Thread: A concern:

I was watching a program called "Trauma:Life in the ER" last night.
Something happend that really concerned me and I would like input on this matter.
A man was on his bike coming back from an AA meeting when a driver opened his car door and the man hit into it, not having a chance to swerve. He flipped over the driver's door and landed on the back of his head...breaking his neck in 2 areas I believe. He was brought into the ER and thankfully he was not paralyzed ( I am not sure the extent of his injuries I may be wrong about the neck being broken in 2 places?) but upon his arrival he was injected with "a cousin of heroine" as the resident had stated. The man right away knew and said "This tastes like heroine, please, I do not want it, I have been clean too long" The doctors still proceeded in administering it (for the interest of the patient I assume) but what really concerns me ... Wasn't there an alternative drug that could have been used? As we do have alternatives for pennicilin (sp?)? Again I am sorry I do not have details of the case, nor do I even know why this drug was administered, maybe as a pain med if I were to take a guess, but a few question that came to mind were:
1. Can doctors administer drugs or any procedure for that matter againt the patients's consent?
2. And if there was an alternative, why wasn't it used?
This question may seem ignorant to some, but again I have not attended medical school and do not know much about meds given to patients or normal protocol.
Thanks

the government is financed by drug money, if we dont put the druggies back on the street our government would collapse

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Heroin comes from a long line of opiate derivatives including and not limited to morphine, oxy-codeine, hydro-codeine, and codeine. There are a number of ethical issues that arise upon giving medication to patient who is unwilling. I think that if the patient’s life is in danger then perhaps that doctor can take control the outcome; however, if there is nothing to worry about besides the pain then it might be wrong to do so.

They are many other alternatives to morphine that can be used. In fact, there is an NSAID called ketorolac that has equal analgesic power. However, there is no way to know the circumstances around that specific patient. It is hard to judge what someone did without knowing the full patients history. That being said, the doc could have been just being lazy and didn't want to go get another drug. anything is possible.

Lazy part. Always too lazy. Could be wrong ...

Toradol (Ketorolac) is a great non-narcotic pain medicine (actually Non-Steroidal Anti-Inflammatory) but is often not used due to problems with NSAIDS (ie gastritis, prolonged bleeding times etc) the one reason it isn't used in orthopedic cases is that it is thought to slow healing times. I don't know the actual studies that's just what the orthopods say. Also if this pt is a recovering alcoholic or drug addict what are his liver functions and/or hepatitis status. Toradol is generally most effective (in my experience) with Kidney stones in conjuntions with small doses of narc's like morphine or demerol. I have never seen anything but narcotics used in acute tramatic injury unless otherwise contraindicated by things such as excessive ETOH or allergies. The one concern is if this gentleman has a head injury narc's aren't the best answer either as these will alter his level of conciousness and sensorium for further evaluation such as : why won't my patient wake up? too many drugs or subdural hematoma. . . .
The true answer was probably for the drama and irony of coming home from an "AA" meeting then getting treated with drugs.
Sorry for the long winded reply but I have been an RN in a regional trauma center for 8 years and am coming to St. Chris' to finish premed and then on to the BIG GAME!

from the information on the post it is unclear if the Doc knew about the AA meeting thing but keep in mind that AA is for alcohol and there are other programs that deal with other addictions and it is certainly possible for an alcoholic to take pain medication as prescribed without getting hooked or reaching for the bottle. So it is vital to know if this guy is only an alcoholic or alcoholic/addict.

It seems that proper communication with the patient and his/her wishes is vital in a case like this and it is obvious there wasn't a clear understanding by the Doc. Hopefully ethics will cover this type of situation

sorry if i I did not make it clear, the patient coherently stated he was an addict , and clearly requested the use of something else.

Misunderstanding by the Doc, but he did nothing illegal for sure. According to the law, even if the patient is a addict, if they are being treated for something other than the addiction or drug dependence, the use the addicted drug is okay. It doc may have used it to prevent withdrawal problem and pain.