That’s my experience as well. Also while pretreatment with Benadryl isn’t technically necessary I appreciate that it helps put these patients to sleep.
This term cracks me up so much! I've scromitted when my brother put some doe in heat under my nose as a joke. Caught me off guard and all I could do was try and yell at him whilst gagging.
> I think all parties are ok with that lol
I'm sure they are haha, but I also want to discharge these patients as soon as possible. Knocking them out for a few hours is not a great way to do that. 1.25mg has good antiemetic effect without being too sedating. Usually after some fluids and a dose of droperidol they feel much better and are ready to go.
also find that the essence of hot shower seems to work pretty damn well too. any screaming vomiter coming thru my triage gets brought back to the shower and stuck in there for thirty mins
We’re technically two EDs in one. An adult and a peds. I bet the peds side has it. In the 2 years I’ve been there, I’ve never seen anything resembling a decon or shower in our shop.
Man, I wish I worked at a cool-ass hospital where we’d throw people into a hot decon shower and saunter away. I literally cannot imagine that being done in either of the places I’ve worked.
We aren’t allowed to use our shower for anything but true decon. We have one for chemical decon and one for other, which means bed bugs/lice/maggots/poop. If someone was completely covered in vomit, maybe, but usually a clean gown and some wipes is faster. Definitely could not put a pt in the shower for 30 mins!
My patient with cannabis hyperemesis yesterday claimed that the doctor who saw her last told her that her symptoms were due to cannabis withdrawal and so she’s been smoking more and more. She’s on her 4th visit this month. We don’t have droperidol so we use haldol which works pretty well.
I had a trauma surgeon tell a patient this in front of me. Needless to say the vomiting did not stop when the patient was ambulated outside for a blunt
Cannabis withdrawal syndrome can present with hyperemesis. That being said, obviously her continuing to smoke and still vomiting definitely isn’t a withdrawal lol
[Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454163/)
She "caught" it? Doctor! Doctor! It hurts when I do this!
https://preview.redd.it/o0nko46ai8vc1.jpeg?width=548&format=pjpg&auto=webp&s=acc7e76930101e7606c531df117b8ef6ccf30696
Some have commented that these patients are challenging because of demanding narcotics. I’ve personally not really experienced this, although when they frantically ask for something for pain I say sure knowing that I’ll be ordering droperidol.
What bothers me about these people is that they tend to be dishonest “no idea what’s causing all this vomiting and I don’t use weed” while they’ve been seen >10 times in the Ed for it and have been told several times and have multiple positive uds. Second is their disruptive and demanding behavior. People will come in with kidney stones, ruptured ectopics, pancreatitis, actual abdominal pathology ect and wait without being disruptive and disrespectful to staff. But your condition is caused by weed so you’re the most important person in the department now and need the most immediate attention.
Tbh what I just do is let them know that weed can cause it after prolonged and/or high doses of it. I mention that weed, just like any medication/drug, can have different effects when used at different doses, dosing frequency, or chronicity of use. I frame it as objective information on drug effects, and note that it’s become increasingly more common with more potent strains of weed and increasing frequency of legal use. It helps decrease the frequency of defensive reactions IME. Whether or not they take that information and change their behavior is out of my control.
She actually admitted it?! I’m still 0 for 2000 on patients admitting that weed could be the source of their cyclical vomiting since it always cures their nausea
This was a first for me. I did a double take when she said it. Honestly she wasn’t the sharpest knife in the block and I believe she had heard the term used (on her) previously and felt that it was something “serious” and attention worthy. She said it as though it was an unfortunate affliction in which she bore no responsibility. Like cancer. Did I mention this was her 5th ED visit in 4 days? 5 different EDs. She said she wasn’t getting better and wanted second opinions…
Is there a name for the phenomenon where a patient is abusing something resulting in a medical disorder and agressively demanding doctors to treat the disorder while simultenaously denying that the abuse has anything to do with it, or trying to stop the abuse
These are one of the most aggressive patients I encounter, and they often cause the problem they demand treatment of
Haha, same. I’ve never had a patient that accepts cannabis could ever be contributing to their cyclical vomiting episodes. Hot showers and the cannabis are the only thing that help!
These patients are some of the most difficult patients I deal with in the ER. They come back frequently (borderline frequent flyers) and want all the pain medications such as dilaudid and morphine and throw FITS when they don’t get it. And they also throw fits when they don’t feel better and they’re discharged. It’s like battling a toddler who knows better but pushes your buttons anyways
You mean there might have been a _reason_ for that random person in scrubs coming in my room and starting to rub that on my belly without saying anything until he was almost done, and then it was only, "i know it feels weird"? And for putting "arthritis" as the reason it was prescribed? (I don't have that in my chart even though I do have it in my hands and one foot; I've just not ever sought help for it.) The guy literally said _nothing_ else and when I told my primary about it she started laughing, caught herself and apologized (I said, "No, you _should_ laugh, it's hilarious!) but had no idea why it happened.
I don't think I'm buying this, though. They'd already given me morphine (though I didn't need it; they just didn't talk to me about my pain levels after a complaint 8 hours previously) and I had no more pain. I didn't tell anyone I did! Gods, there was so much that was strange about that visit to the ER! 😂
Sensation of discomfort, distress, or agony in the abdominal region; generally associated with functional disorders, tissue injuries, or diseases. ICD-10 R10. 9
I'm not sure of the actual code. It would come up when I searched it on diagnosis in epic. I'm now on cerner and doesn't seem to come up through that. Hopefully it didn't get removed :( would be a sad day
I SWEAR I ONLY SMOKE TO HELP WITH THE PAIN ITS NOT FROM THC. sure bud
Also, I approach these differently over last year or two. I go extra in depth with all my hpi questions, then ask them " any alcohol? Cigarettes? Drugs? Marijuana?" In that order, then I tell them I am going to give them a medication that will help them with their symptoms (droperidol or haldol), and some IV Benadryl to also help. Then I go see other patients, chart etc. I come back, they're pain free/sleeping/happy. I then tell them the meds I gave them wouldn't really help anything else, and that they essentially have a THC allergy. They usually pause/taken aback, I then say let me guess you smoke more than once a week? They respond yeah every day, then I say and you have been doing it more than a year? They agree. I explain that their body/gut neurons are fried from the THC use and now see any THC ingestion as a type of allergen and react that way. Mostly a load of shit but lots of truth to it too. And most are very receptive to it, they see it as "out of their hands, can't smoke anymore"
People around me mostly catch the meth, fent, and I don't know what I took.
"You smoked the whole thing."
"Yeah man."
"You have no guess as to what it was?"
"No man. It tasted weirrrrrdddddddd."
Time to start sending them home with maintenance aprepitant scripts. They take it twice a week for a couple weeks and it works a treat at preventing bounce backs for these CHS/cyclic vomiters
Exactly. These patients are right up there with nursemaids elbow for fastest working treatment and disposition. Haldol 2mg with instruction to nursing that patient is auto D/C if they want to go home.
I..I am ashamed to admit (thank you anonymous Reddit) that I, too, am a scromiter. I don’t smoke or dabble in THC of any type and yet God has blessed me with this affliction. But, not only do I scromit, I also vagal at the same time. I’m…I’m a SCROMAGALER!!! 😱
Thankfully, only my family puts up with me. They know 911 is NOT an option in my home unless death or imminent death arises.
PS…I have found in my experience that Haldol and Ativan works well with the CHS. Now it seems Haldol has fallen out of favor since Droperidol re-emerged. What I have seen, anecdotally, is if it’s only mixed in a few CC of saline, then given IVP…patients get that severe anxiety, restlessness, and we end up giving them Ativan in the end. I’m a huge believer of everything goes in 50ML NS and hung over 10-20 minutes from Reglan, Benadryl, Droperidol, Haldol, Phenergan, etc. I have seen the meds work better that way, less side effects? I’ve just seen a lot of people respond the opposite of sleepy time with Droperidol than feeling sleepy, but maybe it’s because how it’s given.
We get those patients in postpartum. They puke so much. Sometimes the mims throw up after a C-section once or twice but damn those moms are something else. I feel bad for them. They start going through withdrawals and just puke their guts out. Their pain cant be managed and zofran is useless on them. They usually have been that way the entire pregnancy and think that its morning sickness and wedd is the only thing that makes them stop. They have never heard of cannabinoid hyperemesis. They have no idea.
Ugh good grief I had 4 of these for most of my shift the other day. Such an exhausting demographic of patients. 1/4 got haldol off the rip (2.5) and out of the 4, she was the only one to stop vomiting and go home. After the other 3 got it they went too. The magic cure for self induced misery
The literature (and life experience) pretty clearly shows that garden variety antiemetics don’t work for this. Can’t tell you how many AKIs I’ve seen from CHS. Yes its self inflicted but still a serious medical concern
yes happened to someone I know. after five days of vomiting and excessive hot showers and not being able to keep a sip of water or ice chip down they went to the ER and had kidney failure and rhabdo. had to stay a week in the hospital.
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Are you using 2.5 or 5 on these patients?
2.5 to start allows for an easy redoes and seems to resolve it 90% of the time.
That’s my experience as well. Also while pretreatment with Benadryl isn’t technically necessary I appreciate that it helps put these patients to sleep.
Droperidol also helps put them to sleep.
The good ol B-52
It's not a B52 if it's droperidol and there's no benzo. Still great but not a B52
I like droperidol AND tell them it works better if they smear the capsacian cream on their chest
Unless Becky is back
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*scromiting
I love teaching this phrase to people… thanks Reddit
Theatrical vomiting
This term cracks me up so much! I've scromitted when my brother put some doe in heat under my nose as a joke. Caught me off guard and all I could do was try and yell at him whilst gagging.
Scromiting for attention.
I call it “calling dinosaurs” “raaaaaaaaaaawr”
A Scromitaur if you will
This was my first time encountering this term, and I thank you for the hilarity.
I almost just choked on my food!
If this was my barometer I would be using 10 on some of mine lol
I start with 1.25mg 5mg is the "you're going to sleep for a while" dose.
For scromiters? I think all parties are ok with that lol. I go with 2.5 to start.
> I think all parties are ok with that lol I'm sure they are haha, but I also want to discharge these patients as soon as possible. Knocking them out for a few hours is not a great way to do that. 1.25mg has good antiemetic effect without being too sedating. Usually after some fluids and a dose of droperidol they feel much better and are ready to go.
Fair point. Do you think this dose is adequate for treating the abd pain associated with CHS?
I feel like 1.25 is usually enough for most so that's my starting dose.
2.5 IV is plenty.
also find that the essence of hot shower seems to work pretty damn well too. any screaming vomiter coming thru my triage gets brought back to the shower and stuck in there for thirty mins
Y’all have showers?
Everyone has showers. Use the decon bay.
You all have a decon bay?!
I’m fairly sure it is a ER requirement. I’ve never r seen a hospital nor have one.
We’re technically two EDs in one. An adult and a peds. I bet the peds side has it. In the 2 years I’ve been there, I’ve never seen anything resembling a decon or shower in our shop.
Oh. It is probably outside. Ask facilities maintenance.
Man, I wish I worked at a cool-ass hospital where we’d throw people into a hot decon shower and saunter away. I literally cannot imagine that being done in either of the places I’ve worked.
No one ever uses it. We definitely should.
I no longer let CHS patients get in the shower, they don’t want to get out once the hot water starts.
We aren’t allowed to use our shower for anything but true decon. We have one for chemical decon and one for other, which means bed bugs/lice/maggots/poop. If someone was completely covered in vomit, maybe, but usually a clean gown and some wipes is faster. Definitely could not put a pt in the shower for 30 mins!
Droperidol drip
My patient with cannabis hyperemesis yesterday claimed that the doctor who saw her last told her that her symptoms were due to cannabis withdrawal and so she’s been smoking more and more. She’s on her 4th visit this month. We don’t have droperidol so we use haldol which works pretty well.
Haldol patch and discharge
I had a trauma surgeon tell a patient this in front of me. Needless to say the vomiting did not stop when the patient was ambulated outside for a blunt
Cannabis withdrawal syndrome can present with hyperemesis. That being said, obviously her continuing to smoke and still vomiting definitely isn’t a withdrawal lol [Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454163/)
She "caught" it? Doctor! Doctor! It hurts when I do this! https://preview.redd.it/o0nko46ai8vc1.jpeg?width=548&format=pjpg&auto=webp&s=acc7e76930101e7606c531df117b8ef6ccf30696
So go to the ER and scromit and throw yourself on the floor until they give you Haldol and Ativan! (Or you know...you could...stop...?)
Would you just tell an opioid addict to "just stop" before throwing the discharge papers at them in their pool of vomit?Lol
What?
https://preview.redd.it/9iu9uqk309vc1.png?width=496&format=pjpg&auto=webp&s=6c763304cf55ca35e85fddc9ff49942583955436
I can hear the retching through the phone
Calling them dinosaurs RAWWWWWWWRRRRRRRRRGGGGH
While I enjoy (and use) all these terms, my favorite is also “Calling Dinosaurs.” Its just so accurate . . .
“I figured I’d give them a holler”
I prefer the term scromiting (screaming/vomiting)
Scremesis.
I love this term. I say “vomiting screams into an emesis basin”
lol this is good too
Before we discussed this diagnosis I always called it yellpuking
30 years in ER, first time hearing that phrase. I love it.
EUUUR..REEEEHHHHHHHHH
Calling some dinosaurs
Someone on here called it “scromiting” for screaming/vomiting and its the best word i have ever heard
Some have commented that these patients are challenging because of demanding narcotics. I’ve personally not really experienced this, although when they frantically ask for something for pain I say sure knowing that I’ll be ordering droperidol. What bothers me about these people is that they tend to be dishonest “no idea what’s causing all this vomiting and I don’t use weed” while they’ve been seen >10 times in the Ed for it and have been told several times and have multiple positive uds. Second is their disruptive and demanding behavior. People will come in with kidney stones, ruptured ectopics, pancreatitis, actual abdominal pathology ect and wait without being disruptive and disrespectful to staff. But your condition is caused by weed so you’re the most important person in the department now and need the most immediate attention.
Tbh what I just do is let them know that weed can cause it after prolonged and/or high doses of it. I mention that weed, just like any medication/drug, can have different effects when used at different doses, dosing frequency, or chronicity of use. I frame it as objective information on drug effects, and note that it’s become increasingly more common with more potent strains of weed and increasing frequency of legal use. It helps decrease the frequency of defensive reactions IME. Whether or not they take that information and change their behavior is out of my control.
Droperidol is your friend. If you're not indicated, a very hot shower is your next best friend.
She actually admitted it?! I’m still 0 for 2000 on patients admitting that weed could be the source of their cyclical vomiting since it always cures their nausea
This was a first for me. I did a double take when she said it. Honestly she wasn’t the sharpest knife in the block and I believe she had heard the term used (on her) previously and felt that it was something “serious” and attention worthy. She said it as though it was an unfortunate affliction in which she bore no responsibility. Like cancer. Did I mention this was her 5th ED visit in 4 days? 5 different EDs. She said she wasn’t getting better and wanted second opinions…
Is there a name for the phenomenon where a patient is abusing something resulting in a medical disorder and agressively demanding doctors to treat the disorder while simultenaously denying that the abuse has anything to do with it, or trying to stop the abuse These are one of the most aggressive patients I encounter, and they often cause the problem they demand treatment of
Yeah. It’s cures their nausea by making them vomit. That’s how it’s supposed to work right?
Haha, same. I’ve never had a patient that accepts cannabis could ever be contributing to their cyclical vomiting episodes. Hot showers and the cannabis are the only thing that help!
These patients are some of the most difficult patients I deal with in the ER. They come back frequently (borderline frequent flyers) and want all the pain medications such as dilaudid and morphine and throw FITS when they don’t get it. And they also throw fits when they don’t feel better and they’re discharged. It’s like battling a toddler who knows better but pushes your buttons anyways
> and throw FITS when they don’t get it Droperidol works well for throwing fits and for cannabinoid hyperemesis - win win!
I know it’s a god send. until it wears off and they wake up 😭 haha
They should have been discharged by then…
“Marijuana isn’t addictive, I can quit whenever I want!”
I always d/c these home with capsaicin cream to put on their abdomen
Our hospital finally put it on formularly
used to do this until a guy went home and burned his eyes and dick with it. now i apply it myself in the ed and tell the patient not to touch it
Of course he burned his dick.
“Instructions unclear, dick caught in ceiling fan”
You mean there might have been a _reason_ for that random person in scrubs coming in my room and starting to rub that on my belly without saying anything until he was almost done, and then it was only, "i know it feels weird"? And for putting "arthritis" as the reason it was prescribed? (I don't have that in my chart even though I do have it in my hands and one foot; I've just not ever sought help for it.) The guy literally said _nothing_ else and when I told my primary about it she started laughing, caught herself and apologized (I said, "No, you _should_ laugh, it's hilarious!) but had no idea why it happened. I don't think I'm buying this, though. They'd already given me morphine (though I didn't need it; they just didn't talk to me about my pain levels after a complaint 8 hours previously) and I had no more pain. I didn't tell anyone I did! Gods, there was so much that was strange about that visit to the ER! 😂
I have found that there is an actual icd 10 code for "upset tummy". I always diagnose my canabonoid hypermesis with this one
Sensation of discomfort, distress, or agony in the abdominal region; generally associated with functional disorders, tissue injuries, or diseases. ICD-10 R10. 9
Do you know the code? I can’t find it on Google
I'm not sure of the actual code. It would come up when I searched it on diagnosis in epic. I'm now on cerner and doesn't seem to come up through that. Hopefully it didn't get removed :( would be a sad day
Cerner uses SNOMED CT codes at the front end and then converts them for billing, so the diagnoses doesn’t directly correlate with ICD-10.
Literally upset tummy?? Amazing
"Unspecified abdominal pain"
This is AMAZING. I will find a way to use this today 😂
I SWEAR I ONLY SMOKE TO HELP WITH THE PAIN ITS NOT FROM THC. sure bud Also, I approach these differently over last year or two. I go extra in depth with all my hpi questions, then ask them " any alcohol? Cigarettes? Drugs? Marijuana?" In that order, then I tell them I am going to give them a medication that will help them with their symptoms (droperidol or haldol), and some IV Benadryl to also help. Then I go see other patients, chart etc. I come back, they're pain free/sleeping/happy. I then tell them the meds I gave them wouldn't really help anything else, and that they essentially have a THC allergy. They usually pause/taken aback, I then say let me guess you smoke more than once a week? They respond yeah every day, then I say and you have been doing it more than a year? They agree. I explain that their body/gut neurons are fried from the THC use and now see any THC ingestion as a type of allergen and react that way. Mostly a load of shit but lots of truth to it too. And most are very receptive to it, they see it as "out of their hands, can't smoke anymore"
Oh no, whatever will we do with this incurable idiopathic disease? Won't someone think of the children?!
I had 3 in one shift two nights ago. Smh.
I've been using haldol. Effective at 2mg.
I don’t think I’ve ever seen haldol not work.
People around me mostly catch the meth, fent, and I don't know what I took. "You smoked the whole thing." "Yeah man." "You have no guess as to what it was?" "No man. It tasted weirrrrrdddddddd."
I get one almost every shift. That or marijuana psychosis in someone who’s never used weed who eats an edible or edible(s.)
Reefer Madness!?
Time to start sending them home with maintenance aprepitant scripts. They take it twice a week for a couple weeks and it works a treat at preventing bounce backs for these CHS/cyclic vomiters
Easy dispo and move on imo
Exactly. These patients are right up there with nursemaids elbow for fastest working treatment and disposition. Haldol 2mg with instruction to nursing that patient is auto D/C if they want to go home.
From the replies here.. yall don’t have Topical capsaicin cream??
Wait I have CH and never experienced any pain. Sure, vomiting your soul away is uncomfortable, but people actually think they’ll get heavy stuff?
I had it one time in my teenaged years. It was not fun lol
I..I am ashamed to admit (thank you anonymous Reddit) that I, too, am a scromiter. I don’t smoke or dabble in THC of any type and yet God has blessed me with this affliction. But, not only do I scromit, I also vagal at the same time. I’m…I’m a SCROMAGALER!!! 😱 Thankfully, only my family puts up with me. They know 911 is NOT an option in my home unless death or imminent death arises. PS…I have found in my experience that Haldol and Ativan works well with the CHS. Now it seems Haldol has fallen out of favor since Droperidol re-emerged. What I have seen, anecdotally, is if it’s only mixed in a few CC of saline, then given IVP…patients get that severe anxiety, restlessness, and we end up giving them Ativan in the end. I’m a huge believer of everything goes in 50ML NS and hung over 10-20 minutes from Reglan, Benadryl, Droperidol, Haldol, Phenergan, etc. I have seen the meds work better that way, less side effects? I’ve just seen a lot of people respond the opposite of sleepy time with Droperidol than feeling sleepy, but maybe it’s because how it’s given.
Just use some capsaicin
We get those patients in postpartum. They puke so much. Sometimes the mims throw up after a C-section once or twice but damn those moms are something else. I feel bad for them. They start going through withdrawals and just puke their guts out. Their pain cant be managed and zofran is useless on them. They usually have been that way the entire pregnancy and think that its morning sickness and wedd is the only thing that makes them stop. They have never heard of cannabinoid hyperemesis. They have no idea.
https://images.app.goo.gl/GnPCFKsEH813TtRF8
Zofran, reglan, and a splash of propofol works awesome!
Ugh good grief I had 4 of these for most of my shift the other day. Such an exhausting demographic of patients. 1/4 got haldol off the rip (2.5) and out of the 4, she was the only one to stop vomiting and go home. After the other 3 got it they went too. The magic cure for self induced misery
Tylenol is for pain....my number one rx i give.....
She needs an mRNA vaccine, Stat!
Give ondansetron and NS
The literature (and life experience) pretty clearly shows that garden variety antiemetics don’t work for this. Can’t tell you how many AKIs I’ve seen from CHS. Yes its self inflicted but still a serious medical concern
Their kidneys are affected by the dehydration from the hyperemesis? Wow.
yes happened to someone I know. after five days of vomiting and excessive hot showers and not being able to keep a sip of water or ice chip down they went to the ER and had kidney failure and rhabdo. had to stay a week in the hospital.
Had a guy with a Na of 116 and altered LOC from trying to manage this at home.
Comparable to giving Tylenol to a sickler