So...I think everyone has their frequent flyers crowding up the already overcrowded EDs across the country. I was wondering if anyone's ED came up with anything that works!!!
We have our usual drunks, of course. At least we finally got some of our EMS departments to NOT transport them in when they have NO c/o!!! We had one local PD who picked up one of chronics and arrested him with public intoxication. Of course, they didn't want to keep him so they bonded him out on a SIGNATURE bond (this is important now!) Then they called rescue to transport him to us...because he was too drunk to be decisional and let go.
Ok so he's decisional enough to SIGN a signature bond...but not to pass out in the confines of his own bed!!??!! Sorry...no such luck!
Anyway...I digress!
I was thinking really of the seekers. We tried to come up with protocols and contracts and care plans...no go. I really HATE being the best dealer in town.
Let me tell you what has worked GREAT at our Er. TORADOL,TORADOL, TORADOL. It is the best pain medication (especially for migraines) and it doesnt give you the least bit of a high. We know that if 60mg of Toradol and 8mg of Decadron doesnt help the pain (even in the least bit) - they are drug seeking. I have migraine headaches (maybe 1-2 x a year) and Toradol stops it every time.Druggies hate it, though. Some have become allergic to Toradol :rotfl: . I pretty much know the regulars...Ill just tell them up front - you're not getting any "snacks" today..we're fresh out. But we do have some ibuprofen... . Ive also told them before that the stuff they get on the street is probably much stronger than what we have here. They tell me "its free here" SAD SAD SAD
Also, we make our drug seekers sit in the waiting room as long as possible. Sicker patients are seen first..They get mad but we tell them that this is not first come-first serve. This isnt McDonalds. pretty soon, they learn that its not going to be as easy as it used to be. (we used to have a doctor or two that seemed to enjoy giving out narcotics, and a lot of it.) Needless to say, they had drug problems of their own. Thank God they're gone..
Let's discuss this a bit. As a nurse and a Migraineur, you know that NO medication works for everyone. I've not been to the ER for about three years, but I'll still use myself as an example. The last time I went to the ER with a Migraine, the doctor said he was going to give me Toradol. Fine by me. Whatever would work was fine. They gave me Toradol and Phenergan. It did literally nothing. I have no idea why. I live in a small city and still go to the ER at the hospital where I was born, so they have all my medical records. The doctor asked me if I had any ideas. I told him that IV Compazine had broken a bad Migraine for me before, so that's what we did.
My point is: One size does NOT fit all. It's impossible to be medically correct and say that if Toradol doesn't help in the least, "they are drug seeking."
I've been following this thread, and what bothers me is apparent assumption that most people presenting in the ER with a Migraine are "drug seeking." Migraine specific drugs such as Zomig and Maxalt do NOT work for all Migraineurs. They work for approximately 85% of Migraineurs. Even then, the don't work for every Migraine episode. I go to one of the top headache and Migraine clinics in the country, yet, on weekends and after hours, if I have a Migraine that is out of control, I'm to go to the ER.
Letting an out of control Migraine go untreated doesn't just mean a patient in distress. It means a patient at increased risk of stroke.
I work on a daily basis with legitimate Migraine patients who have trouble being treated in the ER because of the problem "drug seekers" have created. What suggestions can we give those patients for getting care when they need it?
I try not to bunch migraine sufferers all in one group. IMHO there are those who present c/o a migraine headache, drinking mountain dew, eating potato chips and laughing with their friends... and then there are those who present obviously in pain, vomiting, and even to an untrained eye, experiencing a headache. The latter group of individuals are the ones I get back to see a doc right away, I make sure they have a room with a door, I darken the room and put the chart up ahead of the routine stuff because I feel they do need rapid treatment.
The first group of "migraine" sufferers will wait, sometimes a long time. They are not high priority, as long as they are eating drinking, using their cell phone and laughing it up.
we have some docs who use Toradol, but not enough. Most everyone will get a demerol injection (sometimes morphine) and then get discharged. I am trying to convince our docs to get PO Toradol put in our pyxis so that they can address pain without giving narcs to everyone.
I try not to bunch migraine sufferers all in one group. IMHO there are those who present c/o a migraine headache, drinking mountain dew, eating potato chips and laughing with their friends... and then there are those who present obviously in pain, vomiting, and even to an untrained eye, experiencing a headache. The latter group of individuals are the ones I get back to see a doc right away, I make sure they have a room with a door, I darken the room and put the chart up ahead of the routine stuff because I feel they do need rapid treatment.
The first group of "migraine" sufferers will wait, sometimes a long time. They are not high priority, as long as they are eating drinking, using their cell phone and laughing it up.
we have some docs who use Toradol, but not enough. Most everyone will get a demerol injection (sometimes morphine) and then get discharged. I am trying to convince our docs to get PO Toradol put in our pyxis so that they can address pain without giving narcs to everyone.
I TOTALLY agree with you about the two groups. After 40 years of Migraines, I may be able to at least walk and talk when I'm in misery, but I'm certainly not laughing and carrying on with friends. I've seen those people in ER waiting rooms, and have even confronted them myself. Not too long ago, I took someone else to the ER and observed someone sitting cross-legged in a chair with a walkman blasting music loud enough for me to hear several seats away, eating a candy bar and drinking soda. I asked her if she was waiting for someone. She said she had a Migraine. I handed her one of my business cards, told her she was a liar and making it hard on people who really had Migraines. She said her head really hurt. After several minutes of my challenging her, she left. Had she really had a Migraine, someone else waiting for another patient wouldn't have had that effect on her. She'd have told me off or complained to hospital staff.
I TOTALLY agree with you about the two groups. After 40 years of Migraines, I may be able to at least walk and talk when I'm in misery, but I'm certainly not laughing and carrying on with friends. I've seen those people in ER waiting rooms, and have even confronted them myself. Not too long ago, I took someone else to the ER and observed someone sitting cross-legged in a chair with a walkman blasting music loud enough for me to hear several seats away, eating a candy bar and drinking soda. I asked her if she was waiting for someone. She said she had a Migraine. I handed her one of my business cards, told her she was a liar and making it hard on people who really had Migraines. She said her head really hurt. After several minutes of my challenging her, she left. Had she really had a Migraine, someone else waiting for another patient wouldn't have had that effect on her. She'd have told me off or complained to hospital staff.
WAY TO GO!!! that is awesome. I have observed a direct link in our area, of those types of "migraine" sufferers and the elevation of pollen count. I know when I have a sinus headache I usually end up triaging a large group of people complaining of migraines. I used to work with a doc who had a horrible migraine problem, he would wake up with them, tunnel vision, vomiting, the whole nine yards. what a horrible horrible thing to have...
I try really hard to subscribe to the theory that pain is subjective, sometimes it is hard with those people we have described who are drinking soda and listening to their cd players...
Keep up the good work Teri, I appreciate what you do and its people like you who make my job a whole lot easier. :)
WAY TO GO!!! that is awesome. I have observed a direct link in our area, of those types of "migraine" sufferers and the elevation of pollen count. I know when I have a sinus headache I usually end up triaging a large group of people complaining of migraines. I used to work with a doc who had a horrible migraine problem, he would wake up with them, tunnel vision, vomiting, the whole nine yards. what a horrible horrible thing to have...
I try really hard to subscribe to the theory that pain is subjective, sometimes it is hard with those people we have described who are drinking soda and listening to their cd players...
Keep up the good work Teri, I appreciate what you do and its people like you who make my job a whole lot easier. :)
Thanks! :)
I DO see both sides of the issue, and just wish there were a way for Migraineurs to have a code word to use with ER staff to let them know we're legit. Several years ago, while on vacation, I'd spent two days in our darkened hotel room with a Migraine. Triptans hadn't touched it. My rescue med, Fioricet #3 hadn't touched it. I was keeping a bit of fluids down only because I had Phenergan to take. My husband took me to the ER. I had written down all the meds I'd taken, times, dosage, etc. Took my prescriptions and that list with me. I sat in the waiting room wearing my sunglasses and holding my hands over my ears for nearly four hours while patient after patient was treated and left. Finally, they took me into a treatment room. They refused to turn off the overhead lights, but insisted I leave off my sunglasses. The doctor left, saying he'd send a nurse back with a shot. My husband overheard the doctor tell the nurse to give me saline; that since I wasn't vomiting or crying, I didn't really have a Migraine. My husband wanted to get me up and take me to another ER. I told him that it hurt so bad that if I got up, we'd just go back to the hotel and let me die in peace. So, my usually extremely quiet husband, went to the desk and demanded to see "the person in charge." I don't know quite what was said, but a nurse came in very shortly with two syringes and two vials, insisting that I read the labels on the vials before she injected Demerol and Phenergan IM. She got me a pillow, an ice pack, and a blanket, then turned off the lights and closed the door. 30 minutes later she came back to see if I felt better. I did, and I asked to be discharged. They offered me Percocet to take with me, which I declined.
Now, I don't think that would happen on your watch, but that it does happen. There has to be a solution somewhere, but what is it?
Interesting. Since people who say they are allergic to Toradol are liars, why don't those of you who feel that way go ahead and give me a shot of it? (You might want to have a crash cart avail., though; went into resp distress the one and only time I got it. Of course, I could have been faking , but ABG's don't usually lie.)
I have several more names to add to my list of, "Hope this person gets a full blown migraine for 72h and is treated to the same hateful attitude they hand out to their pts."
I DO see both sides of the issue, and just wish there were a way for Migraineurs to have a code word to use with ER staff to let them know we're legit. Several years ago, while on vacation, I'd spent two days in our darkened hotel room with a Migraine. Triptans hadn't touched it. My rescue med, Fioricet #3 hadn't touched it. I was keeping a bit of fluids down only because I had Phenergan to take. My husband took me to the ER. I had written down all the meds I'd taken, times, dosage, etc. Took my prescriptions and that list with me. I sat in the waiting room wearing my sunglasses and holding my hands over my ears for nearly four hours while patient after patient was treated and left. Finally, they took me into a treatment room. They refused to turn off the overhead lights, but insisted I leave off my sunglasses. The doctor left, saying he'd send a nurse back with a shot. My husband overheard the doctor tell the nurse to give me saline; that since I wasn't vomiting or crying, I didn't really have a Migraine. My husband wanted to get me up and take me to another ER. I told him that it hurt so bad that if I got up, we'd just go back to the hotel and let me die in peace. So, my usually extremely quiet husband, went to the desk and demanded to see "the person in charge." I don't know quite what was said, but a nurse came in very shortly with two syringes and two vials, insisting that I read the labels on the vials before she injected Demerol and Phenergan IM. She got me a pillow, an ice pack, and a blanket, then turned off the lights and closed the door. 30 minutes later she came back to see if I felt better. I did, and I asked to be discharged. They offered me Percocet to take with me, which I declined.
Now, I don't think that would happen on your watch, but that it does happen. There has to be a solution somewhere, but what is it?
OH MY GOD! I am so sorry that happened to you, that is totally believable and unacceptable at the same time. There is NO excuse for treatment like that, not only is it rude it is unethical. I wish I knew the answer, I really do. Good luck with your work, Teri.
I wish your husband would have called the regulating agency for Md's in that state, and reported that dr. talk about illegal!!!! He needs his orifice kicked out of emergency medicine.
I have heard docs talk about injections of saline before, but I dont know any who have enough nerve to prescribe it, especially in PA with our malpractice laws. I did have a doc prescribe 0.5cc NSS iv q 6 hours and as needed for pseudoseizures before though.
TRobert
7 Posts
Let's discuss this a bit. As a nurse and a Migraineur, you know that NO medication works for everyone. I've not been to the ER for about three years, but I'll still use myself as an example. The last time I went to the ER with a Migraine, the doctor said he was going to give me Toradol. Fine by me. Whatever would work was fine. They gave me Toradol and Phenergan. It did literally nothing. I have no idea why. I live in a small city and still go to the ER at the hospital where I was born, so they have all my medical records. The doctor asked me if I had any ideas. I told him that IV Compazine had broken a bad Migraine for me before, so that's what we did.
My point is: One size does NOT fit all. It's impossible to be medically correct and say that if Toradol doesn't help in the least, "they are drug seeking."