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Sunday, October 4, 2015

What is a medical train wreck?

So, we in the medical profession often refer to some patients as train wrecks.  The official term here is "Medical Train Wreck," although we Americans are good at shortening longer words that take too long to say, which is why some of us refer to them as MTWs.

That in mind, We figured we would officially define the term for our Faux Lexicon.

Word:  Train Wreck

Definition.  A person with greater than ten co-morbidities; treatment of one condition may exacerbate another condition

"The patient might be here forever, she is a medical train wreck."

Example #1:  A patient with heart failure, COPD, small bowel obstruction, hypertension,, CVA, myocardial infarction, chest pain, renal failure, sepsis, etc.  Surgery to repair the small bowel obstruction will probably require high doses of fluid; Due to bad lungs the anesthesiologist will refuse to extubate the patient, who will now be moved to intensive care.  The patient will be treated as exacerbation of COPD for three days until the physician realizes heart failure is the actual diagnosis. In the mean time the patient develops sepsis, pulmonary edema, and dyspnea.  Because the pulmonary edema causes an upper airway audible rhonchi, the episode may continue to be confused as bronchospasm, thus requiring a stat bronchodilator. You see, one thing leads to another.  These patients are train wrecks.

Example #2:  COPD, CHF, Diabetic, dementia, kidney failure, rib fracture from falling due to hyponatremia.  This patient has a GI bleed and is given blood, which causes pulmonary edema, which is treated with lasix, which exacerbates the hyponatremia; the patient is given an incentive spirometer, but you can't teach it to the patient due to dementia and the fact the patient is still on a ventilator due to the fact the patient was too sick to be extubated in the Operating Room.  The patient then develops pneumonia, and when the patient is extubated she has a forced expiratory upper airway rhonchi-ish wheeze that is mistaken by the physician for bronchospasm requiring Q4ever breathing treatments. This, in essence, is a medical train wreck.

Urban Dictionary Definition

Trainwreck:  A total f#@#ing disaster ...the kind that makes you want to shake your head.

The people at the party were so was a train wreck.

Trainwreck:  A person or situation that can't escape an inevitable bad outcome; hence, a trainwreck.

"The woman can't ever get a good man, a good job, or education. Her life sucks. She is a trainwreck!"

"The patient may never be extubated, she is a trainwreck

Trainwreck:  A name used to describe a clumsy, dangerous respiratory therapist or nurse. This person will damage things and hurt people (on accident or on purpose). They also take things too far. Rumors are also spreading about a trainwreck virus that causes these symptoms.  Ventolin is suspected as being the antiviral required to reverse Trainwreck-ism, and it will probably be recommended Q4 while in the hospital, and QID once released to home.  Some doctors catch this disease, although most are immune due to surreptitious knowledge obtained from medical school (perhaps they take ventolin at home).  

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