I hate being played...

[MedikErik]

We had a FF who was like that... when asked about drug allergies, the answer was always "everything but morphine". You think she'd've learned that not being discrete wasn't getting her anywhere by now...

edit: Frequent Flier, not Fire Fighter... just realized I should probably clarify that.

 

[Hubbie]

Where I work we can't give any pain meds for abd pain, and we carry four different narcs for pain! However I can see your view, when I had PID I would have KILLED for just a little bit of pain releif. I finally got it when I got my dx.

Hang in there, mistakes have a way of happening. And I'm sure you will not make that same mistake.

 

[firetender]

Isn't it kind of incredible how exquisitely twisted and proficient some human beings can be? We get to see more than most: a blessing and a curse!

 

[OreoThief]

I have got to jump in here....

One of my very first clinicals I had a "seeker", and didn't know it until I got to the back room with the medic who explained it to me. This PT had lots of "undiagnosed" and "not believed" and "dr mistakes" she complained about while crying hysterically. We were actually called to a seizure/possible allergic reaction to her while she was in her car.

My medic, however, was smart, knew I was a newbie, and so she had let me work her up/comfort her/talk to her, just like any other patient before she got me alone and told me how DUPED I got! :blush:

In hindsight, I should have known something was up when the medic suddenly told the PT to "KNOCK IT OFF!" in the midst of her tearful act. She deserved an award, really. We live, we learn...... we get duped too.

 

[Aileana]

Narcs for non-specific abdominal pain in the field, must be nice... I think we might get fired for that.

Here, we're only allowed to give narcs for extremity trauma. Abdo pain is a no-no (in our protocol atleast) because the narcs may mask further pain, indicating gross internal bleeds, or other problems. (that's my understanding of the rationale atleast, please correct me if I'm wrong.)

 

[MEDIC213]

It's rare that we give narcs in the field. Mainly for extremity trauma and burns. I've given a lot more Morphine on inter-facility transfers than on a scene. It's listed in our protocols for AMI, but it's rare that we get one that's legitimate. Mostly just angina that's knocked out with NTG.

 

[Aileana]

Personally, atleast with my knowledge, I prefer fentanyl to morphine. It's a lot stronger, and has fewer side effects. Also, since the time it lasts is shorter, it doesn't restrict treatment the doctor(s) can give, by creating possible contraindications of a drug still being in their system.
Recently I encountered a patient that seemed to be resistant to fentanyl...how common is this for fentanyl, morphine, and other narcs? And what would you do if you encountered a patient that was discovered to be resistant to a drug after administration? (Sorry if I'm hijacking the thread )

 

[mtmedic]

I had a police officer with a broken ankle the other night after an altercation during an arrest and rated his pain at a 9/10 and after 100mcg of fentanyl and 5 mg of valium he was still at a 7/10. The ED gave 5mg more of valium and then 5 mg of ms. Some people just have a higher tolerance for narcs. This guy swears he had never had rx narcs at all ever so I thought this would snow him but it never did. Is it possible to just have decreased receptors???

 

[reaper]

Both my daughter and I are not affected by MS. When she fx her femur, the Dr's had her up to 18mg of MS, with no relief.

Now, give either of us Demerol and we are out like a light!!

 

[DisasterMedTech]

I dont think I would feel too bad about getting played if she managed 18 visits to the same ED before they called her on it. Obviously you had no way of knowing that you were getting scammed if you hadnt run on this patient before. Sounds like you did a thorough workup...as a Basic the only thing I would have seen was that usually with a true 10/10 on the UPS there would be V/S that are elevated or outside the acceptable parameters. Ah well. You took care of your patient using your best judgment and thats all any of us can do.

As for the poster who suggested blasting her with narcan, even when its joking, I always hate that kind of comment. I never think joking about aggravated battery on a patient is funny. YMMV.

 

[jomedic]

Why does the myth of not administering pain medication to patients with abdominal pain continue. There have been multiple articles written to dispute it. I work in the ER and have never seen a doctor diagnosis a patient based just on their assessment. They are going to do lab work, UA, x ray's, and probably a CT. We have protocols in my EMS system and in the ER I work in to administer pain meds (including Morphine) prior to the Doc seeing them. Do a google search and you will find all the ammo you need to change things is your system.

 

[natrab]

I noticed the vitals thing too. Someone in excruciating pain would at least show something in her vitals. Maybe not. Mostly when I find someone crying I make sure to question the pain because that's not the typical adult reaction to severe pain. Guarding, rapid breathing, grunting...more typical in my book. Not that I'd discount it. My other concern with a young female who can't give me a solid medical history is if she's actually taking her birth control and if she could be pregnant (especially the way she keeps throwing out major medical conditions that aren't normal for someone that age). I've had young female pt's with ruptured ovarian cysts grit their teeth, insist on standing up to get on the gurney and refuse pain meds while someone with a twisted ankle will cry and whine until they get their 6mgs of MS which absolutely snows them before they will let me splint (granted it does make them a bit more manageable). It's always a hard call with when to use narcs. I can't tell you what I would have done with this pt without being there, but it could have gone either way. I'm still pretty new at this so my criteria seems to change on every call where pain management comes into play.

Oh, and welcome to the forums jomedic. I hear what your saying as I just stopped working in a "mother-may-I?" county and began working in one where we get to use our own training and judgment. To add to what you said, I've also never had a pt who after receiving pain management could no longer tell me where the pain was.

 

[FFPARAMEDIC08]

I had a 23 y/o F pt who decided to get high and wreck her car into a telephone pole. I gave her a hefty does of narcan.

When she asked for narcs, I informed her that the only drug she'd be getting was ASPIRIN.