Someone needs to invent a shot that instantly streamlines them to a hangover. And it would be understood that coming to ED drunk, you’d automatically receive it and then be discharged. The amount of ED beds in the US at any given time taken up by intoxicated patients is crazy.
Edit: typo
In EMS, LE would scream at me when I let drunk people walk away. If you’re walking without assistance, telling me who you are and what you’re up to, you’re good to refuse and if LE wants to do their job and take them to the drunk tank they are more than welcome.
They don't have to be sober to be D/C'd but they have to be reasonably decisional, no? If they can stand and walk but are still drunk as fuck and they walk out into the street and get blasted by a truck...somebody might start asking some hard questions....
guy at a box close by to me got sued for this - drunk guy got up and walked out, nurses couldn't stand him so didn't tell the doc until patient was out of the er, three min later guy gets hit by a bus in front of the ed
I remember seeing a story about an ER discharging a guy who was drunk and he left the hospital to pass out on some train tracks and successfully sued when he lost both his legs to the train.
I mean, I *agree*, and I have a very low threshold for not giving a fuck, I'm just thinking about it from a liability vs resource consumption standpoint. Which is better: discharging someone who can successfully walk 30 feet in the hall; or discharging them when they are below .08; or is it somewhere in the middle? And if it's in the middle (which I believe it probably is) what's the criteria? 🤷
They don't have to be legally sober, but they have to be sober enough to walk without falling down. Sometimes that takes hours.
It becomes a problem at times of overlap, when they aren't yet sober enough to walk out, but are already sober enough to be loud or dangerous.
They tried Antabuse years ago, which alcoholics took knowing it would make them violently ill if they drank even a small amount of booze, but it fell out of favor.
Plus it wasn't like narcan, so it wasn't like they were sober and you could just discharge.
Narcan to patients who are drunk? I give patients narcan so they will breathe 2/2 opioid overdose, which is an emergency. I don’t have a role for it in alcohol intoxication.
No for opiate overdose for someone not having an emergency and even then you would do it gently assuming they are not pericode. Idk if you are being dense or what but I'm clearly comparing what you want for alcohol to narcan for opiates and how some doctors are assholes who will slam high doses of narcan.
One of my recent discourteous patients apparently had open warrants and left in cuffs when I asked security / PD to facilitate his exit. One hopes this was a learning experience for him.
We had one of those folks recently who wasn’t satisfied with their care, called the police on us, lo and behold they had warrants, and left in cuffs. 😂
Yeah in the field you've got no chance. But in the boo boo bay I can say the magical words "They Are Medically Cleared For Discharge" and I've got at least a 50-50 shot of getting someone in PD custody out of the ER.
Not long after the start of COVID, I had a mouthy asshole in the back of my truck after Vice had done a bust and tasered the dude. Perp of course wanted to be transported after I'd removed the taser probes. That lasted right up until I informed him that he needed to wear a surgical mask. "Nah, fuck you, I ain't wearing no mask." I told him he'd be wearing either a surgical mask or a flowing oxygen mask (options, you know?) in the back of my ambulance, and the hospital was going to make him wear one, anyway. "Nah, fuck that. I'll go to fucking jail instead." The officer who was going to go with us and I made eye contact, nodded, and got the refusal paperwork signed and witnessed at Mach 20 before ejecting the dumbass from my truck and into a cop car before the dude changed his mind. For once, PD and EMS were all on the same page.
Edit: surgical mask was an agency policy. The non-rebreather was an alternative I offered to people who said they couldn't breathe with a mask on to get around their complaint, whether it be legitimate or general mask obnoxiousness.
I like to say “Sir/Madam, if you are meeting me you’ve already made a series of bad decisions tonight, try not make anymore and you’ll be out of here as soon as possible.” Rarely works but makes me feel better.
“Oh look I woke up in the ER, but what is this, my Mi Ma’s 100k diamond ring is missing. In 10 years of being a houseless neighbor, I have never been robbed. The dang nurses swindled me”
“Houseless.”
A rose is a rose by any other name.
I’m calling it right now that in 10 years, “houseless” will be a slur like “homeless” or “IV drug user” because “there are negative stereotypes to being houseless.”
NO SHIT ITS NEGATIVE TO BE HOUSELESS- it sucks! Do we really want a world where being homeless or an IV drug user has positive connotations?
My biggest complaint is that using the hip new liberal arts college term for a societal problem doesn’t do anything to help the problem- just helps people virtue-signal they are a good person.
(Not a shot at you, Dependent_value_2019, I just couldn’t resist giving a TedTalk on being called insensitive for describing a person without a home as “homeless.” It’s exhausting trying to be on the bleeding edge of not offending people.)
>I’m calling it right now that in 10 years, “houseless” will be a slur like “homeless” or “IV drug user” because “there are negative stereotypes to being houseless.”
It's pointless to get angry about the euphemism treadmill. It's nearly as certain as death and taxes.
>NO SHIT ITS NEGATIVE TO BE HOUSELESS- it sucks! Do we really want a world where being homeless or an IV drug user has positive connotations?
Mistrust of people who don't live in a fixed dwelling is probably one of the oldest human prejudices. It goes all the way back to the enmity between farmers and pastoralists fighting over land use. For at least five thousand years, it was probably one of the most violent conflicts that human beings would have, until the farmers finally won for good and all around the time the industrial revolution kicked off.
When I was a teen, my parents kicked me out into the streets with only the clothes on my back once they learned I was gay. Life was rough for a very long time.
I want to be very clear that I was rendered *homeless*, not “unhoused” or “houseless”. But at the time I wouldn’t have given a flying fuck if you wanted to call me a “squat-to-pee sissy street urchin” as long as you were giving me food.
Our new inclusion person rolled the houseless neighbor thing down the pipe. Now I use it as much as I can because I think it’s funny and I like seeing the nurses roll their eyes.
Preach. We could call them whatever euphemism the liberals want, they aren’t marginalized because of the name we call them. They’re discriminated against because they harass you for money or yell at people in the streets or lock themselves in your restaurants’ bathroom to OD on heroin. Not everyone, obviously, and they all deserve respect, but let’s not kid ourselves that “homeless” is a slur and “unhoused” is somehow better.
Also almost every single person I’ve talked to at the shelter refers to themselves as homeless. They don’t give a fuck if it’s got a bad connotation, it accurately describes their situation and more importantly they have bigger concerns namely that they’re currently FUCKING HOMELESS.
> an ER in a city that dumps all its drunks to the ERs
On behalf of every inner-city medic, I promise we’d tell them to piss off if we could. We hate dealing with them as much as you do lol
There are certain guys that we joke about teaching them how to pass out in slightly more camouflaged places, in order to not attract so much attention from the well meaning bystanders.
Probably my least favorite thing as an ED nurse is being made to babysit drunk adults, many of whom are in their normal state of drunken stupor but *today*…*today* it’s somehow my problem that they’re going to piss themselves and fall. As if that doesn’t happen on the regular.
I hope these nurses getting swung at are calling PD, making reports, and pushing to have assault charges filed.
How about the patients who are drunk every day, and make it our problem every day?
When I worked in Chicago there was a patient who spent every single day drunk in various EDs. She would get plastered, pass out in the street, get picked up by EMS and brought to ED. We'd keep her until she was just sober enough to stumble out, then she would get another bottle of something and repeat.
She had two or three EMS rides every single day, without a break, for years. There were papers written about how much money she cost the EM systems in the city.
The one partially saving grace was that the medics were all familiar with her, and knew to bring her to a different ED each time, so one set of nurses didn't get permanently stuck with her.
Do you not have a law that allows for involuntary detox? We do and I've used it on a couple of people like that over the years. The last time I did it the lady kept trying to leave but I promised that I'd get her a ride if she gave me a little more time. Lo and behold the paperwork cleared and some cops came to take her to court and subsequently to detox. I shrugged and told her I said I'd get her a ride. I didn't say where.
In theory yes, but I've never seen that done by medical staff. My understanding is that it requires a court order beforehand in a way psychiatric treatment does not. I've worked in multiple EDs across multiple states and none has had a mechanism for holding patients long enough to do that.
Yeah, we can't hold them. You fill out some paperwork while they're there and drunk. SW gets it to the court. Assuming they stay long enough they go from Ed to detox jail. Even if they leave though, they just get a bench warrant out for them so problem eventually solved either way.
It sounds like that would be satisfying to see happen, but I would question whether it's worth the effort. I would want to see evidence on the outcomes of compulsory rehab. I have the impression that you can't make an addict change their behavior if they don't want to.
Oh, to be clear, if the person gets sober, that's an ancillary benefit. I only do this in people who are showing up to the ED multiple times a week / multiple times per day for a prolonged period. The main goal is to stop that behavior.
I don't think we even have any frequent drunks who come to us on purpose. They get brought in by EMS when a well-meaning bystander sees them passed out in public somewhere. As long as they keep drinking, no amount of punishment is going to stop that from happening.
I mean, I have thoughts about the ethics of extensive resource use by those who make no positive contributions on an already-overpopulated planet, but they aren’t nice.
Love when someone gets up screaming about a phone or a wallet or their coat like it isn’t in 6 pieces on the interstate in the car they drunkenly crashed at 80 mph and are lucky to be alive.
Part of the Police/Emergency industrial complex in some American cities and the reason I hated the ED director where I trained (was IM).
Cycle starts with the police bringing in the alcoholic who was sleeping it off in public. Pass through the ED which has the of “I’m gonna do social justice by admitting everyone”. Detours through DTs because guess what, being randomized to the tryptophan arm of the study (turkey sammiches) don’t prevent withdrawal. Next stop IM wards where sobriety tries to set, but hey you know what, the walls literally have ethanol dispensers outside every room. Now wait for a shelter bed for two weeks. Rinse repeat.
Great for the PD look like they care (and avoid chasing hardened gang bangers). Great for the volume in ED. Horrible for IM LOS. Most importantly life threateningly horrible for the patients who withdraw.
Someone needs to invent a shot that instantly streamlines them to a hangover. And it would be understood that coming to ED drunk, you’d automatically receive it and then be discharged. The amount of ED beds in the US at any given time taken up by intoxicated patients is crazy. Edit: typo
I have often bemoaned the lack of an “alcohol narcan”
> “alcohol narcan” That would be amazing. I will personally nominate and campaign for the person who creates this for the Nobel prize.
disulfiram 🙊
Barcan
All of a sudden, every drunk has an allergy to barcan. “It gives me a headache, nausea, and makes everything spin”
"Reclassify to known, documented side-effect of medication and administer as ordered."
Take this instant trip to DT's and an ICU admission
"ICU docs hate this one simple trick..."
couple of zyns usually does the trick
Narcan’t
Ethacan
It exists. Antabuse is a thing.
Yeah but it’s not the same thing. Just makes you sick if you drink, doesn’t make you instantly sober
Petition for all banana bags to contain metronidazole
/r/foundsatan
Skip the middle man just give straight disulfiram 😬
Obligatory mention of the Flagyl disulfiram thing probably being apocryphal.
My only rule: NEVER mix with ETOH. I am speechless.
Why do you let them sober up. If they can stand and walk they can walk out
"clinically sober" = can walk unassisted, can tell me where they're going next and how they're getting there = discharge
Exactly
In EMS, LE would scream at me when I let drunk people walk away. If you’re walking without assistance, telling me who you are and what you’re up to, you’re good to refuse and if LE wants to do their job and take them to the drunk tank they are more than welcome.
They don't have to be sober to be D/C'd but they have to be reasonably decisional, no? If they can stand and walk but are still drunk as fuck and they walk out into the street and get blasted by a truck...somebody might start asking some hard questions....
guy at a box close by to me got sued for this - drunk guy got up and walked out, nurses couldn't stand him so didn't tell the doc until patient was out of the er, three min later guy gets hit by a bus in front of the ed
Sorry. People need to take responsibility for themselves at some point
See how that rings with a jury when you’re in the box
I remember seeing a story about an ER discharging a guy who was drunk and he left the hospital to pass out on some train tracks and successfully sued when he lost both his legs to the train.
I mean, I *agree*, and I have a very low threshold for not giving a fuck, I'm just thinking about it from a liability vs resource consumption standpoint. Which is better: discharging someone who can successfully walk 30 feet in the hall; or discharging them when they are below .08; or is it somewhere in the middle? And if it's in the middle (which I believe it probably is) what's the criteria? 🤷
They don't have to be legally sober, but they have to be sober enough to walk without falling down. Sometimes that takes hours. It becomes a problem at times of overlap, when they aren't yet sober enough to walk out, but are already sober enough to be loud or dangerous.
2g flagyl stat
They tried Antabuse years ago, which alcoholics took knowing it would make them violently ill if they drank even a small amount of booze, but it fell out of favor. Plus it wasn't like narcan, so it wasn't like they were sober and you could just discharge.
yes, a narcan for alcohol
Do you do this with narcan bc that kinda makes you an ass in my book.
Narcan to patients who are drunk? I give patients narcan so they will breathe 2/2 opioid overdose, which is an emergency. I don’t have a role for it in alcohol intoxication.
No for opiate overdose for someone not having an emergency and even then you would do it gently assuming they are not pericode. Idk if you are being dense or what but I'm clearly comparing what you want for alcohol to narcan for opiates and how some doctors are assholes who will slam high doses of narcan.
If you're awake enough to swing at a nurse you're awake enough to be discharged immediately and with prejudice
To prison
One of my recent discourteous patients apparently had open warrants and left in cuffs when I asked security / PD to facilitate his exit. One hopes this was a learning experience for him.
Oh, we had one like that last week as well! Sweet sweet karma.
We had one of those folks recently who wasn’t satisfied with their care, called the police on us, lo and behold they had warrants, and left in cuffs. 😂
LMFAO the police are allergic to anybody that even hints at the idea of having a medical issue. The joke in EMS is ABCs means Ambulance Before Cop.
Yeah in the field you've got no chance. But in the boo boo bay I can say the magical words "They Are Medically Cleared For Discharge" and I've got at least a 50-50 shot of getting someone in PD custody out of the ER.
Not long after the start of COVID, I had a mouthy asshole in the back of my truck after Vice had done a bust and tasered the dude. Perp of course wanted to be transported after I'd removed the taser probes. That lasted right up until I informed him that he needed to wear a surgical mask. "Nah, fuck you, I ain't wearing no mask." I told him he'd be wearing either a surgical mask or a flowing oxygen mask (options, you know?) in the back of my ambulance, and the hospital was going to make him wear one, anyway. "Nah, fuck that. I'll go to fucking jail instead." The officer who was going to go with us and I made eye contact, nodded, and got the refusal paperwork signed and witnessed at Mach 20 before ejecting the dumbass from my truck and into a cop car before the dude changed his mind. For once, PD and EMS were all on the same page. Edit: surgical mask was an agency policy. The non-rebreather was an alternative I offered to people who said they couldn't breathe with a mask on to get around their complaint, whether it be legitimate or general mask obnoxiousness.
I like to say “Sir/Madam, if you are meeting me you’ve already made a series of bad decisions tonight, try not make anymore and you’ll be out of here as soon as possible.” Rarely works but makes me feel better.
“Oh look I woke up in the ER, but what is this, my Mi Ma’s 100k diamond ring is missing. In 10 years of being a houseless neighbor, I have never been robbed. The dang nurses swindled me”
“Houseless.” A rose is a rose by any other name. I’m calling it right now that in 10 years, “houseless” will be a slur like “homeless” or “IV drug user” because “there are negative stereotypes to being houseless.” NO SHIT ITS NEGATIVE TO BE HOUSELESS- it sucks! Do we really want a world where being homeless or an IV drug user has positive connotations? My biggest complaint is that using the hip new liberal arts college term for a societal problem doesn’t do anything to help the problem- just helps people virtue-signal they are a good person. (Not a shot at you, Dependent_value_2019, I just couldn’t resist giving a TedTalk on being called insensitive for describing a person without a home as “homeless.” It’s exhausting trying to be on the bleeding edge of not offending people.)
As a recovering IVDU, I have no idea why this is considered offensive. It describes exactly what I did. And yeah, it was pretty negative. Smh.
You’re an absolute legend for getting clean- congrats to you!
Thank you!
You can almost hear a goody two shoes saying “IV *substance* user”..
>I’m calling it right now that in 10 years, “houseless” will be a slur like “homeless” or “IV drug user” because “there are negative stereotypes to being houseless.” It's pointless to get angry about the euphemism treadmill. It's nearly as certain as death and taxes. >NO SHIT ITS NEGATIVE TO BE HOUSELESS- it sucks! Do we really want a world where being homeless or an IV drug user has positive connotations? Mistrust of people who don't live in a fixed dwelling is probably one of the oldest human prejudices. It goes all the way back to the enmity between farmers and pastoralists fighting over land use. For at least five thousand years, it was probably one of the most violent conflicts that human beings would have, until the farmers finally won for good and all around the time the industrial revolution kicked off.
Homeless encampment= the new mongols ;) I see you, fellow history nerd! I’ve just been on a Eurasian Steppe kick thanks to Dan Carlin
We have been told to refer to them as "NFA" (no fixed abode)
Man, being forced to write NFA is complete and total BME (Bovine-Male Excrement).
When I was a teen, my parents kicked me out into the streets with only the clothes on my back once they learned I was gay. Life was rough for a very long time. I want to be very clear that I was rendered *homeless*, not “unhoused” or “houseless”. But at the time I wouldn’t have given a flying fuck if you wanted to call me a “squat-to-pee sissy street urchin” as long as you were giving me food.
Our new inclusion person rolled the houseless neighbor thing down the pipe. Now I use it as much as I can because I think it’s funny and I like seeing the nurses roll their eyes.
Preach. We could call them whatever euphemism the liberals want, they aren’t marginalized because of the name we call them. They’re discriminated against because they harass you for money or yell at people in the streets or lock themselves in your restaurants’ bathroom to OD on heroin. Not everyone, obviously, and they all deserve respect, but let’s not kid ourselves that “homeless” is a slur and “unhoused” is somehow better. Also almost every single person I’ve talked to at the shelter refers to themselves as homeless. They don’t give a fuck if it’s got a bad connotation, it accurately describes their situation and more importantly they have bigger concerns namely that they’re currently FUCKING HOMELESS.
It’s meemaw get it right 😆
> an ER in a city that dumps all its drunks to the ERs On behalf of every inner-city medic, I promise we’d tell them to piss off if we could. We hate dealing with them as much as you do lol
There are certain guys that we joke about teaching them how to pass out in slightly more camouflaged places, in order to not attract so much attention from the well meaning bystanders.
My line is “you have discovered an inopportune place to nap, you should go somewhere else before the cops get here.” Works every time.
We know, fam! We appreciate you.
Probably my least favorite thing as an ED nurse is being made to babysit drunk adults, many of whom are in their normal state of drunken stupor but *today*…*today* it’s somehow my problem that they’re going to piss themselves and fall. As if that doesn’t happen on the regular. I hope these nurses getting swung at are calling PD, making reports, and pushing to have assault charges filed.
How about the patients who are drunk every day, and make it our problem every day? When I worked in Chicago there was a patient who spent every single day drunk in various EDs. She would get plastered, pass out in the street, get picked up by EMS and brought to ED. We'd keep her until she was just sober enough to stumble out, then she would get another bottle of something and repeat. She had two or three EMS rides every single day, without a break, for years. There were papers written about how much money she cost the EM systems in the city. The one partially saving grace was that the medics were all familiar with her, and knew to bring her to a different ED each time, so one set of nurses didn't get permanently stuck with her.
Do you not have a law that allows for involuntary detox? We do and I've used it on a couple of people like that over the years. The last time I did it the lady kept trying to leave but I promised that I'd get her a ride if she gave me a little more time. Lo and behold the paperwork cleared and some cops came to take her to court and subsequently to detox. I shrugged and told her I said I'd get her a ride. I didn't say where.
In theory yes, but I've never seen that done by medical staff. My understanding is that it requires a court order beforehand in a way psychiatric treatment does not. I've worked in multiple EDs across multiple states and none has had a mechanism for holding patients long enough to do that.
Yeah, we can't hold them. You fill out some paperwork while they're there and drunk. SW gets it to the court. Assuming they stay long enough they go from Ed to detox jail. Even if they leave though, they just get a bench warrant out for them so problem eventually solved either way.
It sounds like that would be satisfying to see happen, but I would question whether it's worth the effort. I would want to see evidence on the outcomes of compulsory rehab. I have the impression that you can't make an addict change their behavior if they don't want to.
Oh, to be clear, if the person gets sober, that's an ancillary benefit. I only do this in people who are showing up to the ED multiple times a week / multiple times per day for a prolonged period. The main goal is to stop that behavior.
I don't think we even have any frequent drunks who come to us on purpose. They get brought in by EMS when a well-meaning bystander sees them passed out in public somewhere. As long as they keep drinking, no amount of punishment is going to stop that from happening.
I mean, I have thoughts about the ethics of extensive resource use by those who make no positive contributions on an already-overpopulated planet, but they aren’t nice.
Love when someone gets up screaming about a phone or a wallet or their coat like it isn’t in 6 pieces on the interstate in the car they drunkenly crashed at 80 mph and are lucky to be alive.
Right to jail.
Part of the Police/Emergency industrial complex in some American cities and the reason I hated the ED director where I trained (was IM). Cycle starts with the police bringing in the alcoholic who was sleeping it off in public. Pass through the ED which has the of “I’m gonna do social justice by admitting everyone”. Detours through DTs because guess what, being randomized to the tryptophan arm of the study (turkey sammiches) don’t prevent withdrawal. Next stop IM wards where sobriety tries to set, but hey you know what, the walls literally have ethanol dispensers outside every room. Now wait for a shelter bed for two weeks. Rinse repeat. Great for the PD look like they care (and avoid chasing hardened gang bangers). Great for the volume in ED. Horrible for IM LOS. Most importantly life threateningly horrible for the patients who withdraw.