Do a thorough physical – the missing fentanyl patch

When the ER gets busy, we need to rush things a bit to keep the patients moving. Ordinarily, this is not a big deal, but occasionally things can be overlooked. Years ago, a patient came in with a narcotic overdose on just such a busy day. His wife suspected that he was addicted to pain medications and had been trying to keep it a secret. She also thought that he had gotten hold of some from a relative. These patches release potent narcotics gradually into the bloodstream. Hmm. He was pretty sleepy when he came in, and his pupils were small, consistent with a narcotic overdose, but he didn’t have any patches on his body. He needed to be admitted because of his poor mental status, so those arrangements were made. Later on, the admitting nurse called down to the ER to report that she had found a fentanyl patch. It had been placed carefully underneath his scrotum, where his wife was unlikely to spot it. Fooled us too.