pain in the ed - page 19

by MAGIK GIRL 24,348 Views | 189 Comments

i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick. our er uses the pixis and... Read More


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    pain may be what the patiient SAYS, but pain is also what I SEE............ Yes I have a high tolerance for pain, but I am not going to be talking on the phone and eating fritos when I am in the er for abd pain. I am not going to have a HR of 78 with a pain of "10" I am not going to get a prescription for pain meds, and hide it in my bra, only to have my "boyfriend" try to wrestle it out of me in the parking lot. (He only got toradol)

    I have been an er nurse for a long time. but I will not give up the battle. Unlike Teeituptom, I will not "roll over". These people do not warrent my time or the time of truly sick people. Get Out Of My ER! ( go to teeituptoms )
    10MG-IV likes this.
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    Quote from erdiane
    pain may be what the patiient SAYS, but pain is also what I SEE............ Yes I have a high tolerance for pain, but I am not going to be talking on the phone and eating fritos when I am in the er for abd pain. I am not going to have a HR of 78 with a pain of "10" I am not going to get a prescription for pain meds, and hide it in my bra, only to have my "boyfriend" try to wrestle it out of me in the parking lot. (He only got toradol)

    I have been an er nurse for a long time. but I will not give up the battle. Unlike Teeituptom, I will not "roll over". These people do not warrent my time or the time of truly sick people. Get Out Of My ER! ( go to teeituptoms )
    When will the ED get it through their head?
    Pain is what the PATIENT says it is. Nothing more, nothing less.
    I dun't care what you SEE. I stand up to fast I see a few stars. But they're not real.
    I've just about decided that the ER forum has become a ******* contest. A virtual, I kept this patient in pain longer than you did. It's really quite sick.
    More sickening, is this mindset that as the nurse, there is some great ER NURSE in the sky who will rein their wrath onto you for giving an IVP of 2mg Dilaudid. The burden in this instance is going to be falling on the prescriber, and I hate to tell you, but it isn't you. Finally, no one is asking you to roll over. UNLESS, we're talking about an arm, so you can find the saline lock, so you can administer the medication that your SUPERVISING CLINICIAN ORDERED.

    I'm not backing down on this one.
    I understand that it's hard to change years of training and practice, but while you're deviating from proper standards, people are suffering.
    I do not understand though, why people are so resistant to change. Just because you've been intubating the anus for years, doesn't mean a change to the other end of the spectrum wouldn't do your patient a world more good.

    Dave, who's not attacking you, but is sick and tired of the whole troglodytic way of thinking.
    ktwlpn likes this.
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    Thanks for the flame job ERDIANE, wheres my fire retardant suit, smoking.
    Roll me over in the clover.

    In years past, I used to track FFers and Drug Seekers and such. But I have sustained so many knife wounds to the back on that score adn maybe I have just mellowed with age. But I leave the determination of treatment to the MD as he or she sees fit. Now I may occasionally roll my eyes heavenward, but then I also feel that it is better to err on the side of pt comfort.

    But then again maybe Im just getting to old to battle and I like my b/p where its at.
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    -Dave, who reminds people that PAIN is what the PATIENT says it is...not the Nurse/PA/NP/DO/MD says.
    yep the pain is what your patient percieves it to be., i've almost been a nurse 1 year and still hold this to be true. xoxo Jen
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    Quote from hogan4736
    I disagree

    Let's just give the shoplifter the merchandise he wants in the store then...
    GOOD GOD, AND YOU THINK THE Er is clogged up with moles colds and sore holes now, just wait till the "let 'em have it" mentality is in vogue.( from a furniture store in new orleans, you gotta see to believe it... I say I say I say I say I say......... let 'em have it. See the Special Man.
    http://www.bestviral.com/video/8856/...ure_commercial LET 'EM HAVE IT)
    " what, you want a BO-TOX shot today...." Let 'em have it", how about a nice enema for your 89 yr old granny that hasn't pooped for 15 days, see the special man..... sweating too much, ingrown hair, pimple on your #$%?? need a pill for that?
    "let em have it" Can't get it up, CHO to high, Hair falling out, Pain you say, dilaudid is all you can take :::: no problem... here is the menu, just choose your appetizer, entree and dessert, we will have it out shortly,
    would you like an EKG or some LAB work with that, we have A special on CT scans today.... why bother getting a MEDICAL DEGREE??? JUST GIVE THEM SERVICE WITH A SMILE....http://www.bestviral.com/video/8856/...ure_commercial


    I need to sell real estate.
    Last edit by 10MG-IV on May 3, '08
    Dragonnurse1 likes this.
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    Ya know I used to have people come to the ER ( Ijust do triage now, I don't have to take care of them in the back) mostly women with fibromyalgia who would say, "I have pain medicine at home, I take (insert your favorite narcotic here), and it's not helping at all. I just want to know what's wrong with me, none of it makes sense they would say. I didn't believe these women, I thought they were just drug seeking nutties. But know I have, RA, OA and ankylosing spondylitis and I take (insert your favorite narcotic here) and it doesn't help and "I" don't understand why nothing is helping and can't someone please tell me what is really wrong with me??? Of course, I don't go to the ER 3 times a week and ask this question. But.... I can relate to where they are coming from. Tom has the correct answer, your perception is your reality in all things.
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    We wanted menus printed so the patients - oops customers- could pick out what they wanted and throw in a bag of fries with it.

    2nd place was a drive up where we would serve fried chicken and beer. How much you got was based on how much cash you had. Work excuses were the freebie with that.
    10MG-IV likes this.
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    Quote from LilgirlRN
    Ya know I used to have people come to the ER ( Ijust do triage now, I don't have to take care of them in the back) mostly women with fibromyalgia who would say, "I have pain medicine at home, I take (insert your favorite narcotic here), and it's not helping at all. I just want to know what's wrong with me, none of it makes sense they would say. I didn't believe these women, I thought they were just drug seeking nutties. But know I have, RA, OA and ankylosing spondylitis and I take (insert your favorite narcotic here) and it doesn't help and "I" don't understand why nothing is helping and can't someone please tell me what is really wrong with me??? Of course, I don't go to the ER 3 times a week and ask this question. But.... I can relate to where they are coming from. Tom has the correct answer, your perception is your reality in all things.
    this rant is all over the place so bear with me.....
    BUT WHY ARE THEY IN THE ER AT 4am on a Wednesday with 4 bottles of various meds schedule 3+4. The Primary needs to do a better job with pain control give them a rx of 4 different drugs 3 tabs each. a sampler if you will to discover which pill works best. yes Pain is real. Then on the other hand are the seekers that take advantage of us, that
    P* I* S* S* E* S me off too. It is a thin line isn't it?
    It is amazing how you can give some folks morphine 10MgIV and it doesnt do a thing for them, pain is still there,10/10 no slurr in speech, still tachy bp still elevated, but 1-2 of Dilaudid, voila, chill. BTW Dilaudid works wonderfully fast but not too fast,given SubQ and they won't puke on your shoes that way............
    I was the most liberal narcotic pushing HEME ONC nurse, My motto, it doesn't do you any good locked up in the Narc box. Lets get you just a taste to take the pain down a little but not knock you out. So many people are afraid of Narcotics because,even with the DX of CA they thought they would be addicted. Back to the ER......The ER is Clogged up BECAUSE we marketed the ER as a Quick Fix for any ailment back in the '70s as a way for hospitals to make $$$$ remember the "doc in the box" phenom? and now we are reaping what we sow.
    Last edit by 10MG-IV on Sep 17, '08 : Reason: spelling
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    Quote from magik girl
    resources should not be doled out based on the aggressiveness of a patients' demands.


    __________________________________________________ __________________________________________________ ____


    i am not heartless. i realize that pain hurts, but the moral of this is, put it into perspective. )
    i hope i never end up in your er with you as my nurse! four years ago, on a friday morning, i touched base with my internist because i was suddenly and without warning, hemorrhaging rectally and in agonizing pain and my internist told me to quit being melodramatic because it was probably only a few drops of blood and most likely indigestion. good thing i went to the er or i'd have bled to death while in considerable pain from a perforated ulcer. last fall, i injured my right shoulder and tore the rotator cuff i had torn 25 years ago when a very large biker who was high on pcp attacked me when i was a psych nurse. same internist told me there was nothing wrong with it except overuse. when i finally got in to see my ortho a couple of weeks later, the same diagnosis i had made was confirmed. the ortho injected cortisone and ordered more pt. pt that my internist and the er had said i didn't need because i was overdramatizing. i live with chronic pain that is seldom below a 5 or 6 from several sports accidents and some work-related incidents but i use a combo of ice, heat and xstrength tylenol because i don't like that buzz feeling. i took an nsaid until the ulcer (which i didn't know i had) perforated but can't now. i shudder to think how you would have treated me. btw, my old internist no longer has his license...

    sharpeimom
    dreamin' likes this.
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    Good Grief, why are we attacking each other on this thread? It does not matter what your "personal" take is but face it there are thousands of drug seekers in this country and we (the ER Docs and nurses) enable this habit.

    I have suffered with migraines, herniated disks both cervical and lumbar, permanent brachial radiculopathy on my right arm and I am right handed, I have had ulcerated my stomach, been given cortisone injections and currently receive blocks to relieve the edge of my back pain. I worked in the same ER where I went as a migraine patient. I have true compassion for true migraine-rs but I can spot a fake from 60 feet. I know the routine. My life became so much easier when I found reglan. But many of my patients were allergic to reglan but could not remember how it affected them or even when they were given reglan.

    I made the mistake of starting an INT. in patients only to have them run out of the ER with their new, nice safe injection point for the drug of their choice without worrying about dirty needles. Crying and hyperventilating with a HR of 65, BP of 120/70 and a sat of 99 does not equal PAIN in any language!!!:angryfire

    Before my nasty tangle with latex and other misc related items I worked nights in the ER, I was asked more times than I can remember to go assess the "real pain level" as many of the ER Docs called it. I would go wherever the patient was and after my assessment I would return to the desk either with IV supplies and a med request or a headshake.:smackingf
    Many patients were about to be released with nothing done and they needed relief, but some just were seeking. Many of our regular seekers were well known to the police for selling their pain meds on the street and then returning for a refill.

    Patients in the hospital should not be treated the same as ER patients. Cancer, sickle cell, kidney stones, and trauma patients need every bit of pain management they can get and most deserve more that Doctors are willing to give. I personally gave one man 34 mg of morphine and he was still in pain and completely coherent. We began to suspect something else was on board but no he just "JUST" had kidney stones and was suffering a sickle cell crisis at the same time. Are you going to treat this man the same as the know seeker waiting for their prescription for drugs????? I hope not

    We all have different views on drugs and ER patients but we should all be able to treat patients in real pain better than the patient waiting a prescription and showing obvious signs on coming down off their high desperate to get to the street to trade Lortab 10 for crack cocaine.


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