Things to tell/ask drug seekers

[braverepub]

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A fellow resident asked a drug seeker if she wants any pain with her Dilaudid...

 

[skiz knot]

A fellow resident asked a drug seeker if she wants any pain with her Dilaudid...

That's so clever.🙄

 

[deuist]

There is a national shortage of dilaudid (true) and my hospital even ran out for a short time period last month (also true). I offered to substitute toradal.

 

[ccfccp]

There is a national shortage of dilaudid (true) and my hospital even ran out for a short time period last month (also true). I offered to substitute toradal.

This has been the greatest thing to happen to me in emergency medicine. Our hospital has a VERY limited supply of dilaudid and we can use it for true, severe allergies as well as physician judgement (in my case cancer patients, burns, and open fractures...) However, I can honestly tell people, "Yup... sorry about that, there's a national shortage of vitamin D and we don't have any to give to you. It's morphine or toradol or ultram or motrin or nothing, your choice."

Probably hasn't helped my customer satisfaction scores, but it's been fun.

 

[GeneralVeers]

Our hospital was out of Dilaudid on one shift and I had a drug-seeker specifically asking for it. I told her:

"We are out of dilaudid, so I can't give you any, and you're allergic to Morphine".

She said:

"Are you out of it just for me???"

I replied:

"No, we really are out of it, but even if we had it I wouldn't give you any".

 

[braverepub]

👍

 

[Tiger26]

Sounds like a case for the magic of droperidol--hits the opiate receptors too . . .

 

[D P356]

Our hospital was out of Dilaudid on one shift and I had a drug-seeker specifically asking for it. I told her:

"We are out of dilaudid, so I can't give you any, and you're allergic to Morphine".

She said:

"Are you out of it just for me???"

I replied:

"No, we really are out of it, but even if we had it I wouldn't give you any".

Hey, I'm a medical student interested in anesthesiology, but I also read the Emergency Medicine forum b/c some of the things you all write are pretty interesting....and your last line made me chuckle.

 

[Arcan57]

I don't give narcotics for this condition.

 

[WilcoWorld]

Dilaudid has cross-reactivity with morphine, so if a patient reports a morphine allergy to me it's either fentanyl or non-narcotics.

Now, if it's a LOL with metastatic CA who says "morphine makes me itch" then I'll give dilaudid. But the 20 yo with back pain & morphine allergy I muster up my most concerned-sounding voice and say "I'm sorry, but it's just not safe to give you dilaudid, because of your morphine allergy."

 

[la gringa]

i'm the acute pain doctor, not the chronic pain doctor... just don't feel comfortable treating your condition when you're on oxycontin 100mg bid plus ms ir.... only pt i would give 3-4mg of dilaudid to was a very legit sickler who regularly went to his heme doc and would feel better and go home after he had gotten his magic 3-4mg (which, given his tolerance, was probably 1/2 that to him)

 

[Peds2ER]

Sounds like a case for the magic of droperidol--hits the opiate receptors too . . .

Do you do a pre-administration 12 lead followed by 3 hours cardiac monitoring?

Does anyone else?

I've had some outstanding results with droperidol for intractable migraine, but keeping them around for 3 hours of post administration monitoring was less than ideal.

 

[Arcan57]

Do you do a pre-administration 12 lead followed by 3 hours cardiac monitoring?

Does anyone else?

I've had some outstanding results with droperidol for intractable migraine, but keeping them around for 3 hours of post administration monitoring was less than ideal.

Don't give stupid doses of droperidol and hope your hospital doesn't have a pre-existing policy requiring post-administration monitoring. FWIW, I've never waited three hours to DC a patient that droperidol fixed.

 

[alphaholic06]

Do you do a pre-administration 12 lead followed by 3 hours cardiac monitoring?

Does anyone else?

I've had some outstanding results with droperidol for intractable migraine, but keeping them around for 3 hours of post administration monitoring was less than ideal.

I rarely get the EKG, usually only if the nurse is "uncomfortable" giving Inapsine without it. I never do the 3 hour monitoring. As an aside, I love me some Droperidol!

 

[Tiger26]

Do you do a pre-administration 12 lead followed by 3 hours cardiac monitoring?

Does anyone else?

I've had some outstanding results with droperidol for intractable migraine, but keeping them around for 3 hours of post administration monitoring was less than ideal.

The nurses freak out at 2.5 mg because of one of their guidelines, so I give 1.875. I also give a little benadryl beforehand, but I don't get an EKG.

Overall, I think this QTc prolongation nonsense is just somebody trying to make a career out something--I just don't see people dropping from torsades.

 

[GeneralVeers]

The nurses freak out at 2.5 mg because of one of their guidelines, so I give 1.875. I also give a little benadryl beforehand, but I don't get an EKG.

Overall, I think this QTc prolongation nonsense is just somebody trying to make a career out something--I just don't see people dropping from torsades.

I've given it hundreds of times with no complications (other than the occasional dystonia). I don't get a EKG, I don't monitor them for 3 hours. IMO if I had to get an EKG and/or monitor them in order to give the drug, I probably wouldn't give it, as most of the things I would give it for are quicky <1 hour dispos.

 

[Hamhock]

Do you do a pre-administration 12 lead followed by 3 hours cardiac monitoring?

Does anyone else?

I've had some outstanding results with droperidol for intractable migraine, but keeping them around for 3 hours of post administration monitoring was less than ideal.

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