Frequent Flyers in the ED

Specialties Emergency

Published

So...I think everyone has their frequent flyers crowding up the already overcrowded EDs across the country. I was wondering if anyone's ED came up with anything that works!!!

We have our usual drunks, of course. At least we finally got some of our EMS departments to NOT transport them in when they have NO c/o!!! We had one local PD who picked up one of chronics and arrested him with public intoxication. Of course, they didn't want to keep him so they bonded him out on a SIGNATURE bond (this is important now!) Then they called rescue to transport him to us...because he was too drunk to be decisional and let go.

Ok so he's decisional enough to SIGN a signature bond...but not to pass out in the confines of his own bed!!??!! Sorry...no such luck!

Anyway...I digress!

I was thinking really of the seekers. We tried to come up with protocols and contracts and care plans...no go. I really HATE being the best dealer in town.

Anyone with anything that works?

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Just wondering if you are able to drink milk. Thats what I do with meds that upset my stomach. I know there are people who react differently to migraines. I wish I could function during one. :)

Just milk isn't enough. I have to have something more solid.

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Specializes in ER, ICU, L&D, OR.
w/ a migrine food would be the last thing on my mind,,

He was talking of a menu for meds to pick and choose from

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OMG!!!!!!!

He was talking of a menu for meds to pick and choose from
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One of our frequent pain med seekers Got Narcan on a visit to the ER. He thought it was the best stuff he ever had. Actually wanted to take the nurse home with him. I guess it was the first time he was actually clean! And those of you who are wondering, we did tell him that it was Narcan and that it should make him feel better. It worked!

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Let me tell you what has worked GREAT at our Er. TORADOL,TORADOL, TORADOL. It is the best pain medication (especially for migraines) and it doesnt give you the least bit of a high. We know that if 60mg of Toradol and 8mg of Decadron doesnt help the pain (even in the least bit) - they are drug seeking. I have migraine headaches (maybe 1-2 x a year) and Toradol stops it every time.Druggies hate it, though. Some have become allergic to Toradol :rotfl: . I pretty much know the regulars...Ill just tell them up front - you're not getting any "snacks" today..we're fresh out. But we do have some ibuprofen... :p . Ive also told them before that the stuff they get on the street is probably much stronger than what we have here. They tell me "its free here" SAD SAD SAD

Also, we make our drug seekers sit in the waiting room as long as possible. Sicker patients are seen first..They get mad but we tell them that this is not first come-first serve. This isnt McDonalds. pretty soon, they learn that its not going to be as easy as it used to be. (we used to have a doctor or two that seemed to enjoy giving out narcotics, and a lot of it.) Needless to say, they had drug problems of their own. Thank God they're gone..

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Let me tell you what has worked GREAT at our Er. TORADOL,TORADOL, TORADOL. It is the best pain medication (especially for migraines) and it doesnt give you the least bit of a high. We know that if 60mg of Toradol and 8mg of Decadron doesnt help the pain (even in the least bit) - they are drug seeking. I have migraine headaches (maybe 1-2 x a year) and Toradol stops it every time.Druggies hate it, though. Some have become allergic to Toradol :rotfl: . I pretty much know the regulars...Ill just tell them up front - you're not getting any "snacks" today..we're fresh out. But we do have some ibuprofen... :p . Ive also told them before that the stuff they get on the street is probably much stronger than what we have here. They tell me "its free here" SAD SAD SAD

Also, we make our drug seekers sit in the waiting room as long as possible. Sicker patients are seen first..They get mad but we tell them that this is not first come-first serve. This isnt McDonalds. pretty soon, they learn that its not going to be as easy as it used to be. (we used to have a doctor or two that seemed to enjoy giving out narcotics, and a lot of it.) Needless to say, they had drug problems of their own. Thank God they're gone..

Do you know where they went???

I have a couple docs I'ld like to send them!!

:angryfire

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Specializes in ER, ICU, L&D, OR.

I like the cocktails we give

Toradol 30 IV

dilaudid 1 IV

reglan 10 IV

benadryl 25 IV

trouble is how do you know which one worked

or which caused an adverse reactions

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I like the cocktails we give

Toradol 30 IV

dilaudid 1 IV

reglan 10 IV

benadryl 25 IV

trouble is how do you know which one worked

or which caused an adverse reactions

trouble is...

we have one doc who wanted 200 demerol iv...200!

same doc...wanted benadryl 200 iv given...

talk about your adverse reaction risk!

and no...no nurse agreed to give it

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Specializes in Emergency Room/corrections.

we actually have those FF's who come in and ask which doctors are working then leave when they realize its the docs who wont give out narcs to just anyone :rolleyes:

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we actually have those FF's who come in and ask which doctors are working then leave when they realize its the docs who wont give out narcs to just anyone :rolleyes:

ditto here!!

the only good thing is, that we, TOO, know which docs they are looking for...

funny enough they are just NEVER on when those FFs come thru the door.

just plain bad luck I guess!!

:angryfire :rotfl: :angryfire

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we actually have those FF's who come in and ask which doctors are working then leave when they realize its the docs who wont give out narcs to just anyone :rolleyes:

Thoses ones are everywhere.:o We have one dr in our er that tells us to use his name to scare away the seekers even if he is not there. Our seekers really don't like him. (and they just cant understand why he works so much) :rotfl:

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The problem is not the people who are truly in need. I do not doubt for one second the horrific pain some people are living with every day.

The problem is the ER is not the answer. In your case...why DIDN'T your doc/clinic call back??? Why didn't they prescribe a migraine targeting drug like Zomig or Maxalt for those bad ones? Narcotics are not only NOT the answer...they just nake everything more complicated. Not even the seeker problem (which IS an OMG problem) but in your case you were at risk for a rebound HA from the narcotic.Not to mention nausea...which is always soooo fun with a migraine I'm sure!

They are the ones keeping you waiting in a noisy crowded ED waiting room with a migraine that is out of control.

I've been following this thread, and what bothers me is apparent assumption that most people presenting in the ER with a Migraine are "drug seeking." Migraine specific drugs such as Zomig and Maxalt do NOT work for all Migraineurs. They work for approximately 85% of Migraineurs. Even then, the don't work for every Migraine episode. I go to one of the top headache and Migraine clinics in the country, yet, on weekends and after hours, if I have a Migraine that is out of control, I'm to go to the ER.

Letting an out of control Migraine go untreated doesn't just mean a patient in distress. It means a patient at increased risk of stroke.

I work on a daily basis with legitimate Migraine patients who have trouble being treated in the ER because of the problem "drug seekers" have created. What suggestions can we give those patients for getting care when they need it?

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