Guy I have been following for a while with an ileus and also starting to work on a pneumonia REALLY needs to get up and at least sit up in a chair. This will help his bowels start to move again and will help clear the goop from his lungs. I try to emphasize this every day. Yesterday it was "I was up in the chair 3 times last night"......I am skeptical. Later he tells me "I guess I hallucinated that I was up yesterday. The nurse told me that I never got out of bed." At least he copped to it. He is on some pretty heavy pain meds. Good news is that he was up today and even asked for a cane so that he can try to walk. Good for him.
Guy number 2: Comes in with a blood alcohol in the 300's somewhere. Stab wound to the chest. He is still drunk after surgery that revealed that it only hit the muscle. He goes on with this story, saying, "I'm sorry, a man just can't call another man a bitch. Before I could pound on this dude's face he stabbed me!" (like he was shocked. If he had gotten his hands on the guy we would have seen both of them on our service, no doubt........Later in the day when he is more sober...and a total baby by the way .....most "gangster guys" are when they get on the trauma service. They seem TRULY surprised that a gunshot wound or a stab wound hurts). Anyway, the story after he sobers up is that some dude tried to rob him and take his wallet and stabbed him. He obviously did not recall telling us about the altercation earlier. Classic.
Guy number 3: First of all he is this Asian kid that things he is super gangsta, complete with street slang. Super dramatic. Came in as a "walk in" trauma at 9am or so....at this point his blood alcohol was still 188. Apparently sometime during the night he had gone to another ER, but left. So he had to have been really drunk last night to still have this level. This guy's eyes are swollen shut. He is telling us that he thinks that he got attacked. His injuries are telling us another story. He then proceeds to ask us if the police can call to see if he is in that hospital and if they can get his medical information. He says that he doesn't want his PO to know that he was drinking (another peach). We tell him that only if he were involved in a crime or if there were some reason that they were looking for him could they find this information out. We start putting 2 and 2 together. We had a guy who's face literally got stomped on and this is not looking like that at all. In fact looking at what the physical exam is telling us, his eyes look goopy. We start talking about it and we are thinking that he has chemical burns from an airbag (bases are worse than acids because they break down collagen...aka they liquefy most stuff that skin and eyes are made of).....he likely is remembering that he crashed his car (drunk) and is hoping not to go back to jail. Meanwhile the base that is in his eyes is dissolving the collagen and can likely do serious damage. This idiot does not realize that his trying to save his own ass can blind him. Idiot.
Part of the message here is to trust your physical exam. It will give you the info that you need most of the time. He must know that if we find out that he crashed while he was drunk that we need to notify the cops. Sucks for him. I guarantee that he will bail in the middle of the night when he gets wind that we have an idea of what really happened. Again....idiot. And if that doesn't work you tell him that anyone involved in an altercation and found down needs a rectal exam to make sure that he is not bleeding internally. That gets you more truth telling than you can imagine. ;-) Heehee, I love my job.
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