Exorcism in the ER......NOT - page 6

Had a pt come in the other night, female about 40 y/o. She was brought in by her husband and her pastor. She was dragged from the car by them and placed in a wheelchair, and was then intercepted and... Read More

  1. by   estrogen
    Quote from stevierae
    Thank you. Exactly----a deep IM injection of sterile water is a well-known placebo, and it's been around a long, LOOONNG time. And, no, I was not making this up--we did this often (for malingerers and narc seekers) when I was a military corpsman, (age 21) working in the emergency room. Of course, it was ordered by a physician--we didn't just do it arbitrarily.

    It burns like crazy, (but does absolutely no harm----unlike IV Phenergan, which I absolutely will NOT administer, under any circumstances--that type of burning means it is damaging a vein) which makes the malingerer or narc seeker think he is getting something really good, and he or she goes away happy as a clam---but next time remembers how much it burned, and thinks twice about coming to the ER faking various symptoms of various maladies, thinking he has cleverly fooled us all when he gets his "drug." He even fools himself into thinking that he is high.

    Placebos are a wonderful thing, and will always have their place in medicine. In fact, they are downright therapeutic.

    It was not administered to be cruel. Would you have preferred that we simply gave them their narc of choice, (p.o., so that it wouldn't hurt, of course) no questions asked, and sent them on their merry way--until next time they showed up, demanding more narcotics, in ever increasing dosages, for non-existent problems--only to repeat the scenario?

    Okay,
    A) yes, you're right, maybe thirty years ago placebo was legal, acceptable and used... Today it's not...thank God.

    B) You wouldn't give IV Phenergan???? For what, instead of a narcotic??? I have no Idea what you are talking about. IV Phenergan is not a narcotic, but it has calming effects and it makes one sleepy etc... As a matter of fact, there are people that are SEEKING Phenergan. So why would you even think of that?

    C) Most drug seekers WANT their drugs IV, not PO.

    D) If it burns while you're administering IV Penergan, it most likely means that it's damaging the vein because you're pushing it too fast...


    Excuse me, where do you work again?
    Last edit by estrogen on May 10, '05
  2. by   estrogen
    Quote from MAGIK GIRL
    oh, that explains it, med surg. if you have not walked in our path, you have no place calling us cruel, judgemental or presumptive.

    we give our pts what they need. in fact, giving the patient nothing, including placebo, would have been cruel. because perception is 9/10's of reality. if you can get rid of someones pain with out loading them with junk, why not. or should we just creat some more addicts?

    be less judgemental and more open minded and you may find your life a little easier.

    :hatparty: :hatparty:

    ...for this I have no words ...

    How the heck does med surg explain anything? ....and thank you, my life is wonderfull
  3. by   estrogen
    Quote from Angie O'Plasty, RN
    I have issues with placebos, even in jest. I was around 30 years ago and it brings back very painful memories of patients being given no effective therapy for pain.

    I realize that this is off-topic. But just in case some people think it's still OK to use placebos, I offer this:

    http://www.edc.org/PainLink/placebo.html

    Clinicians may administer a placebo, not out of maleficience, but rather in good faith, based on erroneous beliefs that use of the placebo will provide valuable information or help patients by relieving pain without harmful side effects. [Or]... clinicians may use placebos in a punitive sense for patients who have exhibited manipulative or demanding behaviors or for patients in whom diagnosis of the cause of the pain or methods to relieve pain have failed.

    Central ethical tenets of the American Nurses Association Code for Nurses (1995) include truth telling, fidelity, trust, and respectful care. The use of placebos necessarily involves deception, which automatically raises serious ethical concerns. Use of placebos threatens the inherent ethical values and norms of healthcare professionals. Informed consent, which is most often absent in the use of placebos, is a necessary requirement for promoting the autonomy and well-being of patients. The use of placebos may ultimately compromise the therapeutic relationship between patients and healthcare providers by eroding the necessary environment of trust.


    Again, I want to emphasize that the placebo idea was only a suggestion of one poster, I understand it was not used in the OP's scenario, and I am not trying to do anything here but clarify to newcomers that giving placebos is NOT accepted nursing practice today.
    Thank you
  4. by   renerian
    I am with you, very interesting.

    renerian
  5. by   stevierae
    Quote from estrogen
    Okay,
    A) yes, you're right, maybe thirty years ago placebo was legal, acceptable and used... Today it's not...thank God.

    B) You wouldn't give IV Phenergan???? For what, instead of a narcotic??? I have no Idea what you are talking about. IV Phenergan is not a narcotic, but it has calming effects and it makes one sleepy etc... As a matter of fact, there are people that are SEEKING Phenergan. So why would you even think of that?

    C) Most drug seekers WANT their drugs IV, not PO.

    D) If it burns while you're administering IV Penergan, it most likely means that it's damaging the vein because you're pushing it too fast...


    Excuse me, where do you work again?

    estrogen, I was merely trying to clarify that I am not some mean, vindictive, cruel nurse, as I think is your perception of me. I very clearly stated in my original post that it was while I was in the Navy--30 years ago--that we used that technique in our ER. As I said, it was a very different world then----there was no JCAHO; people were not litigious (in fact, at that time, military and their dependents could not sue military health care providers) and the terms "standard of care" and "policy and procedure" had not yet made it into the general health care system vocabulary. In fact, those terms did not even become popular until the '90s--I never heard them in nursing school (I graduated in '81.)

    I used to teach IV nursing, and I am an operating room nurse, as well. If you do a search of the archives here by typing in Phenergan, you will find multiple discussions about whether it can/should be given IV. The Intravenous Nurses' Society has a list of drugs that are vessicants, and should never be given IV. Phenergan is one, and it is also one that is the subject of many IV lawsuits, and has actually caused tissue necrosis leading to sloughing and even the loss of fingers and even arms.

    The problem with Phenergan is, no matter in what volume it's diluted, or how slowly it's pushed, ITS pH REMAINS THE SAME. It remains a vessicant, and can cause serious damage to the intima of the vein--hence the burning--and if it extravasates, tissue necrosis etc. Yet, it continues to be given in ERs all over the country by nurses who think that they are not held to INS standards of care. The truth is, once you choose to give IV meds, of any sort, you are held to the same standards of care that nurses certified by INS are held to.

    The burning with IM sterile water, however, was not causing any damage. It had a placebo affect, which was accepted medicine and nursing care in that era.

    Drug seekers would "prefer" that they get their meds IV? :uhoh21: So what? Are we just supposed to accomodate them, in the name of patient satisfaction? As Mick Jagger said, "You can't always get what you want."

    Actually, I think that the legions of drug seekers who go from ER to ER to ER with vague complaints of "low back pain" or "abdominal pain" (with "symptoms" that aren't supported by lab work or radiological studies) for which they are seeking a script for Percocet or Vicodin disprove your theory that "MOST" drug seekers want their narcotics IV. Again, what SHOULD we do with these drug seekers? They aren't interested in what's therapeutic---they want a steady supply of narcotics, often to sell on the street. Do we simply accomodate them, no questions asked, to avoid risking offending them or being "judgemental?"

    Angie O'Plasty, thanks for that info from ANA. I haven't given an injection of sterile H2O as a placebo since I was in the Navy. It makes sense that patients should give informed consent for any drug they are administered (wonder why they aren't told anything about possible risks and complications--other than "this may burn a little--"--when they are given IV Phenergan?!) and that as nurse advocates we are part of that informed consent and teaching process.

    I am still betting, however, that the use of various placebos is alive and well---right or wrong--we just don't hear about it anymore.
    Last edit by stevierae on May 10, '05
  6. by   Gail-Anne
    Just how does an humorous story become a "Flame" thread?
    Granted, exorcisms in ER may not be in everyones perverted funny bone but can't we let folks have a few laughs and take it with a grain of salt?
  7. by   renerian
    Agreed.

    renerian
  8. by   MAGIK GIRL
    Quote from Gail-Anne
    Just how does an humorous story become a "Flame" thread?
    Granted, exorcisms in ER may not be in everyones perverted funny bone but can't we let folks have a few laughs and take it with a grain of salt?



    thank you!
  9. by   estrogen
    Quote from Gail-Anne
    Just how does an humorous story become a "Flame" thread?
    Granted, exorcisms in ER may not be in everyones perverted funny bone but can't we let folks have a few laughs and take it with a grain of salt?

    Oh, I totally agree. ...And besides, I have to admit, I'm somewhat exhausted by battling raving lunatics who refuse to get off their soap box.

    ....So, I'm moving on. :Melody:


    ...Oh, and thanks for the info on Phenergan, stevierae. I did not know that.
    Last edit by estrogen on May 10, '05
  10. by   stevierae
    Quote from estrogen
    Oh, I totally agree. ...And besides, I have to admit, I'm somewhat exhausted by battling raving lunatics who refuse to get off their soap box.

    ....So, I'm moving on. :Melody:


    ...Oh, and thanks for the info on Phenergan, stevierae. I did not know that.
    Sure---gee, I hope I am not the one you are referring to as a "raving lunatic...."
  11. by   estrogen
    Quote from stevierae
    Sure---gee, I hope I am not the one you are referring to as a "raving lunatic...."
    :chuckle Oh stevie.... It's all good. :icon_hug:
  12. by   MAGIK GIRL
    Quote from estrogen
    Oh, I totally agree. ...And besides, I have to admit, I'm somewhat exhausted by battling raving lunatics who refuse to get off their soap box.

    ....So, I'm moving on. :Melody:


    ...Oh, and thanks for the info on Phenergan, stevierae. I did not know that.

    estrogen,
    enjoyed ya. sorry to see you go! remember, it's all in good fun!

    stevie rae,
    catch ya later!
  13. by   RainbowSkye
    [QUOTE=SARAH CONNOR]wow. what small minds and big egos we all must have to deny others thier beliefs! i wonder what people thoughtwhen they heard about the parting of a whole sea! part a sea, kiss a snake. what ever you believe is ok with me.


    I absolutely agree with the idea of religious freedom. However, this patient came to the emergency room with an apparent physical/emotional problem wanting medical expertise. I'm pretty sure that everyone knows that care in the ER does not include exorcism, so I really don't understand why someone would come to the ER expecting a priest on call for emergency exorcisms.

    Spiritual emergencies need to be referred to the minister, priest, chaplan, rabbi, guru, priestess, whatever...

    This patient is very lucky she didn't get sent off for a 72 hour hold (would of happened in my state). And I'm wondering if a mental health referral would have actually been a good thing...

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