Too much pain medication - page 2

We have a particular md who orders prn pain meds every 15 min. One of our nurses ended up giving 12 mg Dilaudid over 1.5 hr period to 20 yr old girl for flank and abdominal pain. Pt was not hooked... Read More

  1. by   CEN35
    I work 2 jobs right now. ER and PACU - In the ER most docs I have met are always hesitant to give much more than 50-100 of Demerol much less anything else.

    I can tell you that, one patient will passout after 4mg of MSO4 IV, and the next may take 8MG of IV dilauded, or even (seen it) 235mg of IV MSO4 over 1 1/2 hours.

    Everybody is different.

    However, I would give much more than 75 mg demerol, 1mg Dilauded, 8 mg MSO4 (roughly) without a monitor. Ecspecially when it is right there to be used.
  2. by   teeituptom
    In todays world, where pain relief is everything now. Is there really such a thing as too much pain medicine. It seems we are giving larger and larger doses and within shorter time frames.

    Had a pt with Sickle that we gave dilaudid 10 IV to, then she asked for a cup of coffee and a sandwich,repeated the same shot within an hour.

    Just give them all what they want nowadays anymore.
  3. by   avery
    12.5 mg Phenegran iv q15 min prn pain
    VO/VORB/Dr. soand so/Your name R.N.
    That is how we do it.
    Date/Time/Initials at top
  4. by   Larry77
    Quote from jojotoo
    We semi-routinely give Dilaudid 4mg IV (especially to the sickle cell patients). And may have a repeat order X1. But MOST of us know that doesn't mean to run in at 15 minutes and give the second dose. (It means that in an hour you don't have to bother the MD for a repeat dose.)
    I don't think I have ever given Dilaudid 4mg IV in one dose...Not that it can't be done but I guess I just haven't had those circumstances yet. Now Morphine yes 4mg IVP is usually the starting dose unless elderly or young. I think all the Dilaudid I have given was either 1mg or 2mg IV.

    As mentioned before these "titrate to effect" type px med orders are routine in our dept and often just a verbal...we are very close with our docs, they trust us and we trust them.
  5. by   CEN35
    Most ridiculous ever..............

    Dilauded 4 mg IVP
    Fentanyl 100mcg IVP
    Demerol 50mg/Phenergan25mg Im
    Demerol 50mg IVP
    Morphine 14 MG IVP

    ALL in 1 hr and 10 minutes.

    28 yrs old wide awake complaining we are not helping his pain and denies drug use...........

    hmmmmmmmmmmmm................
  6. by   jojotoo
    Quote from CEN35
    I work 2 jobs right now. ER and PACU - In the ER most docs I have met are always hesitant to give much more than 50-100 of Demerol much less anything else.

    I can tell you that, one patient will passout after 4mg of MSO4 IV, and the next may take 8MG of IV dilauded, or even (seen it) 235mg of IV MSO4 over 1 1/2 hours.

    Everybody is different.

    However, I would give much more than 75 mg demerol, 1mg Dilauded, 8 mg MSO4 (roughly) without a monitor. Ecspecially when it is right there to be used.




    Just double checking on this: You did mean 235mg of Morphine? And not Demerol? That would be TWENTY FOUR vials of Morphine 10 mg!! That would normally wipe out my entire floor stock of Morphine in the ER. But I have given that much Demerol IV to a sickle cell patient over the course of a couple of hours.
  7. by   gr8rnpjt
    First, do no harm.
  8. by   gonzo1
    What was that nurse thinking?
  9. by   MeryMellen
    12mg of Dilaudid! I think a lot of people don't even bat an eyelash at giving 1mg of Dilaudid, but may think twice if given an order for 10mg of Morphine. 12mg of Dilaudid is the equivilant of 96-120mg of Morphine! That's insane!
  10. by   wildmountainchild
    "Pain control is important, but breathing is the "A" in ABC!"

    Ummm......actually, it's the "B".:spin:
  11. by   teeituptom
    Ive seen people get severe Resp depression with Dilaudid 0.5 mg, even with Demerol 25 mg. But on the other hand Ive seen people get 10 mg of dilaudid IV and they ask you for coffee and a sandwich. And ask if they can go outside for a smoke. Why not.
  12. by   RunnerRN
    We have one doctor who is very liberal with pain meds as well. When she was new to our dept, she asked me what the "walking dose" of pain meds was. I was thinking 2-4 of MS, then watch 15 min, then go home. She, however, was thinking 1 of Dilaudid, than out the door. She got very upset with me when the patient was still there 20 minutes later.
    For awhile, we were getting transfers from an outlying hospital who was ODing pts on Dilaudid. One I remember....patient was a burn pt, given MS (I want to say 10mg or so). Pt has allergic rxn to MS, so given 50mg Benadryl IV. C/o cont pain, so given 1 of Dilaudid. Then 1 more. Until he had close to 15!! Initiated ground transfer to our ED (over 2 hrs on ground). EMS had to divert to a hospital en route to arrange air transport because this guy respiratory arrested (you think?) and had to be tubed, and still had over an hour transport time. He was flown to us. The kicker? The kid had a very small burn, and would have just been evaluated and d/c'd.

close