DDD/numbness/pain

  1. 0
    Hello all,

    Question for you... How many times have you treated a pt who has Degenerative Disc Disease but has presented with new onset of sx which are severe pain and numbness/weakness in one arm? How have you treated? Do you see this often?

    We had a pt come in, had all of the above, couldn't get in to see her ortho for another week and was clearly in pain. I wasn't too thrilled with the docs attitude in relation to the pt as she's been in twice before with ovarian cysts (4cm+) and he acted as though she was seeking. Ordered an xray and saw some degeneration (as she stated, C-5 - C-7) and ordered IM Toradol. After 45 minutes, pt stated no relief and dr VERY reluctantly ordered IM 1mg Dilaudid. Pt had relief at that point. He insinuated to me and another nurse that DDD couldn't be "that painful", but as someone who also suffers from it, I couldn't disagree more. He said the Toradol should have been sufficient, plain and simple. So I'm wondering, if you've had a pt with the above (suspected cervical radiculopathy), were your drs as callous as this? And what was your tx?

    Thanks in advance!
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  3. 7 Comments so far...

  4. 0
    I don't necessarily think it's callous to note that DDD is not a problem we're going to solve in the ED. Neither are ovarian cysts, for that matter. For both these dx ... the ED's role is to evaluate and refer to appropriate specialty.
  5. 0
    The doc is an idiot. DDD can be horribly painful. That being said, Altra's right, what is the ED going to do for the patient? Pain meds and then the patient needs to call his/her orthopedist in the am.

    Edit--if the numbness/weakness is severe and acute, an ortho consult is warranted.
  6. 0
    Quote from Aurora77
    The doc is an idiot. DDD can be horribly painful. That being said, Altra's right, what is the ED going to do for the patient? Pain meds and then the patient needs to call his/her orthopedist in the am.

    Edit--if the numbness/weakness is severe and acute, an ortho consult is warranted.
    The patient couldn't get in to see her ortho for another week that's why she was at the ER.

    In my case it was a nurse who got all snippy with me when I had my problem. She quickly changed her attitude when the ER doctor order muscle relaxants, steroids and pain killers by injection for my severe pain.
  7. 1
    Sounds like you did the correct thing. Here in oz we are taught that pain is pain. We have no right to assume a patients pain level as they are all different and what works for one person may not necessarily work for another. The doctors are taught this too. C5-C7 would be painful and quite frankly i would have thought the doctor would have her admitted at least overnight to monitor the numbness as it may well have increased. We do admitt when it is spinal degenerative or not and it is treated very seriously straight away. No questions re pain relief start low dose and adjust as required Drs here are good about it.
    Keep_Calm likes this.
  8. 0
    We always do a combo Flexeril/Toradol. If they get no relief after 30 minutes, our docs will usually order 2-4mg of morphine.

    If they've had long standing DDD then our ED will give a script for Flexeril and Ultram and tell them to follow up.

    Anytime my ED docs question giving pain meds, my reply is always, "how would you feel if you were in true pain but could not get relief?" Usually that does it for them.
  9. 0
    duplicate threads merged.
  10. 0
    Thanks all - I appreciate your insights. Felt bad for the poor girl, she was obviously in tremendous pain. As an aside, she returned days later for exacerbated sx, increased numbness/pain, and after a consult with her ortho and an MRI it was determined that she's suffering from Cervical Disc Osteophyte Complex in the C5/C6 - spur pressing against her spinal cord. Yeeouch! That could certainly explain the pain!


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