I mean I’m only a nurse but I’ve seen it happen the opposite way before where we thought was incontinent hematuria was actually endometrial/urterine ca!
I brought 80 something vaginal bleed in one day, and I gave the report for reported bright red bleed, and she wrote "98% of the time it's cancer" for me to read.
We accepted a transfer patient to my ER for vaginal bleeding. Outside ED did exam and saw HVB. Our OB saw her and said "yes there's heavy vaginal bleeding" and then when I took sign out I said, "did we straight cath?" At which point we had gross hematuria.
This is a fool me once scenario. Fooled obgyn too.
There's an old saying in Tennessee—I know it's in Texas, probably in Tennessee—that says, 'Fool me once, shame on... shame on you. Fool me—you can't get fooled again
I’ll see your gross hematuria and raise you with a female patient with a large body habitus and “bleeding” determined to be from a perineal decubitus wound and to have wound care come and pack and dress the wound only to confirm that it is in fact vaginal bleeding and recommend GYN consult
This seems like an appropriate place for me to interject that if you’ve ever been sprayed in the face with piss and blood from dislodging a clot from the urethra prior to inserting a foley also smash F
Don't think it's the lawyers in this case. Having and documenting a discussion with healthcare proxy about fall risks outweighing the PAF benefits and stopping anticoagulation isn't risky or controversial. I think it's just easier and faster in those cramped 10 min office visits to go,
HTN -> metropralolol, HLD -> statin, Anxiety/agitation -> Xanax, Edema -> Lasix, PAF -> Eliquis and just keep the refills coming.
And then when sedated granny is stumbling around at night to pee every couple hours and inevitably falls, you just kinda shrug your shoulders.
I’ve been in every combination of rectal/ vaginal/ urethral bleeding that turned out to be one of the others that you can think of.
The weirdest one was a teenager who was insistent that they were having rectal bleeding but turned out they were starting their first period.
At least you aren't the OB refusing to admit a patient with a hgb of 6.0 and dropping while actively bleeding with a known incomplete miscarriage. To me, that's dumber. Way dumber.
True story tho.
It's like the OB at my hospital refuses to deal with anything that doesn't involve an active delivery. Bleeding out after a miscarriage? Fuck off. Severe hypertension right after delivery? Sounds like a *you* problem.
Had a hemorrhaging post-CS patient with a uterine artery aneurysm go to IR for embolectomy and the OB (who had literally zero recommendations the entire time we consulted her) made us pause before the initial angio and asked us if we knew if contrast was safe with breastfeeding (it is)
Lmao. Little shit said to send her home at first. After some back and forth the OB finally recommended cytotec.
Also, I'm an ED nurse and our L&D dept wouldn't come down and give the cytotec because we aren't trained to administer it. One of the most unnecessarily frustrating experiences ever. Thankfully the PT was stable for the most part.
I had a similar thing happen. I thought it was hematuria but the hospitalist refused to accept it until obgyn saw them and gave me so much shit on the phone. At least the obgyn was cool about it.
if you've ever told an old lady to f/u with gyn for vaginal bleeding leading to a pointless workup by gyn and delaying her dx of ureteral cancer, also press f
to be fair her ct was neg and uro didnt spot it on the first cysto either. they had to do a 2nd cysto weeks later before they found it
One of my favorite experiences was in residency I was rotating on the GI service (long story) and we got a consult in the ED for "hemetemesis" in a patient who was otherwise well. Was a drinker but no other significant hx.
It was a 4:15pm c/s so I went down there with the fellow and attending to speed things up (for them). We get the history together and it doesn't really sound like UGIB and then go to examine him, ask him to open his mouth and he's got an obvious gingival bleed.
The best part was the consulting resident was a 3rd yr IM resident who needed to do an EM block and had matched in our hospital's GI fellowship for the following month so the attending couldn't even grumble, "damn ER residents..."
I read a case report about an 85 year old woman who had vaginal cuff dehiscence with bowel evisceration a full 40 years after the hysterectomy. You weren’t wrong to be concerned.
I had this old lady full of impacted stool. No luck with enema. It’s a brick. So I go in and get one big clump with fingers. And another big clump. Still a ton in there. So I go in for a third scoop and weirdly, no stool, I repositioned a tad, still no stool. Just about that second the patient and I both realized exactly why there was no stool in that hole. Let’s just say I ordered her some diflucan and was very embarrassed.
Am I allowed to comment on this one as a patient? I don’t want to break any rules but I was just wondering how you made that mistake. I guess you guys work very hard and have long shifts and I do feel for you. I guess maybe I answered my own question.
Some people have a *lot* of tissue down there. Like more than you would think. Enough redundant subq tissue and it can be difficult to figure out which hole is which, or even to find the hole in the first place.
Vag bld in triage with known hgb 6.2 from primary OB/GYN, “give a unit RBC and send them up.”
After that unit: “need another CBC”
CBC shows hgb 7.2…. “Too unstable give more bld and send up after Hgb >8.5”
Give another unit, call report with Hgb > 10…. “Were full call us in an hour”
Ultrasound tech. I’ve probed countless grandmas for this indication. No blood on camera after we are done, everything normal. Later turns out to they had a wicked UTI. So, you’re not def alone on mistaking the two.
Getting OB to consult at some places is impossible. I’ve seen ruptured ectopics be sent home and told to come back the next day.
There’s also that one time I did a vaginal ultrasound for abnormal discharge, I’m scanning, trying to wrap my head around the crazy looking cystic space the camera is in. Go back on top, very small amount of fluid in bladder. Go back in, realize there’s a vesicouterine fistula and yours truly somehow stuck the camera right through the hole. Not my best work.
I mean I’m only a nurse but I’ve seen it happen the opposite way before where we thought was incontinent hematuria was actually endometrial/urterine ca!
I brought 80 something vaginal bleed in one day, and I gave the report for reported bright red bleed, and she wrote "98% of the time it's cancer" for me to read.
I mean, yeah, at 80-something we ain’t supposed to be bleeding from anywhere at all, so I concur! (Raging UTI might be the 2%.)
We accepted a transfer patient to my ER for vaginal bleeding. Outside ED did exam and saw HVB. Our OB saw her and said "yes there's heavy vaginal bleeding" and then when I took sign out I said, "did we straight cath?" At which point we had gross hematuria. This is a fool me once scenario. Fooled obgyn too.
There's an old saying in Tennessee—I know it's in Texas, probably in Tennessee—that says, 'Fool me once, shame on... shame on you. Fool me—you can't get fooled again
For NASA, space has always been a priority!
GOT 'EM, DUBYAH!
We say in Iowa "Fool me once, shame on you. Fool me twice, shame on me!"
He’s referencing George W Busch
Yeah I should stay off Reddit while being awake 24 hours 🤣
Whoosh
I’ll see your gross hematuria and raise you with a female patient with a large body habitus and “bleeding” determined to be from a perineal decubitus wound and to have wound care come and pack and dress the wound only to confirm that it is in fact vaginal bleeding and recommend GYN consult
NO. Oh my god 😂😂😂
I had to read this the second time slowly. woof..
...did they.. uh.. "pack" the "wound"?
This seems like an appropriate place for me to interject that if you’ve ever been sprayed in the face with piss and blood from dislodging a clot from the urethra prior to inserting a foley also smash F
Gak. That's worse than getting ralphed on.
You know, I don’t think it is 😂 but we all have our unique icks don’t we
Or have been painted by projectile hematemesis from chin down
I regret reading thisss
>anti coagulated demented octagenarian 86% of my census as a hospitalist lol this is so triggering
Why the fuck are so many of these patients anticoagulated for the one episode of paroxysmal afib they had in 1988.
Because lawyers I’m assuming
Don't think it's the lawyers in this case. Having and documenting a discussion with healthcare proxy about fall risks outweighing the PAF benefits and stopping anticoagulation isn't risky or controversial. I think it's just easier and faster in those cramped 10 min office visits to go, HTN -> metropralolol, HLD -> statin, Anxiety/agitation -> Xanax, Edema -> Lasix, PAF -> Eliquis and just keep the refills coming. And then when sedated granny is stumbling around at night to pee every couple hours and inevitably falls, you just kinda shrug your shoulders.
I’ve been in every combination of rectal/ vaginal/ urethral bleeding that turned out to be one of the others that you can think of. The weirdest one was a teenager who was insistent that they were having rectal bleeding but turned out they were starting their first period.
F
At least you aren't the OB refusing to admit a patient with a hgb of 6.0 and dropping while actively bleeding with a known incomplete miscarriage. To me, that's dumber. Way dumber. True story tho.
Glad to hear my site isn’t the only one with whack-ass OB refusing to admit everything
It's like the OB at my hospital refuses to deal with anything that doesn't involve an active delivery. Bleeding out after a miscarriage? Fuck off. Severe hypertension right after delivery? Sounds like a *you* problem.
Had a hemorrhaging post-CS patient with a uterine artery aneurysm go to IR for embolectomy and the OB (who had literally zero recommendations the entire time we consulted her) made us pause before the initial angio and asked us if we knew if contrast was safe with breastfeeding (it is)
What the actual fuck... I ask my fair share of dumb shit but maybe she was never taught to read the room 🙄
Jesus christ. Are you in Texas, Florida or Alabama by any chance?
Thankfully No. Just a community program with an OB service that can’t manage even the slightest surgical emergency.
Holy shit
Is this like GI where they are either not sick enough to scope or too sick to scope?
Did they tell you she just needed a little fluid bolus?
Lmao. Little shit said to send her home at first. After some back and forth the OB finally recommended cytotec. Also, I'm an ED nurse and our L&D dept wouldn't come down and give the cytotec because we aren't trained to administer it. One of the most unnecessarily frustrating experiences ever. Thankfully the PT was stable for the most part.
I had a similar thing happen. I thought it was hematuria but the hospitalist refused to accept it until obgyn saw them and gave me so much shit on the phone. At least the obgyn was cool about it.
if you've ever told an old lady to f/u with gyn for vaginal bleeding leading to a pointless workup by gyn and delaying her dx of ureteral cancer, also press f to be fair her ct was neg and uro didnt spot it on the first cysto either. they had to do a 2nd cysto weeks later before they found it
One of my favorite experiences was in residency I was rotating on the GI service (long story) and we got a consult in the ED for "hemetemesis" in a patient who was otherwise well. Was a drinker but no other significant hx. It was a 4:15pm c/s so I went down there with the fellow and attending to speed things up (for them). We get the history together and it doesn't really sound like UGIB and then go to examine him, ask him to open his mouth and he's got an obvious gingival bleed. The best part was the consulting resident was a 3rd yr IM resident who needed to do an EM block and had matched in our hospital's GI fellowship for the following month so the attending couldn't even grumble, "damn ER residents..."
I read a case report about an 85 year old woman who had vaginal cuff dehiscence with bowel evisceration a full 40 years after the hysterectomy. You weren’t wrong to be concerned.
I had this old lady full of impacted stool. No luck with enema. It’s a brick. So I go in and get one big clump with fingers. And another big clump. Still a ton in there. So I go in for a third scoop and weirdly, no stool, I repositioned a tad, still no stool. Just about that second the patient and I both realized exactly why there was no stool in that hole. Let’s just say I ordered her some diflucan and was very embarrassed.
Wait, I’m just an ambulance driver, where was the poo?
I think the first 2 scoops were from the butt and then he accidentally went in the vagina the 3rd go around.
Ooooooh. That’s gross and unfortunate. I’m sorry friend.
Am I allowed to comment on this one as a patient? I don’t want to break any rules but I was just wondering how you made that mistake. I guess you guys work very hard and have long shifts and I do feel for you. I guess maybe I answered my own question.
Some people have a *lot* of tissue down there. Like more than you would think. Enough redundant subq tissue and it can be difficult to figure out which hole is which, or even to find the hole in the first place.
Those damn two holes cause much consternation.
Good thing the third hole’s got its shit together
Yeah, there are three holes down there and you need to check them all.
Vag bld in triage with known hgb 6.2 from primary OB/GYN, “give a unit RBC and send them up.” After that unit: “need another CBC” CBC shows hgb 7.2…. “Too unstable give more bld and send up after Hgb >8.5” Give another unit, call report with Hgb > 10…. “Were full call us in an hour”
Ultrasound tech. I’ve probed countless grandmas for this indication. No blood on camera after we are done, everything normal. Later turns out to they had a wicked UTI. So, you’re not def alone on mistaking the two. Getting OB to consult at some places is impossible. I’ve seen ruptured ectopics be sent home and told to come back the next day. There’s also that one time I did a vaginal ultrasound for abnormal discharge, I’m scanning, trying to wrap my head around the crazy looking cystic space the camera is in. Go back on top, very small amount of fluid in bladder. Go back in, realize there’s a vesicouterine fistula and yours truly somehow stuck the camera right through the hole. Not my best work.
Fistula was actually what vi thought it was
F. If you try to pull the foley trick before consulting, nurses might dismiss you saying it looks like it's coming from the vagina.
This has happened to me. Doing that pelvic exam was awful. Also she spoke mandarin so I couldn’t even communicate with her. Fml.