Frequent Flier - Smoker

BossyCow

BossyCow

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Okay, this may not be as much of a rant as a question, but here goes:

We have a frequent flier with multiple cardiac issues and COPD. He is a truly dedicated smoker. In the 3 years we've been transporting this unemployed, uninsured gentleman of 52, we have seen him through 2 heart attacks, he's had a stent put in, two airlifts, and all on the state's dime.

Every time I go to his residence, the air in the place is thick with smoke. You know the kind, the ones that make you feel like you've just chain smoked a carton of Pall Mall straights for hours after the call.

One of his recent visits to the ER (c/o chest pain du-uh) the nurses wouldn't unhook him from the monitor to allow him to go outside for a quick smoke. (he promised he'd be right back) Now he's on the nicotine patch. He's still smoking up a storm, but when he calls us for his bi-montly chest pain call, as he hangs up from 911, he puts on a fresh nicotine patch because he knows he may not get a chance for a smoke while he's there.

One of our volunteers got taken to task because this guy arrived at the ER with the patch on. The admitting rn said that we are supposed to remove those in the field on Cardiac pt's.

That makes sense to me because of the effects of nicotine on the cardio vascular system. I can see asking a pt. who is a known smoker if they are wearing a nicotine patch, but this guy has started lying about it and hiding them and I'm not going a full body search for nicotine patches on someone who seems pretty intent on making his health conditions worse.

So, whaddya think gang? Your experiences? Comments?
 
I don't see anything in my protocols about removing a medication patch, unless it obstructs AED pads.

This guy has an addiction, and if he needs nicotine to surivive a hosptial visit, then to some extent, he should be able to have it. This sounds like an issue that the ED staff need to work out... this guy really shouldn't be smoking... but can his system handle his quitting cold-turkey?
 
He's probably better at hiding them than you are at finding them. I wouldn't lose any sleep over it.
 
Not losing sleep so much as wondering about the legality of our removing a prescription med from a pt. He has a scrip for the patch.
 
BossyCow said:
Not losing sleep so much as wondering about the legality of our removing a prescription med from a pt. He has a scrip for the patch.
Click to expand...

If he's inclined to sue, that's what he'll do.
 
The guy is a sweetie. Not inclined to sue. He comes to all our fund raisers, and is eprsonal friends with many of the volly FF in our department. I'm just wondering if anyone else has been told to remove nicotine patches from pt's. I can see the validity for it. I mean, it is a drug and when the guy is c/o 8:10 chest pain on a regular basis, I can see not self medicating with nicotine along side the nitro he popped before calling us.

I guess what I'm looking for is some insight into the effects of the nicotine patch. I have a volunteer who is telling all the rest of our responders that the ER wants the patches off. This after a comment made by one nurse. Some of our more enthusiastic vollys might take this a bit too seriously and I'd like to mitigate the situation with ... oh... I don't know.. some actual facts maybe?

I have a call in to the MPD, but being the holidays and him having like a billion kids, he's not in the ER.
 
Jon said:
I don't see anything in my protocols about removing a medication patch, unless it obstructs AED pads.
Click to expand...

Although, this is really a picky situation, I do understand the nurses and other points. Smoking and nicotine patch is the key part. One is increasing their nicotine level to a high level, as well as dangerous one.

Yes, chest pain, tachycardia even arrhythmias can be produced. Again, like any other medication it can have toxic effects, and the first line of treatment is to remove the source.

Would we not remove NTG patches or Catapres patch if the patient was hypotensive?..

Usually, cardiologist will prescribe Wellbutrin (Clonidine) for smokers and possibly a patch if that does not "curb" their withdraws for those in a unit.

R/r 911
 
yea, no one has ever told me to remove any type of medication patch, except when applying the pads for the AED, other than that I have had many pt.'s with nicotine, pregnancy and other medication patches on and no nurses have said anything so far..
 
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