Frequent Flyers in the ED - page 5

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   veetach
    Quote from TRobert
    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.

    WAY TO GO!!! that is awesome. I have observed a direct link in our area, of those types of "migraine" sufferers and the elevation of pollen count. I know when I have a sinus headache I usually end up triaging a large group of people complaining of migraines. I used to work with a doc who had a horrible migraine problem, he would wake up with them, tunnel vision, vomiting, the whole nine yards. what a horrible horrible thing to have...

    I try really hard to subscribe to the theory that pain is subjective, sometimes it is hard with those people we have described who are drinking soda and listening to their cd players...

    Keep up the good work Teri, I appreciate what you do and its people like you who make my job a whole lot easier.
  2. by   TRobert
    Quote from veetach
    WAY TO GO!!! that is awesome. I have observed a direct link in our area, of those types of "migraine" sufferers and the elevation of pollen count. I know when I have a sinus headache I usually end up triaging a large group of people complaining of migraines. I used to work with a doc who had a horrible migraine problem, he would wake up with them, tunnel vision, vomiting, the whole nine yards. what a horrible horrible thing to have...

    I try really hard to subscribe to the theory that pain is subjective, sometimes it is hard with those people we have described who are drinking soda and listening to their cd players...

    Keep up the good work Teri, I appreciate what you do and its people like you who make my job a whole lot easier.
    Thanks!

    I DO see both sides of the issue, and just wish there were a way for Migraineurs to have a code word to use with ER staff to let them know we're legit. Several years ago, while on vacation, I'd spent two days in our darkened hotel room with a Migraine. Triptans hadn't touched it. My rescue med, Fioricet #3 hadn't touched it. I was keeping a bit of fluids down only because I had Phenergan to take. My husband took me to the ER. I had written down all the meds I'd taken, times, dosage, etc. Took my prescriptions and that list with me. I sat in the waiting room wearing my sunglasses and holding my hands over my ears for nearly four hours while patient after patient was treated and left. Finally, they took me into a treatment room. They refused to turn off the overhead lights, but insisted I leave off my sunglasses. The doctor left, saying he'd send a nurse back with a shot. My husband overheard the doctor tell the nurse to give me saline; that since I wasn't vomiting or crying, I didn't really have a Migraine. My husband wanted to get me up and take me to another ER. I told him that it hurt so bad that if I got up, we'd just go back to the hotel and let me die in peace. So, my usually extremely quiet husband, went to the desk and demanded to see "the person in charge." I don't know quite what was said, but a nurse came in very shortly with two syringes and two vials, insisting that I read the labels on the vials before she injected Demerol and Phenergan IM. She got me a pillow, an ice pack, and a blanket, then turned off the lights and closed the door. 30 minutes later she came back to see if I felt better. I did, and I asked to be discharged. They offered me Percocet to take with me, which I declined.

    Now, I don't think that would happen on your watch, but that it does happen. There has to be a solution somewhere, but what is it?
  3. by   fab4fan
    Interesting. Since people who say they are allergic to Toradol are liars, why don't those of you who feel that way go ahead and give me a shot of it? (You might want to have a crash cart avail., though; went into resp distress the one and only time I got it. Of course, I could have been faking , but ABG's don't usually lie.)

    I have several more names to add to my list of, "Hope this person gets a full blown migraine for 72h and is treated to the same hateful attitude they hand out to their pts."
  4. by   veetach
    Quote from TRobert
    Thanks!

    I DO see both sides of the issue, and just wish there were a way for Migraineurs to have a code word to use with ER staff to let them know we're legit. Several years ago, while on vacation, I'd spent two days in our darkened hotel room with a Migraine. Triptans hadn't touched it. My rescue med, Fioricet #3 hadn't touched it. I was keeping a bit of fluids down only because I had Phenergan to take. My husband took me to the ER. I had written down all the meds I'd taken, times, dosage, etc. Took my prescriptions and that list with me. I sat in the waiting room wearing my sunglasses and holding my hands over my ears for nearly four hours while patient after patient was treated and left. Finally, they took me into a treatment room. They refused to turn off the overhead lights, but insisted I leave off my sunglasses. The doctor left, saying he'd send a nurse back with a shot. My husband overheard the doctor tell the nurse to give me saline; that since I wasn't vomiting or crying, I didn't really have a Migraine. My husband wanted to get me up and take me to another ER. I told him that it hurt so bad that if I got up, we'd just go back to the hotel and let me die in peace. So, my usually extremely quiet husband, went to the desk and demanded to see "the person in charge." I don't know quite what was said, but a nurse came in very shortly with two syringes and two vials, insisting that I read the labels on the vials before she injected Demerol and Phenergan IM. She got me a pillow, an ice pack, and a blanket, then turned off the lights and closed the door. 30 minutes later she came back to see if I felt better. I did, and I asked to be discharged. They offered me Percocet to take with me, which I declined.

    Now, I don't think that would happen on your watch, but that it does happen. There has to be a solution somewhere, but what is it?
    OH MY GOD! I am so sorry that happened to you, that is totally believable and unacceptable at the same time. There is NO excuse for treatment like that, not only is it rude it is unethical. I wish I knew the answer, I really do. Good luck with your work, Teri.

    I wish your husband would have called the regulating agency for Md's in that state, and reported that dr. talk about illegal!!!! He needs his arse kicked out of emergency medicine.

    I have heard docs talk about injections of saline before, but I dont know any who have enough nerve to prescribe it, especially in PA with our malpractice laws. I did have a doc prescribe 0.5cc NSS iv q 6 hours and as needed for pseudoseizures before though.
  5. by   kids
    What would you (collectively) think of the following person presenting in your ER with c/o migraine:

    States hx/dx of migraine.
    C/O severe HA, nausea, light/noise sensitivity.
    States allergy to Toradol and Ultram.
    States is unable to take other NSAIDS d/t hx of adverse reaction.
    States unable to take Imitrex, Maxalt or Zomig d/t hx of adverse reaction
    Is on large scheduled doses of a sustained release opiod, valium, a SSRI and a tricyclic.
    Sits quietly in a corner of the waiting room with eyes closed sipping coffee.
  6. by   veetach
    Quote from kids-r-fun
    What would you (collectively) think of the following person presenting in your ER with c/o migraine:

    States hx/dx of migraine.
    C/O severe HA, nausea, light/noise sensitivity.
    States allergy to Toradol and Ultram.
    States is unable to take other NSAIDS d/t hx of adverse reaction.
    States unable to take Imitrex, Maxalt or Zomig d/t hx of adverse reaction
    Is on large scheduled doses of a sustained release opiod, valium, a SSRI and a tricyclic.
    Sits quietly in a corner of the waiting room with eyes closed sipping coffee.
    I think that I would consider this pt someone with a HA, I cant consider her/him anything less.
  7. by   ktwlpn
    Quote from kids-r-fun
    What would you (collectively) think of the following person presenting in your ER with c/o migraine:

    States hx/dx of migraine.
    C/O severe HA, nausea, light/noise sensitivity.
    States allergy to Toradol and Ultram.
    States is unable to take other NSAIDS d/t hx of adverse reaction.
    States unable to take Imitrex, Maxalt or Zomig d/t hx of adverse reaction
    Is on large scheduled doses of a sustained release opiod, valium, a SSRI and a tricyclic.
    Sits quietly in a corner of the waiting room with eyes closed sipping coffee.
    I worked with a woman that drank coffee when she felt a migraine coming on....It worked for her........
    I'd say "Hey-Terry,is that you?":
  8. by   veetach
    Quote from ktwlpn
    I worked with a woman that drank coffee when she felt a migraine coming on....It worked for her........
    I'd say "Hey-Terry,is that you?":

    we have a doc who prescribes IV caffeine for headaches.. sometimes it works
  9. by   RNin92
    Quote from kids-r-fun
    What would you (collectively) think of the following person presenting in your ER with c/o migraine:

    States hx/dx of migraine.
    C/O severe HA, nausea, light/noise sensitivity.
    States allergy to Toradol and Ultram.
    States is unable to take other NSAIDS d/t hx of adverse reaction.
    States unable to take Imitrex, Maxalt or Zomig d/t hx of adverse reaction
    Is on large scheduled doses of a sustained release opiod, valium, a SSRI and a tricyclic.
    Sits quietly in a corner of the waiting room with eyes closed sipping coffee.
    I would think this person has a h/a and is seeking help.
    I would also say that this person needs a pain managemnt referral if not already done...there are many treatments out there and different things work for different people.

    I would also say that if I saw this person several times a week over the course of many months/years...I would question whether we have helped them or not...which do they have now? Migraine or Narcotic Rebound h/a?
    Did they f/u or are we the clinic?

    It is not as simple as how they present in triage.
  10. by   teeituptom
    I would say just one thing

    OK
  11. by   kids
    Quote from kids-r-fun
    What would you (collectively) think of the following person presenting in your ER with c/o migraine:
    States hx/dx of migraine.
    C/O severe HA, nausea, light/noise sensitivity.
    States allergy to Toradol and Ultram.
    States is unable to take other NSAIDS d/t hx of adverse reaction.
    States unable to take Imitrex, Maxalt or Zomig d/t hx of adverse reaction
    Is on large scheduled doses of a sustained release opiod, valium, a SSRI and a tricyclic.
    Sits quietly in a corner of the waiting room with eyes closed sipping coffee.
    Whenever there is a discussion of frequent fliers in the ED there are comments regarding migraine fakers. Inevitably nurses with migraine will post about the poor treatment they receive when they resort to going to the ED. It frustrates me that some will then reply that they would not have treated the poster (with migraine) in such a way yet sometimes these same people have posted the kind of personal sentiments that create situations where people with legitimate migraine get treated like crud. I am not referring specifically to this thread but rather in general to threads of its type.

    I am the patient asked about above.

    I recently spent 7 hours in the ER with a migraine.
    This was not a high traffic inner city ER, it is not a regional trauma center and there were points in time where I was the alone in the waiting room or there were empty beds in the ER. My "care" alternated between being ignored or reminded that "they" don't give narcotics for migraine (gee, that's good to know since I have narcotics on board and they aren't helping). I have no doubts my treatment was a reflection of preconceived notions. I really am allergic to Toradol and Ultram, both cause hives. I have a history of wheezing with ASA and GI bleeding with NSAIDS. Imitrex triggers arrhythmia, Maxalt and Zomig symptoms of serratonin syndrome. I get about 3-4 migraines a year and about half the time I am able to knock it down to a tolerable level with caffeine and Benadryl. Because of the infrequency of the migraines and side effects of the meds I am not on any preventives. I have been followed by the same neuro for 18 years, usually I can go to his office for treatment but this one happened on a Sunday.

    When it got to be 8 am my husband was able to call the neurologist's office and tell them what was going on. I finally got the IV Benadryl and Phenenergan I had been begging for. Then I had to wait on discharge for a visit from the drug abuse counselor and referral to a pain mgmt clinic. It was just loverly considering I am a patient at the hospitals own pain mgmt clinic and with the exception of hormones am on no meds other than ones prescribed by the pain mgmt program. Yes, the ER had the info, my chart is flagged that I am a pain clinic patient with a contract and I had given them my clinic ID card.

    BTW, yet more anecdotal examples of nonpharmocological self care for migraine: if coffee is tearing my stomach up to much I drink Coke or Pepsi on ice, the cold & cola help the nausea, the caffeine the head ache. If the nausea is really bad I eat plain Lays potato chips by pressing them 1 at a time against the roof of my mouth and sucking all of the salt out before swallowing. I also have a couple of CDs that I find very relaxing and play them with headphones to help tune out a noisy environment.
  12. by   Medic946RN
    My dad was one of the toughest guys I have ever known. I think maybe he missed 5 days of work in his entire life for illness. If he injured himself while working, he'd wrap the injury with his hankerchief and keep going until the job was done. I saw my dad cry twice. Once when my grandfather died and once when he had a migraine. I know how awful these things are. If you present to me with migraine sx and a list of allergies, I take them at face value, and treat you as I would anyother pt. who needed my assistance.

    But......when I see you every Friday or Saturday with a rotating list of complaints. Migraine, back pain, abd pain and your list of "allergic" meds grows by whatever we gave you last time for your pain.

    Pt:"Oh that Bextra you gave me last time made me break out in hives and I couldn't breathe.
    Me: That was aserious reaction, why didn't you come back to the ED so we could treat that for you?
    Pt: I couldn't find anyone to take me to the hospital.
    Me: For a reaction that serious you should have called 911.
    Pt: I didn't want to bother those guys.

    Then you are seeking a legal weekend high and nothing more.
  13. by   RNin92
    Quote from kids-r-fun
    Whenever there is a discussion of frequent fliers in the ED there are comments regarding migraine fakers. Inevitably nurses with migraine will post about the poor treatment they receive when they resort to going to the ED. It frustrates me that some will then reply that they would not have treated the poster (with migraine) in such a way yet sometimes these same people have posted the kind of personal sentiments that create situations where people with legitimate migraine get treated like crud. I am not referring specifically to this thread but rather in general to threads of its type.

    I am the patient asked about above.

    I recently spent 7 hours in the ER with a migraine.
    This was not a high traffic inner city ER, it is not a regional trauma center and there were points in time where I was the alone in the waiting room or there were empty beds in the ER. My “care” alternated between being ignored or reminded that “they” don’t give narcotics for migraine (gee, that’s good to know since I have narcotics on board and they aren’t helping). I have no doubts my treatment was a reflection of preconceived notions. I really am allergic to Toradol and Ultram, both cause hives. I have a history of wheezing with ASA and GI bleeding with NSAIDS. Imitrex triggers arrhythmia, Maxalt and Zomig symptoms of serratonin syndrome. I get about 3-4 migraines a year and about half the time I am able to knock it down to a tolerable level with caffeine and Benadryl. Because of the infrequency of the migraines and side effects of the meds I am not on any preventives. I have been followed by the same neuro for 18 years, usually I can go to his office for treatment but this one happened on a Sunday.

    When it got to be 8 am my husband was able to call the neurologist’s office and tell them what was going on. I finally got the IV Benadryl and Phenenergan I had been begging for. Then I had to wait on discharge for a visit from the drug abuse counselor and referral to a pain mgmt clinic. It was just loverly considering I am a patient at the hospitals own pain mgmt clinic and with the exception of hormones am on no meds other than ones prescribed by the pain mgmt program. Yes, the ER had the info, my chart is flagged that I am a pain clinic patient with a contract and I had given them my clinic ID card.

    BTW, yet more anecdotal examples of nonpharmocological self care for migraine: if coffee is tearing my stomach up to much I drink Coke or Pepsi on ice, the cold & cola help the nausea, the caffeine the head ache. If the nausea is really bad I eat plain Lays potato chips by pressing them 1 at a time against the roof of my mouth and sucking all of the salt out before swallowing. I also have a couple of CDs that I find very relaxing and play them with headphones to help tune out a noisy environment.
    The picture you paint of your symptoms is not, by any means what I think of by the FF I first referred to.

    It was completely ignorant of the ED staff wherever you were to treat you as they did. As another poster stated...it's the people who are in many times a week over the course of months and years that this thread refers to.

    And...even my FF do not get left sitting in the ED for hours with empty beds available...I prefer to "treat 'em and street 'em".

    I'm sure it is difficult for you when you go in for your migraines...but at most EDs we are talking about the people who are there more that we are.

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