From the monthly archives:

October 2008

Well, it’s that time of year again – October 31st is always an interesting evening in the ER.
I would like to offer this tip to avoid Halloween turning into a true nightmare.
Most ER docs grow to have a healthy respect, (and fear) of peanut allergies. I have seen some truly impressive allergic reactions to peanuts, and Halloween is a particularly dangerous time for children who have these allergies.
The reason is simple. Kids love candy and want to cram as much of it as possible into their mouths, often all at once. If their parents let down their guard and allow even one candy bar with peanuts to be swallowed, the results can be very dangerous.
The last time I saw a child with a peanut allergy, it was from eating a homemade treat that had peanuts in it. The parents were not aware of this, and the boy developed severe hives and wheezing. He ended up doing well after treatment, but everybody got a scare.
If your child has allergies be sure to review this post on Epi Pens:
So please, if your child has a nut, or other food allergy, please take all the candy home for careful inspection prior to eating. Then we can all relax.
If you have a child with a peanut allergy you may find this site and check list helpful:


Best reason I have heard not to wear a wedding ring.
A very pleasant middle aged man presented to the ER after an unfortunate episode with his power drill.
He had lost the normal chuck that is used to change drill bits, and so he has put a bent screw into the chuck receptacle instead. When picking up the drill, he accidentally activated it by pulling the trigger. By the way, this happened to be an electrician’s drill, which is very powerful, able to bore through wall studs as if they were made of butter.
Well, of course when the drill turned on, the screw started spinning,
and it happened to have gotten tucked  under the man’s wedding band.
Thus, as the screw spun, so did the man’s ring finger,
completely pulling it off of his hand.
All that remained attaching the finger were some tendons. Surprisingly, there was very little blood, but you can imagine the pain.
Unfortunately, because of the extensive damage, this was not a re-attachable finger. Had the finger been severed with a sharp knife, a microvascular surgeon may have been able to re-implant it.
Since this case, I always recommend removing jewelry before working with power equipment.


It was my 3rd night shift, and I was feeling a little crispy.  I had not been getting my naps between shifts, and that was taking its toll.  Of course it was a busy night, and I found myself hoping that at some point, the patients would stop coming in.

Shockingly, at about 4am, it appeared my wish was coming true.  No patients had registered to the ER in about an hour, and I had gotten all my work done.  I allowed myself the thought that had been floating around my subconscious since I had gotten to work, “Maybe I could lie down for a little while. . .”

Almost guiltily, I snuck off to the doctors room to close my eyes.  In about 1 minute I was soundly asleep, dreaming vividly.  In about 2 minutes, the phone was ringing.  “Dr. Evans, you have a new patient.”

Like some kind of zombie, I lurched back to the ER.  My skin blotchy, my hair at all kinds of crazy angles, and my brain on some other planet, I found the exam room and chart.

It was a man about 50, who reported that he was having trouble sleeping that night.  He went into excruciating detail about his uncomfortable bed, his strange dreams, and how tired he was.  I tried to be sympathetic, but in my mind, I was hitting him over the head with an oversized frying pan.

I ended up prescribing him some sleeping pills, and thought I might lay down again.  It never happened.  Another patient came in with a very bad heart attack.  That woke me up faster than 3 cups of coffee.


For almost a year now, I have had a strange feeling and noise in my left ear. It sounds like bubbling, and popping. It’s quite noisy. I have had an ear check from my primary physician and an MRI. Everything looked fine. What would you recommend?
Cathy, Incline, NV
 Well Cathy, clearly it’s all in your head.
Literally. I think the next step for you is an examination by an Ear Nose Throat specialist, also known as an ENT or Otolaryngologist.
These physicians have equipment to do a detailed examination of your ears. It sounds like there could be fluid behind your ear drum, or perhaps dysfunction of the Eustachian tube (which drains the middle ear). Fortunately for me, this is not an emergency medical problem, and I am therefore completely off the hook.
You would not believe how much work I get out of this way. I think an ENT is likely to get to the root of this problem and get you some relief as well.


ER doctors and nurses often revert to childish behavior to deal with stress, and one of my colleagues, Dr. Bob, is especially notorious.  He has been known to play practical jokes on the nurses, particularly if they are new.

One night, a brand new nurse named Jill was working with Dr. Bob, and he decided that he would give her a special “welcome.”  He asked Dana, one of the more experienced nurses, to be his accomplice.

First, Dr. Bob found a clear, plastic specimen cup with a lid.  He put about a tablespoon of creamy vegetable soup inside.  He added a bit of ketchup, and stirred.  The result was pretty gross looking stuff.  When Jill was standing at the nurses station, Dana called out, “Hey Dr. Bob, you want me to send this sputum sample up to the lab?”  She held the container up for him to see.

Dr. Bob said, “Hang on, let me see that.”  He took the cup and held it up to the light.  Jill watched this with a puzzled expression.  Then, he unscrewed the lid and looked inside.  Jills eyes at this point got very big, and she looked concerned.

Then, Dr. Bob took a long sniff of the specimen.  At this point, Jill literally took a few steps backwards, trying to distance herself from what was clearly a crazy person.

Then Dr. Bob did the unthinkable.  With a quick flick of the wrist, he swallowed the sputum sample like it was a shot of whisky.

Jill, completely aghast, fell right down onto the linoleum floor with an expression of horror on her face.  The other nurses who were in on the gag were having a hard time holding it together at that point.

But Dr. Bob, straight faced, said “No, I think it’s just bronchitis.”