You know its a seeker when . . .

[BostonTerrierLover]

"Well the last time the doctor gave me these pink oval pills with watson stamped on them, what was the name. . .? (waiting on you to say . . Oh Lorcet, I'll get the script now:jester:!)

"Or, . . .That dilau. . that Hydromor, . . .Oh what was that called?"

. . . .anyway, Whats your seeker's dead give aways?

[VICEDRN, BSN, RN]

.

It's hard to explain, but when you can't find a dragon to chase and you end up in the ER trying to score, you tend to put on a more jovial personality to get your drugs. However, you can only keep that up for so long before your addiction starts to take over and you get agitated when you aren't getting what you need...

A neat test: pull up some saline in a syringe and bring it into the room. Don't say what it is or anything, just walk in and act like you're getting ready to inject it into them. Watch their body language. When you're fiending, you get real fidgety when you think you're about to score...

Funny that you mention these two things because I look for them both. To me, a seeker is a complete picture. First comes the jovial overly friendly attitude coupled with the ridiculous list of allergies and a visitor that doesn't seem all that anxious about their friend's condition. This is followed by the overly generous effort to "try" our non-narcotic relief (at least the smarter ones know they are supposed to fail non-narcotic therapies first.)

This is followed by increased agitation which is fueled by a seemingly sense of loss of control and an increasingly twitchy friend and then just the site of IV access start supplies gets the patient salivating, looking oddly thrilled and a rush that just isn't justifiable by the delivery of medications that have an onset that takes longer than that if you will, lol.

Often, they require larger doses, an impressive interest in medications and doses though most patients rarely ask or listen when you tell them, and disinterest or refusal to comply with Ct scanning, etc.

I don't hold a pillow over their face nor do I want to but I am incredibly angry at them. They are taking away needed resources from other patients. My new tact is to talk to them from the get go about the allergies they will soon develop to narcotics and what they plan to do when they get real pain. I let them know they will be hard to medicate when they have surgery and get old and sick. I let them know that ruining their veins means they will be difficult to get access on and may actually die as a result in a trauma. I tell them they are alternatives to pain management (if they get defensive about being a narc addict) and I make it plain they won't be getting narcs from me and if I can talk the doc into, them either.

[VICEDRN, BSN, RN]

Unfortunately I was the lucky one to be on the opposite end of that one. Admitted to a local ER after MVA I had shattered part of my pelvis but with not a scratch on me. Doc orders dilaudid IVP after my screaming when being rolled off the back board. ER RN decides not to give, I end up begging for pain meds as I'm rolled onto shattered side of pelvis for xrays with no pain relief. It wasn't until after the xrays came back that she gave me the dilaudid.

As she was giving it she was apologizing saying she sees a lot of RN's that divert and since I had nary a scratch assumed I was just seeking. I was none to happy that scrubs = drug seeker for that RN.

No idea why the ER nurse you met with doesn't know how to assess for pelvic fx. She's not so smart. The screaming when rolled thing is classic and I bet you complained of back pain too. Though Fentanyl is the preferred medication in trauma patients, you would be justified to complain.

[SHGR, MSN, RN, CNS]

Phone triage: "I dropped 30 percocet in the toilet."

"My bottle of pain pills spilled down the sink."

" My car got broken into and my bottles of pain medicine got stolen. No, I don't have a police report."

"My mom needs something stronger than these ES vicodin for her arthritis" (this dude who just got out of jail and was "helping" his mom out by staying with her).

[Calabria, BSN, RN]

Walked into one patient's room, her pain was a 8-10/10, even with a morphine PCA (which she refused to use until we told her we were taking it away). Looked at the pump settings... she had used it twice in the last four hours. But she had no problem with calling for her dilaudid q3h (to the minute), and then her pain would go down a bit. Even in her agony, she had no problem cruising down the hallways, or asking for us to heat up her fast food. Or requesting for us to push her dilaudid through the closest port in her central line (the one reserved for blood draws), and not diluting it.

Another patient (who had 10mg morphine IV push ordered after she screamed at the top of her lungs for an hour): "Can you push it fast? And put a sign on my door that says 'do not disturb' when you leave?" :uhoh21:

[NO50FRANNY]

Histrionics, narcissm, time suckage, manipulation, obsession with medication rather than what might actually be wrong, refusal of non-narcotic analgesis (a person genuinely in pain will take anything you throw at them) arguementative, investigated elsewhere / multi-facility presentations, ignorance, wanting to go outside with their IVC- (sorry buddy, if you are going outside, I am taking it out), ambulance crew wouldn't give them anything, know more about medicine than the consultant and only too happy to tell us how stupid we all are, inconsistent performance, difficult to assess / refuse to be assessed / refuse investigations prior to drugs, anyone younger than me with more than 3 presentations for abdo pain without pathology, my favourite- history of "previous" IVDU. The "prior registrations" function on our computer system is my favourite button. This topic gets a great deal of attention, I feel lucky to work where I do. Patients will always be investigated and get pain relief of some kind from us, seekers usually don't get narcotics unless they have obvious pathology or observable, not easily distractable pain. The ones that tell us exactly what opiate they need and how to give it will usually be sat out in the waiting room, performance or not. The best alert I have ever read "Pt found writing up morphine on her own drug chart".

[punkydoodlesRN, BSN, RN]

I work in detox/psych, almost all of my pt are seekers...

They come to my window with completely normal vitals, calm, cool, and collective telling me that they need Ativan IM because they are having a panic attack. Now, I realize that everyone is different, but it's pretty obvious they are not having any kind of attack...

on a side note, didn't realize so many people thought toradol was a wonder drug. Recently began using it to tx increasing severe migraines and it IS amazing!!

[zorabanks]

Pain is what the patient says it is. I know that ppl are drug seekers, but I have been in ER with 2 family members who really were in pain but treated like drug seekers. My was in a car accident and ER doc treated him so bad! Didn't even x-ray him or have nurse do wound care! Just my .

[DemonWings]

When they come into the ER for DKA + back pain, they get their 10 mg Morphine IVP, refuse insulin (sugar 530) and sign out AMA. That was a pretty big sign for me.

FYI: I was a new nurse and flabergasted that you could recieve 10 mg of Morphine and still be able to walk right out of the hospital like you had no medication at all. I would have probably gone into respiratory arrest with that amount of medication.

[SHGR, MSN, RN, CNS]

on a side note, didn't realize so many people thought toradol was a wonder drug. Recently began using it to tx increasing severe migraines and it IS amazing!!

Never had toradol myself, but I love giving it and seeing near-immediate relief. So nice to have some instant gratification in primary care!

[Vespertinas]

They skip their more frequently available medications so they can time it to receive as much as possible together at the same time. These "cocktails" can get quite elaborate: dilaudid + phenergan + ativan + benadryl + ambien... aaaallll at once. Sleep tight!

[dscrn]

agree with toradol...a shot of that and some IV fluids fast...can move the smaller stones along...

[Dixielee, BSN, RN]

You know it's a seeker when......." I brought a copy of my MRI for you to see, it's in my backpack"