Most ridiculous question from a nurse while on call

[jdh71]

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All right.

This constant back-and-forthing between SOLDIER, zenman, and jdh is getting very irritating. Like I said before, TAKE IT TO PMs. If you don't, and insist on continuing this here, I will have to close the thread.

For those of you just joining us, yes, I'm speaking as a moderator for this forum.

don't drag me back into this I signed off the hi-jack a long time back on the 28th, a day before your last post prior to the one quoted above

 

[NotAProgDirector]

Getting back on subject...


1 am ..
Me: Hi, this is the float intern, I was paged
Nurse: Dr! Pt x is complaining of pain!
Me: Ok what does he have for pain medication?
Nurse: Morphine 4mg IV q4, got it at 11pm
Me: Ok (looking at chart) this says he has Vicodin too, when did he last get it?
Nurse: 12 am 2 days ago
Me: What ? Why haven't you given him his Vicodin?
Nurse: Because he just got morphine!
Me: Uhh but you called me because the pt c/o pain?
Nurse: yes
Me: so... why didn't you give him his Vicodin?
Nurse: Because he just had morphine
Me: Ok, give him his Vicodin, he has it PRN so that you don't have to page everytime he's in pain.

I hate to say this, but if MSO4 4mg IV q4 is not controlling the pain, then adding a vicodin PO isn't either. The vicodin order might have been "left over" from before -- when PO meds were being tried to control the pain. I'd say that, given the info above, the call is legit and you should have gone and seen the patient. Perhaps they were a drug seeker. perhaps they perf'ed their bowel. Who knows?

 

[Krazykritter]

Gotta add this one from today (I'm a G.Surg resident):

Nurse: Hi Dr. I just want to let you know that pt X is having some vaginal bleeding.
Me: This is the 37 yo lady who had the lap chole 2 days ago?
Nurse: Yes & she just started having a little vaginal bleeding today.
Me: OK. So, when was her last period & how much blood?
Nurse: Just a little on the toilet paper & about two weeks ago. I just thought you might want to order a UA & make sure she doesn't have a UTI?
Me: A UA??? What is a UA going to tell us about her vaginal bleeding & she didn't have a UTI yesterday (from a UA done 1/2)
Nurse: ......
Me: OK well keep an eye on it. I'm not going to consult Gyn for that much blood on the toilet paper. Thanks.

Does that conversation actually make sense to anyone else? I'm still perplexed why I would actually get a call about it & what the hell a UA was going to tell me about vaginal bleeding.

 

[J-Rad]

... we all have experinces which have made us better clinicians. We are ALL voracious learners. We ALL have some old timer doc who taught us something extra. We have ALL been involved in clinical cases which stumped and surprised us - made us stop and think. Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.

If anything, the mysteries and surprises of medicine have taught us something about humility. Humility in how much we think we know, and in what we are capable of doing. The humility comes so naturally to us that a lack of it destabilizes the way we think and write about the profession itself. Those who know, dont tell. Those who tell, dont know...

Going off on a tangent:
This is (I struggle for a word)...elegent (?).
I have never been overly tempted to quote another poster in my sig. Until now.

 

[DutchgirlRN]

Gotta add this one from today (I'm a G.Surg resident):

Nurse: Hi Dr. I just want to let you know that pt X is having some vaginal bleeding.
Me: This is the 37 yo lady who had the lap chole 2 days ago?
Nurse: Yes & she just started having a little vaginal bleeding today.
Me: OK. So, when was her last period & how much blood?
Nurse: Just a little on the toilet paper & about two weeks ago. I just thought you might want to order a UA & make sure she doesn't have a UTI?
Me: A UA??? What is a UA going to tell us about her vaginal bleeding & she didn't have a UTI yesterday (from a UA done 1/2)
Nurse: ......
Me: OK well keep an eye on it. I'm not going to consult Gyn for that much blood on the toilet paper. Thanks.

Does that conversation actually make sense to anyone else? I'm still perplexed why I would actually get a call about it & what the hell a UA was going to tell me about vaginal bleeding.

Gees, a woman who is still menustrating is having some vaginal bleeding, imagine that! doh. WTH would that have to do with a lap choly anyway? Obviously not a UTI if it's coming from the vagina. She's lucky you didn't rip her a new one.

 

[Winged Scapula]

Gotta add this one from today (I'm a G.Surg resident):

Nurse: Hi Dr. I just want to let you know that pt X is having some vaginal bleeding.
Me: This is the 37 yo lady who had the lap chole 2 days ago?
Nurse: Yes & she just started having a little vaginal bleeding today.
Me: OK. So, when was her last period & how much blood?
Nurse: Just a little on the toilet paper & about two weeks ago. I just thought you might want to order a UA & make sure she doesn't have a UTI?
Me: A UA??? What is a UA going to tell us about her vaginal bleeding & she didn't have a UTI yesterday (from a UA done 1/2)
Nurse: ......
Me: OK well keep an eye on it. I'm not going to consult Gyn for that much blood on the toilet paper. Thanks.

Does that conversation actually make sense to anyone else?

I dunno - how'd you get that gallbag out? NOTES? In that case, the vaginal bleeding makes sense.

I'm still perplexed why I would actually get a call about it & what the hell a UA was going to tell me about vaginal bleeding.

You know a few things:

1) blood on TP can come from a number of sources
2) the nurse was assuming it was vaginal (probably because the patient told her it did)
3) the nurse knows that you can get gross hematuria with a UTI
4) she didn't think it through to see that if it was truly coming from the vagina and not the urethra, that a UA ain't gonna tell you anything about the cause of the bleeding
5) surgical stress can cause irregular periods
6) she might have some irritation from the Foley you placed intraoperatively which was mistakenly thought to be vaginal (unless you let the medical student place the catheter and perhaps the vagina was cannulated a few times 😉 )
7) you should know by now not to be suprised about some of the calls you get 😀

 

[DutchgirlRN]

1) blood on TP can come from a number of sources
2) the nurse was assuming it was vaginal (probably because the patient told her it did)
3) the nurse knows that you can get gross hematuria with a UTI
4) she didn't think it through to see that if it was truly coming from the vagina and not the urethra, that a UA ain't gonna tell you anything about the cause of the bleeding
5) surgical stress can cause irregular periods
6) she might have some irritation from the Foley you placed intraoperatively which was mistakenly thought to be vaginal (unless you let the medical student place the catheter and perhaps the vagina was cannulated a few times 😉 )
7) you should know by now not to be suprised about some of the calls you get 😀

#7 is the only possibility that makes sense to me. You don't place foley's for a lap choly do you?

 

[Winged Scapula]

#7 is the only possibility that makes sense to me. You don't place foley's for a lap choly do you?

Some people place Foleys for all laparoscopic cases; its probably only necessary for pelvic cases, patients with scarred in bellys and long cases.

I'd bet the patient had some between period spotting due to the stress of surgery and no, a UA wouldn't make sense in that case.

 

[DutchgirlRN]

Tell me what you think of this one:

I was in charge and I answered the phone

Me: 3rd floor this is Dutchie (obviously not my real name)
Doc: Go to room 335 and get that nurse away from my patient.
Me: What's wrong? That's the patient that had a ACD this morning right?
Doc: Right. The nurse called me from the patients room, said the patient was having some numbness in her fingers and that I needed to come in because obviously I had accidently paralyzed her. I'm coming right over.
Me: I'll grab her and keep her at the station.
Doc: Good.

 

[Winged Scapula]

Tell me what you think of this one:

Lay off the large colored font (this goes for everyone else as well).

I was in charge and I answered the phone

Me: 3rd floor this is Dutchie (obviously not my real name)
Doc: Go to room 335 and get that nurse away from my patient.
Me: What's wrong? That's the patient that had a ACD this morning right?
Doc: Right. The nurse called me from the patients room, said the patient was having some numbness in her fingers and that I needed to come in because obviously I had accidently paralyzed her. I'm coming right over.
Me: I'll grab her and keep her at the station.
Doc: Good.

Fab4fan tells a similar story and I admit I've made the same call to a charge nurse before when I was worried about the ineptitude of someone caring for one of my patients.

 

[DutchgirlRN]

Lay off the large colored font (this goes for everyone else as well).

Sorry I have Fuch's and the larger colored font is so much easier on my eyes. Keeps the headache away. Anyone else object? How about larger but not colored 🙁

 

[Winged Scapula]

Sorry I have Fuch's and the larger colored font is so much easier on my eyes. Keeps the headache away. Anyone else object? How about larger but not colored 🙁

Ok...you get a bye, as you have a real reason and therefore, I am *much* less annoyed by it.

The others who use it? They have no excuse.😀

 

[zenman]

Zenman, we all have experinces which have made us better clinicians. We are ALL voracious learners. We ALL have some old timer doc who taught us something extra. We have ALL been involved in clinical cases which stumped and surprised us - made us stop and think. Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.

If anything, the mysteries and surprises of medicine have taught us something about humility. Humility in how much we think we know, and in what we are capable of doing. The humility comes so naturally to us that a lack of it destabilizes the way we think and write about the profession itself. Those who know, dont tell. Those who tell, dont know.

Take the Buddhist approach and silently think about what I wrote in blue, and DO NOT respond to it.

I have to compassionately respond to prevent you from injury! This is very good but please do not tell your teachers this as they might whack you for further enlightenment!

"The old people must start talking and the young people must start listening."
--Thomas Banyacya, HOPI

"Right knowledge is gained by honoring your experiences and by reflecting upon the teachings of great books and wise teachers."
--Yoga Sutra of Patanjali

This is good also but wouldn't fly in medical school would it? "Teaching without words, performing without actions: this is the master's way"
--Tao Te Ching

I'm surrounded by buddhists but only one has made an impression on me. It was in Nepal and when she and her male escort walked past by in the airport our eyes met and I could feel her energy. When I walked near her later a voice told me to go over. I did and she stood up and we held our hands out and both of us burst out laughing till we cried. Then, I turned and left....

Actually I would post a nurse call story but I don't have any. I do remember one nurse who walked around to the hospital cafeteria where I was chowing down to tell me we were getting a code in the ER. "Well, shouldn't you be back there getting ready" was my response.

 

[fab4fan]

The older I get, the more I learn to keep my mouth shut.--fab4fan

(Not applicable to everything, but most definitely work related issues.)

 

[SocialistMD]

Does that conversation actually make sense to anyone else? I'm still perplexed why I would actually get a call about it & what the hell a UA was going to tell me about vaginal bleeding.

I'm still perplexed as to why a lap chole is still in the hospital 2 days postop...😉

 

[Winged Scapula]

I'm still perplexed as to why a lap chole is still in the hospital 2 days postop...😉

Good point...I missed that.

 

[Krazykritter]

I'm still perplexed as to why a lap chole is still in the hospital 2 days postop...😉

She was acute, but....a couple of our attendings are known for letting people stay as long as they want. She was still having nausea & only tolerating minimal po intake (not that a day or two of decreased intake would have hurt her).

 

[NarcolepticRN]

will u just get over your self just go to allnurses.com maybe u will be a medical hero there KID and yes I am calling u kid because of your mental age

...

Really?

 

[SOLDIER]

...

Really?

What

 

[4everstudentmd]

2:39 in the Am

Return page:
"the patient in room 218 just dropped his watch in the toilet, what should I do?"

I just hung up.

 

[Droopy Snoopy]

2:39 in the am

return page:
"the patient in room 218 just dropped his watch in the toilet, what should i do?"

i just hung up.

 

[DutchgirlRN]

2:39 in the Am

Return page:
"the patient in room 218 just dropped his watch in the toilet, what should I do?"

I just hung up.

OMG, I would have smacked her up side the head if I heard her making that call!

 

[error404]

2:39 in the Am

Return page:
"the patient in room 218 just dropped his watch in the toilet, what should I do?"

I just hung up.

Answer: "You should fish it out with your bare hands. Then clean it very carefully using sanitary wipes. Take at least 30 minutes to make sure you really get it cleaned well. If the watch has sufferred any water damage, you should wait until the end of your shift and then take it to a local watch repair. You should personally pay for the repairs."

And if you're not going to follow my recommendations, never call me again for watch advice.

 

[fab4fan]

2:39 in the Am

Return page:
"the patient in room 218 just dropped his watch in the toilet, what should I do?"

I just hung up.

You must have pissed someone off big time. That's the only logical explanation for a page like that--revenge.

 

[chimichanga]

2:39 in the Am

Return page:
"the patient in room 218 just dropped his watch in the toilet, what should I do?"

I just hung up.

child, please

who does that??

 

[caroladybelle]

child, please

who does that??

Better question:

Who has the TIME to do that?

 

[johankriek]

You guys might run with the big dogs but I play with the big cats, lol! (This critter is not drugged, nor am I). I'm talking about going into the jungle with nothing but your brains, whatever skills you have, and no meds or any other equipment. Yes, I'm a male nurse with both psych and acute care experience, as well as a Zen Shiatsu therapist and a shaman (Q'ero lineage). Sorry, but the deck was stacked in my favor. I just like to play with you young guys as it keeps me sharp. 😀

I like physicians and in 37 years have only run into about three that needed new careers.

Don't taste the urine, just pour some on a rock and see what the ants do.

Great that some of you do OMT.

Hope you all had a Merry Christmas!

wait until that tiger goes tiger on your a s s and see how zen you really are. dont you remember siegfried and roy. MURSE

 

[MasterShakeDO]

The watch one is pretty good. Would have asked her if she'd ever seen Pulp Fiction.

Real page at 4AM:
Nurse: Can we have an order to D/C restraints on patient in room 5303?
Me: Isn't that the patient I just declared?
Nurse: Yes, Dr.
Me: 😕 You need an order to take restraints off a dead person?
Nurse: Yes, Dr.
Me: Fine, whatever.
Nurse: Thank you, Doctor.

 

[silas2642]

The watch one is pretty good. Would have asked her if she'd ever seen Pulp Fiction.

Real page at 4AM:
Nurse: Can we have an order to D/C restraints on patient in room 5303?
Me: Isn't that the patient I just declared?
Nurse: Yes, Dr.
Me: 😕 You need an order to take restraints off a dead person?
Nurse: Yes, Dr.
Me: Fine, whatever.
Nurse: Thank you, Doctor.

That's awesome. I love hospital administration and their silly rules.

 

[Krazykritter]

Have to post one I got yesterday:

Me: Dr. Kritter returning a page for surgery.
Nurse: Hi. I have your POD#1 Lap appy patient here. She is doing well & about ready to go home but I have a question for you.
Me: Go ahead.
Nurse: When can the patient return to tanning? Are there any restrictions on tanning after a laparoscopic appendectomy.
Me: ...............No, there are no restrictions on when she can return to tanning....you can, however, inform her the health risks associated with artificial tanning. -click-

I must be a magnet for ridiculousness.

 

[Winged Scapula]

Have to post one I got yesterday:

Me: Dr. Kritter returning a page for surgery.
Nurse: Hi. I have your POD#1 Lap appy patient here. She is doing well & about ready to go home but I have a question for you.
Me: Go ahead.
Nurse: When can the patient return to tanning? Are there any restrictions on tanning after a laparoscopic appendectomy.
Me: ...............No, there are no restrictions on when she can return to tanning....you can, however, inform her the health risks associated with artificial tanning. -click-

I must be a magnet for ridiculousness.

While I agree that technically there are no restrictions to tanning after surgery, I would have informed the patient that tanning after surgery can result in a darker than usual scar which will be much more noticeable than if she didn't tan until the scar was fully matured.

 

[dpmd]

I'm thinking someone who is so into tanning that she is asking about it right after surgery is not going to be able to stay away from it for a year. Maybe you could recommend covering them with something opaque in an interesting shape. I've seen people who tan do that randomly on their body.

Got a call the other night just after midnight.

Nurse: Dr. so and so (one of the surg attendings) wanted me to call if the CT scan showed anything on this patient (admitted for PID-15 yrs old, isn't that lovely. Primary team seems convinced it must be an appy despite the purulent cervical d/c and chandelier sign coupled with the neg u/s so they order a CT scan too). The report says there is a small amount of fluid in the pelvis, and the appendix is not visualized. The patient is NPO in case you want to take her to surgery.

Me: Thanks, but its actually a good thing that they can't see the appendix. It doesn't mean she needs surgery.

Can't blame her for not knowing better I guess, but since the scan was done at 6 pm it would have been nice to know about i before I got called in the middle of the night. Funny thing was the attending she claimed wanted me called with the report had never heard of the patient, and the primary team hadn't even consulted surgery yet, so the nurse really should have called the primary team. Arrgh.

 

[fab4fan]

1. Calling to get a restraint order D/C'd on a dead patient takes a special kind of stupid.

2. I would have told the appy patient to hold off on the tanning until she has her post-op visit with the surgeon. Not that I'm so smart, but I would have told her the same thing WS said, not that it would have mattered, because tanners usually can't be reasoned with.

3. Hey, it is not my job to interpret results of CT scans. If someone tells me "So-and-So" needs to be called with the results of a scan or an XR, that's what I do. Sorry if that puts a cramp in your style, but that's how it works. I don't have a crystal ball to know who has/has not communicated with whom. I just call the person I'm told to call.

 

[Smurfette]

I've actually had the ER call me about a CT where they couldn't visualize the appendix thinking the patient had appendicitis. More than once. Ugh.
The worst was in a 8 week pregnant pt with RLQ pain...US neg, so got MRI, couldn't see the appendix, so of course, surgery consult to r/o appendicitis. Then she came back one week later with RLQ pain, same workup, same results, same consult...but this time gyne had told the pt she had appendicitis (which she clearly did not) and the patient and her family were outraged at me for not taking her to surgery for a "pregnancy threatening condition". Sheesh.

 

[fab4fan]

I've actually had the ER call me about a CT where they couldn't visualize the appendix thinking the patient had appendicitis. More than once. Ugh.
The worst was in a 8 week pregnant pt with RLQ pain...US neg, so got MRI, couldn't see the appendix, so of course, surgery consult to r/o appendicitis. Then she came back one week later with RLQ pain, same workup, same results, same consult...but this time gyne had told the pt she had appendicitis (which she clearly did not) and the patient and her family were outraged at me for not taking her to surgery for a "pregnancy threatening condition". Sheesh.

I'll bet she's going to be one "special" OB patient. 🙄

 

[rmp]

Overnight cross cover call: I receive a page "hello doctor Pt X is s/p blank procedure and has a post op infection. She is on amp/gent/clinda. She is due for her amp now but her IV line is infiltrated. Does she really need to have this antibiotic?"

Umm, if the antibiotic is ordered she needs it. Please place a new IV.

I wanted to say so bad hmm repeat what you just said back to yourself and then you answer the question?! I truly think the problem was that it was 630 am and she was scheduled to get off at 7 am and didn't want to undertake the project of establishing a new IV.

Wow

 

[cinapism]

The other night I accidentally ordered a narcan PCA on a Pt instead of morphine due to a new and complicated computer order system.

...its not a stupid call but it made me laugh to think of a narcan PCA (and why the computer let me enter it as an order). 😀

 

[docB]

The other night I accidentally ordered a narcan PCA on a Pt instead of morphine due to a new and complicated computer order system.

...its not a stupid call but it made me laugh to think of a narcan PCA (and why the computer let me enter it as an order). 😀

I had about a dozen patients today I'd love to hook up to a narcan drip.

 

[NateintheED]

I've actually had the ER call me about a CT where they couldn't visualize the appendix thinking the patient had appendicitis. More than once. Ugh.
The worst was in a 8 week pregnant pt with RLQ pain...US neg, so got MRI, couldn't see the appendix, so of course, surgery consult to r/o appendicitis. Then she came back one week later with RLQ pain, same workup, same results, same consult...but this time gyne had told the pt she had appendicitis (which she clearly did not) and the patient and her family were outraged at me for not taking her to surgery for a "pregnancy threatening condition". Sheesh.

Sorry to say, but this is a valid consult. If I can't see it, I don't know for sure its normal. With a non-diagnostic CT, I've reached the limit of my capability as an ER doc, but have not yet ruled out a potentially life-threatening condition. If I've got enough pre-test probability and get a non-diagnostic result, you better believe I'm going the next step and calling.

And yeah, getting thrown under the bus by another specialist sucks.

 

[Excelsius]

Sorry I have Fuch's and the larger colored font is so much easier on my eyes. Keeps the headache away. Anyone else object? How about larger but not colored 🙁

Over 99% of text here is in regular font, posted by others. To really solve your problem, you need to use your own browser's capability to increase the default size of your text. In Firefox: go to to Tools-->Options-->Content (tab). Here you will see "Fonts & Colors" section, where you can change not only the font and the size, but also select any colors you want. Problem solved.

If you're not using Firefox, look up the procedures for other browsers, though Firefox is the best. Finally, most browsers allow instant zoom in when you hold down Ctrl and then scroll up or down.

 

[fab4fan]

Overnight cross cover call: I receive a page "hello doctor Pt X is s/p blank procedure and has a post op infection. She is on amp/gent/clinda. She is due for her amp now but her IV line is infiltrated. Does she really need to have this antibiotic?"

Umm, if the antibiotic is ordered she needs it. Please place a new IV.

I wanted to say so bad hmm repeat what you just said back to yourself and then you answer the question?! I truly think the problem was that it was 630 am and she was scheduled to get off at 7 am and didn't want to undertake the project of establishing a new IV.

Wow

You could have been a smart-aleck and said, "Well, she really doesn't need the amp., but she still needs the gent. and clinda., so yeah, you still need to restart the IV."

I'm afraid that level of sarcasm would have sailed straight over her head though, and she probably would have been dumb enough to take you seriously and D/C the amp. order.

 

[cicuRN]

The duration of action of opioids is longer than that of Narcan--also, a big blast of Narcan for an opioid-dependent person will send them immediately into withdrawal, which can be life-threatening, and certainly will be messy.

For the record, the only thing I can do with my bare hands at work is play online. 🙂

 

[countingdays]

The duration of action of opioids is longer than that of Narcan--also, a big blast of Narcan for an opioid-dependent person will send them immediately into withdrawal, which can be life-threatening, and certainly will be messy.

For the record, the only thing I can do with my bare hands at work is play online. 🙂

Really? What's the duration of action of 'opioids'?

 

[Smurfette]

Sorry to say, but this is a valid consult. If I can't see it, I don't know for sure its normal. With a non-diagnostic CT, I've reached the limit of my capability as an ER doc, but have not yet ruled out a potentially life-threatening condition. If I've got enough pre-test probability and get a non-diagnostic result, you better believe I'm going the next step and calling.

And yeah, getting thrown under the bus by another specialist sucks.

Actually, non-visualization of an appendix has a very high correlation (>90%) of NO appendicitis and therefore can be considered diagnostic...the exception is the patient who has virtually no fat (low BMI) since they can't demonstrate fat stranding around an inflamed appendix. If the patient has been having pain for days, it's even more specific (since the appendix and periappendiceal inflammation becomes more significant).

But in the case I presented above, it was an MRI. Seriously, no general surgeon is going to operate on a pregnant woman with 2 negative US and MRIs for acute appendicitis--if she has a negative diagnostic lap and then loses the baby, we'd be considered liable for the fetal loss due to 'unnecessary surgery'.

 

[SoCuteMD]

The duration of action of opioids is longer than that of Narcan--also, a big blast of Narcan for an opioid-dependent person will send them immediately into withdrawal, which can be life-threatening, and certainly will be messy.

For the record, the only thing I can do with my bare hands at work is play online. 🙂

Opioid/opiate withdrawal is NOT life-threatening, FYI.

 

[Doctor Bob]

Opioid/opiate withdrawal is NOT life-threatening, FYI.

Sure it is... at least that's what the dilaudid/percocet junkies tell me when they come in with a chief complaint of "ran out of medication".

Now that's what I call evidence based medicine.

 

[Speculatrix]

Sure it is... at least that's what the dilaudid/percocet junkies tell me when they come in with a chief complaint of "ran out of medication".

Now that's what I call evidence based medicine.

What do you do if someone runs out of Xanax in the ER? Always been curious about that.

 

[Rendar5]

Actually, non-visualization of an appendix has a very high correlation (>90%) of NO appendicitis and therefore can be considered diagnostic...the exception is the patient who has virtually no fat (low BMI) since they can't demonstrate fat stranding around an inflamed appendix. If the patient has been having pain for days, it's even more specific (since the appendix and periappendiceal inflammation becomes more significant).

Well, pre-test probability does come into play with a non-visualization CT if there's high pre-test probability, to play devil's advocate (not that it applies to the above scenario. That said, that's still useful information that I wasn't aware of.

 

[Rendar5]

The duration of action of opioids is longer than that of Narcan--also, a big blast of Narcan for an opioid-dependent person will send them immediately into withdrawal, which can be life-threatening, and certainly will be messy.

For the record, the only thing I can do with my bare hands at work is play online. 🙂

There aren't too many life-threatening withdrawals. I've seen hyperacute withdrawal (via return to suboxone after use of major amounts of fentanyl patches) before and while I felt absolutely horrible for the guy, we weren't concerned for his life. The only time that opiate withdrawal is life-threatening, as I was taught, is in the neonate. Still, the only reason for a full blast of narcan is cruelty or revenge.

 

[Rendar5]

What do you do if someone runs out of Xanax in the ER? Always been curious about that.

Depends on the provider. Sometimes I'll give them a 5-day Rx, note it in the ED logs in case they try to come again, and tell them they have 5 days to find a way to see their doctor.