Last resort only, and even then only in certain situations. Such as an anxiety attack.
First Ride Along w/ Funny Story
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Sasha
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Admitting to coke use.. probably another thing that shouldn't be posted on the forum.
reaper
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This is where a psychology course should be a requirement! I have never had a pt that I could not clam down, whether by talking or use of meds.
I do not condone lying to a pt or telling them that they are getting a drug, that they are not.
What will you do, when it goes to court and they ask you where you got nitrous on a truck that does not have it?
I do not condone lying to a pt or telling them that they are getting a drug, that they are not.
What will you do, when it goes to court and they ask you where you got nitrous on a truck that does not have it?
Sasha
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The next condition of his question is that you can't call med control for orders for meds because you forgot to stock the drug box or you are in a communication dead zone.
timmy84
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Agreed, I may not have the personal experience TRowe has, however I do know from professional experience that someone coming down from even a major coke binge are not beyond talking to. The fact that the fake nitrous and asa to the forehead tells me that he was not so bad off. If something can be fixed with a placebo, it can be helped with some understanding and reassurance. Let's try to advocate for our patients, why patronize them when it does nothing to help. Now he will go on another binge, and when it's over with he can call an ambulance and ask for a nitrous oxide/asa cocktail to "cure" him up.
Neither have I, but that does not change the fact that not everyone has access the meds, and, not everyone will have the ability to use them. Will it come up in everyones career? Doubtful. Will it come up in some? Yes. Better to have thought about it before.
And if you are stupid enough to document that you actually gave someone nitrous and not what you actually did, then you deserve everything that happens next. If you do something you document it, and that includes a placebo.
No, it also could be that you just don't have any...or you do but can't use them either with online/offline medical control...could be you're working on a BLS transfer unit such as the one you were on... The conditions are only what I said. Let them suffer, or try a placebo (in an appropriate manner). I already know your answer.
Shishkabob
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Shishkabob
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Strange, swearing always made my mouth taste like soap.
To each his own I guess!
To each his own I guess!
Hockey
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Man, I clicked on the thread read the last little bit of the OP and knew that the moral police would be around quite fast. I like with MMiz said. What happens at work, stays at work 
You're absolutely correct but until we start carrying Toradol a narcotic is my only option for pain control. And for the record yes I do tell the nurse my full treatment including any placebos used and yes it is documented in my PCR that a patient was given a saline flush and told it was morphine. I document immediately after that their response to the treatment.
If you read my original post again I said that I use the placebo for those that don't fall within my protocol for morphine administration. You however seem to take people's words too seriously, people lie, they always have and always will and no I will not be the one that gives the drug seeker morphine. Sorry but I believe in practicing responsible medicine not bowing down to anything the patient wants. I am the one with the education, I think I can come up with a better course of treatment than them for that whole 30 minutes that I'm with them.
guardian528
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i'm guessing they aren't normally like this, maybe they were trying to be cool for the ride along? maybe like, "look we do fun stuff..." ... maybe? maybe not?
Melclin
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Misconceptions:
1. Melclin thinks it's okay to make fun of a pt to their face.
2. Melclin thinks it's stupid to take a pt to hospital that requests it.
Corrections:
1. I never said it was. Don't put words in my mouth. What I argued was that it is conceivable that the medics intentions may not have been malicious, and that it may have been falsely perceived that way by the student observer (this may also have coloured the way in which he told the story). It is also conceivable that, given a set of circumstances, of which we are unaware, this may have been an appropriate course of treatment. We weren't there, we don't know the whole story (in fact we know very little of the story), so I feel that given the possibility of a perfectly reasonable and ethical alternative explanation of the situation other than that they were just negligently and maliciously trying to humiliate the pt, that you should back of on the condemnation (as long as the issue is humiliation and intent, rather than the lying, which is a separate issue: see final paragraph*). I think it's likely that they were simply jerks (and I did say that), however, I was playing devils advocate seeing as though everyone seemed so keen to demolish the medics based on bugger all evidence.
I realise it doesn't actually matter, it's not like you're opinions are sending them to jail or anything. I just hate it when people angrily jump to unreasonable conclusions without considering that there might be another side to the story.
2.What I said was: "Why would you take them to the ED otherwise?" [in reference to a good clinical reason]. Then "Unless they were adamant to go themselves" [meaning that the pt wanting to go, is the other reason why you might take them to ED, the inference being that while there might be nothing clinically wrong, their desire to go to ED is good enough. I can, perhaps, see how "themselves" taken out of context could be taken to mean that they would privately attend the ED, but in the context it seemed clear to me, to mean "they wanted to go"]. Otherwise we are perfectly within our rights to tell pt that they don't need to go to hospital and to assist them, if necessary, in seeking more appropriate care.
*More generally if you want to make the argument that lying to the pt is always wrong then I would love to argue the Morality/Idealism vs. Utilitarianism with you, however, I'm not sure this thread is the place for that more general issue.
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akflightmedic
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Man, I clicked on the thread read the last little bit of the OP and knew that the moral police would be around quite fast. I like with MMiz said. What happens at work, stays at work
The moral police... or ethical, educated medical professionals???
And to the other poster (sorry forgot name already) who keeps using an anxiety attack as an example, as that seems to be the only relevant condition for which he thinks a placebo may be the only option...I have this to say:
If they are having an anxiety attack (by this I am thinking you mean hyperventiliating as that what is keeps getting implied) and you have ruled out every other treatable medical condition which may cause hyperventilation (see previous threads on this topic and Vents wonderful replies) and you are unable to talk them down...guess what? The patient will pass out and resume normal breathing, they will also be calmer.
If they are truly in a panic attack with hyperventilation and I am unable to professionally, ethically and intelligently calm them down through the use of several "talking down" techniques, they will pass out and then it becomes a little easier.
At no point will I have to administer fake treatments, lie and say I am giving a drug when I am not, or tape ASA to a forehead. It just doesn't exist in my bag of tricks and I have been pulling from this bag for quite a long time and treated my fair share of panic attacks.
You can not justify these actions, they are unethical in our setting. I am willing to bet that the medics did not document this therapy when clearly we should document ALL treatments, especially if they work...right? So why not this one?
SeeNoMore
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This is depressing. Every patient deserves respect, and if I was that boy and figured out what was going on I would feel terrible. Our communities trust us to act like professionals. Mistakes are made, errors in judgement etc, that is just real life. But going out of your way to act unprofessional is just poor.
Sasha
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Even on my BLS IFT we had the option of calling for ALS if needed, which had valium on board. Sorry but the areas I did clinicals in, live in, and work in all have meds for sedation. We are also not five minutes away from the hospital and if you exhausted all your talking out within five minutes you weren't trying hard enough. You can't go "Okay... calm down..." and then two seconds later you are taping asprin to their forhead or telling them you are giving them an experimental treatment.
And if by some chance talking down and meds don't work, let them pass out. Like AK said they will resume breathing normally upon unconciousness and will be fine.
guardian528
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i'm not in this argument, i've just been observing, but i have a quick question for not just akflightmedic but for everyone.
Are you strictly against using some sort of placebo effect? Maybe you won't use them if lying about drugs, but for more simple things maybe you will? Or do you see them as flat out bad, and never use any sort of placebo? Is there a time for them to be used and a time not to be used?
an example i can think of is when i was working with junior lifeguards, one of them got a little jellyfish sting(around here they just come in the form of little red rashes). usual treatment is to spray with vinegar, but we were out, so i filled the bottle with water, sprayed it on, and told her it was vinegar. she didn't know the difference, and after spraying she let out a sigh like "ahhh, thats better," and went on with her day.
ok for small things, or wrong whenever?
Like I said before if your "bag of tricks" is empty and your patient wants or needs you to do something I have no problem with it. A placebo is never a first choice of treatment but at the end of the day you made your patient feel better. There is a fine line between humiliating a patient and using a placebo though, that line was clearly crossed in this example.
My example of using the placebo was for a headache, morphine is not in my protocols for a headache so I did what I could with the tools I had to work with.
My example of using the placebo was for a headache, morphine is not in my protocols for a headache so I did what I could with the tools I had to work with.