freki 2,206 Views
Joined Dec 8, '09.
Posts: 45 (20% Liked)
The abuse from drug seekers is unacceptable. In Washington there is a law about disrupting a hospital that includes yelling and shouting or otherwise threatening nurses or physicians. I am pretty firm with the people who put on a show and point to that law...and then they usually walk out.
I have been advocating more and more the opioid-free ED (Home). This guy has studies and information about treating common painful conditions with alternatives to narcotics. He has run trials of "shifts in the ED without opioids" successfully. I think part of the problem is that numbing people to their pain with narcotics is the easiest way to deal with patients in a busy environment. Physicians and nurses need to take time and utilize their knowledge and evidence to address pain more deeply, rather than spraying everyone with happy juice. Then those with true pain get the relief they deserve and the abusers come out of the framework.
The only problem I have with your story is whether the family or patient consented first to the transfer. If they were against it and you talked them into, I would say good for you; however if they were against it and you called anyway then you have disregarded a fundamental patient right to choose.
As for the all the ED nurses saying that blood pressure doesn't concern them at all...I think you need to take a step back. I'm an ED nurse, and while I may not be terribly worried about her stroking out, it would at least raise an eyebrow. Especially in a patient who is (I'm assuming) on pain medication and without any complaints of pain or anxiety. She also stated the BP is typically in the 130/70 range...that's a significant difference. Sure, we wouldn't treat that BP alone, but I wouldn't ignore it either. To do so I think would just be negligent. I also want to add that if she is in fact on a bunch of pain medication for her recent femur fracture, then symptomatic pain could have been masked.
I try not to give our ALFs and SNFs a hard time when they send someone in. I may secretly be thinking all sorts of nasty things, but I'm also not in their shoes. And for all the times I've gotten a patient that should have come in days or weeks earlier, I try and appreciate when someone has taken the time to see something in a patient and get ahead of what's going on.
Yeah I've been reading the history on this and it's very interesting! Sounds like subq was kind of the gold standard until flexible angiocaths and then it just went away.
But from the reading, there's a lot of renewed interest specifically because of the hyaluranidase. I've seen demonstrations of 1liter in 30 min without much site swelling at all. And it seems to me that if a momma can hold a kid and get a subq infusion between the shoulder blades they'll be much less fussy and parents will be happier.
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