# we've all been there what did you do?



## irish_handgrenade (Jan 30, 2011)

Ok we have all had the call for the unresponsive pt and when you arrive on scene it is painfully obvious that the pt is completely full of it. How did/do you handle this situation?


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## 94H (Jan 30, 2011)

Nasal Airway


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## NomadicMedic (Jan 30, 2011)

Assess the ABCs and if nothing else is indicated, simply transport.  <_<
If someone is going through all of the hassle of preteding to be unresponsive, they must want to go to the hospital rather badly.

I usually do enough on scene that the play actors just can't keep up the charade long enough. Of course, if I can't rouse them with a trap squeeze or sternal rub, they'll get an NPA. *That* wakes most of them up.


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## lightsandsirens5 (Jan 30, 2011)

94H said:


> Nasal Airway



Oh no you sure as hell don't. Not automatically. 

We are out there to actually CARE about PEOPLE. Not torture those who we determine don't "need" us. 

Don't even get me going on this one. I will try to control myself here. Sorry in advance for anything I might say later in this thread.


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## abckidsmom (Jan 30, 2011)

Depends on the faker in question.  You can count on me to load 'em up to tranport, then talk 'em awake in the truck.

Frustrating?  Sure.  But the nature of EMS is that you play with the hand you're dealt, and if people are sick enough to fake unconsciousness, well then they're sick enough to get a ride to a hospital.

Whatever the problem is that makes them do this (because it's something that normal people just. don't. do.) it's worth investigating.  Even if it's "just" attention-getting psych behavior... let 'em have a ride.


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## MrBrown (Jan 30, 2011)

Tell patient they do not require treatment or transport, get back in ambulance and drive back to ambulance station.


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## abckidsmom (Jan 30, 2011)

abckidsmom said:


> Depends on the faker in question.  You can count on me to load 'em up to tranport, then talk 'em awake in the truck.
> 
> Frustrating?  Sure.  But the nature of EMS is that you play with the hand you're dealt, and if people are sick enough to fake unconsciousness, well then they're sick enough to get a ride to a hospital.
> 
> Whatever the problem is that makes them do this (because it's something that normal people just. don't. do.) it's worth investigating.  Even if it's "just" attention-getting psych behavior... let 'em have a ride.





MrBrown said:


> Tell patient they do not require treatment or transport, get back in ambulance and drive back to ambulance station.



I love the unity of voices on this forum!  So cool to see that every time you call an ambulance, anywhere in the world, you're going to get the exact. same. treatment from the providers who show up!

(I like you a lot, Brown, and I intend to see how this Aussie system works in real life one day.  Care to pitch in for the plane ticket?)


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## cstiltzcook2 (Jan 31, 2011)

Dana- I love it. 
   Perfect summation of this whole deal. No further responses needed.

 Can I close the thread? hahahaahaha


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## JPINFV (Jan 31, 2011)

http://www.emtlife.com/showthread.php?t=21520


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## rwik123 (Jan 31, 2011)

n7lxi said:


> Assess the ABCs and if nothing else is indicated, simply transport.  <_<
> If someone is going through all of the hassle of preteding to be unresponsive, they must want to go to the hospital rather badly.
> 
> I usually do enough on scene that the play actors just can't keep up the charade long enough. Of course, if I can't rouse them with a trap squeeze or sternal rub, they'll get an NPA. *That* wakes most of them up.



Or just before the airway, say " hey partner wanna grab me that big green hose that we'll have to shove down the patients nose" sometimes that'll wake them up. 
But I agree to not do the npa automatically. I do not wanna cause or inflict pain on a person just for giggles.... But if protocols call for an airway for an unresponsive victim, I won't withhold it, even if I know they are faking it.


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## Hockey (Jan 31, 2011)

Bilatteral IO's


Or I sing to them.  If I don't get a reaction, they are dead.  Seriously.  If you're a bad singer, it works...EVERY SINGLE TIME


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## JJR512 (Jan 31, 2011)

Per Maryland protocol, if no other reason can be found for the patient to be unresponsive, oral glucose is to be administered between the cheek and gum. Bear in mind that most MD EMT-Bs cannot check blood sugar levels, hence the blanket protocol.

Administering oral glucose in this manner to a faker probably won't make them "come to", of course. At least that's my guess.


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## NomadicMedic (Jan 31, 2011)

JJR512 said:


> Per Maryland protocol, if no other reason can be found for the patient to be unresponsive, oral glucose is to be administered between the cheek and gum.



Really? Maryland protocol has Basics admin oral/buccal glucose to an unresponsive person? 

I find that bizarre, if not downright dangerous. 

But yes, I googled and it's in the "ALTERED MENTAL STATUS: UNRESPONSIVE PERSON" protocol... 
"Administer glucose paste (10-15 grams) between the gum and cheek.
Consider single additional dose of glucose paste if not improved after 10
minutes. (NEW ’10)"

(http://www.miemss.org/home/default.aspx?tabid=106)
Shocking.


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## JPINFV (Jan 31, 2011)

With proper monitoring, I don't see bucal administration as all that dangerous. However, it's not an administer and forget intervention.


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## truetiger (Jan 31, 2011)

I'm not convinced an NPA is torture, if protocols state unresponsive pts get an NPA, follow your protocol. It gives the pt one last chance to reconsider before they get to the ER and the ER staff inserts a foley.


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## Veneficus (Jan 31, 2011)

this is patient specific, if they are faking there is generally a reason. I do my best to find what the reason is. Look around, there are always clues, even in the hospital. 

I discovered at some point that most people who are fakers generally need help of the nonmedical variety. No reason to try and fit a square peg in the round hole. Is there something you can do in order to help them?

My first EMT instructor once told me: 

"The 2 most important questions you will ever as a patient is:

Can you walk? Have you tried?"

I have several times simply told patients that I knew they were faking, I wasn't carrying them, and if they wanted to go the the hospital they were to walk to the truck and not sit on the cot because that is for sick people. 

Strangely enough it worked rather well in my experience. 

For the truly hell bent on faking, I try to do as little as possible now. After all, if it is attention they seek, there really is no indicated medical intervention.


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## irish_handgrenade (Jan 31, 2011)

Veneficus said:


> this is patient specific, if they are faking there is generally a reason. I do my best to find what the reason is. Look around, there are always clues, even in the hospital.
> 
> I discovered at some point that most people who are fakers generally need help of the nonmedical variety. No reason to try and fit a square peg in the round hole. Is there something you can do in order to help them?
> 
> ...



Probably the best answer to this question.


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## kravturtle (Jan 31, 2011)

There's always the hand-drop test. Although, that's usually frowned upon...


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## 8jimi8 (Jan 31, 2011)

kravturtle said:


> There's always the hand-drop test. Although, that's usually frowned upon...



Let me catch someone trying to hurt a patient.


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## usafmedic45 (Jan 31, 2011)

> Even if it's "just" attention-getting psych behavior... let 'em have a ride.



Yup....this is why I argue for BLS trucks in emergency services. LOL



> Let me catch someone trying to hurt a patient.



Please.....you just have to remember to pick the hand without a ring or at least remove the ring first.  

Or try the "Hey, you know there's big money in kidneys and this guy's got two.  You get the ice, I'll get the prepaid cell phone!"


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## Jon (Jan 31, 2011)

I've also seen ammonia inhalants used to some success. Again though, that's bordering on abuse.

If someone doesn't react to a good sternal rub or trapeezius squeeze, maybe they actually have a medical problem. And if they react by faking - then I'll try to talk them out of it.


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## PotashRLS (Jan 31, 2011)

We always transport and try to assess en route for the cause of the unresponsiveness.  Proving someone is "crying wolf" isn't worth inadvertantly neglecting a truely sick person.  Like said previously, someone faking unresponsiveness is still sick, maybe just not sick in the way ems typically deals with.  

I would use the hand drop without worry.  I am surprised no one said about starting bilateral large bore IVs.  

We never consider NPA in a head injury.  Just not a good idea IMO and are contraindicated in our protocol.


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## Veneficus (Jan 31, 2011)

At one service I worked at we had a frequent flying faker and when I called report the doc answered and told me not to come to his ER until I had established 2 IVs 16g or larger.

Her only reaction to it was tensing her eyes a little. So even that is not always useful.

I evolved from getting angry abot fakers to jst making it as little work as possible. Every intervention needs to be documented. Assessment needs to be documented. Then you have to restock. After that reorder from central supply. 

While I would never suggest not doing a proper assessment, the more equipment you use, the more work you have. Really, why do more work than you have to?


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## 8jimi8 (Jan 31, 2011)

usafmedic45 said:


> Yup....this is why I argue for BLS trucks in emergency services. LOL
> 
> 
> 
> ...



Why would you encourage unprofessional behavior?


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## medicRob (Jan 31, 2011)

I feel the same way about this as I do about choosing who is drug seeking and who isn't... It's not for me to decide. 

Does it piss me off? You bet it does. 

Do I take it out on the patient? Nope.

Whenever I have a patient that I believe to be faking, I might play a game or two like whispering to my partner (making sure the patient can hear me) that this patient must be faking cause a real seizure patient usually urinates. If they urinate on command, that tells me their kidneys are working and that's a good thing. 

If they don't, that's okay too. I will transport them unless they decide to sign a refusal of care. 

I don't believe in punitive IVs. If the patient needs an IV, I will give them one, sure it will be an 18g or lower (Preferably a 16g), but that is only in case the patient might need blood products down the road in that line. If I don't see any medical reason to have an IV in that patient, I won't start one. 

Just my $0.02


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## usafmedic45 (Jan 31, 2011)

I don't consider it unprofessional.  It's a technique that has its place just like anything else.  It's like dropping an NPA.  It's not going to hurt 99.999% of patients so it doesn't really matter.  I don't necessarily encourage the practice, but I don't see anything inherently wrong with it on its face.

My take is if they're going to lie to me and fake, the "kidney joke" is a great way to see how willing they are to run with the lie. 



> If I don't see any medical reason to have an IV in that patient, I won't start one.



Technically an unresponsive patient under most protocols would have a "medical reason" for an IV.


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## medicRob (Jan 31, 2011)

usafmedic45 said:


> I don't consider it unprofessional.  It's a technique that has its place just like anything else.  It's like dropping an NPA.  It's not going to hurt 99.999% of patients so it doesn't really matter.  I don't necessarily encourage the practice, but I don't see anything inherently wrong with it on its face.
> 
> My take is if they're going to lie to me and fake, the "kidney joke" is a great way to see how willing they are to run with the lie.
> 
> ...



Also, urine output is a fantastic indicator of shock.


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## usafmedic45 (Jan 31, 2011)

> Also, urine output is a fantastic indicator of shock.



Its the best indicator according to some.  LOL


We even "track it" in my medical reenacting unit (talk about attention to detail and realism)*.  


*- It's faked obviously and the "catheter" tubing simply comes out from under the blanket covering our simulated casualty.


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## phildo (Jan 31, 2011)

If someone is unresponsive to verbal or light tactile stimuli, they get a modified jaw thrust.  It is a very strong stimulus (have your partner try it on you) which serves a legitimate clinical need.  No response with that, they get an NPA, then intubated.  Fakers come alive with the jaw thrust.  I don't accuse them of faking.  We don't get alot of fake unconsciousness here. However, if we are dispatched to the mall or Walmart for shortness of breath or chest pain, most of the time it is a shoplifter who got caught and doesn't wanna go to jail.  If they wanna go to the hospital, who am I to tell them that they will go to jail (but more likely have a warrant issued, otherwise the PD would hafta babysit them in the ER), when they are through at the ER?


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## MrBrown (Jan 31, 2011)

*!*



abckidsmom said:


> I(I like you a lot, Brown, and I intend to see how this Aussie system works in real life one day.  Care to pitch in for the plane ticket?)



Brown is not an Aussie, so buying a plane ticket to Australia is not going to do ya much good except if you wish to swim to New Zealand from Sydney.

*Seeing as how Brown has been trained so well, Brown goes to ask Mrs Brown permission to spend money on Browns credit card which Brown handed over to Mrs Brown long ago


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## Lady_EMT (Feb 3, 2011)

Yes, these people piss me off. Yes, they usually decide to go "unconcious" at the worst hours of the night. But, I'm not going to risk my license by assuming they're actually faking.

I'd start off with a sternal rub, and if that doesn't rouse them, then they've been practicing 

But they obviously need something at the hospital, because why would they want to spend the money on an ambulance and hospital bill just for giggles? They probably think that the issue they're actually having isn't "important" enough for transport. There's always two sides of the coin.


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## Veneficus (Feb 3, 2011)

Lady_EMT said:


> Yes, these people piss me off. Yes, they usually decide to go "unconcious" at the worst hours of the night. But, I'm not going to risk my license by assuming they're actually faking.
> 
> I'd start off with a sternal rub, and if that doesn't rouse them, then they've been practicing
> 
> But they obviously need something at the hospital, *because why would they want to spend the money on an ambulance and hospital bill just for giggles*? They probably think that the issue they're actually having isn't "important" enough for transport. There's always two sides of the coin.



Are you sure they spend money on these bills?


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## TransportJockey (Feb 3, 2011)

If they do not react to sternal rub or me squeezing the web between thumb and forefinger, a CBG lancet stick without warning might make them wake up. And that's one of the first things I'll check on a down and out anyways.


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## Ghando14 (Feb 5, 2011)

I ran a call  where the "unconscious" pt  woke up the second we shut the doors to the Ambulance. She was a younger woman around 16 who was being abused at home. For some reason she couldn't make a call to Social Services or the police, but in the privacy of the ambulance, she opened up to me and the paramedics. She felt like she would be safer going this way. 

So, I've seen the side of life that makes it "reasonable" to assist faking patients, but, I also know the feeling of the attention seekers who call you out in the middle of lunch, because of whatever. The only thing we do is if we think there might be trickery, we sternum rub to check responsivness, and transport quickly, so we can be available for a real emergency.


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## firetender (Feb 6, 2011)

Pt. on gurney, placed in back of ambulance. You get in. Partner SLAMS rear doors shut.

YOU: Pssst!!  Hey?  You!

NO RESPONSE

YOU: Hey, you made it, Okay? You're in...we're on our way. I'm not gonna do anything to you because there's nothing to do. You wanna go hospital; here we are. But listen, ya gotta help me; WHAT DO YOU REALLY NEED?

Sometimes your job is to make it so you can ask the obvious.

Just sayin".


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## 8jimi8 (Feb 6, 2011)

Is everyone that is referring to a sternal rub just deferring to what they learned in school?

The standard of care has been updated.  

A vigorous sternal rub can cause skin tearing.  Think about granny on coumadin before you start smashing your knuckles on your CUSTOMERS.

Think about peripheral vascular disease, or peripheral neuropathy when you start squeezing peoples distal extremities.

People, please stop abusing your patients.  Use a trap squeeze, or just play along and take them to the ER.


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## Veneficus (Feb 6, 2011)

8jimi8 said:


> Is everyone that is referring to a sternal rub just deferring to what they learned in school?
> 
> The standard of care has been updated.
> 
> ...



While I agree and see your frustration, EMS isn't the fastest evolving job ever. We should be thankful these patients aren't put on a LSB "just incase."


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## JPINFV (Feb 6, 2011)

Well, why wouldn't you backboard an elderly patient with a skin tear from a sternal rub? After all, it's a trauma now!

/sarcasm


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## 8jimi8 (Feb 6, 2011)

I just figure as long as I keep pointing it out, the lifers who actually care, will slowly realize that evolution is one detail at a time.  

I really am a socially normally individual... i only turn into a nitpicker when I see medical professionals setting up for the fail.


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## 8jimi8 (Feb 6, 2011)

i really wanted to make a joke about anterior AND posterior LSB.... but i just can't


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## Veneficus (Feb 6, 2011)

JPINFV said:


> Well, why wouldn't you backboard an elderly patient with a skin tear from a sternal rub? After all, it's a trauma now!
> 
> /sarcasm



Then they are not faking, they have a real emergency!

Somebody call Brown, this will require a level 1 for sure


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## JPINFV (Feb 6, 2011)

8jimi8 said:


> i really wanted to make a joke about anterior AND posterior LSB.... but i just can't




Maybe something along the reason why women are the best at placing an anterior and posterior LSB?

/me ducks and runs away...


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## Aidey (Feb 6, 2011)

8jimi8 said:


> Is everyone that is referring to a sternal rub just deferring to what they learned in school?
> 
> The standard of care has been updated.
> 
> ...



Ok, to be honest it is hard to get worked up about a sternal rub when I've seen ER docs and nurses do them on a semi regular basis. Same thing with the hand drop BTW. Part of using an intervention is knowing who it is appropriate to use it on, and that means doing something else when your patient is more susceptible to skin tears. 

There are some very legitimate complaints about EMS, but when we are talking about something still in common practice in the ER I don't think it is fair to put all the blame on EMS being backwards. 

As far as "play along and take them to the ER", that only goes so far when you are expected to be able to tell the difference between sick and not sick. "Playing along" with a falsely unconscious patient with any sort of trauma results in some VERY pissed of trauma surgeons, ER docs and charge nurses around here. Trauma + A GCS under 13 results in an automatic trauma activation...see where that can be problematic? 

We take the blame for those, and it undermines our credibility for every other trauma patient we bring in. Maybe it isn't right, but it is what happens.


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## 8jimi8 (Feb 6, 2011)

Aidey said:


> Ok, to be honest it is hard to get worked up about a sternal rub when I've seen ER docs and nurses do them on a semi regular basis. Same thing with the hand drop BTW. Part of using an intervention is knowing who it is appropriate to use it on, and that means doing something else when your patient is more susceptible to skin tears.
> 
> There are some very legitimate complaints about EMS, but when we are talking about something still in common practice in the ER I don't think it is fair to put all the blame on EMS being backwards.
> 
> ...



Aidey, 

I didn't at all blame EMS, I simply asked people if they are deferring to an old educational paradigm.

Every time I see a sternal rub on a patient, I follow up with that practitioner and remind them that the technique is outdated and potentially harmful.

I also, do not work (nor have ever been paid in EMS) so I haven't picked up on the idiosyncracies of transport politics.

I would not activate a trauma alert on a patient i suspected to be playing unconscious.

I have never, nor would I ever intentionally harm a patient.  If I have ever needed to asses level of consciousness on a suspected unconscious, even people on their death bed have not been able to ignore my trap squeeze.  I'm a rock climber, I have very strong hands, maybe that's why... But when I was the "victim" for my EMT-Basic skills class, I could NOT ignore my instructor's trap squeeze either... Even though I was supposed to be an unconscious diabetic.


so all the anecdotes aside, the point being.  Sternal Rub is outdated and shouldn't be employed as a tool in modern EMS


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## Aidey (Feb 6, 2011)

It isn't a matter of us saying "Trauma activation" on the patch or not. It is the hospital's own policy. If we patch in with a GCS of 13 or lower, and a CC of a traumatic injury, the hospital activates. 

They have some discretion when it comes to the exact situation, but only so much. If I call in with "85 year old female, fall, obvious R hip deformity, GCS of 12, pt has hx of dementia said to be acting normal" they will do a modified activation, where they call the trauma surgeon to notify him, but the whole team doesn't come rushing to the ER. 

However, the guy who robbed a convenience store, ran from the police and got tackled and is now playing unconscious will end up an activation. 

There are much worse things out there being used by ER docs. Ammonia in a mask and saline in the ear are two that come to mind.


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## 8jimi8 (Feb 6, 2011)

Do you do those things with your license?  I mean what are you arguing here?


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## 8jimi8 (Feb 6, 2011)

The hospital activating a trauma alert based on the info you give, doesn't have a thing to do with your fault.  Sure maybe a trauma alert is a great way to get a conscious cold caloric, but at the end of the day are you the one abusing people?


I saw one of my intensivists use a laryngoscope on an fully awake and alert patient, but its not something i'll ever repeat... watching a guy in restraints flail and gag with his head dangling off of that hook...

I'm not trying to win anyone's points here, i'm just being an advocate for the people we are charged to care for.


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## Aidey (Feb 6, 2011)

Oh go grief no, those were both things I saw ER docs do to unconscious patients. I have asthma and don't even allow ammonia in the back of the ambulance. If a FFs sets one of those things off after I warn them, I get to drive and they get to ride in the back. 

The problem is that we are blamed for the accuracy of that info. If we call in a GCS of 12 and the patient is faking it, they expect that we would have figured that out and never called in with a GCS of 12.


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## 8jimi8 (Feb 6, 2011)

I think we are on the same page here.

As usual we end up splitting hairs in the middle of the night.  Don'tcha love the night shift.


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## yotam (Feb 7, 2011)

Too many variables, too little time to differentiate. Your patients' reason for faking could range from a 16 y/o adolescent seeking attention from his ex-marine father or a 45 y\o lady with breast cancer that doesn't want to tell her family, but doesn't know how to go to the hospital without alarming them (given the etiology of her unconsciousness could be easily explained by low BP\low sugar\stress. True story, BTW).

So, bottom line- play the game, don't judge it. It's nothing personal, and they are not lying to you- they're lying to the man that could bring them to the hospital. 

In the service I had many of those fakers, soldiers who just wanted some rest. You'd be surprised how much your endurance for pain rises when you just wanna go to bed. There is really not much to do- At most times the usual physc games don't work- just strap'em and driv'em.


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## lampnyter (Feb 7, 2011)

Just to put in my 2 cents, a nasal airway isnt torture. If it is torturing the person there you are doing it wrong.


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## 8jimi8 (Feb 7, 2011)

lampnyter said:


> Just to put in my 2 cents, a nasal airway isnt torture. If it is torturing the person there you are doing it wrong.



If it isn't indicated, it is incorrect.


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## yotam (Feb 7, 2011)

8jimi8 said:


> If it isn't indicated, it is incorrect.



We all do it... Giving 1CC seline to someone who wants morphine but really doesn't need it (or if you're riding a BLS and you don't have), or giving oxygen to an HY patient who clearly isn't in any respiratory trouble (provided it isn't an acute HY. They can actually become apneic!).

So, we all do it. I guess it's all about damage control. Never tried nasal (we don't have it here), but it certainly doesn't look pleasant.


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## usafmedic45 (Feb 7, 2011)

> provided it isn't an acute HY. They can actually become apneic!



Who told you that?  You might get a pause in breathing, but making someone fully apneic normally takes a lot more than hyperventilation + a little O2.


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## usafmedic45 (Feb 7, 2011)

> If it isn't indicated, it is incorrect.



That wasn't his point.


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## reaper (Feb 7, 2011)

> > If it isn't indicated, it is incorrect.
> 
> 
> 
> ...



So do you document that on your report? That you lied to the pt and gave them something other then what you told them you were giving them?

If a pt is unresponsive to you, then a NPA is well within indication!


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## cruiseforever (Feb 8, 2011)

yotam said:


> We all do it... Giving 1CC seline to someone who wants morphine but really doesn't need it
> 
> 
> Please do not use  " we all do it",   I have not given saline in place of morphine.
> ...


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## 8jimi8 (Feb 8, 2011)

In the words of Bob Marley, "Who feels it, knows it"

I give pain medicine to drug seekers on a daily basis.  Not my place to judge.

My whole dog in this hunt has been against punitive interventions.

Please people, don't take it personally, when a patient lies to you, or pretends something is wrong.

That isn't pretend, something really is wrong.


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## Icenine (Feb 11, 2011)

My protocols make this very easy.

Airway- Jaw thrust (hurts like *#%)

AVPU- Usually nail bed "stimulation"

Narcan IN (If indicated)

BGL- The stick is usually not unsuspected, and the seasoned players know it's coming when you start milking the finger.

Glucagon IN (If signs and symptoms, south of 80 mg/dl)

An unsuspected anything (IN spray, NPA, etc) is a rude awakening.  If you don't verbalize what you are doing prior it helps.

And I have any pt that can walk, do so at least to the front steps.  This is no exception.  I don't mind transporting, but don't make me kill my self.


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## usafmedic45 (Feb 11, 2011)

> I give pain medicine to drug seekers on a daily basis. Not my place to judge.



It's also not your place to feed someone's addiction.  It is your place to judge whether someone needs pain medication.  If you want to claim to be a superior provider, perhaps you should not be admitting to something just as indefensible (not to mention potentially illegal) and potentially far more harmful than a nasal airway or sternal rub.  Just my two cents....


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## 8jimi8 (Feb 11, 2011)

usafmedic45 said:


> It's also not your place to feed someone's addiction.  It is your place to judge whether someone needs pain medication.  If you want to claim to be a superior provider, perhaps you should not be admitting to something just as indefensible (not to mention potentially illegal) and potentially far more harmful than a nasal airway or sternal rub.  Just my two cents....



Pt reports  pain and I assess: severity(1-10/flacc scale/faces scale), location, quality, onset, duration, aggravating factors, alleviating factors, my actual intervention and the evaluation of the response to my interventions.

I'm not a lie detector, but I can see it in your face.  if you report a pain less than or equal to 3 you get acetaminophen or some other non-narcotic analgesic.  If you report pain 4 or > you get narcotics.

I know when someone tells me that they are having chest pain and they are allergic to nitro, that they are lying.  But the still get morphine, because they still have chest pain.  

Never once have I EVER said that I was a superior provider, rather I feel that I have  encouraged people to be superior providers.  I think you find that the majority of my response posts begin with asking a question about why you did what you did and encouragement to behave professionally.

I don't mind being called to task, but don't put words in my mouth.

I'd also invite you to read your own responses and see if maybe there is a bit of projection going on.


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## medicRob (Feb 11, 2011)

*The old Pain scale:*









> 0:  Haha!  I'm not wearing any pants!
> 
> 2:  Awesome!  Someone just offered me a free hot dog!
> 
> ...



*The New Pain Scale*













> 0:  Hi.  I am not experiencing any pain at all.  I don't know why I'm even here.
> 
> 1:  I am completely unsure whether I am experiencing pain or itching or maybe I just have a bad taste in my mouth.
> 
> ...





All content from above taken from here: http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html


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## 8jimi8 (Feb 11, 2011)

medicRob said:


> *The old Pain scale:*
> 
> 
> 
> ...



classic... reminds me of the cartoon that bangs his head on the keyboard


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## Veneficus (Feb 11, 2011)

usafmedic45 said:


> It's also not your place to feed someone's addiction.  It is your place to judge whether someone needs pain medication.  If you want to claim to be a superior provider, perhaps you should not be admitting to something just as indefensible (not to mention potentially illegal) and potentially far more harmful than a nasal airway or sternal rub.  Just my two cents....



It is if methadone clinics don't do it everyday?

Like I keep trying to point out...

Even if in a provider's heart of hearts they may believe they are doing the right thing and not feeding the addiction. When the pt doesn't get their fix, they will go into withdrawel, and should they be brought to the attention of a healthcare provider, will be getting what they are addicted to anyway, with a much bigger bill paid by society. If they don't resort to violent crime which society will still be paying for at a much higher cost.

If they don't come to medical attention or that of the law and die from withdrawel or not paying a dealer, then the healthcare provider basically sent them out to die. Not exactly medicine's finest moment.

It is quite an ethical debate.

"How is this going to look on the evening news?"


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## 8jimi8 (Feb 11, 2011)

Veneficus said:


> It is if methadone clinics don't do it everyday?
> 
> Like I keep trying to point out...
> 
> ...




At the very least we know that when we administer it, it is under the guidelines of physicians orders.   Rather than finding them DRT with a syringe hanging out their arm scaring a busload of kids.


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