drunks

chicagrl72 · Jul 29, 2005

i'm curious how others handle the drunks that come into your ER's.
i used to have sympathy for them and do what i could for them but the longer i am in the ER, the less patience i have for them.
figured maybe i could learn a trick or two to keep my sanity when dealing with them.

i say do a search on this site for that subject..i would provide a link for one of the links if i weren't so just darn tired

twin#2 · Jul 29, 2005

i'm curious how others handle the drunks that come into your ER's.
i used to have sympathy for them and do what i could for them but the longer i am in the ER, the less patience i have for them.
figured maybe i could learn a trick or two to keep my sanity when dealing with them.

Yes, alcoholics can be irritating; I, too deal c many however (having been sober 15 years now) I can assure you sympathy backfires as we use it as we live for self-pity & sympathy until we get sober & the frequent fliers usually don't want sobriety. If I encounter the rare pt who wants help I refer them to AA (& remind them it's free :-)) but unless they've sobered up a bit they won't remember. I was young & poor when I got sober so I never ended up in an ER. Indeed; alcoholics can get on my last nerve as well; my only advantage is that I know 1st hand & treating them is akin to looking into a mirror of my past. I can share c you that (active) alcoholics live c a disease that I wouldn't wish upon my worst enemy &, when sober, are different people. I always call in a social service consult. hope this helps.

z's playa · Jul 29, 2005

My ER just puts them in the drunk tank c an IV drip...a vitamin B12 shot and thats that.

B'bye.

Z

NorthER,RN · Jul 29, 2005

Hi Dave,

Like you I used to have a lot of compassion for drunks - particularly those in their teens, early 20's. I work in a rural setting in a small hospital, and we all agree that without ETOH we would likely not have very much work at all. Between the young girls who drink too much and can't stop vomiting to incredible violence (we have a guy we had to vent last night because he had been so badly beaten by his drunk relative - had his pelvis fractured and a collapsed lung among the long list of injuries). We can call the police to take them to cells if they are stable, but mostly I tend to keep them around until they can walk - if they are in their teens I usually call family to pick them up - if the family member is sober enough to come and get them.

However, now I am very quick to get them into adult diapers - I just got tired of cleaning up urine. Some nurses won't bother - they say that they want the people to go home in urine soaked clothes - as if that's going to stop them the next time they have money and access to ETOH. Some docs don't order IV's but I usually push for them - the young ones generally don't need thiamine or multivites - the older ones do. If they do aspirate I want a line in - and these days it isn't just ETOH it's usually some chemicals too....

I find that I am much more brisk with them than I am with others who come in looking for a bit of help - I really don't need to listen to the excuses. We have cards with the number of AA on them and I give those out when I discharge them - other nurses can't be bothered it seems. The ones that I have the hardest time of all with are the older women - my mom was an alcoholic and I find that I kind of freeze up. It's such a shame.

So Dave, all I've done is share my feelings of distress - when you were the one looking for help. I guess that I just don't know. Guess they have to reach the bottom and make their own decisions, and in the mean time we just patch them up and send them back out - maybe they'll figure it out. We do our best to provide the emergent care that they need - and the rest is up to them.

All the best

Rae

ClaireMacl · Jul 30, 2005

My London ED is one of the worst for drunks, we get far too many frequent flyers who see the waiting room as somewhere warm and dry for them in the colder months, we've since caught onto that and get them seen and discharged via security!

The young drunks are often the worst, we had a spate of 14 year olds last week at the beginning of the summer holidays, the parents were the worst! They were all like "oh my little baby" and "can't you give him something to help him"? like what? an antidote to copious amounts of alcopops?! Thankfully, our ED has started admitting the underagers to the paediatric department where they are not discharged until seen by the health visitor and paediatric psychologist, if anything will give them a shake, that does!

I personally have lost alot of my compassion for the eternal drunks who come in caked in faeces and urine that we have to clean up because they've lost the ability to coordinate their arms I tell them they'll see a doctor when their time comes but there is very little we can do without them sobering up, lol.

The worst thing is, we used to use the end of the majors desk to line up the drunks where we could see them but they were out of our nasal range, if you know what I mean, however, a death a couple of years ago from a drunk who didn't remember hitting a bus with his head prior to getting drunk means they pretty much always get a cubicle. If I hear the words "pabrinex and librium" one more time *ahem*

lee22 · Jul 30, 2005

"Drunks" are human beings and deserve the same respect as anyone else coming into emerg.

Gennaver, MSN · Jul 30, 2005

i'm curious how others handle the drunks that come into your ER's.
i used to have sympathy for them and do what i could for them but the longer i am in the ER, the less patience i have for them.
figured maybe i could learn a trick or two to keep my sanity when dealing with them.

Hi Dave,

I am not a nurse yet, (am 39 yo though and have worked with people in service capacities). I only want to share that at one time I reached a point were I was downright disgusted by alcoholics and drug addicts and a certain population that I associated with them.

Now my attitude is changing, thanks to my father, an ex cop and a natural social worker. Now I am embarassed that I have refered to this patient population as 'those people'. Know what I mean?

After watching one of many encounters with some addicts that lived in a building he managed, I asked him how he dealth with 'those' people every day.

It isn't apathy but, acceptance. You or I cannot save or eliminate all the problems that an addict may have at the moment or has had for the last 10-20 years, we can only manage the moment and ourselves. Self-awareness of ourselves and trouble shooting the unpredictability of an addict seeking to service their addiction, (that takes precedence for them, not anything else).

My dad is also the kind of guy who knows when to duck, when to laugh or find humor in a situation but, many of the situations are sad and tragic and those are were acceptance needs to be.

Also, one time I remember asking him how he could be such a tough talker...know I realize he wasn't, that they just didn't respond to normal social cues, "Besides" he said, "in that state that is all they respond to and they sure as he** won't remember tomorrow." He pretty much said to save yourself the misery and be very, very direct.

Genn

p.s. the tenants that my father helped manage were at the end of line so to say, one was a former high school class-mate of mine, some were older some were younger, in the last 3 years 4 out of 8 of them have died due to alcohol or drugs and related problems....

Dave11, BSN, RN · Jul 30, 2005

thank you all for the posts to date, however i was wondering if anyone had any work-related tips on how to deal with the drunks (sorry... human beings) when they get unruly, agressive, etc.

some of the docs order ativan when they are acting up. others expect us to babysit them till they pass out. the babysitting duty is usually what puts me over the edge.

this is the usual chain of events:

1.person passes out in public

2.concerned citizen calls police (this step is optional. can go straight to police step)

3.police roust said person and forces them into ambulance.

4.ambulance brings said person to ER. neither crew nor the person is happy about this.

5.person wants to leave ER but cannot d/t being severly intoxicated.

6. person is now completly pissed off and becomes obnoxious towards anyone and everyone.

7.person eventually passes out and when relatively sober given a dose of anti-seizure meds then d/c'd

8.repeat with the same person 3-7 times per week till they vanish for a period of a few months.

any tips on handling step 6?

Whispera, MSN, RN · Jul 30, 2005

How about calling the police and having them take them to the "drunk tank" to sleep it off? At a hospital in which I worked, only those who wanted help to remain sober were brought in to the ER by the police. They were evaluated and if they wanted help, we hooked them up with it. If they didn't, we let them go. Being belligerent is a big signal that they don't want help at that particular time.

Dave11, BSN, RN · Jul 30, 2005

the police around here dont take the drunks anymore. one died in a drunk tank a few years back, now they all go to the ER whether they want to or not. the ERs around here are now the drunk tanks.

schoona · Jul 31, 2005

Hi Dave,

Two things with etoh challenged human beings are 1) the aggression and 2) the over enthusiastic junior ed dr's.

As we'll soon be coming up to the festive season, yet again I will have to educate our new batch of dr's that the young, one off drunks (not the seasoned alcoholics) don't need to have 2L NaCl and thiamine, they need to experience the full force of a hangover so as to decrease the event occuring too soon. As I've said to the dr's yes I have been very drunk in my youth but never to the point that required hospitalisation.

The seasoned aloholic is another story.

As far as the aggression, if they don't want to be there we can't force them to stay unless they are scheduled under mental health guidelines, which is a bit over the top for the one off drunk. It's a case of sign the A30 (if they can) and try to get them home with a sober relative or friend. :balloons: