Faking or not faking? That is the question.

[Dustdevil]

LetMeSleep, I just straight up ask them if they just need a place to sleep. If they say yes, I'm cool with them and write that as my chief complaint. No problem. When they fake is when I lose my bedside manner.

This is my philosophy too. Maybe it's the cop attitude in me, but I am cool with a lot of things, so long as you don't lie to me. No me friegas!

[Harold1]

After consulting at least a dozen ED-physicians, nurses and paramedics, we would still stick to the practice of shooting 70% alcohol trhough the nose when dealing with fakers.

It is definetely not harmfull. and those of you that call it torture...give me a break. I'm not waiting for any American to tell me what is to be considered torture and what not. I'm glad that I don't work in a stressed environment like in the US where you have to fear to face trials even if you fart to loud.

[Dustdevil]

Can you please point us towards any link to a credible medical source online, or a textbook, or a protocol that advocates this procedure?

Because if this is just something that you and your buddies are pulling out of your arses, without any medical precedent, you're just looking for trouble. Only a loser does what everyone else does, just because everyone else does it, without first researching the scientific (and legal) validity.

[JPINFV]

Dust, I believe your sarcasm detector is broken (or mine is, because it's peaked).

[Harold1]

If all of our actions were to be limited to protocols and procedures, you may as well put robots on the ambulance instead of medics.

Don't tell me that you never divert from the book. That would be too much of the puritan blood or a total lack of creativity.

Keep thinking that you guys are soooo good and that every medic outside of the US is a monkey in uniform. We don't expect any different, that's why you're American for. My buddies and I do pull a lot of ideas out of our arses, Dustdevil. We do think about our work. You guys don't have the freedom to think for yourselves. We do a lot of good work down here, so I couldn’t care less if you approve or dissaprove what we do, just because we do things differently.

[Dustdevil]

Nobody is questioning the good work you do, nor the quality of your system. I have no questions about that. This discussion is very specifically about one particular practice that you bring up. And if you don't find it in print in a credible medical source, you're looking for trouble. This isn't like some new way to clean your cot or something. This is a procedure that you are undertaking on a human being without their consent. Yes, that requires some credible scientific validation, not just "we always do this!"

Scenario: You think your patient is faking. In fact, he is faking. You squirt alcohol up his nose. He comes up swinging and breaks your face open -- which is exactly what I would do. You think that guy's going to jail? Possibly for the moment, but don't count on a prosecution. You assaulted him. He fought back. I can't speak for your local laws, because I don't even know where you are. However, the concept of assault is pretty universal. And the patient has every right to fight back, and to file charges on you. When that happens, kiss your career goodbye. Don't be stupid just because all your retard buddies are.

[letmesleep]

Dust, are you telling Harold1 that this treatment in his situation is like this?

or maybe this?

Sounds about right to me!

[fireflymedic]

Harold - the practice which you describe is totally and completely unethical. Alcohol SPECIFICALLY states not for internal ingestion for a reason - if you squirt something up a patient's nose some of it is bound to end up down their throat. If you don't believe me, give versed IN and notice what happens. Alcohol is EXTREMELY irritating to the mucosal lining in the nose, throat, esophagus and stomach. If you have a patient which may have a problem such as varices or whatever and you irritate that you have just broken rule number one - you have caused harm ! As far as being a "good" idea - well look at it this way. If a patient ever came against with that statement, I guarantee you would experience problems not only from the medical community but also the courts. Our actions are judged against what a person of similar experience would do based on established protocols and treatments. I don't know of ANY service or medical director that would support that. You are asking for a lawsuit.

On the topic of possible causing injury to patients when attempting to determine level of consciousness I have faced a dilemna of sorts with students. Many out there are still advocating the use of the sternal rub. I admit that's what I was taught when going through class some time ago. However, I have since deviated to other methods as especially with trauma patients, there may be damage to the sternum (ie fracture etc) or underlying structures and if rubbed vigorously could produce injury. How many out there are in the same boat and do you teach your students sternal rubs or do you move away from that?

[Dustdevil]

Harold - the practice which you describe is totally and completely unethical. Alcohol SPECIFICALLY states not for internal ingestion for a reason - if you squirt something up a patient's nose some of it is bound to end up down their throat.

End of discussion.

I can just see it now:

• Prosecutor: Do you recognise this bottle?

You: Yes.

Prosecutor: What is it?

You: Alcohol.

Prosecutor: Would you mind reading the bold red print at the bottom of that label for the court?

You: Danger. For external use only.

• You're screwed. There isn't a medic, doctor, instructor, or textbook in the world who is going to back you up on that in court, even if they did tell you somewhere down the line to do it. Then you're on your own, all because you wanted to be cute and assault a patient who pissed you off. And the whole profession ends up with a black eye over your stupidity. Thanks a lot.

[AnthonyM83]

Don't tell me that you never divert from the book. That would be too much of the puritan blood or a total lack of creativity. Keep thinking that you guys are soooo good and that every medic outside of the US is a monkey in uniform. We don't expect any different, that's why you're American for.

Where the heck did that little speech come from? Don't be so dramatic.

We're not slamming a country, we're slamming your practice of putting alcohol up their noses. You could have any flag next to your picture...I bet most people who read your post didn't even notice you were from a different country. Chill out with that stuff.

(And no, I never divert from the book that badly. People here divert by using a shoulder pressure when protocol said use finger pressure to check responsiveness....not freaking pouring alcohol up their noses. Those who diverge more are the exceptions, the deviants, just like you have...wonder what they do? Light hair on fire and wait for response?)