What is the most interesting case you've seen in the ER?

Emergency RN · Nov 30, 2011

Suspected Serotonin Syndrome; came in walking talking c/o back ache, VS stable with mild tachycardia; later comatose, Fever 105.8 rectal, Finger Stick 10, and she was dead within five hours.

DixieRedHead, ASN, RN · Nov 30, 2011

Had this guy walk in claiming overdose in tylenol. Girfriend problems, yada yada. Total OD work up. Level was not high as tylenol had no been in system long enough. And he of course seemed fine.

As it turned out the guy had beat his girlfriend in the head with a hammer and she was in the hospital in another city.

About 30 minutes later, he decides to go AMA. I explain to him about tylenol toxicity, etc. Not having it. he's going. I call the cops, try to have him taken into protective custody, cops refuse. His mother arrives to take him home.

I explain to him, mama, and the cops that this is a long, slow, ugly death. He's insists he will go to the ER where girlfriend is, he just "loves her so much he has to see her", hammer notwithstanding. Mama says she will take him to the ER there. He signs out AMA and is gone.

Later we hear: long, slow, ugly death.

You can't fix 'em all.

**NickiLaughs, ADN, BSN, RN** · Nov 30, 2011

I'm ICU. This was really a nightmare but interesting case as well. This young teenager came in with a seizure. No history, CT/labs everything normal. And we seriously couldn't get the seizures under control. Intubated quickly to protect airway. Ativan, Dilantin, all the usual meds weren't working. He ended up getting transferred to a Level I Med Center. I can't imagine he did very well. We were suspcious of some rare disease as he was a foreign student spending a year abroad or that he had done some drug and short circuited.

sweetnurse63, BSN, RN · Nov 30, 2011

When I was a nursing student, I saw my first flesh eating disease and my clinical instructor picked me to dress the area. I had never seen nothing like it in my life. The male patient looked like he had all of his skin removed from beneath his navel to his groin area including his member, there was nothing but pink flesh. I was numb, even as I was doing the treatment. :eek:

AnonRNC · Nov 30, 2011

As a nursing student I did a dressing change on a shoulder wound that had a 3-inch island of eschar in the middle, surrounded by a little pink moat, then healthy tissue. The wound was secondary to advanced lymphoma. That was the defining moment when I knew I had the fortitude for nursing.

Later I worked at a tertiary pediatric center and saw many strange things:

* Maple Syrup Urine Disease

* Glycogen Storage Disease

* Cystic hygroma

* Epidermolysis bullosa

* and more that I've forgotten

turnforthenurse, MSN, NP · Nov 30, 2011

Patient came in with a miscarriage...saw a 20-weeker completely intact with placenta and all.

ChristineN, BSN, RN · Nov 30, 2011

The most interesting case I ever saw in the ER was a pt who came in and found out she was pregnanat--despite IUD being in place

The most interesting case I ever saw when working a peds medical unit was when we had a 17 year old male come in, hx of Marfan Syndrome (think Abe Lincoln). The kid had been perfectly healthy his whole life, no meds, only past medical hx was a mild cardiac defect caused by the Marfan that when they went in to do surgery they accidently cut something and the kid ended up with a pacemaker. Anyway, pt came in with all the signs/symptoms of a triple A, severe abd pain, etc, but they had ruled triple A out. We kept trying to drop a NG tube and it would not go down. Finally a abd x-ray revealed that the NG would not go down because his stomach had literally flipped on himself and instead of an opening being where one would expect it to be, there was stomach wall. They ended up taking the kid to the OR to put in a stat PEG tube so they could decompress him, and they were hoping once decompressed he would shift back into place. Talk about bizarre.

FlyingScot, RN · Nov 30, 2011

1. Abdominal compartment syndrome in a 12 year old. Tragic outcome on that one. 2. Mesenteric venous thrombus resulting in ischemia and necrosis of the entire large and small intestine caused by BCP's. Also tragic outcome. 3.Old guy. Full arrest in the field, completely smurfed from the chest up. No cardiac activity on US after multiple rounds. Asystole on monitor. Went in to do morgue care 30 minutes after code called and ALL care stopped. Ears now pink and patient with slow but spontaneous respirations. Saw him 3 days later outside smoking!

zorro_wrangler · Nov 30, 2011

nice.

Esme12, ASN, BSN, RN · Nov 30, 2011

I'm ICU. This was really a nightmare but interesting case as well. This young teenager came in with a seizure. No history, CT/labs everything normal. And we seriously couldn't get the seizures under control. Intubated quickly to protect airway. Ativan, Dilantin, all the usual meds weren't working. He ended up getting transferred to a Level I Med Center. I can't imagine he did very well. We were suspcious of some rare disease as he was a foreign student spending a year abroad or that he had done some drug and short circuited.

I'll bet it was Tetnas.....http://www.dhpe.org/infect/tetorifice.html I saw that once and will never forget it.

getoverit, BSN, RN, EMT-P · Nov 30, 2011

strange aneurysm around the aortic root, closest surgeon who would accept the case was 1000+ miles away (Baylor). He exsanguinated right in front of us as we were loading him into the plane, gone in less than 3 sec.

young child needed a heart transplant (and successfully received it). his cardiac silhouette filled the cxr. he was so fatigued that his lips would turn blue and his hr increased 200+ just lifting his arm for a bp cuff or sat probe.

and flyingscot, I've also coded someone and ran into them a few days later in the grocery store holding a case of budweiser and carton of marlboros. nothing like getting a new lease on life!!