[athomas91]

i am not perpetuating any myths - i do not believe that i ever stated that sedation equals pain relief - i only said that when i wake a snoring patient and they tell me their pain is 10/10 that i believe that to be impossible - perhaps if i gave them 5mg of dilaudid - but let's face it - we rarely medicate patients that heavily........
HOWEVER - after giving a pt w/ a migraine a total of 8mg of dilaudid, 30mg of toradol, 2mg of haldol, 12.5mg of phenergen and i awaken them from snoring and with a smile they tell me their pain remains a 10/10 - GET A CLUE......
the only thing i am perpetuating by believing them is drug abuse.

[fab4fan]

Originally posted by harry Krishna
Come back to reality my friend and get off thy high horse. If someone is sleeping, I would call that pain relief, regardless as to what your "reputable pain mgmt authorities" say.
If what you say is true, then the whole concept of conscious sedation would be ranked up with bloodletting, Lobotomy, and ECT without sedation. What I mean is when you perform conscious sedation (or whatever the PC term of the month for it may be), the person whom you are {reducing a fracture/dislocation etc...) will scream, writh, and shout while you are performng the procedure, yet whne they awaken, they cannot recall experiencing any pain, AND YET we inflicted some serious pain upon the patient while fixing the problem.
There are basically two type of patients seeking pain relief. One is too lazy or broke to drive down to the local corner to score a fix. The other is a person truly in severe pain and if you offer them a medicine "to make them sleep" chances are they will take you up on that offer, regadless if their pain is not totally relieved on some higher metaphysical level.

Well, if you know better than the info according to the Amercian Pain Society, the Agency for Healthcare Policy and Research on pain, the American Society for Pain Management Nurses, etc., you should fill them in.

Sleep is one of many escape mechanisms when a pt is in pain. This isn't my idea, it's in all the recent literature. Take a look at Margo McCaffery's pain mgmt manual...you'll see the same thing.

And I wasn't on my high horse, so I don't get the hostility, but, whatever...

[fab4fan]

Originally posted by 3rdShiftGuy
Please, please tell me you are not a nurse and never will be.

Ditto...big time.

[fab4fan]

As a former ED nurse, I know about "warped humor." Big difference.

[harry Krishna]

OK first off forgive me if my earlier posts seemed a bit smart alic.
What I think is being overlooked here is the actual role of an E.R. in pain management. First one must rule out life threatening illness, second, we can make the patient comfortable. Our job is not the job of Pain Management specialist. I have mainly worked nights over the last 13 years and to be honest, the patient's so called "Pain Managment " PMD either never returns phone calls, is not on call, or cannot recall the patient. Basically they are of no help.
And while it is not a law yet, we are under no obligation (yet) to relieve pain totally. This is what I was attempting to get at earlier, that if someone was truly in 10/10 pain and not someone who frequents the ER, chances are they would relish the chance to sleep. That's all I'm saying.
I've worked all over the country (over 25 E.R's) and it is RAPIDLY BECOMING a major crisis facing E.R.'s. You cannot fault your ER nurse to become jaded by the manipulators that all too frequent the ED's. If they choose to vent their frustrations on this board, that is their perogative. It doesn't make them a terrible nurse.
I also work w/ a local agency in a large metro area. I see the SAME Migraine patients (notice pleural) at 4 different ER's!!!!!!! Come on!!!! And it is all too ironic that they are allergic to NSAIDS, Compazine, tylenol, Phenergan, Talwain, Nubain, etc....
It is sad that these types of patients set a sterotype for the other patients who suffer w/ migraines and do not frequent the ER.
.Enough of my spewing.....

[mrnurse2u]

Originally posted by harry Krishna
And while it is not a law yet, we are under no obligation (yet) to relieve pain totally. This is what I was attempting to get at earlier, that if someone was truly in 10/10 pain and not someone who frequents the ER, chances are they would relish the chance to sleep. That's all I'm saying.
I've worked all over the country (over 25 E.R's) and it is RAPIDLY BECOMING a major crisis facing E.R.'s. You cannot fault your ER nurse to become jaded by the manipulators that all too frequent the ED's. If they choose to vent their frustrations on this board, that is their perogative. It doesn't make them a terrible nurse.

Hear hear! Great points. If a nurse can't vent here, that's a shame.

As for the girl with the sudden need to play the part of a migraine sufferer, there's only so much time a nurse or doctor has to determine whether or not it's legitimate, and they should no more believe another disgruntled patient's "testimony" either.

How sad that some people are all too willing to make fools of themselves trying to get free prescription meds through an ER because they've obviously tried it before and it worked.

Did you hear the one about the 12 year old boy walking into GNC asking for Percocet and shocked when the GNC employee informed him that they don't sell prescription drugs (much less to minors!). How very sad.

[fab4fan]

When I read posts like this, the evil part of me hopes that the poster becomes a chronic pain sufferer for a while, just to be on the other side of the sarcasm, disbelief, and hostility.

Yes, there are people who abuse the system. But to penalize all for the actions of a few is wrong, plain and simple. You cannot make a diagnosis of addiction in a brief ED visit.

There but for the grace of God...

[harry Krishna]

Originally posted by fab4fan
When I read posts like this, the evil part of me hopes that the poster becomes a chronic pain sufferer for a while, just to be on the other side of the sarcasm, disbelief, and hostility.

Yes, there are people who abuse the system. But to penalize all for the actions of a few is wrong, plain and simple. You cannot make a diagnosis of addiction in a brief ED visit.

There but for the grace of God...

But you must admit (unless you have not worked in an ER recently) that there is a growing epidemic of narcotic abusers using the ER to feed their habit(s). And it is not "just a few" as you say. Ask ANY ER nurse to name the "regulars" in their own ER and they most likely can rattle off name and SSN of each pt. Where I work currently, I have only been there three months and I can name 15 people off the top of my head right now.
I am not nulifying a person's suffering and if indeed they are under a 'Pain Managemen MD" I am sure their treatment plan does not include go to the ER whenever the need arises.

[LilgirlRN]

I've worked the ED for a long time. I'm wondering if any of my fellow ED'ers have noticed this.... it's the weekend, most people are not working, means time spent together. Have you noticed how many more women migraine pt's you have on weekend nights? I think they have psychogenic pain, I think they don't want to spend time ( a euphamism for have sexual contact) with their significant other, so suddenly they have a migraine that requires them to come to the ER and get a BIG shot that will knock them out for a while. Now I am not saying that there are not real migraine sufferers, I used to be one so I know. Just wondered if anyone else noticed this?

[dawngloves]

I'll tell you what, due to some recent injuries, I have personally noticed a trend toward undermedicating pts in the ER and on the floors.
Are we that jaded that we think a Tylenol will suffice a broken bone or an Motrin will relieve a migrane?
Pain is now considered a vital sign and is part of a routine assesment. Why do we try and get pts to "tough out" a rating of 8 and hand them Tylenol? Why not the T3 as ordered? Don't deny your patients the pain relief they need.