Friday, June 06, 2008

The "O", "Q", and "Dotted Q" Signs

Gallows humor is one method many of us use to handle horribly sad or tragic situations. Guilty.

I recalled today, as I drove past a hospital I spent much of my third-year of medical school in, about the "O", "Q", and "dotted Q" signs.

A crusty old attending who has now passed (bless him) was waxing poetic about hospital work before heroic measures, 'code blues', and death prolonged by machines. The following physical findings ("signs") were, evidently, quite common then, and quite diagnostic.

The "O Sign": Patient with agonal respirations, mouth agape, near death. The mouth is in the shape of an "O" hence the "O sign"... very bad.

The "Q Sign": Patient dead. Tongue now lagging out of mouth (thereby changing the "O" to a "Q").

The "Dotted-Q Sign": Patient long-dead. Fly on end of tongue (thereby dotting the "Q").

Now you know and you wish you didn't.


  1. "O Sign?" That's funny, she was 22 and didn't seem anywhere near death.

  2. I made the mistake of reading this at work. There's a patient in the waiting room giving me a funny look now.

  3. Cheer up 911, the "O" sign isn't limited to the near-dead, I occasinally display this sign myself. Then there's the "dotted O" sign, when theres an endotracheal tube in the middle of the O, again, not always terminal.

  4. I'm thinking I might take that new chick from Logistics. If things go well I might be showing her my O-face. "Oh... Oh... Oh!" You know what I'm talkin' about. "Oh!"
    Office Space (1999)

  5. Humor???

    I'm glad you can laugh at your dying patients. I hope one of the family members hears you talking about their mother like this.

    New low.

  6. Um, trix?

    One of his patients' family members won't hear him talking about their mother like this because he's making these very funny comments on AN ANONYMOUS BLOG.

    Perhaps the words "Gallows Humor" at the beginning of the post confused you. Google it, you dumbass. He's not laughing at his dying patients.

    Fucking troll.

  7. Trix needs to work around death for a little while. If we couldn't laugh a little at death (and the patients that are dying), then we'd all go crazy and wouldn't be available for them.

  8. That tears it; I'm going straight to hell with the lot of you because I found this uproariously funny.

  9. Trix, we used to call the Neurological ICU the "Vegetable Garden" because, well you know,..oh forget it. NICU rounds were referred to as "Plowing the Garden"

  10. trix,
    you are right, shame on me, but to be fair, i'm only making fun of one dying patient, the other two patient's are dead, graveyard dead. Also, when I have to tell a patient about a family member's death all I say is, "what's your family member's name that was... I mean is here?? they have a 'dotted q' sign. good day." i actually don't think this is as funny as this... now this is really funny. hope i get to see a kid with a kidney stone today. they are such pussies.

  11. Hey docs, funny as usual. But I've got a request.

    How about a ask your random question (not for medical advice) post? I know it's not quite ranting but I've got some questions that are begging for answers.

    Such as:

    What if you have an excessively hirsute guy code? You know the guy with the chest pelt luxurious and thick enough to make a beaver jealous. Do you have to shave them down really quick to get the paddles to work?

    And dry drowning--WTH?

    Talk about every parent's worst nigtmare. How would you even know? Hypoxia? I mean aren't tons of kid's lips a little blue after getting out of the pool on a not blazingly hot day?

  12. hirsute beaver guy? shave him stat!

    dry drowning? doesn't matter. this is a persistent and out of date but of misinformation... there is no difference in treatment for folks whether they sucked in salt water, fresh water, or had laryngospasm leading to 'dry drowning'. tempest in a teapot.

  13. THanks 911.

    I'm still confused a bit on the dry drowning. So your kid can't have that happen if they suck in a bit of water in the bath tub and choke a bit? We've all sucked in too much water as a kid when swimming. How do we know as parents when it's serious? Or are there signs that your kid is slowly drowining inside?

  14. amy,
    what this really is is 'aspiration', and the name 'dry drowning' is misleading. unless i am mistaken the aspiration of water into the lungs then leads to something called ARDS and it can happen quickly and it is often deadly. that being said, this is a bizarre case and i would not be at all surprised if the kid has baseline respiratory problems like asthma. he should have been coughing and sputtering to beat the band and coughing up STUFF. i would also not be surprised if this DID happen and was ignored. just a guess.

  15. Thanks 911. I totally get aspiration and the dry drowning was portrayed as something separate. Much more sensational that way I'm sure.

    So if your kid sucks in too much water, then they should be coughing and sputtering, and hypoxic etc.

    Thanks, I CAN definately tell when respiratory things are up with my kids. We survived RSV this winter when J was 6 months old afterall.

  16. Hey 911, you're bringing back memories. Training in a coastal city, that was a fairly common discussion you'd hear in the E.R. "Fresh Water or Gulf?" with Attendings giving 3 Stooges eye pokes to each other. The ones who survived all ended up in the ICU on ventilators so it sorta makes sense that it doesn't matter.

  17. drack,
    theoretically there could be a difference, but the volumes required to cause a physiologic difference between fresh and salt water drownings is so large that it exceeds the capacity of the lungs to take it in.

    you still haven't told me your college football team.

  18. Drack, I swear to God this is true..I used to practice in a Medical Mecca where we sent the should not have been born to a facility called...Drumroll...

  19. Sorry, 911, AUBURN TIGERS.

  20. then i will have to out myself as a georgia bulldog fan. love auburn though. lots of ties twixt the schools. auburn will ruin georgia's run this year, or maybe florida will, or lsu, or arizona state, or tennessee. the sec is the best conference, hands down. go war-eagle-tiger-plainsmen.

  21. Vince Dooley, played QB at Auburn, brought Georgia back from the dead as Coach. Pat Dye, All American Offensive Linesmen at Georgia, coached Auburn back from the SEC cellar. My family is all Ga Tech and UGA fans. UGA's got a good shot of winning the College World Series this year, they won the first game today against NC State, only need one more to make it to Omaha.

  22. D sign:

    Like a Q but the tongue points in the direstion of the CVVHD dialysis machine.

    98% of being dead in 7 days.

  23. I love you guys. Thanks a lot. :D Was /thinking/ about how depression SHRINKS YOUR BRAIN (my interest in psych plus my desire to become a psych ARNP eventually) but damn, definitely more interesting things out there. Having worked in the ED and being a cutter, tetanus is a huuuge curiosity. Mostly, hoping I just don't get it. But still. I love you guys.

    Also: we've already read House of God. C'mon. :>

  24. Hannah,Hannah,Hannah, hide Bin Laden, join a polygamist cult, anything but Psychiatry. Seriously, that specialty could use some competent people going into it, but thats like complaining about High Tide, 10,000 years from now it'll be the same.

  25. Today, on Man vs. Wild, Bear Gryliss (or however you spell his name) killed a lizard so he could eat it. It had a + "Q Sign."

  26. Hmm, shockingly old post, but I'm almost positive this is from House of God. That's where I remember reading it from, at least...

  27. Ah, yes. These were originally created by Samual Shem, Author, "House of God". Tons of good medical humor.. such as, Age + BUN = Lasix Dose. Anyone in medicine MUST read House of God.