I’m glad August is OVER! What is normally a shit month in my life was a shit month at work too. Low census, poor staffing, sick-ass train-wrecks and all the goodies of a urban tele floor.
But truly I’ve had some records shattered. We see far out and funky lab values all the time, but these were some doozies this month.
And the Winners are:
HbgA1C: 14.6! Also had a 13.9 as a runner-up. Both patients with Type I diabetes, both young, one with OK support, one with none. We worked the diabetic educator to the bone trying to teach these young’uns to not end up destroying themselves. For those playing along with the home game, <6 is good control for diabetics. And when you translate that to eAG (estimated Average Glucose) you get 372mg/dl and 352mg/dl. Bad mojo.
Worst Case of Thrush EVER: Candidal Esophagitis, from the oropharynx to just above the lower esophageal sphincter. And in a twist, the patient was not immuno-compromised.
Highest WBC in a non-cancer patient: 68.8. Yes, 68,800! And it had jumped from 48,000 less than 12 hours earlier.
Lactate: 10.8. Of course what do I say? “Last time I saw a lactate that high we were coding the patient.” Sure enough the patient did expire (they had the nasty white count). They were sick with a capital “F”.
Dumbest idea of the month: dude comes in drunk and complaining of nausea and vomiting. After being triaged he goes to the bathroom and pops a couple of poppers, promptly turns grayish-blue with a pressure of 50 and a raging onset of methemoglobinemia. At least he was in the ED when he did it.
Oh, and for two Fridays in a row, had rapid responses at shift change…a helluva’ way to start the shift!
I hope September is better…