Treating pain in ER

Butterfly0328 · Apr 14, 2011

same med, different formulation, therefore NOT the same thing.

I couldn't have said it better. I knew they were the same, but different, but just didn't know how to explain it. You explained it perfectly. Thank you.:)

Toquay · Apr 19, 2011

I left in about the same pain I arrived in, only not vomiting. I made it a point to tell the Dr that I unfortunatelly have a high tolerance to pain meds, but he didn't care. Said chronic pain isn't treated in the ER. I thought if someone comes into the ER in chronic pain it must be treated, regardless of the cause. I wasn't asking or and RX or narcs, as I already had that at home, just wasn't working with this severe pain.

Just a question for the OP, since it seems vomiting was relieved why not go home and take the RX's you already had?

Toq

Butterfly0328 · Apr 19, 2011

That is what I did, however, the pain I was having was so severe that the medication I had at home didn't even touch it. It is still a mystery as to what exactly happened and why I was in so much pain, but thank God I am feeling much better.

Music in My Heart · Apr 19, 2011

A few observations...

1) I'm sorry that you're dealing with the chronic pain thing. Whoever suggested that you might rethink nursing as a career is probably right. Clinical nursing is pretty unforgiving.

2) Every doc has their own approach to pain control, particularly in the ED. Some of our docs might have given you 2-3 of Dilaudid along with 60 of Toradol but others would've played it just the way that guy did. You might have gotten some Ativan to go along with 'em.

3) Our society has become very intolerant of discomfort and we have an expectation that pain should be immediately eliminated. The reality is that, while you did suffer for awhile, it sounds like you did recover. Some docs just don't ascribe to the philosophy that we should be pumping the super-narcs until the pain gone; others, though, do.

Be aware that the state and feds are cracking down on docs who are perceived to be over-writing for narcs.

Also be aware that opioid-tolerant folks are much more difficult to deal with because their therapeutic thresholds are very near the toxic thresholds and it's easy to push these folks over the edge and kill 'em. It's happened more than once in our neck of the woods where chronic pain folks with other narcs at home have gone home and woke up dead d/t the synergistic effects of the various narcs and the required levels to attain pain control.

It really is something to be worked out with the doc who knows you. That doc is just guarding his free time by saying, "go to the ER." The ER docs get tired of the PCPs dumping patients on them because they don't want to take night call.

Esme12, ASN, BSN, RN · Apr 19, 2011

600mg of oxycotin is a lot of a narcotic and roxicodone is oxycontin.Esme12
the comment in bold is not correct!
I once had a patient on 1000mg of oxycontin daily divided into three doses....

They are the same drug.....one sustained relief one immediate relese

ROXICODONE® (oxycodone hydrochloride tablets USP) is an opioid analgesic.

Each tablet for oral administration contains 5 mg, 15 mg or 30 mg of oxycodone hydrochloride USP.

Generic Name: oxycodone (ox i KOE done)

Brand Names: ETH-Oxydose, OxyContin, Oxyfast, Oxyir, Percolone, Roxicodone, Roxicodone Intensol

1000 mg of narcotics IS alot of narcotics!

Esme12, ASN, BSN, RN · Apr 19, 2011

That is what I did, however, the pain I was having was so severe that the medication I had at home didn't even touch it. It is still a mystery as to what exactly happened and why I was in so much pain, but thank God I am feeling much better.

I am glad you are feeling better......((hugs))

Butterfly0328 · Apr 19, 2011

Esme12-Thank you so much.:)

morte, LPN, LVN · Apr 19, 2011

They are the same drug.....one sustained relief one immediate relese
ROXICODONE® (oxycodone hydrochloride tablets USP) is an opioid analgesic.
Each tablet for oral administration contains 5 mg, 15 mg or 30 mg of oxycodone hydrochloride USP.
Generic Name: oxycodone (ox i KOE done)
Brand Names: ETH-Oxydose, OxyContin, Oxyfast, Oxyir, Percolone, Roxicodone, Roxicodone Intensol
1000 mg of narcotics IS alot of narcotics!

Yup, still rousable and oriented.

Kooky Korky, BSN, RN · Apr 20, 2011

Call your family doctor if you are having pain. don't let it get so bad that you need to come to ER. You need to be specific about your pain. If you're having pain in 3 different areas at the same time, it's hardly an acute condition unless it's related to recent trauma. You mentioned you had spinal stenosis, kidney stones, and neuropathy. These are all chronic conditions, and while I do believe they flare up at times, it is important that you be on the proper medicine to prevent the flare ups, and also do the appropriate things to make your life better, such as not drinking tea and eating all the Brewster's ice cream you can find. And for god's sake, stay away from the damn cupcakes and carboyhydrates if you are overweight or diabetic.
It sounds as if you became addicted to pain killers. I probably would not give you pain medicine either to be honest. I would just be adding fuel to the fire, and you will just come back another time for the same thing.

So what WOULD you do for her, Pete?

Kooky Korky, BSN, RN · Apr 20, 2011

A few observations...
1) I'm sorry that you're dealing with the chronic pain thing. Whoever suggested that you might rethink nursing as a career is probably right. Clinical nursing is pretty unforgiving.
2) Every doc has their own approach to pain control, particularly in the ED. Some of our docs might have given you 2-3 of Dilaudid along with 60 of Toradol but others would've played it just the way that guy did. You might have gotten some Ativan to go along with 'em.
3) Our society has become very intolerant of discomfort and we have an expectation that pain should be immediately eliminated. The reality is that, while you did suffer for awhile, it sounds like you did recover. Some docs just don't ascribe to the philosophy that we should be pumping the super-narcs until the pain gone; others, though, do.
Be aware that the state and feds are cracking down on docs who are perceived to be over-writing for narcs.
Also be aware that opioid-tolerant folks are much more difficult to deal with because their therapeutic thresholds are very near the toxic thresholds and it's easy to push these folks over the edge and kill 'em. It's happened more than once in our neck of the woods where chronic pain folks with other narcs at home have gone home and woke up dead d/t the synergistic effects of the various narcs and the required levels to attain pain control.
It really is something to be worked out with the doc who knows you. That doc is just guarding his free time by saying, "go to the ER." The ER docs get tired of the PCPs dumping patients on them because they don't want to take night call.

They woke up dead, eh? :jester: What is "worked out"?

Esme12, ASN, BSN, RN · Apr 21, 2011

Yup, still rousable and oriented.

Depending on the patient....sure.......should they be working with dangerous machinery???? I don't think so........Should that be at the bedside? I don't think so. Nursing is a very physical/emotional/intellectual taxing job......I get one may need this much of a med for pain control.....but it still is ALOT of medicine. BUt now we are off topic....

morte, LPN, LVN · Apr 21, 2011

Depending on the patient....sure.......should they be working with dangerous machinery???? I don't think so........Should that be at the bedside? I don't think so. Nursing is a very physical/emotional/intellectual taxing job......I get one may need this much of a med for pain control.....but it still is ALOT of medicine. BUt now we are off topic....

This was a patient, a bed bound dying patient.......just mentioned the amount to point out the really large amounts that can be taken.