"IM doesn't work for me"

Specialties Emergency

Published

Had a patient last week who presented with multiple track marks and NO veins. I'm a pretty good stick, and couldn't even find a spider vein to get a 24 in. She claimed migraine, and also stated that "IM phenergan doesn't work for me." Said only thing that worked was IV Dilaudid and Phenergan. I've never run across a true instance of an IM med not working well when the IV form does...maybe takes longer, but still usually works. What is your experience?

I've found out that AMA paper work is just as easy to fill out as discharge instructions.

A woman after my own heart, that's my attitude. Yup just a drug seeker wanting that "rush" you get from IV Dilaudid. I hate Dilaudid. I have yet to see one patient not get addicted to that if they take it for more than 24 hours. They offered that to me when I had my heart attack, I refused. I'd rather suffer.

Up Vote Up Vote ×
Specializes in ER.

So, am I the only one who not only immediately pictured a particular patient when I read the title of this thread...but also heard it in their voice? :D

Up Vote Up Vote ×
Specializes in Emergency & Trauma/Adult ICU.
So, am I the only one who not only immediately pictured a particular patient when I read the title of this thread...but also heard it in their voice? :D

Nope, you're not the only one ...

The sad thing is, not one but about a dozen patients were immediately visible in my mind.

A patient like the one the OP described is far enough along in her addiction that she's stopped pretending to come up with a legitimate story. Her personal appearance and social skills are probably deteriorating, or they will soon. In her mind, it's all about whether or not you'll do this for her or not (i.e. medicate her with IV narcotics).

Up Vote Up Vote ×
Specializes in ER.
I agree with everybody so far. My experience has been that they don't think they are actually getting what they want if they can't feel the burn. My reply to them in this IM vs IV situation would be that... IM administration of this medication is safer than IV, this is the way it was ordered by the doctor, if you don't want it IM you are refusing treatment and may now leave.

I usually hear some crap about how I am refusing to care for the pt, but I don't bite. I just calmly explain that they had been seen, treated and released by the doctor, this is the treatment he ordered. You have the right to refuse this treatment and may still be on your way.

I've found out that AMA paper work is just as easy to fill out as discharge instructions.

going to have to remember that.

Up Vote Up Vote ×
Specializes in ED, ICU, Heme/Onc.

"IM doesn't work? Well, I suppose the doc can order these PO..."

If you aren't barfing large quantities and aren't otherwise hemodyamically unstable, or are not going to require a CT with contrast, then I don't place an IV until *after* the doc sees them.

I've also asked the shooters where the best spot is. If they require an IV for a medical reason, then I might as well not waste my time on a fishing expedition. After all, one can't be an "apathetic" evil ER nurse all the time... it's way too tiring...:icon_roll

For the poster who said that the IM didn't work for her sister, I'm thinking that the needle might have only gotten as far as subq tissue. I'd drop a line in a person with a tib/fib fx. and probably draw pre-op labs while I was there, since you never know how the ortho. wants to proceed.

Blee

Up Vote Up Vote ×
"IM doesn't work? Well, I suppose the doc can order these PO..."

For the poster who said that the IM didn't work for her sister, I'm thinking that the needle might have only gotten as far as subq tissue. I'd drop a line in a person with a tib/fib fx. and probably draw pre-op labs while I was there, since you never know how the ortho. wants to proceed.

Blee

that is what iwas thinking,....never made it thru to the muscle, needed a longer needle.....

Up Vote Up Vote ×

Oh I am laughing now. Currently I am on assignment in NM, where many of my patients are Heorin users...but because it is so common in this town, most of them right off the bat tell me they shoot up, and they dont seem to come in except for burns, abcesses, or broken stuff...

But we did recently have a patient "allergic to tylenol" Will never forget the look on his face when another nurse brought him a Lortab, and after learning he was allergic to tylenol, put it right in the sharps box and said, "Oh well, guess you can't have that."

He arrived next week with a different list of allergies....:banghead:

Up Vote Up Vote ×
Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.
Had a patient last week who presented with multiple track marks and NO veins. I'm a pretty good stick, and couldn't even find a spider vein to get a 24 in. She claimed migraine, and also stated that "IM phenergan doesn't work for me." Said only thing that worked was IV Dilaudid and Phenergan. I've never run across a true instance of an IM med not working well when the IV form does...maybe takes longer, but still usually works. What is your experience?

OOOHHH, the things drug seekers will say.... She probably prefers IV because if she were to get it IM she wouldn't be able to claim that it wore off and get more as quickley as the IV route.

:banghead:

Up Vote Up Vote ×
Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
I don't think the IM route is what this patient came in for. Because IM works over time, she does not get that "high" that comes with the IV administration.

Exactley!!!!!!!!:banghead::nurse::nono:

Up Vote Up Vote ×
Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
Thanks for the replies so far. Like I said, I've never run across any legit pt who would say that, but I didn't want to judge without hearing opinions of others who weren't involved in the situation. Every cell in my body was screaming "seeker" and she hit all of my top 5 seeker cues....complimented my earrings, addressed me by my first name before I introduced myself, told me where the good veins usually were, stated "I've had people ask me if I'm a IV drug user since I have no veins", and said "I haven't had an IV in months" when she very obviously had multiple new track marks. And on top of that, she did a little commentary as I was vein searching..."she thinks she found one she likes, can she get it to pop at all, reaching for the needle...inserting, inserting, nothing....hee hee hee." So very odd.

Yeah um can we say nutssss! Someone would have to be absoulutely nuts to try and put in there own line, I know Id pass out if I tried that trick, doc should have ordered her some po meds and maybe some IM compazine and ketorolac I bet that would solve her problem lol!!!!:chuckle

Up Vote Up Vote ×
Specializes in Emergency Department Nursing.
Without wanting to sound judgemental, what TX ICU RN said.

Ah... me too.

Up Vote Up Vote ×
Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Should've tried her foot, every time I hae had one of these I offer to put a line in there foot, take of the shoe and start looking alot of the ones I get this is enough to discourage them or when one of the medics or I starts looking at the neck and trying to find the ej then sometimes theyll give up say forget it and leave-hopefully.:bow:

Up Vote Up Vote ×
+ Add a Comment