Frequent Flyers in the ED - page 4

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... Read More

  1. by   duckboy20
    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!
  2. by   RN92
    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 . 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... . 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..
  3. by   RNin92
    Quote from ERslave
    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 . 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... . 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
  4. by   teeituptom
    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
  5. by   RNin92
    Quote from teeituptom
    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
  6. by   veetach
    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
  7. by   RNin92
    Quote from veetach
    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
    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 :angryfire
  8. by   parkernurse
    :hatparty:
    Quote from veetach
    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
    Thoses ones are everywhere. 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)
  9. by   TRobert
    Quote from RNin92
    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?
  10. by   TRobert
    Quote from ERslave
    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 . 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... . 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..
    Let's discuss this a bit. As a nurse and a Migraineur, you know that NO medication works for everyone. I've not been to the ER for about three years, but I'll still use myself as an example. The last time I went to the ER with a Migraine, the doctor said he was going to give me Toradol. Fine by me. Whatever would work was fine. They gave me Toradol and Phenergan. It did literally nothing. I have no idea why. I live in a small city and still go to the ER at the hospital where I was born, so they have all my medical records. The doctor asked me if I had any ideas. I told him that IV Compazine had broken a bad Migraine for me before, so that's what we did.

    My point is: One size does NOT fit all. It's impossible to be medically correct and say that if Toradol doesn't help in the least, "they are drug seeking."
  11. by   veetach
    Quote from TRobert
    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?
    I try not to bunch migraine sufferers all in one group. IMHO there are those who present c/o a migraine headache, drinking mountain dew, eating potato chips and laughing with their friends... and then there are those who present obviously in pain, vomiting, and even to an untrained eye, experiencing a headache. The latter group of individuals are the ones I get back to see a doc right away, I make sure they have a room with a door, I darken the room and put the chart up ahead of the routine stuff because I feel they do need rapid treatment.

    The first group of "migraine" sufferers will wait, sometimes a long time. They are not high priority, as long as they are eating drinking, using their cell phone and laughing it up.

    we have some docs who use Toradol, but not enough. Most everyone will get a demerol injection (sometimes morphine) and then get discharged. I am trying to convince our docs to get PO Toradol put in our pyxis so that they can address pain without giving narcs to everyone.
    Last edit by veetach on Mar 7, '04
  12. by   Marie_LPN, RN
    I like one nurse's response to teh FF that asked what doctor was on, then left when she learned the name:

    "Oh you're leaving? Would you like me to inform the dr. that you stopped by then??"
  13. by   TRobert
    Quote from veetach
    I try not to bunch migraine sufferers all in one group. IMHO there are those who present c/o a migraine headache, drinking mountain dew, eating potato chips and laughing with their friends... and then there are those who present obviously in pain, vomiting, and even to an untrained eye, experiencing a headache. The latter group of individuals are the ones I get back to see a doc right away, I make sure they have a room with a door, I darken the room and put the chart up ahead of the routine stuff because I feel they do need rapid treatment.

    The first group of "migraine" sufferers will wait, sometimes a long time. They are not high priority, as long as they are eating drinking, using their cell phone and laughing it up.

    we have some docs who use Toradol, but not enough. Most everyone will get a demerol injection (sometimes morphine) and then get discharged. I am trying to convince our docs to get PO Toradol put in our pyxis so that they can address pain without giving narcs to everyone.
    I TOTALLY agree with you about the two groups. After 40 years of Migraines, I may be able to at least walk and talk when I'm in misery, but I'm certainly not laughing and carrying on with friends. I've seen those people in ER waiting rooms, and have even confronted them myself. Not too long ago, I took someone else to the ER and observed someone sitting cross-legged in a chair with a walkman blasting music loud enough for me to hear several seats away, eating a candy bar and drinking soda. I asked her if she was waiting for someone. She said she had a Migraine. I handed her one of my business cards, told her she was a liar and making it hard on people who really had Migraines. She said her head really hurt. After several minutes of my challenging her, she left. Had she really had a Migraine, someone else waiting for another patient wouldn't have had that effect on her. She'd have told me off or complained to hospital staff.

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