January 7, 2007, 9:41 am

A Meditation on Regurgitation

nose

Oh, now this is attractive!

One can only hope that one would use a different applicator for the nasal application than, say, for the rectal application.

Hmmm…

According to my Mac dictionary widget, catarrh means “excessive discharge or buildup of mucous in the nose or throat”.

How would one have rectal catarrh?

Isn’t that called diarrhea?

How would you know you have stomach catarrh anyway?

Just saying catarrh makes me feel like I’m coughing up a hairball!

******************************

How on earth is one able to tie in a “food” theme to working in the emergency department?

Well, it is true that every single patient in the ER wants a meal (after the commode and a glass of water), but you really can’t write an entire post on that!

And….we do hold the world’s record for shoving pizza down our gullets on those nights from hell when the only person who will deliver is from “Mr. Pizza Man”.

But no…I don’t think that’s too interesting.

But the theme for this week’s Grand Rounds is food!

What’s a blogger to do?

*****

Then, inspiration! It struck last night!

Or should I say it flowed…from both ends?

You see, the San Francisco Bay Area is in the throes of a vomiting/diarrhea epidemic of, well, epidemic proportions. And what are vomiting and diarrhea but the products of, you guess it! Food!

We in the ER are privy to food in the post-production, post-consumption phase. We see food in every way, shape, form, color and smell you can imagine (and some you wouldn’t want to!)

I have just returned home from a night shift full of food in varying stages of digestion.

The fact that I am sitting here two hours after my shift

  • having shed my uniform at the door,
  • dived into a hot bath with antibacterial soap and
  • washed my hair…

… and still smell the gastrointestinal buffet presented to me last night has put me into a meditative frame of mind.

Join me as I contemplate the regurgitation and prodigious elimination of food in the ER.

*****

I think we all should buy stock (no pun intended) in Campbell’s soup, because I do believe everyone in my county of employment had the Chunky Chicken version for dinner.

I know because they all gave it back to me.

Everybody vomited the same bright yellow color, the same chunky texture, and the colorful vegetables with the same smell. Everyone except the little boy who supposedly had tuna casserole for dinner but threw up macaroni and cheese. He may have been saving his up since lunch.

They call it the “flu”. I think I would call it the “spew”.

And then there are the different styles of regurgitation of. We have:

  • The Dribbler: this person just lets the reappearance of the last meal dribble down their chin without expending a lot of effort. This is the only person an emesis basin works for.
  • The Projector: this person will saturate their socks with the remnants of their last meal without getting a bit on their sweat pants. No basin works for this person unless it’s at the foot of the bed.
  • The Puffer Fish: this person is able to hold the regurgitated food in their ever-expanding cheeks until you give them a large basin at which point they will proudly display their achievement for your assessment and evaluation. I saw productions tonight that should have gotten standing ovations.
  • The Dry Heaver: this person tries so hard to produce anything of a semi-digested nature, but they are so dry they can’t even give you a hint of bile in the basin. You almost want to give them Campbell’s Chunky Chicken soup so they can at least have a chance at competing in the World Emesis Championship.
  • The Two-Fer: this person goes for the gold by giving not only a world-class emesis, but prodigious diarrhea at the same time. This usually occurs after doses of Zofran and Phenergan and most likely just as you begin to transport the patient to their room after waiting five hours for a bed assignment. These patients are 99.9% likely to be bedridden, requiring two nurses to clean them up, resulting in another two-fer.
  • The Starbucks Throwback: these coffee ground emesis givers are troublesome in that they usually require an NG tube to assess for bleeding. Which is silly because if they just threw up coffee grounds, there’s trouble in Gastric City and you don’t have to go looking for more!
  • The Cough and Urp: these patients are pediatric in nature and are rushed in by their parents for repetitive vomiting. With a bit of careful investigation, along with observing the child vomiting on your stethoscope while assessing respirations, you realize the child is experiencing post-tussive vomiting secondary to gagging on their copious respiratory secretions. While not officially related to the intake of food, you do get to see what curdled breast milk looks like and so it is included in this overview.
  • The Non-Chewer: this producer of stomach contents does not chew their food and so you will see entire florets of broccoli floating in a sea of intact shrimp with a bit of parsley for decoration. It’s impossible for them to aspirate as the expelled food is too large to fit in the trachea.
  • The Bottomless Pit: this patient puts out more in one emesis than a normal person eats in an entire day and repeats the performance at least three times! No wonder they are sick – their stomach is like an overfilled helium balloon.

So there you have it. The various and sundry ways in which perfectly good food is turned into a gut-churning experience.

This is how we experience food in the emergency department.

Consumed, semi-digested and returned with enthusiasm.

Luckily when it comes to the “other” end, people are more private about their production.

Don’t even get me started on that!

28 Comments


  • universalhealth

    January 7, 2007 at 12:04 pm

    Remember Glidden Paints slogan, “covers the earth”? Your post sure gave me pause to consider that. Er – thanks – I think! 😉



  • orthorn

    January 7, 2007 at 12:17 pm

    We had the same virus in the Southeast in mid December. Contrary to the popular belief among healthcare workers that we rarely get these “bugs”, this one was not selective. After a night like you just described, about half the ED staff had it within 48hrs. Or maybe they couldn’t bring themselves to go through another shift of recycled food?



  • attack rate

    January 7, 2007 at 1:15 pm

    Urp. Shouldn’t have read this while eating breakfast (although shredded wheat and a peach fortunately don’t much resemble anything you described…)

    This post encapsulates one of the reasons that I became a vet, and then moved into public health. Ick.



  • Deacon Barry

    January 7, 2007 at 1:38 pm

    I laughed my socks off. I did the puffer fish once at primary school during school dinner. I think I put most of the other kids off their pudding. Of course I went back and had mine.



  • A Bohemian Road Nurse...

    January 7, 2007 at 6:56 pm

    Too funny!



  • ChiaLing81

    January 7, 2007 at 7:16 pm

    Oh Kim, you have me laughing through my swollen lymph node pain and fever! So gross, but oh-so funny. Thanks for sharing!



  • Melissa

    January 7, 2007 at 9:02 pm

    Funny post. Thanks for the laugh.



  • Carrie

    January 7, 2007 at 9:08 pm

    Oh Kim, I had to laugh! I don’t know if you’re aware of my GI problems of the last several months….or….how to lose 15 pounds or so rapidly by vomiting and not because you’re trying to!

    Reflux in the middle of the night into the metal bowl next to my bed is my latest chosen favorite. I wake up and feel the nausea and can smell the sickening smell in my nostrils before I get sick…that means I’ve been refluxing while asleep. And if the esophageal spasms get going, too – it’s a special treat and means I’ll be heaving up the contents of my stomach and my stomach right along with it. I didn’t know abdominals could contract quite that hard! And that’s even more scary when it comes with the rattly chest – the first time I had that with the esophageal spasms, I thought my esophagus had ripped. (Yes, I’m a nurse…and I had that kind of dumb thought…) But now I’ve had a wet cough for about 5 days thanks to refluxing in my sleep and aspirating something – no doubt. But thanks to the reflux (in spite of zegerid, zantac, domperidone 6-7 times a day, and zofran), vomiting, and weight loss – well…life has been special. My next step might be pH probe testing and other awful not fun things.

    Emesis is…..grand…..ain’t it? :-/ Blehhhhhhh……

    One wonders why I don’t get sleep at night – it’s because I don’t like to fall asleep to wake up puking – so I hate to lie down anymore! We’ll see what Dr. GI doc (best doc ever) has to say tomorrow!

    I can define all kinds of baby puke for ya on another day – I’ve seen it all! 😉

    Hugz,
    Carrie 🙂



  • DisappearingJohn

    January 8, 2007 at 2:19 am

    Yeah, not the post to eat with my midnight snack…

    But then again, we all rush into the break room to snarf pizza during brief lulls in these pandemics, so I guess reading about it makes in no worse…

    Although the absolute worst smell I have ever smelled was a guy who got too drunk on cheap beer and gobs of popcorn… Cleared out a room quickly!



  • Rita Schwab

    January 8, 2007 at 2:52 am

    Eeewww…

    Now I remember why I didn’t go to nursing school, although I’m thankful every day that there are people who did!



  • S. R.

    January 8, 2007 at 2:57 am

    What really frazzles me is when they come up to the floor vomiting into a cylinder with a 24-gauge IV that doesn’t work. Woo boy!



  • Annemiek

    January 8, 2007 at 4:45 am

    That sounds like what we’ve had here since before Christmas. This virus has worked it’s was through the staff and patients, it has been horrible. Despite all the handwashing, I got it after just 1 shift. I hope you will be spared!



  • dgm

    January 8, 2007 at 5:29 am

    such a helpful exposition! now that you’ve covered the styles of hurl, will you touch on the sounds next? my husband and mother in law vomit loud and deep, like harbor seals. i, however, am much more refined, with little sound from my vocal cords.

    be well.



  • Surgeon In My Dreams

    January 8, 2007 at 6:37 am

    Ughhhhhhhhhhhhhhhhh….yuck!

    Please tell me I am not the only middle aged female who “loses urine” when she hurls!?!?!

    I rarely vomit except with migraines, but when I do I have found it is physically impossible to do those kegels adequately to stop the urine while heaving over a toilet bowl at the same time.

    Say what you like, I blame it on two large 9+ pound babies.



  • ~RN Faye

    January 8, 2007 at 7:38 am

    OMG. I am having flashbacks. And I need to go into work tonight!!



  • Kelly

    January 8, 2007 at 8:47 am

    The South is in the throws of the same epidemic.

    And I hear the Northeast is going through it too.

    Someone said that America is under biological attack…..;)



  • Sid Schwab

    January 8, 2007 at 8:57 am

    Re: catarrh. When first in practice, and after taking out a normal appendix (rare, I might add), I was surprised at the path report which read “acute catarrhal appendicitis.” I asked my partner what the heck it was. He said, that’s just ol’ Jim the pathologist giving you a pass on your first one. Means he saw a couple of histiocytes or something. If he doesn’t say “purulent” it ain’t appendicitis.

    Your list might have included “hurler horribilis” (can’t think of a better term just now): the results of colon obstruction, wherein the vomitus is what you’d normally expect from the other end. Pretty unpleasant.



  • laura

    January 8, 2007 at 9:04 am

    looks like the spew is traveling west!
    we had it here in the central valley for christmas. it was a beautiful thing with all of my circus sick at once.
    bad mommy.nurse that i am i just don’t handle vomiting well at all and even worse when i am vomiting too.
    we survied thought without an er run thankfully…that would have made for an even more memorable christmas! still the hardest part wa when my little boy who recently said goodbye forever to his g tube and has overcome a severe oral aversion was dealing with the spew…poor buy! he desperately tried to hold it in not understanding why his little body was rejecting breakfast lunch and dinner from the last day.
    i can relate to those days where we dump the scrubs at the door and hop in the tub/shower before touching anything or anyone else in our home.
    ICK!



  • Candy

    January 8, 2007 at 1:03 pm

    Oh, Surgeon — I lose urine when I *think* about hurling (and my babies were only 7 lbs and 5 1/2 lbs!).

    Kim, this was the best ever, I laughed till I thought I was going to give my lunch back! Here’s my personal favorite: the person who barfs so hard that vomit comes out of their nose at the same time. Looks especially fetching when spaghetti has been their last meal…



  • Susan

    January 8, 2007 at 2:19 pm

    That was so gross. Thank you.



  • Deacon Barry

    January 8, 2007 at 2:57 pm

    I’ve just had a bowl of spaghetti bolognese. Now I have that image burned on my associative memory!



  • Deacon Barry

    January 8, 2007 at 3:02 pm

    In Scots, we have a wonderful word for vomitting – to boak or boakin’ . The dry boak is where you retch and retch but nothing comes out.
    We’ve also got talking to Hughie on the great china telephone, as well as his friend Ralph.



  • apgaRN

    January 8, 2007 at 3:38 pm

    GREAT SUBJECT, Kim!… as evidenced by copious comments. 🙂 I didn’t even manage to read through all the comments yet. I just have to get this out.
    Vomiting has got to be one of my absolute, without-a-doubt least favorite things to DO, and unfortunately, I am of the really, loud and obnoxious (although this is obviously completely uncontrollable) variety. Every heave has to come up with a loud exclamatory yell, as if to announce its arrival. Ugh. Which is probably why I can still count with my own fingers and toes the number of times I’ve thrown up in my life.
    On the nursing front, my funniest patient vomit story ever: the patient who had just delivered and decided she was ready to devour the tray of food placed in front of her, starting with the pineapple chunks and strawberry milkshake, both of which rapidly reappeared and were subsequently spewed all over the rest of her food… nice combination of pink and yellow puke. Argh.
    One more thing. Least favorite medication: hemabate for postpartum hemorrhage… it’s difficult for a patient who has a spinal for her C-section to be “private” about the diarrhea produced as a side effect of this life-saving med. Although I have heard it said, if they really needed it (i.e., they were bleeding THAT much), they won’t get the diarrhea.
    You had me laughing once again.
    Kudos!
    N


  • […] In sickness and in health. Impacted Nurse’s guestimates vomitus trajecticus after a magic mushroom quiche you’ll never forget, and Kim at Emergiblog meditation on regurgitation wants to rename the “flu” the “spew”. Her identification of the Starbucks Throwback, the Two-Fer and the expected if disgusting Non-Chewer has nutritional implications. Chewing is also inadvisable if, for example, you are uninformed and in the wilderness, about which Paul Auerbach’s wild plants and mushrooms is clear. […]



  • Deire

    January 9, 2007 at 1:04 am

    Oh, trust me, the cough and urp is not limited to pediatrics. Asthma is fun!



  • TC

    January 10, 2007 at 3:53 am

    Mmmmm….shrimp and broccoli. Maybe I’ve been a nurse too long.



  • emmy

    January 11, 2007 at 1:29 pm

    We’re having that pandemic on the east coast too. My daughter had it earlier this week, spewing from both ends. Greatfully she had the forethought to jump in the shower to do it. Only had to clean up the tub, three times. I took her to her doctor and she fainted after a shot of Visteral. Bad news! My question is who gets food in an ER. After many visits, I can truthfully say that I have never been offered food there.



  • Tricia

    January 24, 2007 at 10:29 am

    I think you missed one: the one with so much force it comes back out of the basin and showers the vomiter. (Like those beverage commercials where the drink goes into the glass and makes that sort of slow-motion swirl as the glass fills – but this comes right up and back) To the nurse who cleaned me up, and to all medical personnel who have to deal with this stuff, I’d just like to say thank you so much for everything you do.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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