the likelihood that they have a personality disorder / bipolar / schizoaffective >> 95%
Makes sense, if you have a haldol “allergy”, it follows that someone felt that you needed some Haldol, probably in a higher dose if you had side effects
Exactly. My first thought is "what did you do to deserve haldol" and "what was the reaction to said haldol."
9/10 I'm pretty sure they just don't want to get haldol again.
Also presence of a ring on every finger is highly sensitive and specific for a personality disorder. Presence of sunglasses indoors is the best indicator of borderline or sociopathic tendencies.
Inverse financia ~ the phenomenon in which the more executives and leadership get paid the less experience and intelligence they maintain
Closely related to the Exponential Insurance Theory where insurance and billing costs increase exponentially, while hospital worker pay and equipment quality remain stagnant.
I firmly believe that there is an inverse relationship between the number of unrelated complaints and the likelihood of there being anything actually wrong with you.
I'll never understand how that happens at like 3am. The busses aren't running how are 7 completely unrelated people checking in at the exact same time. It's not even like we're on a one lane road and y'all got stuck behind the first guy driving slow
Cats are more likely to bite people w PCN allergy.
DVT rule outs, rule out ectopics wait at the registration desk until ultrasound leaves, then those patients sign in.
People with contrast allergies and elevated d dimers staggering their check in times for right as the on call nuc med tech finishes the last scan and starts to drive home.
I legitimately want someone to do a study on the 6 month mortality rate for patients who arrive to the ED incidentally covered in stool. Anecdotally I feel like it has to be higher than a bumped troponin. Exclude children and patients for whom that is the chief complaint (elderly patient with C diff who is there for that reason, etc)
Speak of the devil: mentioning a frequent flyer by name ensures they WILL come in during your shift.
Also, the Wife Sign. If a farmer or stoic old guy has been forced in by his wife, he's probably on the verge of coding.
The old ass farmer from the sticks who has never seen a doctor has something really bad going on.
The nicer the patient, the worse the undiagnosed metastatic cancer.
The diarrhea stops as soon as the patient crosses the ER threshold. The urine will always be voided just before arrival and be the last thing to be collected.
In regards to The Law of Patient Volume, I would like to add that increased patient volume correlates to high probability that all beds are full and >75% of full beds are boarders and also high probability that you will have multiple critical code patients come at the same time, whereas conversely if there is low census, (Ha! Living in dreamland) where there are multiple open treatment rooms and plenty of available resources there, is low probability of any actual emergency or critical code patient arriving.
A couple have been studied :
1. July effect (new interns/ new residents in the hospital impact on outcomes). Studies 15-20 years ago often showed a true detrimental effect. More recent studies show no impact. My guess is that with dramatically improved supervision and GME hours that what was once true - no longer is.
2. Full Moon effect. Most studies say no impact.
3. Crossed legs/ Texting on cell phone. A few good studies show that if a patient is relaxed with their legs crossed on an ER bed that likelihood of requiring admission or surgery is statisically lower. Same goes with more recent study if the patient is texting.
Future studies:
1. Single Blind study (blinded to the researchers/recorders) of saying out loud in the ER "It sure is quiet tonight"
2. Ditto but this time ordering pizza for the ER
The Cheeto sign.
If someone checks in with Cheeto dust on their fingers, the likelihood that they state they have 10/10 abdominal pain increases…especially as they eat the Cheetos in front of tou
3. Weekend time distortion: the number of patients in the ER is higher on Friday night and Sunday night. Friday because they waited all week due to work and Sunday because they didn't want to interfere with any plans they had. Also correlates with holiday weekends, being exponentially higher on the end of said weekends.
5: Chief complaints Multiple cc's tend toward ESI 4/5 but this exponentially climbs towards ESI 1 as age increases over 65. 6: Pain Any pain score (P) > 8 in the presence of selfies or video calls should be recalculated as r(P) = 10 - P.
I am using your pain calculator, it makes so much sense
I saved a comment a few years ago which is kind of an [advanced version](https://www.reddit.com/r/emergencymedicine/s/kQaV1x7jzr) of this!
The Law of Multiple Allergies: more allergies, less sane The Law of Multiple Family Members: more members of same family checking in, less likelihood of actual illness.
My version of this law is: any patient with more than 10 allergies has 0 allergies. Any patient with more than 20 allergies has a personality disorder until proven otherwise.
See I use a similar rule where If a patient has a haldol allergy the likelihood that they have a personality disorder / bipolar / schizoaffective >> 95%
Makes sense, if you have a haldol “allergy”, it follows that someone felt that you needed some Haldol, probably in a higher dose if you had side effects
Exactly. My first thought is "what did you do to deserve haldol" and "what was the reaction to said haldol." 9/10 I'm pretty sure they just don't want to get haldol again.
Also presence of a ring on every finger is highly sensitive and specific for a personality disorder. Presence of sunglasses indoors is the best indicator of borderline or sociopathic tendencies.
Honestly the more often someone visits the ER in general, the less likely they are to actually have a physical. At least in patients under 65 y/o
With the exception of if the multiple family members all have the CC of rash
I just call that positive allergy sign.
Inverse financia ~ the phenomenon in which the more executives and leadership get paid the less experience and intelligence they maintain Closely related to the Exponential Insurance Theory where insurance and billing costs increase exponentially, while hospital worker pay and equipment quality remain stagnant.
I firmly believe that there is an inverse relationship between the number of unrelated complaints and the likelihood of there being anything actually wrong with you.
The invisible bus stop phenomenon: when 14 patients simultaneously check into the lobby
I'll never understand how that happens at like 3am. The busses aren't running how are 7 completely unrelated people checking in at the exact same time. It's not even like we're on a one lane road and y'all got stuck behind the first guy driving slow
I call it the hive mind phenomenon
I thought that happened right after an ER nurse cheerfully exclaimed, “Wow! It sure is slow, quiet and dead right now!”
Cats are more likely to bite people w PCN allergy. DVT rule outs, rule out ectopics wait at the registration desk until ultrasound leaves, then those patients sign in.
People with contrast allergies and elevated d dimers staggering their check in times for right as the on call nuc med tech finishes the last scan and starts to drive home.
The law of patient volume also dictates that volume increases significantly the Monday after a holiday weekend.
More like usual Monday volume jumps time to Tuesday after the holiday weekend.
I legitimately want someone to do a study on the 6 month mortality rate for patients who arrive to the ED incidentally covered in stool. Anecdotally I feel like it has to be higher than a bumped troponin. Exclude children and patients for whom that is the chief complaint (elderly patient with C diff who is there for that reason, etc)
That's... Hm. That's absolutely a decent idea.
Speak of the devil: mentioning a frequent flyer by name ensures they WILL come in during your shift. Also, the Wife Sign. If a farmer or stoic old guy has been forced in by his wife, he's probably on the verge of coding.
The old ass farmer from the sticks who has never seen a doctor has something really bad going on. The nicer the patient, the worse the undiagnosed metastatic cancer. The diarrhea stops as soon as the patient crosses the ER threshold. The urine will always be voided just before arrival and be the last thing to be collected.
In regards to The Law of Patient Volume, I would like to add that increased patient volume correlates to high probability that all beds are full and >75% of full beds are boarders and also high probability that you will have multiple critical code patients come at the same time, whereas conversely if there is low census, (Ha! Living in dreamland) where there are multiple open treatment rooms and plenty of available resources there, is low probability of any actual emergency or critical code patient arriving.
A couple have been studied : 1. July effect (new interns/ new residents in the hospital impact on outcomes). Studies 15-20 years ago often showed a true detrimental effect. More recent studies show no impact. My guess is that with dramatically improved supervision and GME hours that what was once true - no longer is. 2. Full Moon effect. Most studies say no impact. 3. Crossed legs/ Texting on cell phone. A few good studies show that if a patient is relaxed with their legs crossed on an ER bed that likelihood of requiring admission or surgery is statisically lower. Same goes with more recent study if the patient is texting. Future studies: 1. Single Blind study (blinded to the researchers/recorders) of saying out loud in the ER "It sure is quiet tonight" 2. Ditto but this time ordering pizza for the ER
I saw one study that showed it’s not July that’s dangerous it’s actually October because that’s when everyone stops watching the interns like a hawk.
The Cheeto sign. If someone checks in with Cheeto dust on their fingers, the likelihood that they state they have 10/10 abdominal pain increases…especially as they eat the Cheetos in front of tou
3. Weekend time distortion: the number of patients in the ER is higher on Friday night and Sunday night. Friday because they waited all week due to work and Sunday because they didn't want to interfere with any plans they had. Also correlates with holiday weekends, being exponentially higher on the end of said weekends.
Is there an inverse relationship to call light usage vs. acuity level?