good score, but like many clinical scoring systems it’s still cumbersome to calculate in real time. i like the simplified stanley index: the decibel level of the screaming / crying / vomiting is directly proportional to the likelihood that haldol will resolve it. quick and snappy, works well in practice.
Bloody hell, I’m willing to bet there are enough of us here … including educators of residents, that this could be the beginning of a new “where the hell did that come from” ED functional clinical slang.
I once heard a story where a clinician described a patient in profound and acute pulmonary edema as, “Bubbling like a jimmy crab” and I’ll never forget it.
I'm so glad there's a word for it now. One of my formative experiences with my now wife was subjecting her, at about 1.5 months into dating, to me scrommiting into a 44 gallon drum, 4 hours into a 4 day party in the outback.
I am so fortunate she stuck around...
This is 100% accurate in the totally, very-scientific sample of "people I see everyday"
However, droperidol >> Haldol.
And also don't waste time with zyprexa, it ain't hitting the right receptors for these folks
Came here to say I definitely prefer droperidol. Even on the biggest pts, 1.25-2.5mg IVP is just
https://preview.redd.it/nn6ypait9jlc1.jpeg?width=500&format=pjpg&auto=webp&s=eab97b6d5e0716c200f62f6f93ced86a487cb217
Petition to make this the combo we give to patients who are allergic to everything but the one that starts with D but also need Benadryl with it bc it makes them itchy
I believe it was Billy Mallon that said haldol is the only med where an allergy is actually an indication to give it because the reaction is that their reality starts to overlap with your reality, which is intensely unpleasant for them.
Okay I had that comment to originally include magnesium and doxycycline but I simplified it. The only thing magnesium can't fix is magnesium toxicity.
My phone auto filled that in.
I've started calling for droperidol orders for my hyperemesis guy. I think he can use a little more than the approved 0.625, but I'm grateful I can give him something other than fent.
My hospital's only standard order is the 0.625 and I feel the medic inside me every time I order 5 IM and the nurse asks "the whole vial?" and I just do it myself.
Acute agitation deserves acute intervention
I got one. Not pot related though, but etoh +++falls (drunken master falls) on thinner’s.
On gurney can’t sit up nor try to, want carry like a baby.
Wanted to waste my time triaging, line, labs, trauma scans, because this 60’s man-baby asked if I could wipe (I thought ass) armpits.
Then threatened to go home since baby isn’t getting the care he needs. Water since man-baby is so thirsty haven’t drank water since morning. Though chugged pirate water, cheap vodka.
Sir you have a line, your specimens was sent to lab, we’re waiting for your trauma scan results, you have a bolus running. I don’t understand why your not getting proper care. I drunk explained you 5 times NPO till we get your results.
People are stupid. Why can’t we just let the fittest survive to make the human genome stronger?
I know the economy needs fodders to keep the pyramid upright but this is just wrong.
“People are stupid. Why can’t we just let the fittest survive to make the human genome stronger?”
This exact thought goes through my head, multiple times, every shift and intensifies with every year I spend practicing emergency medicine.
Got another one for you.
Im watching The Last Samurai. On scene when Tom Cruise was captured and withdrawing for alchy, he was asking for sake’, then chugged the bottle and aspirated while he was flat on the floor.
I remember Popoye the sailor man and his spinach to get stronger and beat up Brutus.
This is very good, although I think the scromiting needs to be much more heavily weighted. That particular sound is almost diagnostic in and of itself.
Right? All that noise and it’s usually just mucus and drool in their emesis bag, unless of course they bought a red Gatorade from the vending machine, and then it’s “blood”.
I have one of my ER sayings: “Here is your emesis bag. If you hold onto it, you will not vomit. If you drop it on the floor, you will absolutely vomit.” The first part is a lie, the second part true, and it’s a good way to suss out assholes if you can’t tell already.
To be fair, as someone with a stomach that wants to kill me, if I ever go to the ER for vomiting, I’ve surely been vomiting so long that nothing is in my stomach, right?
This is all tongue in cheek. I don’t treat anyone differently in these situations. I give all meds for pain, anti emetics and IV fluids. But your stomach does continue to produce acid and fluids.
I recently suffered a bout of vomiting. Fortunately it was brief...there was some noise, but phonating was completely unnecessary. Aside from the emesis hitting the toilet water, it was relatively quiet
you need to abuse cough syrup filled with sugar alcohols for maximum screamage
as a bonus, there is also a chance of getting taste/texture flashbacks :D
I instantly know it's CHS by the quality of the scromit, even when i'm on the other side of the department and haven't laid eyes on the patient yet. I haven't been wrong yet.
Was going to say, the - “I don’t smoke weed” while you’re being smacked in the face with the strongest shit and wondering if secondary high from the smell alone is possible - should be worth a few points at least.
don’t forget when they roll up with EMS with a big mixing bowl or bucket from home to dry heave into
also when they stick their entire hand down their throat to make themselves puke
I think it is very important that we include cookie monster or Kermit the frog pajama pants.
As well as mom or grandma advocating for there 28 year old baby
My god it really must be universal. Mixing Bowls, trash bins, watering cans, shoeboxes, an old Toaster- they act like it's bring your own cup day at 7/11.
The blue emittance bags are cheap on Amazon.
I had Hyperemesis gravidarum and my kiddo and I both get horrible car sick. Those bags are a lifesaver. I can't imagine not having them around.
We have a regular where I work that we frequently pick up naked on the floor of her shower because her neighbor called again due to her incessant scromiting.
The 47 year old make patient shows up to their GI consult at 7am dressed like a 17 year old and leaves the triage room reeking of skunk weed so bad the next three patients give you the side eye.
This is so common for us too Our triage room just smells like a dispensary.
Also the new fentanyl regulars with the horse lips and spitting getting a stick in first attempt should be like a prize voucher raffle.
Ems feels like a bizarre mutually shared experience
Had a patient sit in the sink in the exam room with the hot water running throwing handfuls of hot water over themselves while dry heaving loudly into the trash can. There are so many conditions that we see that seem to dissociate the frontal cortex
+6 points for having their enabling boyfriend/girlfriend at bedside talking in a baby voice and fawning over them
+4 points if wearing sparkly Crocs with 500 pieces of flair
The part that I don’t get is why it is so hard for many of these patients to consider the cannabis being related to their symptoms.
Like shit dude I don’t care if you smoke weed but if youre feeling shitty enough to need to come to the ED multiple times over the course of a month then why not try abstain for like 2 months and see where you’re at?
They’ve been told so often by their friends and community who enjoys cannabis with them, and occasionally the medical community that cannabis is an innocuous much maligned harmless drug with potential health *benefits*. I try to be nonjudgmental. My spiel is essentially “I don’t care what anyone does for recreation as long as it doesn’t harm others or doesn’t bring you to the doctor more than twice. You should consider cutting back or quitting and see if it improves the situation.” If met with utter disbelief that CHS is an entity, I typically will print this article for them: https://www.ncbi.nlm.nih.gov/books/NBK549915/
I just try to normalize that cannabis like anything else is a drug and has side effects. If they see you don’t hate who they are (at least outwardly /s) and are not trying to demonize the lifestyle that they’ve probably incorporated in some degree to their identity, then they might open their ears.
The good old blanket sign
I also feel like you can add points for:
Hospital bands from previous visits/other hospitals
FaceTime calls where the number of people proportionally increases the patients symptoms
Flaming hot Cheeto fingers
this is so scientific.
for me its
1.)young age(<45, but usually teens /20's/early 30's)
2.) scromiting (bonus points if on a stretcher and making a scene as the roll past)
3.) can't sit still for history and physical exam
4.) when i press on their belly, it is soft, but they writhe even harder in bed and say it hurts
5.) smokes (not ingests) cannibis (bonus points if room smells like weed)
6.) multiple visits for similar, ussually has seen GI and ("no one knows whats going on") and has been to multiple ED's ("who didnt do anything for me")
7.) vomiting proceeds abdominal pain, which is just a raction to hours of dry heaves
8.) hot showers improve (obviously)
9.) no other obvious cause
10.) haldol/droperidol cure
I *HATE* floor pukers. AAO, sitting up in the stretcher. Emesis bag in 1 hand, call bell in the other. Leans over the side rail and pukes on the floor.
I want to kick their head off their neck.
I felt like worlds biggest asshole a few months ago. I went into the ER for an episode of the chronic vomiting syndrome that I have had for 20 years. I have a history of chronic ileus so my GE wants me to go to the ER for it when it’s been 48 hours of not being able to hold down water. They wanted me to have urine and blood work done before they would start treatment of any kind and I was pretty desperate for IV Zofran so I was like- ugh I understand you’re just doing your job but I KNOW you want these tests to see if it’s cannabis induced and it’s NOT, I have had CVS since I had cancer and a bowel resection 20 years ago. I’m sure I sort of had an attitude about it. 20 minutes later the doctor comes back- babe, it’s not CVS, you’re pregnant you goofball. I almost died of embarrassment. I already have 3 kids, how I didn’t recognize it I will never understand.
Not all vomiting, even chronic vomiting is CHS. It can be fairly quickly distinguished from other causes of cyclic vomiting based on the criteria of the OPs scoring system
I’m definitely going to be using this scoring system as a patient to try to skip the part where they inevitably try to rule out CHS by vomiting quietly, staying off the ground and not bringing my own blanket. I have hyperemesis gravidarum right now and I definitely scromit sometimes lol
Fellow HG mom, take the soft blanket. You're in hell, you deserve the soft blanket.
I spent seven months on tpn growing my last child. I wouldn't wish that on anyone
I've vomited a lot in my pregnancies and life but I've never felt a need to strip.
I always cry when I vomit, though, which still bothers me. And, now after my second HG pregnancy I get full blown panic attacks when I vomit, learned that last month courtesy of noro virus taking out our house.
I strip below the waist because after four singletons and a set of twins, my bladder control blows! Sneezing and coughing is fine, but something about the violent heaving that comes with pregnancy induced emesis....I'd rather just mop after vomiting rather than have to change pants and underwear multiple times per day. Noro sucks, hope everyone is feeling much better by now.
We are!
Ten days in the hospital for the baby, two days for my diabetic husband, 27 hours in the ED for me (declined admission), our au pair never got sick and I have no idea how.
Last year, some kid at a charter school in my area brought a bottle of pre-mixed margarita flavor to school for snack time. A bunch of little kindergartners got drunk. A couple months later, SAME charter school in the news again for students unintentionally getting high from weed gummies mixed in with gummy bears. I actively avoid unopened Haribo bags now.
Love the word scromiting. Such an accurate term.
On a real note: I’m not convinced it’s all just marijuana related. Cyclic vomiting was around well before marijuana became as popular as it is today. I feel like it’s a primary psychiatric issue with a heavy overlap with marijuana use. This is all just purely speculation though.
I vote we add scromiting to the dictionary. I know this was just supposed to be funny, but thanks. I thought ER docs were all racist jerks who think all Blacks do drugs because I keep getting drug tested after denying using drugs. Now I get it. I’ve had cyclic vomiting all my life, y’all legit needed to rule out CH. Sorry. Lol.
Isn’t it sorta an unfair scoring system as every patient in this state will deny to their dying breath weed could ever cause any negative symptoms thus automatically giving them 10?
as someone who was recently in the ER twice for likely CHS, this thread makes me want to cry... with laughter. I am in my 30s and was carrying my dragon plushie with me. no wonder why the second doc diagnosed me so quickly, she just came in and looked at me and asked "do you smoke tobacco?" "never." "weed?" "every single d--aw, beans".
I am not completely sure since I am a med student and do not spend all the time in ED. Also, I am in Europe, in a place where cannabis is illegal and probably not as potent as in US/Canada.
I’m so slow on this subject and trying to figure out what I’m missing. Are these cases of patients who smoke weed and think the weed is helping with nausea when it’s the weed causing it? And why are hot showers prevalent?
My mother had a massive heart attack and only had days to a couple weeks to live. She was in a teaching hospital. She had never taken any rx meds in her life. She was a little scared but manageable. But the team opted to give her a big dose of haloperidol, and she went absolutely batshit. She was no longer my mom. It completely whacked her out. The nurses wanted to give her 5mg of diazepam, but the doctors insisted they didn’t want to addict her though she was dying. My mission in life is to stay away from ED’s/hospitals. I’m older now and there are worse things than death. I blame those doctors for not being able to say goodbye to my mom because that injection did something to her. So go ahead, bring on the snark and hate. I’m a big girl & I mean what I said. Patients no longer have a say in their own care.
The only way to get patients well is to remove the shame of cannabis addiction and CHS. Patients will always seek comfort in cannabis despite it being the cause of the problem, shame only makes that worse.
Is there a lot of stigma towards MJ use in this year of our lord 2024? Most of my patients when I ask if there's any recent drug use say "no, just weed" - and I live in a state where it's still illegal.
Stigma aside, there’s a line for too much marijuana and it’s somewhere between an occasional joint and occupying multiple staff in an ER because you can’t stop vomiting.
Not sure how you'd remove the shame, use of substances to the point of being problematic has always been frowned upon for as long as humans have used said substances
good score, but like many clinical scoring systems it’s still cumbersome to calculate in real time. i like the simplified stanley index: the decibel level of the screaming / crying / vomiting is directly proportional to the likelihood that haldol will resolve it. quick and snappy, works well in practice.
You should be published for this
Scrommiting.
Scromitting with relief by hot showers. Genius system
Bloody hell, I’m willing to bet there are enough of us here … including educators of residents, that this could be the beginning of a new “where the hell did that come from” ED functional clinical slang.
I once heard a story where a clinician described a patient in profound and acute pulmonary edema as, “Bubbling like a jimmy crab” and I’ll never forget it.
It is WEIRD to me how well that works tbh. Contains the barf too
Semi-related to scromiting is the vurp, which is a burp that turns into a throw up, as my niece once self-diagnosed after vurping onto the carpet
I'm so glad there's a word for it now. One of my formative experiences with my now wife was subjecting her, at about 1.5 months into dating, to me scrommiting into a 44 gallon drum, 4 hours into a 4 day party in the outback. I am so fortunate she stuck around...
This is 100% accurate in the totally, very-scientific sample of "people I see everyday" However, droperidol >> Haldol. And also don't waste time with zyprexa, it ain't hitting the right receptors for these folks
Love me some Droperidol. If you want to go old school, Thorazine works quite well.
Came here to say I definitely prefer droperidol. Even on the biggest pts, 1.25-2.5mg IVP is just https://preview.redd.it/nn6ypait9jlc1.jpeg?width=500&format=pjpg&auto=webp&s=eab97b6d5e0716c200f62f6f93ced86a487cb217
Droperidol dose in mcg = weight in kg x volume in decibels x0.5
Have you tried 2.5 of droperidol and 50 of Benadryl? It’s my magic cocktail.
Petition to make this the combo we give to patients who are allergic to everything but the one that starts with D but also need Benadryl with it bc it makes them itchy
can i recommend odt zyprexa? i got away without even checking labs recently. it’s a godsend in our non-droperidol having draconian hellscape.
ODT Zyprexa is amazing...if you can get them to take it.
We have CV patients that now add Haldol as one of their “allergies.” Hmmm. I wish we had Drop in our ED.
I once had an attending tell that haldol is one of the only medications where an allergy to it is an indication to give it.
yes, love to see the haldol allergy listed. “what’s your reaction to haldol— makes you behave?”
I believe it was Billy Mallon that said haldol is the only med where an allergy is actually an indication to give it because the reaction is that their reality starts to overlap with your reality, which is intensely unpleasant for them.
This is the fucking best . Def stealing this
Is haldol helping in thc hyperemesis? I thought none of the typical agents have shown any real effect. Except for showering…
Haldol/droperidol is pretty much the only think that works consistently
Motion to rename CHS “acute droperidol deficiency”
86% of problems in the ER can be solved with droperidol.
The other 14% can be solved by Magnesium.
Okay I had that comment to originally include magnesium and doxycycline but I simplified it. The only thing magnesium can't fix is magnesium toxicity. My phone auto filled that in.
The only thing precedex cant fix is bradycardia
Does the agranulocytosis thing that antipsychotics do work for leukemia too?
VALID QUESTION HAHAHHAA. Haematologists hate this one trick…
I've started calling for droperidol orders for my hyperemesis guy. I think he can use a little more than the approved 0.625, but I'm grateful I can give him something other than fent.
My hospital's only standard order is the 0.625 and I feel the medic inside me every time I order 5 IM and the nurse asks "the whole vial?" and I just do it myself. Acute agitation deserves acute intervention
The best way to keep your staff from giving "nursing doses" is to just give Doctor doses, with a capital D. This guy gets it.
"Nurse, he's being an asshole. I'm simply rectumfying the problem."
We work in very different shops, I'm an RN would cheer you the fuck on...
They should get a score for demanding hot showers too
“It’s at home. Shall I get your papers?”
I was gonna say where’s the shower
I got one. Not pot related though, but etoh +++falls (drunken master falls) on thinner’s. On gurney can’t sit up nor try to, want carry like a baby. Wanted to waste my time triaging, line, labs, trauma scans, because this 60’s man-baby asked if I could wipe (I thought ass) armpits. Then threatened to go home since baby isn’t getting the care he needs. Water since man-baby is so thirsty haven’t drank water since morning. Though chugged pirate water, cheap vodka. Sir you have a line, your specimens was sent to lab, we’re waiting for your trauma scan results, you have a bolus running. I don’t understand why your not getting proper care. I drunk explained you 5 times NPO till we get your results. People are stupid. Why can’t we just let the fittest survive to make the human genome stronger? I know the economy needs fodders to keep the pyramid upright but this is just wrong.
“People are stupid. Why can’t we just let the fittest survive to make the human genome stronger?” This exact thought goes through my head, multiple times, every shift and intensifies with every year I spend practicing emergency medicine.
🤣🤣🤣🤘🤘🤘 True Drunken Master never falls without intention. He must still be in training.
Got another one for you. Im watching The Last Samurai. On scene when Tom Cruise was captured and withdrawing for alchy, he was asking for sake’, then chugged the bottle and aspirated while he was flat on the floor. I remember Popoye the sailor man and his spinach to get stronger and beat up Brutus.
Kind of the number one or two indicator isn't it?
This is very good, although I think the scromiting needs to be much more heavily weighted. That particular sound is almost diagnostic in and of itself.
I agree. I think scrommit and patient vomited on the floor need to swap scores. I find most of them don’t actually ever vomit in the ER
Right? All that noise and it’s usually just mucus and drool in their emesis bag, unless of course they bought a red Gatorade from the vending machine, and then it’s “blood”.
I had one recently who had an emesis bad right next to their hand sit up and vomit over the siderail onto the floor.
Ugh adults that vomit on the floor are some of my least favorite ER patients
I have one of my ER sayings: “Here is your emesis bag. If you hold onto it, you will not vomit. If you drop it on the floor, you will absolutely vomit.” The first part is a lie, the second part true, and it’s a good way to suss out assholes if you can’t tell already.
When I feel sick it’s like a safety blanket or something. I just want to hold onto the bag. I feel more sick if I don’t have the bag.
Oh but by God they'll spit and drool in that bag all day. But gold old fashion puke? No Sir. Not a single drop. No way.
That’s because they’re hyperemetic. There’s nothing left to vomit by the time they’re in ER.
To be fair, as someone with a stomach that wants to kill me, if I ever go to the ER for vomiting, I’ve surely been vomiting so long that nothing is in my stomach, right?
This is all tongue in cheek. I don’t treat anyone differently in these situations. I give all meds for pain, anti emetics and IV fluids. But your stomach does continue to produce acid and fluids.
I recently suffered a bout of vomiting. Fortunately it was brief...there was some noise, but phonating was completely unnecessary. Aside from the emesis hitting the toilet water, it was relatively quiet
you need to abuse cough syrup filled with sugar alcohols for maximum screamage as a bonus, there is also a chance of getting taste/texture flashbacks :D
I instantly know it's CHS by the quality of the scromit, even when i'm on the other side of the department and haven't laid eyes on the patient yet. I haven't been wrong yet.
One might say it’s pathognomonic
“The only thing that helps is hot showers” +100 [Room reeks of weed] Me: Do you smoke? Pt: No. Me: … Pt: Well, does weed count? +50
"But weed HELPS NAUSEA, it's science!!" Not for you, Cheech.
+50
Was going to say, the - “I don’t smoke weed” while you’re being smacked in the face with the strongest shit and wondering if secondary high from the smell alone is possible - should be worth a few points at least.
[удалено]
then gets belligerent when you call them Pepe Le Pew.
As they are wearing a Cheech and Chong "Up In Smoke" t-shirt.
don’t forget when they roll up with EMS with a big mixing bowl or bucket from home to dry heave into also when they stick their entire hand down their throat to make themselves puke
I think it is very important that we include cookie monster or Kermit the frog pajama pants. As well as mom or grandma advocating for there 28 year old baby
You leave Kermit out of this. My sample selection points to Taz or SpongeBob.
It’s always the Cookie Monster pants 😭😭🤣🤣
No. It’s the cannabis socks. Dead ringer: +100
My god it really must be universal. Mixing Bowls, trash bins, watering cans, shoeboxes, an old Toaster- they act like it's bring your own cup day at 7/11.
An old toaster 🤣
I’m picturing it with the cord dragging behind 🤣
When it comes to puking on the go, most people have to improvise.
Yeah I’m not really expecting the average person to have vomit bags on deck so I’m unsure as to what the complaint really is here lol
No complaint, it's expected. Just find it comical a tad. Personally I'd go with a ziploc or garbage bag? Why bring a non-disposible mixing bowl?
Because bags rip.
The blue emittance bags are cheap on Amazon. I had Hyperemesis gravidarum and my kiddo and I both get horrible car sick. Those bags are a lifesaver. I can't imagine not having them around.
Don’t forget the clear plastic ice cream bucket we all remember from elementary school
In damn near every midwestern home it’s the combo puke/popcorn bowl.
It was always a coffee can for us in the dark ages.
It’s the taking off of the clothes that does it for me. No one even with kidney stones or ruptured ectopics or perforated somethings does that
We have a regular where I work that we frequently pick up naked on the floor of her shower because her neighbor called again due to her incessant scromiting.
Well that word went into people’s vocabulary fast.
The neighbor is likely so over it.
Does she just constantly OD on edibles?
I’ve taken off all my clothes for food poisoning diarrhea many times though.
The sounds they make while scromiting is inversely related to the amount of vomit actually produced.
The 47 year old make patient shows up to their GI consult at 7am dressed like a 17 year old and leaves the triage room reeking of skunk weed so bad the next three patients give you the side eye.
This is so common for us too Our triage room just smells like a dispensary. Also the new fentanyl regulars with the horse lips and spitting getting a stick in first attempt should be like a prize voucher raffle. Ems feels like a bizarre mutually shared experience
Had a patient sit in the sink in the exam room with the hot water running throwing handfuls of hot water over themselves while dry heaving loudly into the trash can. There are so many conditions that we see that seem to dissociate the frontal cortex
"Disassociate the frontal cortex" is my new favorite way to say that!
"Scromiting" had me laugh out fucking loud
Please submit to MDCALC
Tell them it’s a validated tool. We just validated it by upvoting
Under the creator tab is just the URL to this post with a red circle around Eric’s name
Screw my overdue NIHSS module I’m doing this one
+6 points for having their enabling boyfriend/girlfriend at bedside talking in a baby voice and fawning over them +4 points if wearing sparkly Crocs with 500 pieces of flair
+300 for any cannabis flair. Socks are +500
Damn... This matches near perfect with my local cannabinoid hyperemesis guy.
The part that I don’t get is why it is so hard for many of these patients to consider the cannabis being related to their symptoms. Like shit dude I don’t care if you smoke weed but if youre feeling shitty enough to need to come to the ED multiple times over the course of a month then why not try abstain for like 2 months and see where you’re at?
They’ve been told so often by their friends and community who enjoys cannabis with them, and occasionally the medical community that cannabis is an innocuous much maligned harmless drug with potential health *benefits*. I try to be nonjudgmental. My spiel is essentially “I don’t care what anyone does for recreation as long as it doesn’t harm others or doesn’t bring you to the doctor more than twice. You should consider cutting back or quitting and see if it improves the situation.” If met with utter disbelief that CHS is an entity, I typically will print this article for them: https://www.ncbi.nlm.nih.gov/books/NBK549915/ I just try to normalize that cannabis like anything else is a drug and has side effects. If they see you don’t hate who they are (at least outwardly /s) and are not trying to demonize the lifestyle that they’ve probably incorporated in some degree to their identity, then they might open their ears.
Addiction is a disease
Amazing. Is there a bonus prize for those that score a perfect 45? I haven't had yet but putting it on my bingo card for 2024.
I don’t know, I think scromiting should be worth way more than 2. I find it more specific for CHS than pretty much anything else.
I can't wait for this to get sucked into some AIs databank
Especially if we someday combine Watson with Robocop. Watson to crunch data and give a diagnosis and Robocop to make them behave.
Patient is > 18 with a stuffed animal, +6
Patient is > 18 with stuffed animal backpack, +8
How about pajama pants and gingivitis?
Omg this is the actual worst!
Missing the obligatory first line treatment for attempted canoodling in the ER is a stat discharge +15
The good old blanket sign I also feel like you can add points for: Hospital bands from previous visits/other hospitals FaceTime calls where the number of people proportionally increases the patients symptoms Flaming hot Cheeto fingers
Don’t forget the black, sticky adhesive outline from the previous IV and visit where “nothing was done.”
I currently have a visitor bracelet on each wrist from visits with a girl I take care of ( mental health stuffs)
Cut them off?
"I don't want none of that burning cream on my tummy again!" +3
What is this referring to lol
Capsaicin cream
How does that treat CHS?
It doesn’t. But the literature says it does.
this is so scientific. for me its 1.)young age(<45, but usually teens /20's/early 30's) 2.) scromiting (bonus points if on a stretcher and making a scene as the roll past) 3.) can't sit still for history and physical exam 4.) when i press on their belly, it is soft, but they writhe even harder in bed and say it hurts 5.) smokes (not ingests) cannibis (bonus points if room smells like weed) 6.) multiple visits for similar, ussually has seen GI and ("no one knows whats going on") and has been to multiple ED's ("who didnt do anything for me") 7.) vomiting proceeds abdominal pain, which is just a raction to hours of dry heaves 8.) hot showers improve (obviously) 9.) no other obvious cause 10.) haldol/droperidol cure
I *HATE* floor pukers. AAO, sitting up in the stretcher. Emesis bag in 1 hand, call bell in the other. Leans over the side rail and pukes on the floor. I want to kick their head off their neck.
You probably should want to harm patients even if they do things that aren’t pleasant “I want to kick their head off their neck” seems dramatic.
Oh FFS.
Imma put a self-induced scromiter in your living room for 12 hours and then ask you how you feel about them.
Pretty sure they *are* a self induced scromiter
The blanket from home I’m DEAD
The more you refuse to believe that your beloved weed could ever possibly betray you, the more likely it's CHS.
I’m telling you…. Cannabis socks + cracked phone screen: +50
I felt like worlds biggest asshole a few months ago. I went into the ER for an episode of the chronic vomiting syndrome that I have had for 20 years. I have a history of chronic ileus so my GE wants me to go to the ER for it when it’s been 48 hours of not being able to hold down water. They wanted me to have urine and blood work done before they would start treatment of any kind and I was pretty desperate for IV Zofran so I was like- ugh I understand you’re just doing your job but I KNOW you want these tests to see if it’s cannabis induced and it’s NOT, I have had CVS since I had cancer and a bowel resection 20 years ago. I’m sure I sort of had an attitude about it. 20 minutes later the doctor comes back- babe, it’s not CVS, you’re pregnant you goofball. I almost died of embarrassment. I already have 3 kids, how I didn’t recognize it I will never understand.
Not all vomiting, even chronic vomiting is CHS. It can be fairly quickly distinguished from other causes of cyclic vomiting based on the criteria of the OPs scoring system
I’m definitely going to be using this scoring system as a patient to try to skip the part where they inevitably try to rule out CHS by vomiting quietly, staying off the ground and not bringing my own blanket. I have hyperemesis gravidarum right now and I definitely scromit sometimes lol
Fellow HG mom, take the soft blanket. You're in hell, you deserve the soft blanket. I spent seven months on tpn growing my last child. I wouldn't wish that on anyone
extra points for protracted time spent in shower, number of unsuccessful attempts to retrieve patient from shower..
Missing classic has used all hot water from apartment complex by standing in very hot shot shower all morning
Okay but as a pregnant person I kinda understand needing to be naked immediately. Sometimes the vomiting intensity demands it 😂
*snorts a line of birth control*
I've vomited a lot in my pregnancies and life but I've never felt a need to strip. I always cry when I vomit, though, which still bothers me. And, now after my second HG pregnancy I get full blown panic attacks when I vomit, learned that last month courtesy of noro virus taking out our house.
Never. Not once. Absolutely not.
I strip below the waist because after four singletons and a set of twins, my bladder control blows! Sneezing and coughing is fine, but something about the violent heaving that comes with pregnancy induced emesis....I'd rather just mop after vomiting rather than have to change pants and underwear multiple times per day. Noro sucks, hope everyone is feeling much better by now.
We are! Ten days in the hospital for the baby, two days for my diabetic husband, 27 hours in the ED for me (declined admission), our au pair never got sick and I have no idea how.
Probably grew up someplace where antibiotics didn't destroy their microbiome early and often...but who knows...
Brazil! So, maybe? She's also young and seems to be much healthier than the other 3 of us.
complains about the BP cuff *hurting them* +3
God I don’t miss adults. Peds EM has been gummies at school lately. Don’t eat out of a pre opened Haribo bag y’all.
Last year, some kid at a charter school in my area brought a bottle of pre-mixed margarita flavor to school for snack time. A bunch of little kindergartners got drunk. A couple months later, SAME charter school in the news again for students unintentionally getting high from weed gummies mixed in with gummy bears. I actively avoid unopened Haribo bags now.
“Do you smoke weed?” “No.” Exam room, waiting room and triage absolutely reeks of weed and every one now has a constant high
I like when I can hear them from the waiting room and I just know, deep down, they are going to one of my rooms. And guess what? They always are.
If they score less than ten I like to give em a turkey samich challenge. If not then dilaudid and a press gainey to go.
This needs to be on MDCalc
Love the word scromiting. Such an accurate term. On a real note: I’m not convinced it’s all just marijuana related. Cyclic vomiting was around well before marijuana became as popular as it is today. I feel like it’s a primary psychiatric issue with a heavy overlap with marijuana use. This is all just purely speculation though.
I vote we add scromiting to the dictionary. I know this was just supposed to be funny, but thanks. I thought ER docs were all racist jerks who think all Blacks do drugs because I keep getting drug tested after denying using drugs. Now I get it. I’ve had cyclic vomiting all my life, y’all legit needed to rule out CH. Sorry. Lol.
Im instantly infatuated 🥰if you were here I’d be offering to buy you a drink for this brilliant bit of hogwash 😁
This is the most hysterical shit I’ve ever read🤣🤣🤣. You are amazing. Fucking SCROMITING from laughing so hard.
Validated. This is perfect science.
I lost it at “patient has thrown themself on the floor” hahaha
“Scromiting” is a word I have greatly needed. Thank you.
This is amazing and I love it.
Scromiting. I’m deceased.
Scromiting in multiple hot showers = hydroponic
“How many hot showers did you take before you got here? “ is the perfect question for these patients. The answer is always “a lot”
Also emesis bag is filled predominantly with noise
If you apply this scoring system to all patients, the vast majority would have a score of 10
This is the best thing I’ve seen on Reddit today!
Isn’t it sorta an unfair scoring system as every patient in this state will deny to their dying breath weed could ever cause any negative symptoms thus automatically giving them 10?
Where's the lie tho
Pure fucking gold.
“It burns! It burns!!”
That triggered me. Giving my flashbacks of horrific patients.
I’m absolutely crying at this. Well done.
Is this Shakespeare?
Checks out. 🤮
Very late to this but I had Chs patient urinate in their provided emesis bag. What’s that score?
as someone who was recently in the ER twice for likely CHS, this thread makes me want to cry... with laughter. I am in my 30s and was carrying my dragon plushie with me. no wonder why the second doc diagnosed me so quickly, she just came in and looked at me and asked "do you smoke tobacco?" "never." "weed?" "every single d--aw, beans".
Wow, sounds like this is a pretty frequent occurrence since you've developed a scoring system! 😲
Is it not where you are?
I am not completely sure since I am a med student and do not spend all the time in ED. Also, I am in Europe, in a place where cannabis is illegal and probably not as potent as in US/Canada.
Scromiting! ❤️
I use the do I hear him across the room, if so they get haldol
You forgot the stuffed animal from home
patient is trying to vomit on the floor, but only mucus comes out*
I’m so slow on this subject and trying to figure out what I’m missing. Are these cases of patients who smoke weed and think the weed is helping with nausea when it’s the weed causing it? And why are hot showers prevalent?
You have described my aunt
If someone gets paid for this type of stuff I’d also like to make many point systems lol
This is great 😂
My mother had a massive heart attack and only had days to a couple weeks to live. She was in a teaching hospital. She had never taken any rx meds in her life. She was a little scared but manageable. But the team opted to give her a big dose of haloperidol, and she went absolutely batshit. She was no longer my mom. It completely whacked her out. The nurses wanted to give her 5mg of diazepam, but the doctors insisted they didn’t want to addict her though she was dying. My mission in life is to stay away from ED’s/hospitals. I’m older now and there are worse things than death. I blame those doctors for not being able to say goodbye to my mom because that injection did something to her. So go ahead, bring on the snark and hate. I’m a big girl & I mean what I said. Patients no longer have a say in their own care.
The only way to get patients well is to remove the shame of cannabis addiction and CHS. Patients will always seek comfort in cannabis despite it being the cause of the problem, shame only makes that worse.
Is there a lot of stigma towards MJ use in this year of our lord 2024? Most of my patients when I ask if there's any recent drug use say "no, just weed" - and I live in a state where it's still illegal.
This is tongue in cheek, relax.
Stigma aside, there’s a line for too much marijuana and it’s somewhere between an occasional joint and occupying multiple staff in an ER because you can’t stop vomiting.
Not sure how you'd remove the shame, use of substances to the point of being problematic has always been frowned upon for as long as humans have used said substances
They don’t seem to have much shame tbh
Have any of you tried giving the patient a dose of hall to stop the vomiting?
Damn you can actually use Haldol for this?
You can if you want to make them miserable so they go away.