[Separated] Give drugs to drug seekers

[epipusher]

heading up to the bay rooms friends, thanks for the discussion. lets hope for a slow night.

 

[usalsfyre]

Don't you love how we've swung from "2mgs of morphine for your femur sticking out" to "how much fentanyl do you want for your hangnail dear? I'll make sure I push it really fast in the closest IV port..."

We really need some balance on the whole issue.

 

[triemal04]

Alot of times it is an absolute cop out. Not to sound corny, but I could change cop out to saying its a "keep out" of the Quality Assurance Chiefs office.

Ok, I feel your pain on that one. Not trying to sound like to much of an *** if that's the case, but still...come on...

This isn't one of those situations that can't be dealt with. If you have someone who is truly drug seeking, be very clear when talking with the recieving doctors and nurses about what happened and why you didn't do anything, and very clearly document the same in your chart. "patient complains of 10/10 head pain, is holding head, rolling on the floor and yelling initially. During exam patient stops yelling/holding head and rolling on the floor and begins speaking normally, appears in no distress and holds an amicable conversation. While distracted patient does not complain of pain or discomfort."

Overly dramatic, but you get the point, right?

We really need some balance on the whole issue.

It isn't balance that's needed. People on both sides need to think before they do something, and think before they don't do something.

 

[DrankTheKoolaid]

re

Ok, I feel your pain on that one. Not trying to sound like to much of an *** if that's the case, but still...come on...

This isn't one of those situations that can't be dealt with. If you have someone who is truly drug seeking, be very clear when talking with the recieving doctors and nurses about what happened and why you didn't do anything, and very clearly document the same in your chart. "patient complains of 10/10 head pain, is holding head, rolling on the floor and yelling initially. During exam patient stops yelling/holding head and rolling on the floor and begins speaking normally, appears in no distress and holds an amicable conversation. While distracted patient does not complain of pain or discomfort."

Overly dramatic, but you get the point, right?

It isn't balance that's needed. People on both sides need to think before they do something, and think before they don't do something.

Absolutely! I am QA/QI and if people would write a narrative in a proper manner, it is very easy to justify both providing and not providing analgesia. But when you document someone cant get comfortable on the gurney with a stated 7 - 8 pain with a 45 minute trip to the ED, c'mon on that's just bad medicine. And then when I find out said patient had kidney stones etc etc on my follow up, there is a problem. It's funny when I talk with paramedic students where I teach almost 95% of them come in with the attitude of not wanting to give "narc's" which has been beaten into them by other providers they have worked with. And when asked why they would not give narcotics in a particular situation the most common answer is "Well I can live with that pain".

I do believe it relates back to our lack of pain control options as field providers. But unfortunately as long as the majority of EMS read : (Encouraging Minimum Standards) (swiped that one from someone else here) state medical directors would be hard pressed to offer other alternatives. If a "provider" cant bother him/herself with a little out of the box education on pain control why would they expect them to further their education on the many many side effects and contraindications of other non narcotic analgesics and synergistic medications we could actually be using.

 

[Remeber343]

Saying giving everyone with pain Narcs is exactly like saying everyone GCS less then 8 = intubate.

 

[Squad51]

I say it's 10ml of saline. That's all I say. If it makes their pain go away then that's all them. I don't tell the patient it's any sort of pain med.

That's not saline, I like to call it "normalzaline"! WOAH! Sounds good huh? LOL

 

[usalsfyre]

That's not saline, I like to call it "normalzaline"! WOAH! Sounds good huh? LOL

Coming from a guy that works for a place that think nalbuphine is appropriate pain control crap like this doesn't surprise me .

One of the more miserable episodes of my life was due to the Green Machine's lack of pain management.

 

[Squad51]

Coming from a guy that works for a place that think nalbuphine is appropriate pain control crap like this doesn't surprise me .

One of the more miserable episodes of my life was due to the Green Machine's lack of pain management.

10mg Nubain + 10/10 pain= 10/10 pain.

 

[Basermedic159]

Patient rates pain at a 10 out of 10 but yet are still smiling and no issues moving. Then you follow that with the wonderful 10ml preload of the "pain medication" saline. Their pain magically drops to a 1 or 2.

Unethically and illeagal. that is considered a placebo and anytime a pt is given any type of placebo the pt must be made aware that they may or may not be getting the actual medication.

 

[DesertMedic66]

Unethically and illeagal. that is considered a placebo and anytime a pt is given any type of placebo the pt must be made aware that they may or may not be getting the actual medication.

If you care to read all my posts then you will find out that there is nothing unethical or illegal about it. The patient is told it is saline. The patient is not told any about it being a pain medication, because it's not any kind of medication.

The saline is used as a flush to flush out an IV. After the IV is flushed the patient feels pain relief. They see someone push something into an IV and they feel better right away.

 

[Basermedic159]

I never withold pain meds, but I can't help but think that if drug seekers weren't given opioid analgesia by EMS and ED staff, then they would stop calling 911?

There has to be a way of stopping the repeating cycle. Why would anyone in my state try to buy drugs on the street / commit crimes to pay for them, when they can call 000 (911) get an ambulance straight away, lie to receive opioids, lie to the hospital and not get charged a single penny.

You cant prove anyone is a drug seeker anymore than you can prove they're in pain. You can NOT say well their pain is 8/10 but their bp is 120/80, so they must be a drug seeker. Thats ludacris!

 

[Basermedic159]

If you care to read all my posts then you will find out that there is nothing unethical or illegal about it. The patient is told it is saline. The patient is not told any about it being a pain medication, because it's not any kind of medication.

The saline is used as a flush to flush out an IV. After the IV is flushed the patient feels pain relief. They see someone push something into an IV and they feel better right away.[/QUOTE

I understand this concept. I thought you where telling the pt it was pain medication. But it really bothers me on a moral and ethical level, that Pain is so under treated in the pre-hospital setting as well as the ED, because of the stigma surrounding pain, seekers, and Opiod analgesia. I have had migraines since I was 8 years old and had to visit the ED several times in my life for Migraine pain. I myself have been refused pain medications because "my vitals are normal." I can tell you I am NOT a drug seeker. That goes to show you that refusing pain meds to someone who you think is a seeker, infact may not always be a seeker. There should be something done to improve pain analgesia and efficacy in the pre-hospital setting as well as the ED.

 

[Basermedic159]

Plus refusing pain meds to a pt that may or may not be a seeker, will not put a dent in the prescription abuse problems in america. You have the calls where you absolultely know they are, but when in doubt give em the pain medication, and you might have actually helped someone who actually needed it.

 

[the_negro_puppy]

You cant prove anyone is a drug seeker anymore than you can prove they're in pain. You can NOT say well their pain is 8/10 but their bp is 120/80, so they must be a drug seeker. Thats ludacris!

No-one is suggesting this, But, when I pick-up a patient for the 10th time in a matter of weeks, with the same chief complaint of chronic pain and having been told at the last arrival at hospital that they are a drug seeking patient under a management plan I can safely assume they are not genuine. This is particularly relevant when they are sitting, talking freely appearing in no discomfort stating pain is 10/10 and requesting analgesia by name and dosage strength.

Giving large doses of analgesia to every patient because "you cant" disprove pain is just as bad as withholding it from genuine cases. Use your clinical judgement along with the patients circumstances, presentations and history.

 

[the_negro_puppy]

Plus refusing pain meds to a pt that may or may not be a seeker, will not put a dent in the prescription abuse problems in america. You have the calls where you absolultely know they are, but when in doubt give em the pain medication, and you might have actually helped someone who actually needed it.

Or you may be perpetuating abuse of the EMS and hospital system because its "too hard" to determine a patients pain level and which analgesia is appropriate.

 

[Basermedic159]

Or you may be perpetuating abuse of the EMS and hospital system because its "too hard" to determine a patients pain level and which analgesia is appropriate.

No, thats not true. If you have a pt that is taking on the phone, laughing, no facial grimace, requesting narcotics by name and dosage than they are more than likely a seeker. Now if you pick up a Migraine or Lower Back pain pt. that presents with N&V, photophobia, facial grimace, trying to find a position of comfort. Why withold pain meds? Mabey it's because you have a "Paragod" complex and you are unsure of the appropriate type of analgesia.

I'm not saying snow the pt with 100mcgs of fentanyl or 10 of morphine for an OBVIOUS drug seeker, but their are criteria of which can be utilized to determine a drug seeker. I'd rather be fooled by a damn good actor than not treat someones pain because I'm unsure. You just have to think about the reason you're there...to help people when they need help. Not to judge them or try and save the world, one seeker at a time. If thats the reason you're in emergency medicine, maybe you should think about switching to addictionology at a mental health institute.

 

[epipusher]

It seems to me our profession is filled wit a lot of burned out and judgmental medics. It's absolutely embarrassing.

 

[systemet]

Thats ludacris!

No, this is ludacris:

What you're describing, is clearly ludicrous.

 

[johnrsemt]

Remember that when you are looking at vital signs that you don't know what the patients normal vital signs are:

Case in point: My Normal B/P is 80/50; so if I am telling you (prehospital or Doctor) that I am in extreme pain, and my BP is 120/80 and you are thinking that I am a seeker: My BP is actually more than 50% higher than normal. So you can't go just by vitals.
And as an earlier poster stated; sometimes pain does NOT increase pulse or BP especially if the patient is on meds for HTN

 

[systemet]

And as an earlier poster stated; sometimes pain does NOT increase pulse or BP especially if the patient is on meds for HTN

Or if there's a component of vagal stimulation occurring simultaneously, e.g. distension of a hollow organ.