ER Doc give his advice to drug seekers.

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I have gotten very good results with real migraines using Toredol 60mg,Reglan 10 mg ,Benadryl 25 mg IV and a liter of NS. When it doesnt work morphine or dilaudid are next line. The drug seekers you usually just have to give them their 2 mg of Dilaudid and an Rx for 12-15 Vicodin before they will go away.
Damn do I hate drug seekers . They prevent you from getting to the people who are in real need in a timely manner, they stress the whole staff and make everybody bitchy, their families sue you when they finally die and they are multiplying like freaking rabbits. The next category I hate are the ones who call an ambulance for a three day old paper cut to the finger or the pencil eraser sized rash on the arm that started yesterday.
Ask why they called an ambulance and they say "well if I didnt I would have to wait in the lobby for three hours, Duh?" I love the ones who come in and say they have a severe headache and when you ask if they took any tylenol or motrin they look at you as if they want to say; "Why would I do that when I can come in here and spend $800. of taxpeyer money and get 25 cents of tylenol for free ?"
Everybody wonders why healthcare cost are rising its because of what I call Malignant Entitlement Syndrome. They dont pay taxes, they get free gold plated healthcare even taxi vouchers to go see doctors.
What do they care if the working taxpayers are struggling and have to buy their own substandard insurance?
OK Im going to STFU now because a man with a scapel in his hand can be dangerous when his blood pressure goes up.
 
Interesting... we laugh at the ER guys who use narcotics for headaches... because it doesn't work. The pain is not a mu-receptor based pain. Which is why they give Phenergan and Ativan and IVF: that knocks the person out. And it spares them from having to diagnose basilar or hemiplegic migraine. Avoiding Toradol and other NSAIDs avoids the embarassing complication of furthering bleeding if the "migraine" is a missed intracranial bleed. Thorazine is a joke; the reason it's given is the same reason big narcs are used, it knocks you the fuck out and so you can't complain. Thorazine doesn't really act as an analgesic at all.

It's shotgun CYA medicine. It shuts the patient up until they can get a CT scan done, or gets them out of the ER. Since 90% of migraines will go away with hydration anyways, its a false efficacy and a waste of money.

Triptans work very well for true migraine, but that requires history and physical and diagnosis. In short supply in a lot of ER's due to a variety of reasons.

By the way, easiest way to figure out a drug seeker? 10/10 pain with stone cold normal vitals. You can't have that much pain and have a heart rate of 60 not on a beta blocker with BP 120/70. Again, history, physical, diagnosis. You know, that old school doctor stuff.
 
So I have had a grand total of 3 migraines. 1 was when I was 14 maybe, the other at 19 or 20 then one more at 21. All of them present the same way. I get an aura(spotty vision, difficulty formulating sentences, not really too much pain) then I get the headache.Weird thing is that the headache is never really that horrible. maybe 4/10. However the aura symptoms and assosciated symptoms of the headache are much worse(light sensitivity). I seriously am almost unable to speak.

Anyways back to the topic of pain seekers. I have seen lots of em, and the one thing that jumps out at me is when they freak out at the IV stick, if you are in 10/10 pain a lil needle stick in your arm is not gonna phase you. Granted this doesn't work on IV drug users, but it will work on guys that are pill poppers.

I have also had a pt that I coulda sworn was drug seeking. Came in screaming and hollering about all her back pain said it was 10/10, calling nurses bitches and all this stuff, then she flinches at the IV. I was an SFMS student at the time on the indian reservation, so I am thinking this lady is a classic case of a drug seeker. Until we find out she has kidney stones and is literally deathly afraid of needles. Gave her fluid therapy and some pain meds and the lady was prolly one of the sweetest lady's I had the pleasure of treating. Learned from that one for sure.
 
I was only a EMT-B that transported the frequent fliers to the ER. I can tell you thorazine shuffle was common on certain ER DRs shifts. Certain RN's saw nothing but GOMERs and others were very compassionate. Just like all walks of life there are good uns and not so good uns. Just an observation from the least qualified on the board.
 
Interesting... we laugh at the ER guys who use narcotics for headaches... because it doesn't work. The pain is not a mu-receptor based pain. Which is why they give Phenergan and Ativan and IVF: that knocks the person out. And it spares them from having to diagnose basilar or hemiplegic migraine. Avoiding Toradol and other NSAIDs avoids the embarassing complication of furthering bleeding if the "migraine" is a missed intracranial bleed. Thorazine is a joke; the reason it's given is the same reason big narcs are used, it knocks you the fuck out and so you can't complain. Thorazine doesn't really act as an analgesic at all.

It's shotgun CYA medicine. It shuts the patient up until they can get a CT scan done, or gets them out of the ER. Since 90% of migraines will go away with hydration anyways, its a false efficacy and a waste of money.

Triptans work very well for true migraine, but that requires history and physical and diagnosis. In short supply in a lot of ER's due to a variety of reasons.

By the way, easiest way to figure out a drug seeker? 10/10 pain with stone cold normal vitals. You can't have that much pain and have a heart rate of 60 not on a beta blocker with BP 120/70. Again, history, physical, diagnosis. You know, that old school doctor stuff.

Now you start talking abou Mu, Delta and Kappa receptors and you get me all fooked up again. :confused:

Neuro Pathway's etc Agonists, opiod receptors. We have to know this shit to treat a migraine ?? :D
 
All I know is I hate the damn things (pain meds)

Having been prescribed a few over the years, after few, next thing I know is I'm backed up from here to Oshkosh. Turns my damn inards into a dust bowl..........:confused:
 
All I know is I hate the damn things (pain meds)

Having been prescribed a few over the years, after few, next thing I know is I'm backed up from here to Oshkosh. Turns my damn inards into a dust bowl..........:confused:

That's why they should tell you to use a laxative when taking them over a longer period of time.
 
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