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- Nov 4, 2000
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so i'm out in the middle of nowhere on a rural med rotation. the hospital i'm at is super tiny (ie 20 beds). we've got an ER, but it's not staffed unless someone shows up. i'm staying in a call room for the rotation, so i'm 1st call whenever someone comes to the ER at night.
anyway, we've got this lady who for the past few months or so has been coming in every 2 or 3 nights with migranes. the docs have basically dumped her in my lap because they're so sick of dealing with her... as in if she shows up - and is the only er patient - they won't be coming in. basically they say, "we don't care what you do as long as you don't give her narcotics and get her out of the ER before we round in the morning."
she's been ct'ed several times and worked up by 2 different neurologist over in the big city (our nearest specialist backup is 85 miles away). no cause of the migranes can be found. no objective findings on PE.
i'm reaching the end of my rope with this patient. no matter what we throw at her, she doesn't get relief (unless it's narcotics, and that's not happening).
she reports that she can't take anything po b/c of nausea. so the last few times i've just given her im toradol and rectal reglan. of course this just pisses the patient off and she ends up storming out AMA. not that i care if she leaves, but she keeps coming back - sometimes in less than 24 hours. i don't know if she's banking on me not being there or what, but i'm gonna be the only person she see's @ night for the next month or so.
what the hell should i do here guys? the attendings are generally nice guys and good doctors, but they've been handling this lady for months and don't really have any sympathy for me... or any useful suggestions.
i've heard a little bit about some of the older anti-psychotics being used for migranes... is there enough evidence out there to support the use of thorazine or haldol in this sort of patient? it would make me and the nurses really happy if we could hit her with some haldol... she's such a malignant, nasty person. it would be great if we could just snow her and stick her in a corner until she falls asleep or leaves...
ok guys, help!
anyway, we've got this lady who for the past few months or so has been coming in every 2 or 3 nights with migranes. the docs have basically dumped her in my lap because they're so sick of dealing with her... as in if she shows up - and is the only er patient - they won't be coming in. basically they say, "we don't care what you do as long as you don't give her narcotics and get her out of the ER before we round in the morning."
she's been ct'ed several times and worked up by 2 different neurologist over in the big city (our nearest specialist backup is 85 miles away). no cause of the migranes can be found. no objective findings on PE.
i'm reaching the end of my rope with this patient. no matter what we throw at her, she doesn't get relief (unless it's narcotics, and that's not happening).
she reports that she can't take anything po b/c of nausea. so the last few times i've just given her im toradol and rectal reglan. of course this just pisses the patient off and she ends up storming out AMA. not that i care if she leaves, but she keeps coming back - sometimes in less than 24 hours. i don't know if she's banking on me not being there or what, but i'm gonna be the only person she see's @ night for the next month or so.
what the hell should i do here guys? the attendings are generally nice guys and good doctors, but they've been handling this lady for months and don't really have any sympathy for me... or any useful suggestions.
i've heard a little bit about some of the older anti-psychotics being used for migranes... is there enough evidence out there to support the use of thorazine or haldol in this sort of patient? it would make me and the nurses really happy if we could hit her with some haldol... she's such a malignant, nasty person. it would be great if we could just snow her and stick her in a corner until she falls asleep or leaves...
ok guys, help!