r/emergencymedicine • u/Asleep-Palpitation43 Nurse Practiciner • Feb 02 '25

Advice Allergy Olympics

Is it wrong that if I see a patient has more than 10 allergies I IMMEDIATELY assume she's (bc it's always a she) a psych case?

In 24 years I've never been wrong.

You'll never read this in a textbook but add it to your practice today and thank me later👍

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u/AppalachianEspresso Feb 02 '25 edited Feb 02 '25

Dyed hair over the age of 30? Borderline personality disorder.

Patient pulls out the cell phone charger in the room? They aren’t having an emergency.

Seizure + stuffed animal upon arrival? PNES

Non English speaking belly pain + never in the department before? Appendicitis or cancer

Contrast allergy? Liar or actually has the PE and that VQ will be equivocal.

Psychotic malingering patient that is there everyday? Will one day actually have badness someone will not believe, will die, someone gets sued

John Boy who comes in drunk every day will be dangerously hypoglycemic or have a head bleed inevitably.

If you’re ever going to have a bad outcome, it’ll be in the last hour of your shift when you’re trying to leave.

The laws of ER.

6

u/crash_over-ride Paramedic Feb 02 '25

Psychotic malingering patient that is there everyday? Will one day actually have badness someone will not believe, will die, someone gets sued

Had a frequent flyer do this to me. Had their standard chest pain but looked like absolute garbage. I was concerned something was up with them, they were so diaphoretic I was having bear of a time getting the EKG leads to stick. About the time I finally did was when they went to V-Fib arrest.

We were able to chat about it a couple months later during another transport. They were discharged with no reported issues after 29 days.

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u/AppalachianEspresso Feb 02 '25

It’s so humbling. Good catch.

1

u/crash_over-ride Paramedic Feb 03 '25

Honestly, not really a good catch at all. The STEMI with the ventricular pacemaker didn't stand out in the very short time between when I did it and she arrested. Definitely humbling though. I was going through the motions and doing the workup because they had called all the time for years for various complaints. Chest pain, anxiety, pancreatitis, withdrawals. A lot of seeking behavior and drug abuse history (pacemaker b/c their heart said 'fuck it' in their 30s from drugs), and they'd change their complaint when the ER would get wise and stop automatically throwing Ativan/opiates at them (first entry in our charting system is benzo abuse).

I was wrong, she was right, but thankfully they are alive and calling less.