ER nurses & others, identifying crack abusers

[hoolahan, ASN, RN]

I have a question for you er nurses. If you have a 39 year old female present with CP, what are the differential diagnoses that go thru your mind? Am I wrong to put crack abuse near the top of the list?

I am aware of a woman in our office who c/o CP the other day. She did indeed look so bad, I called 911. Many of her co-workers just kind of rolled their eyes, later commenting on how she always gets CP when she is about to get into trouble. I have noticed some mood swings, but who doesn't have them now and again? This woman also claims to have many pulmonary problems which she reports stem from a latex allergy, so severe, she did require intubation in the past.

She frequently comes in c/o her asthma, she does use her advair, I have seen her. She is always hoorifice, not a lot of coughing, but sounds wheezy a lot.

Am I crazy to suspect she may be a crack user? She is a compulsive liar, that much I have discovered, but I can't say she has those feelings of profound depression that I read about with crack abuse. I feel she has some psych issues that is for sure, she is abusive to employees in the field, threatens them, and does, at times , seem to have feelings of grandiosity, but not sure I would say delusions exactly. She doesn't use the BR frequently, or smoke. Am I just mean??

What kinds of things should I look for?

[prn nurse]

naturally revealed via the eye-rolling co-workers.Wouldn't you hate to work with that bunch? What if you were having a heart attack? Coronary artery spasm? Or one of two dozen other things that cause stress-related chest pain. Sounds like the poor woman is in a no teamwork-friendless-anxiety producing work envoirment. That will certainly cause psych issues if you desperately need the job and have to try & cope in that unfriendly envoirment. Cocaine abuse is the last option I would have thought of. If you can't breathe....your chest hurts. Female coronary complaints are the #1 overlooked and neglected aspect of medical care. It has been verified statistically. No one takes us seriously when we complain of chest pain.

[nicola]

Hoolihan, been there, done that! If this person is smoking crack, auscultation of the lungs will sound like some one poured a gallon of snot in them. (I know that's gross, but that's the only way I can think of to describe it.) I had a client who sounded like that when I made a visit to her home. She thought she was having an asthma attack. I asked her what she'd been smoking - she denied everything, but did go to the ER. (That was appropriate given her situation.) They did a u. tox which came up positive for cocaine (imagine that!). She told them she'd been snorting. In the mean time, I called her primary and alerted her to my suspicians. When the doc confronted the patient, she copped to smoking crack. After this incident, the patient never lied to me again about her use of drugs!

Seriously, tho, I do think that when some one has CP, ya gotta rule out MI just to CYA. If you think she's using, learn the other s/s of drug use (the different kinds of drugs have distinctive calling cards that can't be denied) and don't be afraid to share your findings and suspicians with this person. My experience with users is that they have more respect for those who are able to speak honestly and non-judgementally about things. I've been able to have fair success with the addicted - not curing them, mind you, but helping them to have the best possible life until they were ready to get sober.

Good luck!

[hoolahan, ASN, RN]

I have no doubt that her chest pain was real, whatever the cause. I do also agree 100% that MI must be ruled out, I was speculating as to crack/coke abuse as a cause of the CP.

prn, I wish I could say why she was in trouble, you would understand why she is so worried about it. She has very good reason to be. In fact it is such a hideous offense, that I may resign without notice. If she is feeling stressed, she should, but I would never wish ill-will on even my worst enemy.