Cyclic vomiters (drive me up the wall)

ogerpus · Sep 27, 2014

It is caused by hypodilaudidemia...

ADeks · Sep 27, 2014

I've only had one cyclic vomiter that made me believe in him. He wasn't even complaining of pain really just that awful feeling retching. Which I believed.

Anna Flaxis, BSN, RN · Sep 27, 2014

I think that, while CVS may have psychogenic causes in many of its sufferers, it is very real and an awful thing to have. Imagine feeling sick as a dog for days and days, unable to participate in your normal daily life. It's easy to lump patients into categories and decide how you're going to feel about them based upon their illness- for instance, "cyclic vomiters" are a certain type of person to you. What helps me is to see the individual person, not the diagnosis- for instance, I think of them as a "person with cyclic vomiting syndrome".

It's true that there are some common threads and we can make some generalizations, but I try to get away from that and look at the individual person. I've taken care of some people with CVS who, from all appearances, do nothing to manage their condition- they don't follow up or establish care with a primary or gastroenterologist, they don't get their scripts filled, they don't make efforts to identify triggers and make lifestyle changes- they just keep coming back again and again and it can be irritating- sometimes it seems like they'd rather just live at the hospital and be taken care of all the time. But then there are others who truly don't understand why this is happening to them, and they are hungry for answers and they do seem open to what you have to suggest. They don't WANT to keep coming back and would rather do what they can to stay OUT of the ED.

Not to say that I'm a saint and that no patients ever step on my last nerve, and I won't lecture you on how you should have compassion for these poor people or you're a terrible nurse and an even worse human being. The fact is, we're all human and we all have our own individual life experiences and biases that contribute to our attitudes toward individual patients. R.N. does NOT equal sainthood.

For me though, it stinks to be stuck taking care of someone that I really don't like for hours on end, so out of self interest, I try to just put myself in their shoes and see the individual human in the picture. It makes my time with them a little less yucky and more bearable if I can dredge up some semblance of being able to identify with them even just a little.

Emergent, RN · Sep 27, 2014

Good advise, Stargazer. Yes, I recently spent hours with one of our 'persons who vomit'. Her personality just annoys me, although I work very hard to put on a good face while in the room. On the light constantly, ultimate goal seemed to be Dilaudid, demanding warm blankets after throwing previous ones on the floor, alternating between demanding whininess , profuse apologies, servile gratitude. Of course it was in the middle of a code blue, and an abundance of impatient other patients and their disgruntled family members. Lots of minor complaints and unmet psycho-social/emotional needs, and Dr Slow was on.

Thanks for humoring my little vent.

Guest219794 · Sep 27, 2014

I have never had an otherwise normal, functional person who was going about their normal life when, all of a sudden, they develop CVS. I suppose it could happen, just haven't seen it.

Have noticed that a lot of these folks smoke pot. Ironic, as it is also an anti-emetic,

SionainnRN · Sep 28, 2014

I have never had an otherwise normal, functional person who was going about their normal life when, all of a sudden, they develop CVS. I suppose it could happen, just haven't seen it.
Have noticed that a lot of these folks smoke pot. Ironic, as it is also an anti-emetic,

I had one guy who would come in every 6 weeks for CVS. Turns out he had cannabis induced hyperemesis. He smoked so much pot everyday all day long it got him admitted in the hospital every couple of weeks. You know what they say...too much of a good thing.

Anna Flaxis, BSN, RN · Sep 28, 2014

Good advise, Stargazer. Yes, I recently spent hours with one of our 'persons who vomit'. Her personality just annoys me, although I work very hard to put on a good face while in the room. On the light constantly, ultimate goal seemed to be Dilaudid, demanding warm blankets after throwing previous ones on the floor, alternating between demanding whininess , profuse apologies, servile gratitude. Of course it was in the middle of a code blue, and an abundance of impatient other patients and their disgruntled family members. Lots of minor complaints and unmet psycho-social/emotional needs, and Dr Slow was on.
Thanks for humoring my little vent.

Oh, believe me, I get it. Unmet needs are at the root of so many of the "repeat customers" we see in the ED, and their behavior can just grate on your nerves. I get especially annoyed at the nickel and diming of my time, when it's so thoroughly obvious that we're bursting at the seams and I'm needed in about five places at once.

Again, it comes down to self preservation- do I want to spend my shift being annoyed and resentful every time I have to go into "that room"? It makes it so much easier to just try and put myself in their shoes. I wonder "what happened to that person to make them this way?" and I imagine them being locked in a closet as a child, or sexually abused, or some other horrible things, and I figure there's a reason they're the way they are, and I might be that way too, if circumstances in my life had been different.

tarotale · Sep 28, 2014

It is caused by hypodilaudidemia...

I LOVE this. I'm gona use this term from now on in my ED :roflmao:

hey doc, she has hypodilaudinemia, can we get a bolus of 1000mg dilaudid? lol

Editorial Team / Moderator · Sep 28, 2014

and Dr Slow was on.

Man, that doc works everywhere! Lol.

(Or, doesn't work. Haha.)

Sassy5d · Sep 29, 2014

Every cyclic vomiter i've ever taken care of smoked large quantities of weed.

I've yet to take care of one who wasn't demanding of pain meds.

It is what it is and working in ER keeps me humble. Thank goodness I'm not the one on the gurney

HoneyMagnolia · Sep 29, 2014

My daughter was diagnosed with CVS at the age of 8 but she'd had symptoms since she was 2. It started on "vacation" at my mother-in-law's house. Dtr was still breastfeeding then. Vomited for 24 hours straight. Of course, my MIL blamed it on the fast food I'd given her just before she got sick. She vomited every 4-6 weeks, each episode lasting roughly 24 hrs, until about the age of 11. She'd be exhausted for a day after, and ALWAYS started the episode with a sore throat and came down with a runny nose/cold symptoms following the vomiting. (Checked for strep many times, always negative.) We went to the ER once and she got an Rx for Zofran, which sometimes worked, sometimes not. When she vomited blood, we again went to the ER and they got lab work but nothing significant was found. Of course, weed wasn't an issue. She was diagnosed after a work-up (w/endoscopy) at a well-known children's hospital in our area, mostly based on history. This was after her PCP tried everything. We did all the common elimination diets, allergen testing, lab work etc. Finally we were told it's a type of migraine - an "abdominal migraine" - and that she'd probably have menstrual migraines (she's 14 now, and yes, she does). The vomiting literally tapered off after she started menstruating. Typically the vomiting cycle would start with a sore throat and loss of appetite, then active vomiting moving onto dry heaves every 10 minutes at the peak. She always asked for Sprite on ice even though nothing would stay down until the cycle moved on. (Pedialyte - no way.) Once it passed, she'd be ravenously hungry and ask for something awful like a double cheeseburger or dye-filled Icee. Still haven't figured out what the runny nose was about. She had an episode a couple of weeks ago that coincided with the start of high school but didn't progress to vomiting, just sore throat, runny nose, nausea - and yes, stress and menstruation was a part of that picture. BTW, she was a "late" baby - had her at 41 after many years of migraines. Her dad also gets visual migraines with the wavy lines, obscured vision. Have to say, my migraines were never as bad after having her and the years of breastfeeding. She's our third child and the only one affected.

One more thing, I've been reading this site since before I started nursing school in 2011 (RN since 2013) - just now signed up, to share our experience. Thanks for chance to chime in!