Originally Posted by prmenrs
I had this proceedure done to me yesterday. I haven't had that much pain since I had appendicitis! I was told I got 100 of Demoerol and 5 of versed, but I'm here to tell you IT DIDN'T WORK!! I remember everything, including saying ouch continuously throughout the fun and asking them to stop at least twice.
Can anyone explain why they didn't stop and get the pain under control?
When I asked later why it hurt so much the doc mumbled something about me being "too fat"! (I am fat, but I don't believe that's why it hurt so bad, and if that's really the case, why wasn't I warned ahead of time?)
It's been >24hours, and everytime I think about this, I start crying.
Any insight you can provide would be appreciated. Thanks
Hi,
I do conscious sedation for an endo lab, have done cardiac E/P requiring 360 J shocks previously and have had little problem with pt.s remembering. Docs need a better understanding of c/s, although lo and behold, a few trust our judgement. It has been my experience that more than a few docs don't know their patient. Example: a terminated ERCP. The patient rushed to RR for code due to VT. I pointed out that the patient had an implated defibrillator that was doing it's job overdrive pacing. The doc didn't know. Another example is a doc who was performing a colonoscopy and couldn't understand the anatomy he was seeing. I advised him that the patient had a history of partial colectomy, and had to read his H&P to convince the GE of the patient's history. He was viewing an anastomosis. These things make the nurse unpopular for pointing them out.
ASA score done correctly are a good index to start, meds regularly taken, and simply asking the patient their experience with painkillers and the like. Let them vent their anxieties, annswer questions, help them to feel at ease. I used to play Tai C'hi music in the background with low lights and soft verbal suggestion, as well as accupuncture point stimulation. It is controversial as to the power of suggestion, I think it works. I have probably put over 2000 people under sedation. That being the case, my gut helps a lot. I use the Ramsay scale and shoot for about a 4. This is an objective scale and has justified my practice on a few occasions.
Some will tell you that if they are on antidepressant/antianxiety drugs they require more painkiller. I have seen nurses just start pushing heavy doses on this class of patient. Wrong! Don't assume anything and start pushing. I usually give a test dose of 1-2 versed without the patient knowing, and observe results as I attend to other duties. Titrate to your desired level carefully and according to policy. I realize that the physician thinks they should be well sedated in 5 minutes or so, which is a violation of policy on most patients. Or they expect that one can just keep pushing drugs after they start the procedure. Getting through the sigmoid with an ill sedated patient is extremely painful, especially if a loop forms. Remember that extreme pain is just as dangerous as oversedation. Read the literature.
I prefer Fentanyl, less side effect, rapid response and recovery, more controllable, less instance of nausea. Why the docs are so hung up on Demerol, I don't know. If you read c/s literature, there is little or no mention of Demerol, fentanyl and MS being the preferred agents. You can't use MS in an endo setting due to the side effect of causing or exacerbating colon spacticity. When you have a patient with an MS implanted pump you have this dual problem of spacticity and delayed reaction where they are difficult to arouse post procedure when everything catches up.
IMHO, practitioners should be familiar with the Ramsay scale and utilize it to achieve optimal sedation without going beyond your constraints of how deep a nurse can take a patient.
There will always be the occasional patient that just won't go down for reasons beyond me, given that they were honest on their history form. So you do the best you can.
My 2 cents=====================snake
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