Gotta Stop

OK, I am getting sick of this growing group of drug seekers I have been seeing. Most notably, those with recurrent shoulder dislocators.

Of course this is not an new thing. Dislocating your shoulder is a great way to get drugs. After all, you now have an objective physical (and radiographic) finding that IS painful. However, once you have popped it out a dozen or more times, the pain is not nearly as bad but you can easily exaggerate it.

In the past, we had few options. People would fuss and scream until they got multiple doses of Narcs and Benzos and then because they were so habituated to it, they would be able to fight your efforts to pull the damn thing back in. By the time you were done, they would get 6 of Dilaudid and 4 of Versed. And of course go home with an Rx for Percs.

But now, we have the solution. The Michael Jackson Death Drug ™, Propofol. No one can resist it. They are powerless. They simply go limp within 15 seconds and you can pop the shoulder back in so easily you don’t even need anyone to apply counter traction. Then, they wake up all nice and lucid and ready to be dischareged. With an Rx for Naprosyn of course. The main problem with it is that patients have to wait 6 hours after eating or drinking anything but water before they can get it. That means that for several hours you have have to sit there with them and endure their demands for nacs. I of course refuse this and have had a few people sign out AMA before their shoulder is back in. Big deal. Hit the road. You can probably pop it back in yourself if you really wanted to.

12 Responses to Gotta Stop

  1. Mingle says:

    As someone who put up with a lot of shoulder dislocations from a torn labrum (before we learned it was a torn labrum) these people make me extra extra disgusted, as if drug-seekers don’t already make me disgusted.

    From my own experience, there is a way to replace it with 0 drugs and almost no pain, but that also ONLY works on someone who is compliant and definitely NOT a crazy drug-seeker…..

    If it was up to me, I’d strap them down and fix it without ANY meds…(which I’ve also done before in the ER, minus the straps).

  2. Susan says:

    All that time, pain and trouble!! Why don’t these people find someone that sells pot and use that? I couldn’t take having to harm myself, going to the ER and then not even getting what I wanted because the docs and nurses aren’t stupid.

    What bothers me the most is what is happening with the people that really need to be in the ER. They have to wait while you all have to mess around with these losers.

  3. ER Jedi says:

    @ Susan. They have to pay for their pot, so they don’t smoke it. They get their percs essentially for free, at at least on an endless stream of “credit”.

  4. tracy says:

    @ Susan You obviuosly don’t understand self injury and that it is a real problem and the guilt that follows, because one was there taking up space that the “real patients” needed.

    Grow some compassion!

  5. tracy says:

    Susan. i apologize. We are talking about two different things entirely.

  6. Susan says:

    @tracy :)

    Cripes, I forgot these losers don’t even pay! It pisses me off that the rest of us have to pay outrageous insurance premiums. If all that crap was cut out, I really wonder if there would be a healthcare crisis in this country.

  7. Almost Jesus says:

    I was doing clinicals when we had a shoulder dislocation come in to the ER. The patient was opioid dependent due to this shoulder injury. (fentanyl patches, etc). We ended up giving him 50mg of morphine and 10mg of versed IV and he was still able to buck the attempt by ortho to put it back in. They also had anesthesia come and try blocks, etc. Lo and behold, when they propofol’d him, it went right in. After the post reduction film, he popped it back out and he needed to be propofol’d again. Around the point of the propofol, we started to suspect the drug seeking.

  8. prunebelly says:

    6 hours? Really?

  9. Mellee says:

    So…. If someone pops their shoulder out a few times (too many for you) they get no pain meds while waiting for the 6 hours to pass???? Why?

  10. Mellee says:

    @ Almost Jesus there is a huge difference between dependence and addiction.

  11. Doc says:

    If they are a regular dislocator that is here all the time, yes. I make them wait. You’ll find that regular dislocators are very comfortable sitting there if they don’t move. So I advise they sit still or offer them some Toradol.

  12. Mellee says:

    Oh ok :) Just wondering, I use to be a seeker, the person the Doctors would cringe to see. I faked everything, and 99% of the time I would walk out with an opiate. (Vicodin, Percs, Norcies, Lortab) I haven’t done any seeking in years tho, I learned my lesson when I went to the ER for real rightside abdominal pain, and they didn’t believe me, but the doc decided to do a CT anyways and found appendicitis. Never again did I seek, next time I go to the ER I am gonna be sick! For real!

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