Chest Pain "Addicts"

[Katie82, RN]

I worked as a Medicaid Case Manager in Maryland, and now in North Carolina. Drug seekers know how to work the system. They know if the present in the ER complaining of chest pain they will most likely be admitted and placed on IV pain meds. I have had several patients who did this a couple of times a week, each time at a different hospital. Hospitals and ER need to network to prevent this. As a case manager, I made it a point to notify the staff of all the hospitals my friends visited and get an alert placed on the demographic page of their record. THis helps for a little while, but in a large metro area like Baltimore - Washington, there are too many hospitals to cover, they even go out of state claiming to be on vacation. The feds are pushing for national medical records and while this may sound like Big Brother, it may be the only way to guarantee real continuity of care.

[rita359]

Was reading an article on womens health, I believe in Newsweek. Stated that women can have heart disease in the microvascular blood supply to the heart, not show up on caths etc but still give symptoms such as chest pain etc. Sometimes we have to remember that even though we think we have tests that show everything we don't. Doctors still have much to learn about how this body of ours work. The current theory on pain is that pain is what the patient says it is. Just because our tests don't confirm heart disease doesn't necessarily mean it doesn't exist.

[getoverit, BSN, RN, EMT-P]

I've seen the same article about atypical chest pain without any diagnostic findings (cath lab, enzymes, etc.) and you have to take chest pain seriously. But there are lots of people who know how to "work the system", are in excruciating pain until they find out they're not going to get narcotics.

Chest pain is a no-brainer as far as a workup and tx go. What about people who are having back pain, or leg pain unresolved for 15+ years? nothing can explain the pain or relieve it (other than 75 of Demerol cause 50 just won't touch it---actual quote). I knew a guy who could dislocate his hip and would do so about 2-3 times each week. Finally an ortho doc got tired of it and reduced it in the ER without any analgesia. Seemed cruel but miraculously his hip didnt' dislocate again.

Or people who can carry on to beat the band about how they can't take their pain, unable to move, etc....in front of their small kids who are crying because daddy's hurt. Then when they are told they aren't getting a narcotic they spring up out of bed and walk out of the ER screaming and cussing, but with no limp or any painful expression. It's awful that they put their families through that and are willing to scare their own children in order to get high.

I know pain is purely subjective and you cannot prove or disprove it. I hope this doesn't cause a backlash against me, because I will load someone up if that's what they need. But I have a problem with people who are obviously working the system and treating us like dirt.

[Lorie P.]

we have a few of those too, but i have stopped a few frequent fliers in their tracks.

i have cad, cabg of the left main coronary artery , lad 55% blocked and pda 45% blocked. so when these pt's come to my floor and i go to assess them, they start with the oh the chest pain is 10/10, i need pain meds, not nitro. they tell me, you just don't know how bad this chest pain is, i smile sweetly and say oh i do know, then point to my chest and show them the top of my cabg scar, they usually get bugged eye by then. they ask what happened tell them i had to have emergency by-pass surgery at age 35, 9 years ago.

so long story short i do take chest pain very seriously but i can also see thru the fakers!

yes, chest pain has to be treated serioulsy, but when a pt's states i came to the er with chest pains, i get seen quicker!

blows my mind cause these type people take up a spot that is needed for someone else.

[nursemoons14]

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:

Well unfortunately here in Canada, our frequent flyers get a nice warm bed to wait in and maybe even a sandwich and drink and pay zero. At the smaller hospital I used tow ork at, the docs would sign the bak of the ambulance rec, and that pt. would be charged the 120 bucks it costs for a ride in the ambulance. I used to love it when they did that. Then they would have the nerve to ask for a cab vouture after ahaha. blows my mind

[banditrn]

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.

I remember one time a 'frequent flyer' came into our ICU with chest pain. Just as I was coming on, the lady's second set of cardiac enzymes came back - they were quite elevated. I carried the report over to the doctor and the day nurse who were sitting there snickering that the lady was probably just having some 'reflux' problems. The doc about fell out of his chair.:icon_roll

Just because they have a 'history' doesn't mean that this time they aren't really having a heart attack. It's best to always go with that assumption.

[RunningWithScissors]

Of coarse these folks always get the whole workup each time they come in...enzymes, labs, cxr, heparin or lovenox. Then, 4 days later after all is neg, they still sit with their IVP pain meds every 2 hours and PCA's after the nitro and heparin are stopped.