No Judgment Zone- Drugs in the Emergency Room

One of the screening questions that everyone gets asked when they come into the emergency room is whether or not they do drugs. We all specify what we mean, breaking the question into three parts: 1) Do you use IV drugs? 2) Do you smoke weed and 3) Do you some other form?

The hospital is one of those few places that can be a place without judgment. You won't go to jail for fessing up to drug use in the emergency room.

Many of my coworkers are amazing nurses that have been emergency nurses for a very long time. They have seen a lot. And unfortunately, they have been taken advantage of a lot as well. Just in the short time that I have been in the emergency room, I have seen some patients that I have worked my tail off for urn right around and come back for another overdose. Or they will sit there and scream for their pain medications. There are way more patients that come into the emergency room that use drugs that are mean and nasty towards us nurses than patients who are not.

But who can blame them? They are immediately on the defense because of their addiction. They know its an addition, they know its wrong, and I have yet to meet a person addicted to drugs that would tell me they are just absolutely loving life. They come in for various reasons, some legitimate others not so much. But either way, they have to admit to someone they are using and then they typically receive a long lecture and judgment. I would probably be pretty defensive from the beginning as well in that case.

So what can we do to help this process as nurses faced with the difficult questions we must ask?
We should be careful how we ask them. If it feels right, feel free to explain to the patient exactly why you need the information.

I had the absolute perfect example of this just this past weekend. We had a young gentleman come in with sinus tachycardia. His heart rate was consistently between 170-180 in the waiting room and we brought him back to a bed immediately. We asked him all of the basic questions, including the questions about drugs, as we slammed to large-bore IVs into his arms, drew labs, slapped the monitoring equipment on him, and even got the crash cart ready for the worst case scenario.

The young man received THREE doses of adenosine, two liters of fluids, and a whole bunch of other cardiac drugs. Nothing was working. We were worried we were going to have to cardiovert him. And the entire time, he didn't seem to quite understand the situation.

It took some time for his urine drug screen to come back, and what do ya know? He tested positive for a large amount of cocaine in his system.

We stopped his heart THREE different times with that medication. He was screaming in pain. He was terrified. His girlfriend looked like she was going to be sick the entire time. It was a very serious situation. And no matter how many times we asked him if he did any drugs, he continued to say no.

Our course of treatment would have been different. Our panic would have been considered overkill. A lot of things could have been done differently. But he didn't tell us.

Why didn't he tell us? That's a good question. Maybe he really didn't understand the importance of telling us that information. Maybe his girlfriend doesn't know that he does drugs and he didn't want her to find out like this. Maybe his felt too much shame. Maybe he was being a jerk and just didn't feel like he had to tell us. There are so many reasons that could have been his actual reason.

But the one potential reason that upsets me is: was it my fault? Did I come across in such a way that made him feel like I was not a safe place to confide that information in? Did I somehow come across judgmental?

Whatever his actual reason was, this patient taught me a lot. I have decided that I will always work to ensure that I am as understanding and nonjudgmental as possible when trying to figure out people's drug usage histories. Its vital information that could mean the difference between life and death. Therefore, our execution and our education on the matter are imperative. We have to be better for them, even if they are ungrateful. A life is still a life, and it doesn't get to be our call which patients we put more effort into. They should all be treated the same, no matter what.