True Surprise | Hacker News Reader

True Surprise

docbastard.net

193 pointsdmit27 comments

One of my favorite ER patients was a guy who got stabbed in the chest by his girlfriend with a 10" serrated bread knife. Came in with the knife still in him, buried to the handle. Bellowing that this proved ... something about him. He was clearly pumped. But not really bleeding. After a chest CT and removing the foreign object from his chest, there was still no real bleeding. The knife had gone in at a bit of an angle, but what really saved him was the fat. 10" of steel and it never made it to the pleural cavity.

First case report I'm aware of where fat was cardioprotective.

In the bad surprise category was the 50-ish guy I admitted as an intern for uncomplicated chest pain. He got married that day but left the ceremony in an ambulance instead of a limousine. The plan was cardiac enzymes and put him on a stress test in the morning. First set was negative and the anginal pain had abated. All the right things were done. Seemed straightforward.

Three hours later while I was trying to sleep I get a frantic call from the ED that he was coding. He was sitting up watching TV, suddenly turned grey and clutched his chest, and fell back in ventricular fibrillation. We shocked him into pulseless electrical activity and then did a three hour futile code because his new wife couldn't grasp the fact her new husband had died right in front of her. And really, who can?

Surprise.

What does "coding" mean in this context?

https://en.wikipedia.org/wiki/Hospital_emergency_codes

Code Blue - cardiac arrest

https://en.wikipedia.org/wiki/Cardiac_arrest#Code_teams

Yeah because this is HN, I first read it as "the patient started programming in the middle of the night".

The irony of surprise is misunderstanding in the HN context too. I too pictured the poor bloke got up, cracked open his laptop to do some coding in a hospital bed. LOL. Thought: poor guy can't even get a break from devops on his wedding day and even after a fucking heart attack.

No surprises!

Doc, is there any way to measure my current risk of sudden cardiac arrest/death?

This unfortunate person was probably in a different risk category than you (not knowing your personal history, and obviously diagnoses over HN are fraught with peril ;). He had fairly classic anginal symptoms, putting him at higher risk due to presumed pre-existing ischaemic heart disease, and most likely his heart simply chose that time to have the attack that killed him. Note I'm stating that cause of death clinically since I don't recall he ended up being autopsied and a heart attack can easily throw you into v-fib.

Sudden cardiac death can come from a massive heart attack, but it can just as easily arise from abnormal heart rhythms of other causes which aren't related to coronary artery disease (and the risk factors for same, such as diabetes, obesity, etc.). Essentially you're looking for conditions that would screw up the normal electrical function of the heart and its internal "wiring." The risk factors for that otherwise include pre-existing anatomical defects (bad valves, congenital abnormalities, abnormally large heart size such as hypertrophic cardiomyopathy), abnormal blood chemistry or electrolyte levels, history of abnormal cardiac rhythm (things like long QT syndrome, Wolff-Parkinson-White), and certain medications and recreational drugs.

If you fall into those categories, have a personal history of heart disease or are otherwise unsure, a simple EKG will rule in or out quite a number on that list. Similarly, if you have a family history of heart disease, you are probably in a higher risk category as well. While the USPSTF doesn't recommend EKGs in asymptomatic individuals at low risk, falling into one of those groups would probably not be low risk anymore. See https://www.uspreventiveservicestaskforce.org/Page/Document/... for more details.

Hopefully that was somewhat helpful. As always, this wouldn't replace asking your primary care doc about it.

That's incredibly helpful! Thank you!

>First case report I'm aware of where fat was cardioprotective.

Happens all the time. If all you have is one of those $80 handguns chambered in .3-something-weak and loaded with hollow-points (they were popular in the 80s and a lot of them are still floating around the streets) a fat person dressed for winter in a cold climate (hollow points don't like thick clothing) might as well be bulletproof.

I met a soldier who had been shot in the head in Iraq. He had a scar all the way round his head from near the temple right to the back of his head where the bullet had gone under the skin and travelled round the surface of his skull before exiting. He was a very lucky bastard.

Luck seems relative. He did get shot after all

True. Amend it to, 'much luckier than most other people who have been shot in the head'.

Is it normal in medicine to refer to a baby's physical sex as its "gender"? I'm not looking to start a debate on whether that is right or wrong, just curious to know if that's the common usage or just this particular writer's preference.

In medicine, at least in my experience, the terms are used fairly interchangeably.

I wonder why that is.

Similar with scientists in my experience. Though it's more easily explained as the older generation sees the terms as interchangeable or not worth arguing about. The younger generation tends to use sex specifically and might call out improper use of gender.

// "MICE DON'T HAVE GENDER!!!!" <- something I've heard at high volume too many times

Interesting the way it changes within a couple of generations, the "older generation" in my day, i.e. my dad - a linguist - would call out the then-modern interchangeable usage, by insisting "nouns have a gender, people have a sex!"

Seems common to use both (I've heard gender used by doctors many times when it should probably technically be sex). To me gender means "male or female" but sex means "male or female or f*cking." I assume lots of people think that way and that's why they prefer the word gender.

Great blog. Lots of cool and interesting tales. Thanks for sharing.

That is interesting. I don't know if I'd ever feel 100% sure that the bullet actually bounced out until the bullet is actually found.

The bullet would have to be made of something really exotic in order to hide from a head-to-toe CT.

Turns out the lab next door was testing a prototype explosive-pumped particle weapon. There was never a bullet. Surprise!

Didn't Mythbusters do an episode of that? IIRC they tried an ice bullet and one made out of frozen meat, neither really worked.

-log(probability_of_our_prediction)

There are no "true" and "false" surprises, it's continuous. And it is additive.

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