Smelling Salts

[theotherphil]

So when do you use smelling salts versus painful response? When I deal with an ETOH I usually use a sternal rub. When I was doing rotations in the hospital I saw the nurses use ammonia inhalents on the drunks and they would respond in a similar way to a good 'ole rub on the sternum.

I tend to use the smelling salts on patients who are obviously feigning unconsciousness. You know the type....you can see their eyes moving. When you lift their hand above their head and release it, it conveniently doesn't hit them right in the face but flops to one side. I have never seen anybody resist smelling salts before.....they smell vile and make you wanna hurl at the slightest whiff. When concentrated in a mask the unsuspecting punter usually does hurl.

But, there is an exception to every rule. I had a lady recently who had been arguing with her boyfriend. He disappeared down to the local shop for a packet of cigarettes. On returning 5 minutes later, he found her "unconscious" with an empty 20 packet of paracetamol close by. She was a big girl and there was no way I was carrying her down 2 flights of stairs when she was clearly feigning. I told her to sit up and stop messing about....paracetamol doesn't make you go unconscious. I could see her eyes moving, she was swallowing and her hand wouldn't hit her face when I released it above her head. She resisted a sternal rub, the pressing of a pen to her nail bed and a pinch of the ear lobe. This lady was good! I decided to use a nebuliser mask with a bottle of smelling salts jammed into the hole where the medication bowl usually goes. She took it without flinching. My colleague and I were gob smacked. She wasn't going to beat me though so I left the mask on and told my colleague I'd be back. I went to the vehicle to grab a size 8 NPA and some KY. I lubed it up and started to insert it down the lady's nostril. She screwed up her face but refused to open her eyes until it hit the back of her throat and she started gagging. Her boyfriend then started to wretch in sync with her. I told her to open her eyes or she'd be getting a bigger tube down her throat. She immediately opened them and went to GCS 15 in under a second. She went mental at her boyfriend for "putting her through all this".

If she'd only opened her eyes when I told her to :roll: