ammonia capsules for fainting?

[brownbook]

Do all nurses think ammonia capsules need to be used every time a patient gets faint?

I have fainted three times, I know what it feels like. Fainting lasts ?? a few seconds and as soon as the head goes down, blood flow goes "up" to the brain, and it is over.

Let us assume I have special powers, I know the patient is "just" fainting, vaso-vagal, no "serious" medical issue is going on. I wouldn't use ammonia.

I can see it being useful if you are walking with the patient and want to prevent a fall, but if there is not a fall, self-harm, issue I wouldn't use one. Would you?

[USIJurgy]

They can play opossum all they want- no reason to shove ammonia in their face. A trick we use to determine if someone is "faking" is to place their arm above their head, bend their elbow and have their hand in front of their face. Once you let go of the arm gravity should do it's job and their hand should hit their face. If the hand, after multiple attepts, continues to fall above their head or below their face it is a good indicator that they have voluntary muscle control- who wants to hit themselves in the face?!

[flashpoint]

They can play opossum all they want- no reason to shove ammonia in their face. A trick we use to determine if someone is "faking" is to place their arm above their head, bend their elbow and have their hand in front of their face. Once you let go of the arm gravity should do it's job and their hand should hit their face. If the hand, after multiple attepts, continues to fall above their head or below their face it is a good indicator that they have voluntary muscle control- who wants to hit themselves in the face?!

Also an outdated practice...when I did my EMT / Paramedic training over ten years ago, we were taught to NEVER do this. It seems pretty cruel...especially of they are not faking. It was one of those things that you heard everyone talk about, but were pretty sure no one had actually done.

[Popwhizbangz, LPN]

I know of one physician (trained in Soviet Med School by the way), and no nurses (except on this post) who use ammonia clinically, and that, as far as I can tell when I've (rarely) seen it used, was largely to dissuade dramatic attention-seeking fakers to find another way to meet their needs. I've seen no need for it myself, although it has been harmlessly unpleasant when I've seen it used. I do find ways to convince folks to stop faking (which I encounter not exactly rarely, along with frequent real events & pre-events), usually involving discouraging staff drama and using standard measures for high fall risk that the fakers find too inconvenient to be worth the trouble - a cure of sorts!

[mappers]

I started working in an outpaitent infusion center recently. They have amonia capsules taped to all the beds. I kind of wondered, since I'd never seen that before. One nurse who came from a different hospital than me had one taped to her ID. I asked why. She said because they could never find one a the hospital when they needed them. I said that I'd never seen them used before and didn't even know if we had them at the hospital where I had worked.

BTW, I've never seen one used where I work now. I just can't imagine using one on a patient getting chemo. Don't they have enough toxic chemicals around them as it is?

[bjaeram]

I've seen them used a few times in our ER. I don't carry them or really even think to use them but a few of the docs ask for them, especially for the fakers.

I do use the arm drop technique to out a faker all the time. I don't find it cruel as I am correct 99% of the time! It just helps prove to the faker that you are not an idiot that can be manipulated.

[CCL RN, RN]

I used to use ammonia in the field as well. But then I learned the arm trick...

They can play opossum all they want- no reason to shove ammonia in their face. A trick we use to determine if someone is "faking" is to place their arm above their head, bend their elbow and have their hand in front of their face. Once you let go of the arm gravity should do it's job and their hand should hit their face. If the hand, after multiple attepts, continues to fall above their head or below their face it is a good indicator that they have voluntary muscle control- who wants to hit themselves in the face?!

This test is the only 100% accurate test in medicine!! I love it! After they have failed, I lean in and tell them I know they are faking and they can stop now. Works every time..

[Popwhizbangz, LPN]

Perhaps in some circumstances such a practice is justifiable. Not where I work - I prefer to keep the use of interpersonal sledge hammers (so to speak) to an absolute minimum. At least in my practice, there are less aggressive/harsh methods to achieve the same purpose with more finesse, and less patient resentment that staff will pay for in time, somehow or another.

Also, I might be concerned about someone swallowing one of those toxic little packages - I'd never leave anything like that lying around in the open - it only takes one time, one swallowed ammonia or the like, to render years of convenience hardly worth the cost. Of course, I'm in Psych, so I see more of this kind of risk, but my patients receive care, and more of it on average than the general population, throughout the healthcare system. There are suicidal folks here and there everywhere, and also people who just pop pills impulsively just to see if they can get high somehow. Patients and visitors. Imagine trying to explain yourself after such a scenario arose.....

[Popwhizbangz, LPN]

I used to use ammonia in the field as well. But then I learned the arm trick...

This test is the only 100% accurate test in medicine!! I love it! After they have failed, I lean in and tell them I know they are faking and they can stop now. Works every time..

I like it - very clever. There are many variations on this theme- As you describe, I also tell patients the jigs up, so to speak, matter of fact and diplomatically, e.g. many times I've told pts in pseudoseizure that it's not so easy to fake a seizure as they might think, that if they need any help getting up or with anything else up let us know -

[brownbook]

I hadn't even visited my own post recently. Thanks to all of you for your replies.

I work same day out patient surgery.

My co-workers really, REALLY, believe in having them available. I haven't seen one used, just frequently hear comments like, "I couldn't find a ammonia capsule, my patient felt faint." and the reply usually is, "Oh we have them right here, they should be (or are) taped above every patients bed, I have one taped to my name tag."

I am old, my co-workers are bright, young, newer grads, and they are the ones praising their use?

It seems that they are sometimes a good intervention. The orthopedic unit and the OB patient in the bathroom. But their use should be a 2nd, 3rd, or 4th, intervention to a patient fainting or feeling faint, not the first thing you go for. As I originally posted, I have magic powers and know we are just dealing with a vaso-vagal faint.