Abdominal Pain
Back during residency we used to tell people that 50% of patients who walk in with abdominal pain, walk out without a definite diagnosis. Often we’d recommend a return follow…
Anxiometer
Try typing something like “Hernia” or just scroll to see the list.
Medicine is a sea of grey. Because of this you’ll find “happy words” vs. “red flags” throughout these posts. A red flag for back pain is urinary incontinence, whereas happy words may be, “my soreness goes away after I go to the gym and stretch.”
Our Anxiometer is a symptom checker aimed at helping you to assess yourself. Hopefully it will give you a better idea for when to call 911, Pre-R or your primary care doctor. If no red flags and if all the happy words seem to apply, then it’s probably ok to patiently “don’t just do something, stand there!”
Accidental Overdose
Toxicology is a field in and of itself. Any element or molecule you can put in your body by swallowing, snorting, smoking, applying, injecting, inserting, or bathing in (Did I…
Alcohol Poisoning
In honor of Super Bowl weekend… Back in high school I worked on a social studies project with a friend. The day before it was due, however, he never showed…
Allergic Reaction
A recent patient of mine went camping in Big Sur and returned with swollen arms, body and face – the picture of poison oak misery. So thought I’d post on…
Altered Mental Status
With our current political climate, maybe this anxiometer post could have merit. Just about every ER shift patients are brought in by family or by ambulance because they’re not thinking…
Altitude Illness
Maybe not so relevant down here at sea level in San Luis Obispo, but since I’ve had two calls in the past couple weeks from friends headed to high places,…
Animal Bite
A couple weeks ago I got a call from someone parked outside an ER who had suffered a dog bite… his dog. It was about 2 inches long on the…
Ankle Sprain
A friend with limping daughter just appeared at my door with the age-old question: “Do we need an X-ray?” She’d twisted her ankle. Red Flags:• Bone broke through skin •…
Appendicitis
On my last shift three roughly equivalent appearing patients arrived in a two hour period all worried about appendicitis. The one who was least comfortable on arrival ultimately went home.…
Back Pain
Back pain – or what I call “the human condition.” If you get through this life having never suffered back pain, consider yourself blessed. I myself wrestle with it about…
Bloody Stool
Exciting I know. But it’s all different when you’re the one hovering over the reddened bowl. I’ll start with the take home points: Chances that I diagnose your colon cancer…
Bloody Vomit
Our anxiometer needle moves a little higher when patients arrive in ERs spewing blood, but the buzz words are virtually the same as they are for lower GI bleeding. Red…
Burn
On July 4th I received a call about a child who was burned by a sparkler and the level of his parents’ concern got me typing. Very few medical problems…
Chest Pain
Since becoming a father I’ve had intermittent chest pain. Not sure why, but it’s worse when I lie on my left side and sometimes hurts with deep breaths. All gone…
Common Cold
Antibiotics for colds is the never ending discussion. You may be surprised by how many patients come to ERs with colds, convinced they need antibiotics. Truth is, I can’t blame…
Concussion
To CT or not to CT… is pretty often the question. A friend was just concussed playing soccer, so this came to mind. At the root of the head CT dilemma again…
Conjunctivitis
Conjunctivitis and pharyngitis have many parallels. Usually viral, fairly contagious, they drive parents and daycares crazy, and typically they get better with no help from me… except for some. Whether…
Constipation
Pretty regularly, patients come to ERs because they can’t poop. Those of you with bird-like regularity are amazed. Those of you with anaconda-like regularity get it. My worst blockage happened…
Cough
I’ve been postponing this Anxiometer post for at least a year. People periodically call me to chat or come visit when they are on week two or three of a…
COVID-19
I haven’t been typing as much lately because, well, life. But I’ve been asked by a few folks for an Anxiometer post on COVID-19. Since I work at two hospitals,…
Delirium vs. Dementia
“I think, therefore I am,” according to Descartes anyways. But this philosopher asks, “if I have my head up my behind, am I still?” This came to me a few…
Dental Pain
Regularly patients with dental pain turn to ERs. Unfortunately, most leave with a little less pain, but problems that still need fixing + ER bills. Nearly all receive some form…
Diarrhea
Another fun topic, but pretty relevant on the Central Coast these past few weeks. Three experiences over the years have taught me more on this than any textbook. The first…
Ear Pain (Pediatric)
Why so many ear infections in kids? The short answer is bad plumbing. The middle ear drains to the throat through the eustachian tube, and in kids these pipes are…
Eye Injury & Foreign Bodies
In 1989 I learned about eye foreign bodies and syncope on the same day. Driving with windows down past some road construction a bit of metal found one of my…
Fainting / Syncope
In high school I first learned about syncope after waking up next to a toilet in an ophthalmologist’s office. He’d just removed some metal from my eye. When I stood…
Fever (Pediatric)
“Treat the patient, not the numbers.” At least once a shift I’m handed a chart that says something like “pediatric fever.” It’s usually assessed and solved by the triage nurse long…
Finger Dislocation
I received a call a few days ago from someone sitting in the parking lot of a closed urgent care. He said his finger was bent at a crazy angle…
Flesh Eating Bacteria (due to Blisters)
I recently got a call related to a blister; a healing blister. But the real reason for the call was to ease worry about possible infection… “I went swimming and…
Hallucinations
This one inspired by a midnight call to a psychedelically painted bus parked outside a hotel. The bus was part of a documentary focused on marijuana and its legalization in…
Headache
How I’ve waited this long to type about headaches is unclear. This is another in the category called “probably gonna be fine… could be deadly.” My perspective on headaches was…
Hernia
A few days ago I got a call to evaluate someone’s “new belly lump,” so here’s a short bit on hernias. First off, many people live with these for years.…
Hyperthermia
I remember as a kid a variety of adults advising me to drink hot beverages to help beat the heat. The mechanism is to stimulate more sweat and evaporative cooling.…
Hypothermia
The Dawn to Dusk adventure race in SLO (April 2015) was exciting to watch, but medically boring… which is good. Barely a stubbed toe to report. That said, the kayak…
Joint Pain
A few weeks ago I officially became old. After kneeling to place an IV in a patient’s arm I stood up and felt a shooting pain in my leg. I…
Laceration
“Does this need stitches?” The key word here is “need,” and for perspective I’ll start with a story. About 20 years ago I was an exhausted medical student on my gynecology/oncology…
Limb Swelling
A super athletic and fit friend just had knee surgery. Shortly after she developed exquisite pain and leg swelling, and today she’s on blood thinners to treat a deep vein…
Limp (Pediatric)
Adults who limp generally give a story, but toddlers typically keep the story to themselves. On my last ER shift a mom was sent by her pediatrician because her two…
Mastitis
For whatever reason I’ve had a bump in calls related to post partum breast infections lately. Plus, I had a request for this Anxiometer post over a year ago. I…
Motion Sickness / Sea Sickness
In another life I worked on cruise ships for a few weeks a year. The longest trip in 2011 lasted 3 months. (Shortly after, I moved to San Luis Obispo…
Narcotic Withdrawal
Periodically patients appear in emergency departments seeking methadone. During my residency I recall one in particular who said he was traveling cross country, but unfortunately had run out of his…
Neck Injury
Patients periodically arrive in the ER after fender benders concerned they’ve broken their necks. Or sometimes 24-48 hours later they appear after someone not paying the bill says “you really…
Nose Bleed / Epistaxis
Not sure where the rumor started that it’s best to pinch the bridge of the nose to stop a nose bleed, but I’m typing now to end it. You’d be…
Nursemaid Elbow (Pediatric)
“I think I broke my kid’s elbow!” On occasion I’ll meet a distraught parent who was happily swinging junior by the arms one minute, only to have junior whimpering and…
Palpitations
A neighbor came a-knocking just last night with the sense of a racing or “flipping” heartbeat, aka “palpitations.” Most immediately useful when someone has this symptom is the EKG, so…
Puncture
“Clawed by tiger” is not something you get much in the ER, and meeting the tiger never happens. However, Pre-R is a different game. I was called to visit someone…
Rash
(Dermatology for dummies… and ER docs) My favorite rash story comes from a cruise ship. One of the filipino band members visited the ship’s clinic with pus dripping from sores…
Sea Urchin Sting (Wana)
Every practice setting has its specialty. For Poipu Mobile MD it appears to be “Wana” stings. Patients often arrive after surfing, or walking on shallow rocks. They generally describe a…
Seizure
A couple months ago I was working with Vanessa in a coffee shop, when it seemed all eyes had turned to the floor under one table. The group gaze pointed…
Shock
Slishman’s Unified Theory of Human Emergencies “SLUTHE” (joking)… However, I do have an odd take on the word “shock,” which gets thrown around quite a bit. Shock comes in a…
Shortness Of Breath (Pediatric)
More plumbing… Just like Eustachian tubes, pediatric lungs and tracheas are simply smaller than they are in adults. As such, any bit of inflammation can lead to all kinds of…
Sinus Pain
For some infections we’re sold that antibiotics help. UTIs, kidney infections, and skin infections are a few examples. People with these frequently get better over hours. I myself had a…
Skin Infection / Cellulitis + MRSA
A patient of mine last week made me think of my own personal experience in 2005 with “MRSA,” so I thought I’d type about cellulitis today. Having once been a…
Snake Bite
In 2015 we provided medical support for the Primal Quest Expedition Race. It included a 600 foot ascent up Calaveras Dome. However, fear of falling wasn’t the issue. It was…
Spider Bite
For starters, I’ll say this… I/we frequently don’t believe you. Even if you actually saw the spider rearing its head, when you head to the ER it’s probably best just…
Strep Throat
I’ve received a number of calls lately from patients certain they have strep throat. This link is a useful tool to estimate the likelihood. With fever, tender lymph nodes below chin along the…
Stroke
Very few decisions in emergency medicine are as challenging as whether or not to give a “thrombolytic” to someone suffering a stroke. This hasn’t changed at all for me since…
Suicidal
Since mental health coverage seems headed the direction of women’s health… and actual women in the Trumpcare room… I thought suicidality might be the right next Anxiometer post. As for…
Thermal Burns
This post, inspired by a smiling patient with a sub 1st degree, coffee burn that found me in an ER. There are bad burns and everything else. The above injury…
Ticks
I never thought I’d be typing about ticks this Saturday, but it feels suddenly and strangely important. A student called a few days ago after a hike to tell me…
Urinary Discomfort / Dysuria
If men got UTIs as often as women, there’d be antibiotic vending machines. Very little that I do seems to spread more relief (sometimes sheer joy), than the destruction of…
Vaginal Bleeding – Early Pregnancy
Some medical problems may appear only once in a career; alligator bites in SLO for example. Then there are the bread of butter problems of emergency medicine that arrive every…
Vaginal Bleeding – Later Pregnancy
As Vanessa and I sit here waiting for baby two to arrive, it occurs to me that this area of medicine is really a black box for me, and partially…
Vertigo
I recently was called to a hotel to see someone with such bad vertigo, he was stuck on the floor with eyes closed and head pinned to the side of…
Vomit (Pediatric)
Like most folks this season I’ve developed a hack, and a couple days ago my toddler Max joined along. He’s still super active, breathing, eating, peeing, pooping, so not too…
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The content on this website is made available for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. To get a medical diagnosis on your condition you should request a consult with Dr. Slishman or with your primary care doctor. This blog (The Anxiometer) and all contents herein are the intellectual property of Pre-R and may not be used or copied without permission.