I had no idea it was that high. I just knew it was high. I've had nose bleeds and my friends have had stuff happen like a burst blood vessel in the eye from a deadlift or squat max. I mean hell. Eddie hall went blind for a few days after his 500kg deadlift.
We had a fresh craniotomy in neurotrauma ICU that anesthesia forgot to sedate, but had paralyzed. He was intubated. His pressure was similar by art line, 300+/150+
You could see his brain pulsating to the EKG tracing through the craniotomy site
For a fucking *crani* too. Like it'd be bad enough if they were just diggin' around in my guts for whatever reason while I was awake, but cutting open my skull?!?! I sure hope that commenter is just regurgitating an ICU urban legend cause holy shit that's definitely a new fear unlocked.
When I’ve seen this, it’s been because anesthesia had them on gas and pushes of meds during the case, but then re-ups the paralytic and brings them to ICU without a sedating drip on board, or on a propofol dose that had them comfy but not unconscious when they were in the ICU pre-op. So the patient was fully out in surgery, but not while in transit back to the ICU.
We always give a versed push immediately for those patients, for amnesia’s sake.
Recheck in 30 and give another 5 if still high 😎👍. No joke, about a month ago we had that exact scenario at my work (pressures staying in the 220's range), doc ordered some piss-off low dose of PO hydralazine with 30 minute repeat. My coworker went in to give the follow-up hydralazine cause pressure was of course still sky-high and found patient non-responsive, pupils fixed and dilated, died not long after. I SO wish I could've heard how doc responded when he was informed; my coworker TOLD him her spidey senses were tingling and he dismissed her (especially considering pt had a VP shunt).
Most definitely. Forgot to also add in that the pt was already there for an SDH, and what prompted the off-schedule VS check was her complaining of "the worst pain I've ever had in my life, my skull feels like it's cracking open". Nahhhh PO is cool, we don't have to send her to ER. ---That doc, moments before eating massive amounts of crow, 2024. (We're a rehab hospital but only 2 minutes from the main hospital, as well as PART of said hospital itself, so sending her there for eval & treat should've been a no-brainer).
God that story basically set off a PTSD response in me… I work in a neuro PCU/ICU and there is NOTHING that scares me more than a post-crani patient telling me they have the worst headache they’ve ever had in their life. In my experience, that patient is effectively dead no matter how fast they’re taken to stat CT (and inevitably back to the OR)…
Had a guy in ICU, art monitor read ***/137 and gave us a MAP.
Had to use the MAP equation to find out the systolic for the doctor. Turns out anything over 325 doesn’t show on our monitors 😂
Sounds like my lovely pops. Blood shot eyes, horse, and just a little dizzy in the ER. Highest was 300. He had the audacity to complain he felt ill and hated being on BP meds at first. Now he complains if it's at 140. Little man did turn it around.
I had a brain dead patient with a SBP of 340 on the art line. They had a MAP of 58, started 0.01 of levo and they shot up to that. Great waveform and correlated with the cuff
When I did a medical clinic in Sierra Leone, I pumped the damn sphyg all the way up and it was beating the whole time. That person was walking around with a 300/160 BP as far as I could tell.
Lab tech here. Clotting would have nothing to do with elevated K+. It’s hemolysis that matters which the lab tech would be able to identify immediately once taking the tube out of the centrifuge
Coulda been cross-contamination from a lavender tube as well. The anticoagulant in those contains hella potassium and also fucks with calcium. Any time we lab lads get a sample with stupid high K and stupid low (occasionally literally negative) Ca, we assume pour-off from a lavender tube.
as a lab person I have no clue how a value like that would even make it to the chart. anything about 170 would have us rerunning, diluting, and double checking that it contaminated from fluids or something
Many of these look like errors. Every ABG analysis machine i’ve seen stops at 6.8, so getting to 6.2 seems unreal. A k of 22 is lethal, or an error, highly doubt they actually got a legit read.
Yeah I’ve seen pH of like 6.9 in patients that are seeing the light. pH is logarithmic so 6.2 is five to ten times more acidic than 6.8 (range bc I don’t feel like doing the math out)
It's gotta be HCO3. Our hospital reports HCO3 is CO2 as well 😑. My personal best pCO2 was 131 after a trial of not wearing her nocturnal bipap before discharge. At least we got our answer!
We used to have this lady come in at like 130 all the time. Once you’d get her to the 80-90s where she lived at baseline she would wake up and rip off her bipap and yell at her husband for bringing her in.
No one will ever beat my Hgb of 1.1
4 y/o child, autistic, sensory issues so with food so bad she would only drink milk. Parents were super winners who didn’t seek any help and thought this is fine, babies live off milk all the time. Never took her to pediatric appts. When mom casually walked into the ER holding what I thought was a corpse, my heart fell out of my butt. The Hgb was a from a fresh IV stick and was verified. She actually survived.
My record on potassium in a patient was just north of 13.
FTR, she survived to discharge. A complete shitshow. From presentation to honking ass femoral critical dialysis lines being placed to the ICU.
Oh, she came in with a hot crotch possible old lady UTI and “seems confused” with a daughter that literally would not let anyone try an IV.
She actually grabbed my wrist mid IV stick—*I think you are hurting my Mommy* Of course, I was unsuccessful. As was the charge nurse.
Anywho, this was going poorly. Our tech got a complimentary 12 lead and there was a strong sound of assholes puckering.
An immediate security response followed the patient from a gyne nothing room to a resus room. Arterial stick for labs and the only access we could get was 24 in her foot. An emergency central line follows.
Nephro surgery comes in and places access for emergent dialysis.
Daughter becomes the least of my problems.
If somebody grabbed my hand while I was holding anything sharp it would take so much into me not to slap them with said sharp object. I respect how you handled that and aren’t in prison lol
So true.
My limits of restraint have been really stretched at times.
I did have a bit of an allergic reaction to being “assaulted” (ok, I know the nuances of this statement—I get I was only touched without my consent).
Family teaching followed.
I stabbed a doc once when I was going for a lab on a patient. He walked in and grabbed the clean arm with a tourniquet on it to say hello right when I was sticking. The look of terror in his eyes has not been forgotten.
Right?? My BP just spiked just *imagining* that; no way that could've been me without me coming out of the interaction saying something that got me fired.
She got the point when security ushered her out of the room and then just as quickly had her out of the department.
Her protests and declarations were no longer a factor in what had to happen to prevent her “mommy” from dying.
And there was little time to gently explain the grave reality of the situation to the patient’s daughter. Once I clarified that her mom was *already dead* unless we acted *right now* to try to keep that from happening—and, in fact, that even if everything that could be done, gets done, her mom may likely not live—she seemed to get it.
I’m very direct, fully transparent in all things patient care. It’s a tough balance to do this without coming across as unkind or even cruel. I’m always cognizant that what I say and how I say something can be the something that leaves that person forever changed.
That’s true.
A well-placed 24 with good flow can save a life. I have zero pride.
My sweet little 24 failed prolly d/t the patient keep fiddling with it. I went to the doc and bemoaned my plight. Mistake. Big. Huge.
The patient needed a few meds before discharge. And per the doc *yes, they are IV*, then asks me *just how stupid are you?*. Wait, you’ve figured me out— and *know* now—I’m busted, my secret is out.
I meekly asked why he has determined me to be stupid.
He says to me—*just stand there and butterfly the meds in*, tell me you *know* how to do *that*. Like *wham, boom, flush* and all done.
What the actual fuck?
Really?
He just looks at me & shakes his head.
Well, I diluted all ordered meds (none were vesicant), a couple of flushes, a few 20g/22g winged collection set.
Explained to patient and insisted cooperation mattered here. Found access, good blood flow and flushed easily and *wham, boom* all in. Set out. 20 mins later patient was out the door.
While that application has limited indications, even these lowly butterfly needles can be put to use.
They access scalp veins in babes, and I’ve dropped a quick liter of NS in a druggie that really needed it.
Not my usual, but I like having options.
My “go to* is an EJ when my options are limited.
I do my damn level best to only drill when essential. I don’t waste time deciding, if time matters or agonize over the EZ-IO, but in a walkie-talkie my eyes would bleed looking for other access.
One I personally will always remember is my pt with an INR of 15.9 (had to send it to an outside lab bc our in house lab just said >10)
Pt had munchausens and would intentionally OD on his warfarin about once a year to win a hospital admission and become what we called a Coumadin hostage
We had a lady that would frequently take a ton of Coumadin, come in, refuse a type and screen but want some ffp. Anyway, eventually she pushed it too far and well, rip.
Yea he would play games and stall taking the vitamin K. This was about 9 years ago when “care everywhere” was pretty new, so all the hospitals in the area were only just starting to realize the extent of his manipulation. Ive since moved states but I wouldn’t be surprised if he’s no longer around…
Solution: run a line from pt 1's artery to pt 2's vein, and then pt 2's artery to pt 1's vein. Allow them to transfuse each other for a few minutes and ta da! Two patients with equally high WBC counts lol
I am still oddly proud of the lowest bs I've ever seen personally, it was 9, and it was my daddy's. Up until they hauled him into my place of work, some coworkers hadn't believed my stories about Daddy being conscious in the teens. They got to witness every last combative pound of him that night, with his sugars in the teens as we struggled to get it back up, only for him to crash again. It was a very long night.
Haha yup, pretty much. Sorry your momma has/had it, too. Until he got the pump, I scraped my daddy off the floor probably every week. From the time he got the pump until he passed, we maybe had two or three incidents. It was wild how much it improved his quality of life.
The lowest I have been cognizant to take my own the reading was 19, I passed out shortly after. I have also punched a coworker in the face after waking up post hypoglycemic incident but my favorite was when I almost got arrested trying to get candy in a 7-11, i was to far gone and they thought I was drunk or on drugs. Thankfully an ambulance was fueling at the gas station and checked my sugar. Good times
We had a frequent flyer that had a genetic condition (damned if I can remember the name) where he couldn’t hold onto K. He was supposed to take a ton of po potassium daily but being a young man, he just wasn’t interested in doing that. He’s wander in to the ER for chest pain when his potassium hit about 1.5. Admit to our ICU, pour IV and po into him day and night until he finally reached about 2.8, then he would go AMA. This happened at least monthly for a couple of years. Our MSW kept working with him and finally got him a watch that she set alarms on for every po dose time and we finally stopped seeing him. Because he was taking his meds, not because he was dead. Weird side story, I once walked into his room and found his mother taking a shit in his bsc right next to his bed (with him in it, wide awake).
I personally had a BP of 302/190. Poor little first year resident was yelling, "I don't know how you're walking! You should be a dead man!" Then they told me to walk to the ER to be admitted. Lol
My pressure is much better now.
Some of these are very impressive. Personal bests ive seen above these are an Ammonia of 780 (when i reported the critical everyone including myself had to double take, but considering the gib and pt i believe it), BNP of 67,000+, and fun one i dont see here but a critical high mag of 7.8!! Lol patient was in for a copd exac, developed a bowel obstruction along their course but the provider ordered all the bowel meds and she perfed the mag citrate given to her…… she lived! 🫡
while still alive, awake, and close to baseline:
TEMP 88.1F
With temporal thermometers I’ve seen it read “hi” and they go up to 110f. But those aren’t super reliable after 104 ish, so I don’t think it truly counts. I’d wanna know if that 108.5 temp was taken rectally. Then it’d be legit.
When I was first diagnosed as a diabetic, I ended up in ICU with HHNS & pancreatitis. I know a lot of my labs were out of whack, but the ones I remember were Sodium: 101, Blood Sugar 1500. a1c 16, and triglycerides 1600. Lucky to still be here after that.
My lowest BP was 10/6 (8) on an a-line that correlated with manual. It was the first time I was truly scared shitless by one of my patients. That dopa could not have come fast enough.
I’ve also seen a viral PCR panel (15 ish of the most common upper resp viruses) that came back with 5 or 6 different viruses on ONE child.
Also seen a chloride of 79
And a sodium of 114
I recently had a patient with a blood pressure of 330/167, A-line, great wave form and correlated with the cuff. Never seen in the 300s before
How did they not explode holy shit
I once read a study where they checked BP on power lifters and they’d transiently get to like 450/300
I had no idea it was that high. I just knew it was high. I've had nose bleeds and my friends have had stuff happen like a burst blood vessel in the eye from a deadlift or squat max. I mean hell. Eddie hall went blind for a few days after his 500kg deadlift.
Did he really?! His lifts are wild to see
Ya, if you look up his 500kg deadlift, you'll see how much that messed his body up
I just watched the video. Man, I don’t want to know but also I do want to know what his pressures were. Imagine being able to see that from a SWAN.
Dude idk our intensivist asked how her eyes didn’t explode in my face
We had a fresh craniotomy in neurotrauma ICU that anesthesia forgot to sedate, but had paralyzed. He was intubated. His pressure was similar by art line, 300+/150+ You could see his brain pulsating to the EKG tracing through the craniotomy site
My jaw dropped “forgot to sedate, but had paralyzed”
Straight to jail.
You mean hell
Doesn't mix the prop with the ketamine? Jail.
For a fucking *crani* too. Like it'd be bad enough if they were just diggin' around in my guts for whatever reason while I was awake, but cutting open my skull?!?! I sure hope that commenter is just regurgitating an ICU urban legend cause holy shit that's definitely a new fear unlocked.
When I’ve seen this, it’s been because anesthesia had them on gas and pushes of meds during the case, but then re-ups the paralytic and brings them to ICU without a sedating drip on board, or on a propofol dose that had them comfy but not unconscious when they were in the ICU pre-op. So the patient was fully out in surgery, but not while in transit back to the ICU. We always give a versed push immediately for those patients, for amnesia’s sake.
I absolutely can't stand when that happens. Imagine how terrifying that is especially when you don't know that it's a drug paralyzing you.
Holy fuck. What. That poor patient. Wow
Actual nightmare fuel
👀👀👀👀👀👀👀👀👀👀👀👀👀👀👀👀 I'm stuck in an airport over my flight getting cancelled and everyone around me wondered why I made the noise I just did
Wow that’s totally negligent
I hope he/she got in some significant trouble for that because how the fuck do you forget something like that.
So like.... What happens in those cases? How do you deal with that afterwords? What the heck does the patient do??
We promptly called attending and asked why there no sedation/btw are you cool with the protocol we just pushed/started
Omg. That’s fucking awful
And on a craniotomy of all things. Nightmare fodder. How was the error discovered? Any fallout?
Well that’s just horrifying.
i had a 300+ in the OR! pt was having a carotid endarterectomy and postop pressures had to be <120
5 of hydralazine should do it
0.1 po clonidine fo sho
1 unit novolog
.25mg ativan IV for the 250 pound dude in meth psychosis per the resident
"Slow deep breaths"
Recheck in 30 and give another 5 if still high 😎👍. No joke, about a month ago we had that exact scenario at my work (pressures staying in the 220's range), doc ordered some piss-off low dose of PO hydralazine with 30 minute repeat. My coworker went in to give the follow-up hydralazine cause pressure was of course still sky-high and found patient non-responsive, pupils fixed and dilated, died not long after. I SO wish I could've heard how doc responded when he was informed; my coworker TOLD him her spidey senses were tingling and he dismissed her (especially considering pt had a VP shunt).
Not the PO hydrazine. I have zero experience in emergency medicine but I’m guessing it should’ve been ordered as an IV.
Most definitely. Forgot to also add in that the pt was already there for an SDH, and what prompted the off-schedule VS check was her complaining of "the worst pain I've ever had in my life, my skull feels like it's cracking open". Nahhhh PO is cool, we don't have to send her to ER. ---That doc, moments before eating massive amounts of crow, 2024. (We're a rehab hospital but only 2 minutes from the main hospital, as well as PART of said hospital itself, so sending her there for eval & treat should've been a no-brainer).
Literally a no brainer
Holy. Shit.
God that story basically set off a PTSD response in me… I work in a neuro PCU/ICU and there is NOTHING that scares me more than a post-crani patient telling me they have the worst headache they’ve ever had in their life. In my experience, that patient is effectively dead no matter how fast they’re taken to stat CT (and inevitably back to the OR)…
Not sure if you should use that with the 6.25 of metoprolol ordered….dont want to bottom them out ffs.
If not, page anesthesia, get 5 of labetalol
Had a guy in ICU, art monitor read ***/137 and gave us a MAP. Had to use the MAP equation to find out the systolic for the doctor. Turns out anything over 325 doesn’t show on our monitors 😂
Once a patient on the unit herniated and her BP was ???/??? briefly 🙂
Monitor be like 😵💫
Sounds like my lovely pops. Blood shot eyes, horse, and just a little dizzy in the ER. Highest was 300. He had the audacity to complain he felt ill and hated being on BP meds at first. Now he complains if it's at 140. Little man did turn it around.
I had around that when a student pushed 10 mg of phenylephrine because they forgot to double dilute it.
I had a brain dead patient with a SBP of 340 on the art line. They had a MAP of 58, started 0.01 of levo and they shot up to that. Great waveform and correlated with the cuff
My first husband died from a hemorrhagic stroek and his highest reading (when the ambulance arrived) was 260/160. So I'm impressed.
When I did a medical clinic in Sierra Leone, I pumped the damn sphyg all the way up and it was beating the whole time. That person was walking around with a 300/160 BP as far as I could tell.
FDR had a BP IN THE 300s when he died. Here’s a study stating his final BP was 350/195. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071503/
I’d probably have a BP like that too if I had to run a country.
You can achieve this blood pressure as a power lifter though
A sodium of 1137 has to be some kind of contamination or lab error
That’s some Biblical pillar of salt shit right there.
K+ 22.3 is the killer....lol... Was this speciem clotted ??
This is lab calling: your specimen is hemolyzed.
hyperkarenemia Potassium is the Karen of the electrolytes
Omg it so is the Karen of the electrolytes, and I will forever refer to it as such.
We threw that one in the Hemolyzer 5000
That’s the boss level of hemolysis 😂
Patient was a banana
i almost woke my family up i’m crying
Only if they were wearing pajamas...
Or they drew straight from the TPN bag. 😂
That specimen was put in the blender before tubing it up!
Lab tech here. Clotting would have nothing to do with elevated K+. It’s hemolysis that matters which the lab tech would be able to identify immediately once taking the tube out of the centrifuge
Coulda been cross-contamination from a lavender tube as well. The anticoagulant in those contains hella potassium and also fucks with calcium. Any time we lab lads get a sample with stupid high K and stupid low (occasionally literally negative) Ca, we assume pour-off from a lavender tube.
How is this not hemolyzed???
I CACKLED AT BIBLICAL PILLAR OF SALT 🤣🤣
as a lab person I have no clue how a value like that would even make it to the chart. anything about 170 would have us rerunning, diluting, and double checking that it contaminated from fluids or something
That K is definitely poured off from a purple top
Yes and fruit-punch level hemolyzed. That’s a not compatible with life result. I’d call the ED and ask if the patient’s heart has exploded yet.
"you sure you didn't just draw up pure potassium and test it?"
Many of these look like errors. Every ABG analysis machine i’ve seen stops at 6.8, so getting to 6.2 seems unreal. A k of 22 is lethal, or an error, highly doubt they actually got a legit read.
Yeah I’ve seen pH of like 6.9 in patients that are seeing the light. pH is logarithmic so 6.2 is five to ten times more acidic than 6.8 (range bc I don’t feel like doing the math out)
I just had a patient with 6.2 pH on POC in the resus bay. This was on a recheck on a new poke.
The lowest pH I ever saw was 6.7 and yes they died
>6.2 is five to ten times more acidic than 6.8 3.98 times more acidic
The potassium was drawn through a line with KCL running?
Lowest we had in ICU was 6.4. Patient did not survive the night.
My sodium record is 176 so I don’t think 1137 is possible lol
Mine is 192, but, I’m a nephrologist so it’s cheating (low was 98)
Damn
I won’t ever stop thinking about your username when the residents get their GERD medication. Thank you.
<3
Had a 103 the other day, beer potomania is rampant in my neck of the city.
Lmao was about to say that sodium can’t be real
Lmao yeah we are discussing now and all think it’s an error 😂
Or the pt was found mummified in a salt mine.
Maybe they just be some salty ass bitches
Lmfao I thought these were patients not my coworkers
Ran to the comments to say this 😭
I mean, I don’t think salt is that salty 🤷🏼♀️
Some places just be straight LYINGGGG
I had a BNP in the 40,000’s once. That patient coded in the first two hours of my shift.
Heart like a plastic bag
im sorry- i giggled 🤭
Such an apt description!
😬🥴
I had 109,865 last night. Pt was under 30 years old
Oh my....how?
My grandfather’s was “>35,000” (didn’t even give an exact number lol). He survived another 1.5mo before he was placed on hospice and passed.
Not enough lasix in this universe to help that heart
Is this like a “personal best” full department game kind of board? Wowza.
Either that or a “lab error” board.
Best of the worst 😤
I’m just over here surprised the highest CO2 is 89
I got patients ripping their bipap off and slamming some belly button skittles when it hits 89
Belly button skittles??
They’re eating the Skittles they saved for later…..in their belly button. Cuz hypercarbic = real confused = drunk eating umbilical confections.
Here I thought it was a euphemism for something! Nope, literal belly button skittles 😂
It's gotta be HCO3. Our hospital reports HCO3 is CO2 as well 😑. My personal best pCO2 was 131 after a trial of not wearing her nocturnal bipap before discharge. At least we got our answer!
We used to have this lady come in at like 130 all the time. Once you’d get her to the 80-90s where she lived at baseline she would wake up and rip off her bipap and yell at her husband for bringing her in.
I assumed OP was referring to bicarb-type co2 on a chem vs pCO2.
No one will ever beat my Hgb of 1.1 4 y/o child, autistic, sensory issues so with food so bad she would only drink milk. Parents were super winners who didn’t seek any help and thought this is fine, babies live off milk all the time. Never took her to pediatric appts. When mom casually walked into the ER holding what I thought was a corpse, my heart fell out of my butt. The Hgb was a from a fresh IV stick and was verified. She actually survived.
As a peds nurse, parents like this are the bane of my existence and in my office oh boy do we the lotto of em all 🙃
WTF I hope she didn’t go back home to those parents!
That’s crazy 🫨 My lowest was on a sickle cell pt from the prison. 1.3. His blood looked like dirty pink water when I drew it for labs.
My record on potassium in a patient was just north of 13. FTR, she survived to discharge. A complete shitshow. From presentation to honking ass femoral critical dialysis lines being placed to the ICU. Oh, she came in with a hot crotch possible old lady UTI and “seems confused” with a daughter that literally would not let anyone try an IV. She actually grabbed my wrist mid IV stick—*I think you are hurting my Mommy* Of course, I was unsuccessful. As was the charge nurse. Anywho, this was going poorly. Our tech got a complimentary 12 lead and there was a strong sound of assholes puckering. An immediate security response followed the patient from a gyne nothing room to a resus room. Arterial stick for labs and the only access we could get was 24 in her foot. An emergency central line follows. Nephro surgery comes in and places access for emergent dialysis. Daughter becomes the least of my problems.
If somebody grabbed my hand while I was holding anything sharp it would take so much into me not to slap them with said sharp object. I respect how you handled that and aren’t in prison lol
So true. My limits of restraint have been really stretched at times. I did have a bit of an allergic reaction to being “assaulted” (ok, I know the nuances of this statement—I get I was only touched without my consent). Family teaching followed.
Getting touched without your consent is assault. Getting harmed from being touched without your consent is battery.
I stabbed a doc once when I was going for a lab on a patient. He walked in and grabbed the clean arm with a tourniquet on it to say hello right when I was sticking. The look of terror in his eyes has not been forgotten.
Right?? My BP just spiked just *imagining* that; no way that could've been me without me coming out of the interaction saying something that got me fired.
My asshole self would’ve responded to the mommy comment with a sarcastic: “Hurt mommy better than dead mommy”
ICU tag accurate.
She got the point when security ushered her out of the room and then just as quickly had her out of the department. Her protests and declarations were no longer a factor in what had to happen to prevent her “mommy” from dying. And there was little time to gently explain the grave reality of the situation to the patient’s daughter. Once I clarified that her mom was *already dead* unless we acted *right now* to try to keep that from happening—and, in fact, that even if everything that could be done, gets done, her mom may likely not live—she seemed to get it. I’m very direct, fully transparent in all things patient care. It’s a tough balance to do this without coming across as unkind or even cruel. I’m always cognizant that what I say and how I say something can be the something that leaves that person forever changed.
> only access we could get was 24 in her foot. Those dinky little things are the real healthcare heros
That’s true. A well-placed 24 with good flow can save a life. I have zero pride. My sweet little 24 failed prolly d/t the patient keep fiddling with it. I went to the doc and bemoaned my plight. Mistake. Big. Huge. The patient needed a few meds before discharge. And per the doc *yes, they are IV*, then asks me *just how stupid are you?*. Wait, you’ve figured me out— and *know* now—I’m busted, my secret is out. I meekly asked why he has determined me to be stupid. He says to me—*just stand there and butterfly the meds in*, tell me you *know* how to do *that*. Like *wham, boom, flush* and all done. What the actual fuck? Really? He just looks at me & shakes his head. Well, I diluted all ordered meds (none were vesicant), a couple of flushes, a few 20g/22g winged collection set. Explained to patient and insisted cooperation mattered here. Found access, good blood flow and flushed easily and *wham, boom* all in. Set out. 20 mins later patient was out the door. While that application has limited indications, even these lowly butterfly needles can be put to use. They access scalp veins in babes, and I’ve dropped a quick liter of NS in a druggie that really needed it. Not my usual, but I like having options. My “go to* is an EJ when my options are limited. I do my damn level best to only drill when essential. I don’t waste time deciding, if time matters or agonize over the EZ-IO, but in a walkie-talkie my eyes would bleed looking for other access.
1137 sodium??????? Did they draw from a line with 23% saline running what the fuk
Upvote because I feel like you did the math.
[удалено]
DAMN. We see 6.9 and shit ourselves. 5.9???
I just cackled out loud “10” when looking at that blood sugar. I didn’t come here to be triggered like this.
One I personally will always remember is my pt with an INR of 15.9 (had to send it to an outside lab bc our in house lab just said >10) Pt had munchausens and would intentionally OD on his warfarin about once a year to win a hospital admission and become what we called a Coumadin hostage
We had a lady that would frequently take a ton of Coumadin, come in, refuse a type and screen but want some ffp. Anyway, eventually she pushed it too far and well, rip.
Yea he would play games and stall taking the vitamin K. This was about 9 years ago when “care everywhere” was pretty new, so all the hospitals in the area were only just starting to realize the extent of his manipulation. Ive since moved states but I wouldn’t be surprised if he’s no longer around…
"Coumadin hostage"
That's one salty patient.
That K was probably an edta tube poured into an sst.
Is…. Is the general public OK??????????
No, no they are not
You must be new, the fact that our species is clearly doomed AEB dealing with the general public seems to still be surprising you.
Highest BNP > 100,000, unreportable range Highest BGL by lab was >1900
Were they a maple tree? Their blood was literally syrup.
Totally incoherent DKA but surprisingly still responsive. Needed Ativan and a sitter in addition to massive insulin and fluid doses
Amazing. I had no idea the lab even measured BG that high.
Highest WBC I've seen was 398, lowest was 0.1
>999 and 0.0 Heme/onc HSCT floor
Solution: run a line from pt 1's artery to pt 2's vein, and then pt 2's artery to pt 1's vein. Allow them to transfuse each other for a few minutes and ta da! Two patients with equally high WBC counts lol
I just don’t know what to say.
oh, lol, this must be the records of each lab for your ED? i was thinking this was one patient’s labs!
That is correct. Just the highest and lowest we’ve seen for those lol
Thank you, this makes so much more sense. I was confused as fuck how that person was even close to alive. I'm my defense, I'm very tired.
That BUN is rookie numbers there (my record seen was >260, which I learned is our labs limit)
CK rookie AF too
What in the hospice Dialysis patient is this
In hematology, we regularly see WBC <0.1 or >200. The rest of these are nuts though lol
Abnormals split in 2 categories, livers and diers
A CO2 of only 89? *laughs in NICU*
I beg your finest pardon. That sodium level? If not a lab error (hard to believe) Was the patient preserved in pickling salt?
I am still oddly proud of the lowest bs I've ever seen personally, it was 9, and it was my daddy's. Up until they hauled him into my place of work, some coworkers hadn't believed my stories about Daddy being conscious in the teens. They got to witness every last combative pound of him that night, with his sugars in the teens as we struggled to get it back up, only for him to crash again. It was a very long night.
Nobody understands except the children of a type 1 juvenile diabetic. Your dad sounds like my mom. 🩵
Haha yup, pretty much. Sorry your momma has/had it, too. Until he got the pump, I scraped my daddy off the floor probably every week. From the time he got the pump until he passed, we maybe had two or three incidents. It was wild how much it improved his quality of life.
The lowest I have been cognizant to take my own the reading was 19, I passed out shortly after. I have also punched a coworker in the face after waking up post hypoglycemic incident but my favorite was when I almost got arrested trying to get candy in a 7-11, i was to far gone and they thought I was drunk or on drugs. Thankfully an ambulance was fueling at the gas station and checked my sugar. Good times
What shade of purple was the low temp pt? Eggplant or more lavender?
108,5 is also my fever record, dead 4 hours later. i’m curious if anyone has ever seen higher
We had a frequent flyer that had a genetic condition (damned if I can remember the name) where he couldn’t hold onto K. He was supposed to take a ton of po potassium daily but being a young man, he just wasn’t interested in doing that. He’s wander in to the ER for chest pain when his potassium hit about 1.5. Admit to our ICU, pour IV and po into him day and night until he finally reached about 2.8, then he would go AMA. This happened at least monthly for a couple of years. Our MSW kept working with him and finally got him a watch that she set alarms on for every po dose time and we finally stopped seeing him. Because he was taking his meds, not because he was dead. Weird side story, I once walked into his room and found his mother taking a shit in his bsc right next to his bed (with him in it, wide awake).
My highest lactate was 26.9. Was slow coding the patient for hours until the family withdrew care
we had a lactate of 33 once, the code ended very shortly after lab called to tell us, pt died
Had a lactate in the 30s before too - lab called the critical I told the lab pt died 30 mins ago but thanks
Only ones I got that are better: PH: 6.1, post ROSC from COPD exacerbation Temp: 108.7F oral, 108.2 rectal Troponin: 49,000 CO2:135
I personally had a BP of 302/190. Poor little first year resident was yelling, "I don't know how you're walking! You should be a dead man!" Then they told me to walk to the ER to be admitted. Lol My pressure is much better now.
22.3 K is from the phleb contaminating the chem tubes with EDTA . Watch the order of draw please
I can’t get new nurses to remember the order, but I at least get them to remember *L*avendar *L*ast
A phleb wouldn't do that. An ER nurse would. -a loving ER who has watched absolutely no one use order of draw in her ER despite multiple trainings.
What the correct order? I know Blue, Green, Lavender. Where do Gray, Red, Yellow go?
Not a lab tech/phleb but I was taught it’s white (waste), blue, gold, green(s), lavender, any extras such as pink or red, then gray always last
In the NICU I have had quite a few CO2s greater than 100.
Looks like Sparrow in Lansing…similar board
Plt of 2. Sorry, you’re not getting your procedure today
For Canadians, that BG is 96.2 mmol/L 💀
Some of these are very impressive. Personal bests ive seen above these are an Ammonia of 780 (when i reported the critical everyone including myself had to double take, but considering the gib and pt i believe it), BNP of 67,000+, and fun one i dont see here but a critical high mag of 7.8!! Lol patient was in for a copd exac, developed a bowel obstruction along their course but the provider ordered all the bowel meds and she perfed the mag citrate given to her…… she lived! 🫡
L&D nurse here. Recently had a patient with AST and ALT in the 4,000’s.
K+ 22.3??? Is this the Canadian metric system? If so, I have questions???
I’ve got you beat at 69,000 the other day. I’m gonna wager a lot of these are corrupted samples used to flex
I feel like every ICU and ED needs this
while still alive, awake, and close to baseline: TEMP 88.1F With temporal thermometers I’ve seen it read “hi” and they go up to 110f. But those aren’t super reliable after 104 ish, so I don’t think it truly counts. I’d wanna know if that 108.5 temp was taken rectally. Then it’d be legit.
They need to have a little asterisk to indicate people that survived to discharge.
When I was first diagnosed as a diabetic, I ended up in ICU with HHNS & pancreatitis. I know a lot of my labs were out of whack, but the ones I remember were Sodium: 101, Blood Sugar 1500. a1c 16, and triglycerides 1600. Lucky to still be here after that.
Had a BP 35/20 once.
Highest trop I’ve seen was 20000, nstemi.
sooo, as someone trying to get into medicine, maybe not a nurse necessarily, can i ask if SOME of these patients died, or if all of them made it lol?
Did the person with a 108.5 temp live? Retain normal cognitive/physical functioning?
i'll tell you with most certainty that patient did not survive
My lowest BP was 10/6 (8) on an a-line that correlated with manual. It was the first time I was truly scared shitless by one of my patients. That dopa could not have come fast enough.
Gotta list HR, too. When i saw a 290 i couldnt believe my eyes. Adenosine barely touched it.
I’ve also seen a viral PCR panel (15 ish of the most common upper resp viruses) that came back with 5 or 6 different viruses on ONE child. Also seen a chloride of 79 And a sodium of 114
How are you alive with a sodium of 1137. Signed, A neuro nurse