morphine ivp

[oharnp]

I have several kidney stone patients come through the ED daily as it is common where I work. Every doctor I work with is seeming to decide to go with morphine IVP or Demerol IVP for the patients pain. I have always tried to prescribe a less sedating approach. Zofran,Toradol,and bentyl. I have been aggravated with the docs telling me to order the narcs,because I don't like to prescribe narcs until a underlying cause is verified. And when the patient (As some are) is there once a week with the same complaint or different complaints,seeking pain relief. I will not just jump and order a narcotic when they are several alternative options for effective pain control. I have a young lady who come in every week who has been seen 89 times this year who always is asking for narcotics. Idont give in when I pick up her chart. What do your providers start with? What do your drug seekers come in and ask for ? do they get it? What are some of your seeker stories? and I know there are threads out there like this.

Holy Ef.... IV Demerol for kidney stones? Yikes.

I've done the Demerol dance back in the day (as a patient) and all I can say is, "I understand how heroin junkies become junkies." That's a big ol monkey to put on someone's back and it gets there in a hurry.

Demerol works the charm but nothing to be trifled with.

Toradol with a touch of morphine is the way to go IMO

[oharnp]

As in any and all complaints of pain? Even narcs to a person with sprained ankle pain? Maybe I missed it earlier, what position are you in where the providers are telling you to order something?

Im a nurse practitioner who works in a 69 bed er and the attending docs are constantly telling us the midlevels were not very good at treatingpain.they are telling us to order narcotics as a first line treatment for ALL complaints of pain. yesterday i had a young py.with a stubbed toe for pain i ordered 1 gram of tylenol. the doctor that was there seen the pt. canceled the order dor tylenol and ordered the patient as follows Dilaudid 4mg IVP,valium10mgIVP,and Percocet 10/325 x 2 tabs. i avout died the only thing wrong with the patient was a stubbed toe.

[Gabby-RN]

Where. I work we start with toradol 30mg, zofran 4mg, a liter of NS, and Morphine 4mg q5m x 3 doses. I give the toradol, zofran, fluid, and 1 dose of morphine. Then send them off to CT. The morphine starts to work faster that the toradol and tends to relax the patient a little, enabling them to stay still for the CT . True kidney stones HURT! Many patients never require the additional doses of morphine, many do.

We do not use Demerol in the hospital where I work.

Once the CT confirms its a stone and able to pass, we make sure the patient is somewhat comfortable, has a ride home, give them a screen, a urology referral, some teaching, an Rx for ibuprofen 600mg, percocet 5/325mg 5-10 tabs, and zofran 4mg ODT.

A true kidney stone is very painful, I have no problem giving narcotics when narcotics are needed.

[Esme12, ASN, BSN, RN]

Im a nurse practitioner who works in a 69 bed er and the attending docs are constantly telling us the midlevels were not very good at treatingpain.they are telling us to order narcotics as a first line treatment for ALL complaints of pain. yesterday i had a young py.with a stubbed toe for pain i ordered 1 gram of tylenol. the doctor that was there seen the pt. canceled the order dor tylenol and ordered the patient as follows Dilaudid 4mg IVP,valium10mgIVP,and Percocet 10/325 x 2 tabs. i avout died the only thing wrong with the patient was a stubbed toe.

As a provider the MD is telling you what to do? I'm confused. I haven't seen Demerol used in a LONG time.

Since bedside nurses do not "order" meds this might be answered in the Advanced practice forum.

[Esme12, ASN, BSN, RN]

Im a nurse practitioner who works in a 69 bed er and the attending docs are constantly telling us the midlevels were not very good at treatingpain.they are telling us to order narcotics as a first line treatment for ALL complaints of pain. yesterday i had a young py.with a stubbed toe for pain i ordered 1 gram of tylenol. the doctor that was there seen the pt. canceled the order dor tylenol and ordered the patient as follows Dilaudid 4mg IVP,valium10mgIVP,and Percocet 10/325 x 2 tabs. i avout died the only thing wrong with the patient was a stubbed toe.

Thread moved for best response.

[NP2BeNY]

We do not use Demerol in our ED - ever.

As for those reporting that patients can come in and they have no way of knowing if the patient is seeking or not - NYS has a centralized database for tracking controlled substance RX's. Do other states not do this? Granted, its based on the patient presenting a real ID with the real name, DOB,etc on it but it's better than nothing.

We use Demerol but only for febrile rigors or shivering in post-ROSC induced hypothermia.

[Altra, BSN, RN]

Im a nurse practitioner who works in a 69 bed er and the attending docs are constantly telling us the midlevels were not very good at treatingpain.they are telling us to order narcotics as a first line treatment for ALL complaints of pain. yesterday i had a young py.with a stubbed toe for pain i ordered 1 gram of tylenol. the doctor that was there seen the pt. canceled the order dor tylenol and ordered the patient as follows Dilaudid 4mg IVP,valium10mgIVP,and Percocet 10/325 x 2 tabs. i avout died the only thing wrong with the patient was a stubbed toe.

1 gram of Tylenol, you say? Replaced with Dilaudid, Valium and Percocet?

Hmm. An *unusual* situation, for sure.

[ghillbert, MSN, NP]

It drives me crazy when I tell one of my known drug-seeking patients "no narcs today" when they come into the ER (again) with some new spurious complaint and then one of the fellows or attendings gets called by the ER due to the patient whining and says "sure, give them dilaudid". Exhausting patients. They must spend so much of their time coming up with new crap to compain about. And must also think we are either exceptionally stupid/naive, or will give them the narc just to shut them up.