Chest Pain "Addicts"

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We've got a few chronic "resident patients" who come in every other week, stay for weeks, then go home for 10 days or so, all with histories of having coronary interventions in some distant past. They come in, complaining of 10/10 chest pain while giggling at the TV shows, sometimes get PCA's and IVP narcotics on top of it, (regularly,) and then go home. No one is addressing their addiction to the narcs, except one patient was finally put on methadone, and went to narc rehab, only to be put back on the narcs by an ER doc and the cycle began again.

Occasionally they will go back to the cath lab, finding no new disease, but come back again in a week or 2. Same doctor. We are talking about 2 or 3 different patients. It's maddening.

I was wondering, is this a regional thing or is anyone else experiencing this phenomenon?

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Oh heck yes. I work in southwestern ontario in a cardiac/neurology centre. We have the same regulars that come in, but normally our regular rotating ER physicians know them. Don't start nitro drips or give morphine or anything like that. I mean in theory they shouldn't be going to cath lab if there aren't any indications on the ECG or ck/trop levels. They shouldn't be getting repeat cath'd for no clinical signs. But anyway yes, we occasionally had our "rent a docs" who are like a travel company. And the regulars would come in with their great stories of "crushing chest pain radiating to left arm, w/ sob and sweating" and some of the docs who didn' tknow them, would start nitro drips, put in central lines (because their veins are all gone from the chest pain protocol being peformed twice a week) and give morph. Its frustrating but unfortunatly our job in emerg is treat everyone, even if u know damn right that they aren't having an MI. but it could potentially always be the big one, and that one time is when you'll get burned .

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These folks all heave mediports just for their narcotic-receiving pleasure. Hey, come on down to General Hospital, the drug emporium of the US!!

Sometimes I feel like a licensed drug pusher...does that make the doctors pimps? :bugeyes:

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Specializes in Acute Care Cardiac, Education, Prof Practice.

My issue with cardiac frequent fliers is...you can't ignore them when they say they have chest pain!

At my current job we give three nitro, stat EKG and then call if unrelieved. There is nothing quite like being greeted with a doc a who goes..."gdmmnt! She does this too me every night!"

This is the time when I really have to admit I am glad I am not a physician, because with chest pain you really have to consider each situation as a potential. Just because they cry wolf, doesn't mean this might not be the time its really out there chopping the herd.

:\

Tait

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Specializes in SICU, EMS, Home Health, School Nursing.

We have several here too... I rarely see them since I work in surgical, but I do know of a couple. One time I had a guy come in with a history of heart problems and he was complaining of all the classic symptoms, so the doc started him on a nitro drip with prn narcs. Well, I gave him a dose of the narcs and went up on the nitro. Well, about an hour later (while I was on break) he decided that he was having 10/10 chest pain again, so the nurse that was watching my patients went up on the nitro and refused to give him anymore pain meds since it wasn't time. Well I come back to this guy yelling and the nurse was explaining to me what was going on. He ended up signing himself out AMA because we went up on the nitro and refused to give him more pain medication. Hm... could it be anymore obvious what he was looking for?

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Specializes in all things maternity.

I have a cardiac history. Several angioplasties w/ stent placements in a two year period. I take somewhat better care of myself and fortunately, my episodes of pain are at a minimum right now. But I do still have cardiac spasms that are very painful and scary. Especially now with this artic weather we have been having as cold stress and emotional stress are my biggest triggers. I go out to the mail box and have pain walking back up the drive. And don't even ask me to go clean the snow off the truck and warm it up. I can't do it. I do NOT head to ER every time though. I will probably get burned by this eventually as my cardiologist is not happy with my "playing doctor" and treating myself at home. I take my 3 Nitros and go to bed with my cell phone usually. If 30 minutes of rest can't relieve it, I'll go to ER. Unwise? Yes. But if I went for each episode I would NEVER be out of debt. I do have unstable angina as a diagnosis along with CAD and coronary artery spasm. I do carry Nitro with me at all times. And aspirin for that matter.

I have to say that the few times I have gone to ER, the nurses have been very supportive of me and I have always ended up taking the bus with the flashing lights and sirens to the big heart hospital in the big city. Each time I go there, they find a blockage of 95% or more, or a heart arrhythmia (PVC's or a fib.) My heart history is very well documented. I am also a 20 year diabetic.

I always worry about the first time some nurse has the "she's just a drug seeker" attitude with me. But when I have to go, I go! And without apologies for irritating some nurse or some doctor.

:balloons:

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Specializes in Acute Care Cardiac, Education, Prof Practice.
I have a cardiac history. Several angioplasties w/ stent placements in a two year period. I take somewhat better care of myself and fortunately, my episodes of pain are at a minimum right now. But I do still have cardiac spasms that are very painful and scary. Especially now with this artic weather we have been having as cold stress and emotional stress are my biggest triggers. I go out to the mail box and have pain walking back up the drive. And don't even ask me to go clean the snow off the truck and warm it up. I can't do it. I do NOT head to ER every time though. I will probably get burned by this eventually as my cardiologist is not happy with my "playing doctor" and treating myself at home. I take my 3 Nitros and go to bed with my cell phone usually. If 30 minutes of rest can't relieve it, I'll go to ER. Unwise? Yes. But if I went for each episode I would NEVER be out of debt. I do have unstable angina as a diagnosis along with CAD and coronary artery spasm. I do carry Nitro with me at all times. And aspirin for that matter.

I have to say that the few times I have gone to ER, the nurses have been very supportive of me and I have always ended up taking the bus with the flashing lights and sirens to the big heart hospital in the big city. Each time I go there, they find a blockage of 95% or more, or a heart arrhythmia (PVC's or a fib.) My heart history is very well documented. I am also a 20 year diabetic.

I always worry about the first time some nurse has the "she's just a drug seeker" attitude with me. But when I have to go, I go! And without apologies for irritating some nurse or some doctor.

:balloons:

Your history and attitude would set you apart from the pack of frequent fliers in my book. I hope you don't deal with "drug seeking" nurses very often. :)

Don't misinterpret this thread to mean we don't think anyone has real , frequent chest pain. Most of us are just talking about a few instances we are familiar with.

I am sorry that you have to take flak for other people seeking medications and crying wolf. I really hope it never effects your care you receive!

Tait

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It's not regional, it's everywhere. And at a time when hospitals are closing because of insufficient Medicaid payments, or simply NO payments for the uninsureds, it's even MORE maddening.

People who have legitimate pain, diseases and disorders need to be treated. Those who have become dependent on prescription medications and fake symptoms in order to receive their "fix" need rehab.

And since there's no hope of getting any payment for THAT, we just go ahead and admit with 'chest pain', 'abdominal pain', 'nausea/vomiting'.....pick something that gives good narcs, and you're in.

Sickening.

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Specializes in Emergency Room.

as an ER nurse i take chest pain very seriously. of course you have the people that have history of anxiety attacks or narc addiction that you look at suspiciously but if someone has a true cardiac history i don't ever take their chest pain for granted. everyone receives the same treatment from me. even when i know a patient is pulling my leg, i just go along with it and give the best possible care.

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sorry, but i agree w/angel.

anyone w/a remarkable cardiac hx, can drop dead at the drop of a dime.

just recently, i had a pt who was laughing at a tv show, hooked up to all his narc meds, and dropped dead.

just like 'that'.

i've seen this a few times.

their lives are restricted enough.

whatever floats their boat.

leslie

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Good grief, Earl, I hope you coded that poor fella...must've been an arrhythmia to go THAT fast.

We're talking here about the folks who use their past cardiac histories as a crutch to lay in bed, get high, and get 3 catered meals plus snacks all on your dime. Repeatedly. Like, every other week. And they know you know their game but there's nothing you can do about it.

Oh, and if they can get a butt-wipin' every once in a while, they'll take that too.

And they're TOTALLY aware of Press Gainey, and all that implies.

:twocents:

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Specializes in OB, M/S, HH, Medical Imaging RN.

We had a frequent flyer CP patient who laughed and cut up with everyone, and in between ha ha's would ask for pain meds. Everyone including the doc thought that he was faking his CP but with his history nobody wanted to take any chances. One day he was found dead sitting on the toilet. Massive MI.

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