Killer Pain Killers

According to a CDC report published in June, medications were either given in the ED or prescribed at discharge at 76.7 percent of all emergency department visits. This represents about 1.8 medications given per person, per visit. The most frequently prescribed drugs at discharge are pain relievers. (In fact, the first antibiotic on the list of top twenty prescribed drugs appears at number eight on the list.) The top medications prescribed/ordered/recommended at discharge, in order of frequency, were:

1. Ibuprofen
2. Acetaminophen with hydrocodone
3. Acetaminophen alone

This makes sense, given the fact that the number one reason people give for coming to the emergency department is to obtain pain relief. Given the number of prescriptions written annually for prescription pain medications, parents and caregivers are reminded that these medications are a threat to teenagers and very small children, principally because they are so readily available at home.

The news on young people and drugs these days is mixed. A government report out this week shows a decline in all types of drug abuse by children ages 12 to 17, from 11.6 percent in 2002 to 9.5 percent in 2007. The same study shows a rise of 12 percent in illicit use of prescription pain relievers among young adults ages 18 to 25. A report out earlier this year from the Centers for Disease Control and Prevention shows that despite an overall drop in illicit drug use, deaths from drug use among people age 15 to 24 more than doubled between 1999 and 2005.

A study published this week in the Annals of Emergency Medicine reports nearly 10,000 accidental ingestions of opiates by children age six and under; study authors speculate that the actual number is likely much higher, since their study only assessed a portion of U.S. poison control centers, not all of them.

Here are some tips for restricting access to prescription medications:

· Hide all medications in a secure location, which may not be the bathroom medicine cabinet.

· Discard any prescription medications that are left over or expired.

· Alert grandparents who visit or host their grandchildren that their prescriptions should always be locked up and hidden away, including individual pills which curious toddlers may put into their mouths.

· Monitor your teenager’s internet use for shopping on pharmaceutical websites.

· Discuss with neighbors and parents of your child’s friends the importance of keeping prescription medications locked away.

Top Ten Reasons to Come To the Emergency Department

QAccording to data in Emergency Department Visits for Adults in Community Hospitals from Selected State, 2005, released by the Agency for Healthcare Research and Quality (AHRQ) yesterday, these are the top reasons for emergency department visits:

1.) Sprains and strains (2.4 million visits)
2.) Bruises and other superficial injuries (2.0 million visits)
3.) Abdominal pain (1.7 million visits)
4.) Non-cardiac (not heart related) chest pain (1.6 million visits)
5.) Back problems (1.4 million visits)
6.) Leg and arm open wounds (1.3 million visits)
7.) Headaches, including migraines (1.2 million visits)
8.) Nose and throat infections (1.1 million visits)
9.) Skin infections (1.1 million visits)
10.) Urinary tract infections (1.1 million visits)

The number one diagnosis among patients admitted to the hospital was pneumonia.

It would seem at first glance that many people come to the emergency department for “minor” complaints, but keep in mind that these statistics are based on the FINAL diagnosis. Most people would not choose to wait hours in a crowded waiting room if they knew for sure that the bone was not broken, the belly pain was gas, or the chest pain was reflux.

In fact, twenty to twenty-five percent of the patients with “non-cardiac” chest pain were admitted to the hospital from the emergency department for further evaluation and observation, and only received the “non-cardiac” diagnosis upon discharge.

Remember this: a “minor” emergency is what happens to someone else.