ERDoc

I rarely write for more than 20 narcs and it is 99% of the time for norco. About the only time I wrote for more or something stronger is for someone with a real fx that is being sent home. I'm using Ultram more since I can eprescribe it and it works well. Just because we can't find the cause of some pain in the ER doesn't mean it isn't painful. Unless I have a concern that pain meds will mask something and delay the pt from coming back if they need to, I have no problems prescribing a very short course.

I know I am in a bit of a different situation than most. I am a partner in my group and we pay the full premium for our policy (which is a PPO). It's up a little bit next year, but it is the normal year-over-year increase, nothing out of the ordinary. The copays and deductibles are staying the same. Our HR department looked at a similarly priced plan on the exchange and it has deductibles that are almost double what we have right now. We also have an HSA/HDHP option which I am looking at. I have not personally tried to sign up for the exchange.

I think we need an American to Canadian translator on this site, lol. It looks like Maxeran is the same thing as Reglan, both of which are metoclopramide.

I've never had dilaudid but I did have morphine once. I can't say I felt much since it was for a kidney stone and I was asleep in a matter of minutes from the phenergan. I did take a vicodin once and I agree, I can see how someone would get hooked.

I never use narcotics with migraines, both real and fake. For people who really have migraines, they can get some pretty wicked rebound headaches that are hard to control. FOr the fakers, because it pisses them off. My standard goes something like this: Round 1: 1L NS bolus, 0.625 IV Droperidol (when it is available, otherwise 10mg reglan), Toradol 30mg IV, Benadyl 50mg IV and Ativan 0.5mg IV Round 2: Droperidol 0.625mg IV, Benadyl 50 mg IV, Ativan 0.5mg IV and Solu-Medrol 125mg IV Round 3: DHEA 1mg IV The few that make it this far will get narcs for true migraines and a script for OTD for seekers.

Don't forget, there is a difference between being dependent and addicted.

I think we work in the same hospital, Mike.

Let's combine this with high flow oxygen for everyone when we do the wiki

But but but, they have 20 out of 10 pain. You are not them and cannot judge if they are really in pain!!! I could not believe the amounts of narcotics prescribed when I moved here to MI. We were told by the police that of all of the prescription narcotics they confiscate, they can trace about 70-80% back to our ERs. I am pretty stingy when it comes to narcs unless there is verified pathology. I've had people see me in the ER and leave without being seen.

Even in this thread she disappeared for a bit and then came back.

I just looked through some of the old posts by Vent (especially the $10million dead baby one) and you are right, istater sounds almost identical.

Sure they can, it's called online DNP.

...if you don't see a problem with you and a bunch of your buddies blocking up the ER hallways in full turnout gear, strongly smelling of the house fire you just came from, disrupting the care of other pts while you wait for your buddy who got a small piece of ash in his eye. Bonus points if you think it is a good idea to curse out the University Police officer who takes you and a friend out in handcuffs when you refuse to listen to the nice doctors and nurses.

How about a "links to your protocols" thread?

I'm offended that physician was left off of that list. I'm going to have a tantrum now. I needz valiumz.

Sounds like a great idea. I think the EMS forum on SDN has a pretty good starting point for this. I think ours would need to be more comprehensive (including the things you brought up, Ruff). I think we could use a suggestion/feedback thread also.

SuperMedic5050 DrEMTBob WhenSecondsCount321 Iliketoshockyou360

Lucky for him, from a sick and twisted provider kind of way. Not so lucky for the pt. Better?

TraumaBuff6969 LightsandSirens911 HotLightsColdSteel This is fun.

Why is it that, other than crotchity, I miss all of the crazies when they come on here?

Call the helicopter and clear the scene (sorry, couldn't resist).

No, I have never seen it. There are very few cases in the literature also. Mobey, consider yourself lucky as you have seen something that many will never see (though you will probably never see it again).

I would have him on triple therapy just to enjoy the look on his face as he is dealing with the horrible GI side effects.

Wow, just wow. Putting aside insulting several of our more prominent members and a colleague of yours (no wonder nurses are stereotyped as eating their young), you are wrong. No attending should be blasting any resident, especially in front of others. That is a disgusting lack of professionalism. As for the ego of the ER doc deciding to call the NICU, who else is he going to call? It's hard to care for a baby for days in the ER. Remember though, not every hospital is an ivory tower with a NICU team and every specialist you could want. The closest NICU team for me, when I work at my rural hospital, is over an hour away. If I'm lucky, the hospitalist who is on will be med/peds but not likely. Until the NICU teams arrives in their golden chariot, guess who manages that baby. Yup, that egotistical ER doc And unlike the NICU team, he has to manage the mother also (hopefully she's not hemorrhaging from undiagnosed placenta previa due to a lack of prenatal care. yeah, that was a lot of fun). Luckily I work with a bunch of awesome nurses who don't have huge egos and feel the need to berate and belittle someone to feel better about themselves.

Chyluria FTW!