Thanks from a family

Last night I cared for a patient from out of town. The patient had a migraine, which was fairly usual for the patient, but was an unwelcome addition to the families’ vacation.

Standard migraine therapy (not involving a narcotic) was applied, and as expected the patient was pain-free after about 30 minutes. Much incredulity over ‘How did you make her better so fast’?

The best part: effusive thanks from the 5 and 8 year olds: “You fixed or mom, so we can stay on vacation and not have to go home”.

Emergency Medicine: making the world safe for vacationers of all ages.


Comments

  1. Mrs. Fred says:

    Emergency medicine: making it all better.
    Thanks again!

  2. Sometimes it’s the littlest of things that make us glad we do what we do.

    On a semi-related note, several docs in town once got taken in by a very clever scam: a call from a “doc” saying he was flying to a conference and had to land in town with a migraine. Was able to mention to various docs the name of someone they’d trained with whom he’d supposedly called for a reference in town; just needed one vial of demerol…. By the time I got the call, I’d been warned. I’d like to think I’d have smelled something, but who knows. Meanwhile, keep up the good work. Saving lives, saving vacations; either one

  3. Okay, I’ll bite, what non-narcotic RX did you use?
    Ken Jago, MD

  4. 1 liter of NS and 10mg of IV Compazine.

  5. Kudos to you! I’ve landed in the ER with the occasional flare up of my constant migraine that I couldn’t control and I went to the ER for my very first cluster headache attack, since it lasted 4 hours. Since I used to work in the ER and know just exactly what I’m up against (and needless to say, it ain’t pretty) I always take time out of my nausea-producing, head spinning moment to explain that I don’t want pain medication, that I used to work in headache research, that I’ve had this thing for well over 5 years, and please start with DHE or something that might actually help stop the severity of the migraine instead of just covering it up. But no, I’m not proactive or anything like that. :) It has yielded far better results than the usual migraine to ER visit, even though I still run up against every stigma imaginable, and then some.

    ER + migraine + non-narcotic options = compazine, phenergan, DHE, imitrex, droperidol even, benadryl, NSS, solumedrol, reglan, depacon if you really don’t feel like sending them to neuro service….The options are out there, but most won’t think outside the box (or feel like taking the time to look for prolonged QT on EKG before giving droperidol, etc). :)

    Thanks for stopping one more migraine out there – sure as hell wish there were more like you.

  6. Compazine is the migraine-buster. I usually give a cocktail of 30 mg of Toradol, 5-10 mg of Compazine, and 25 mg of Benadryl with the liter of saline, but honestly the compazine alone usually is enough.

    If they really have a migraine, and not a “migraine” then they will be amazed how well it works. There is a population of “migraine” patients who just will not get relief from anything other than (read: want) a Demerol shot, and it’s occasionally easier to just give it rather than go through the time-consuming nasty-letter-inducing “confrontation.”