pain in the ed

Specialties Pain

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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 computerized mar's. the doc orders a drug, you have to wait, wait, wait, and then go to the pixis, get a witness for a waste (if you don't need all of the pre measured dose), and then give the pain patient his dose. never mind the fact that on the way to the pixis you have 6 other things that suddenly need to be done and that pain patient has sent each of his 6 visitors individually at 5 minuet intervals to complain that the 2 hour er stay is rediculous and that he missed his dinner and wants you to fix him something to eat.

by the time you get to the patient, the award winning draumatic preformance is simply breath taking!

now i know that some pain is true. but if i have a kidney stone, an acute appendix, labor pains, or chest pain, the er nurse shouldn't have to come out to the smoking area, tell me to put out my cigarrette, put down my big mac and accompany her to a room where my vs are 120/80 - 70 - 16!

thanks for allowing a "newbw" to vent!

I have frequent visitors to my "fast-track" who are simply there to obtain narcotics; they know I'm a softy. But I gained this attitude in part from doing numerous diaper changes and avoiding airborne vomit while caring for someone in narcotic withdrawal (let's not even dwell upon the times I have had to put central lines in seizing IV drug users-no veins, you know). I have also come to believe that pain is vastly magnified in the opiate-addicted (how they keen like banshees just over being stuck for blood!) because their bodies want the stuff. Nonetheless, all of my chronic pain folk have to endure my speech on the high cost to the user of drug dependence. I ask if the 12 hour wait to see me really makes it worthwhile. I talk up the great times to be had with the local Narcotics Anonymous group (this is very effective when injecting lidocaine into a shooter's abscess that needs lancing). I mention how The Man is sending his kids to college while profiting from their addiction (works with tobacco, too). I also say that I have confidence that they can quit once they make up their minds to do so. So far, 6 of my patients have gone to NA and 4 are sticking it out. One is now in ...drumroll, please...nursing school. :p

:p

a little communication, a little education, and less complication and the world would be a better place.

thank you avigail.:)

i always wonder about those who speak of themselves in third person......

i agree that people can function in pain - however until i walk a day in your shoes or you in mine this debate is going nowhere

you all continue to assume that i am speaking of a patient who has a back inj and ........ IF you bothered to ready any of my posts in their entirety you would see that i actually know these people as well as the doc's know these people and we have evidence that they are selling rx on the street - they are not in pain they are ACTUALLY there for the narc's either for themselves or to sell...... believe it or not it actually does happen.... and believe it or not they actually threaten our lives when we don't give them that 8th dilaudid shot.......

i have all the empathy in the world for those in pain - you all have no clue what my life consists of - perhaps i myself have been a cancer patient..... i just post here at times to vent - to allow a small window into my world - i guess that is too much to ask of some.....

-the real slim shady....

oh - by the way - a little culture never hurts.....

Originally posted by athomas91

i always wonder about those who speak of themselves in third person......

i agree that people can function in pain - however until i walk a day in your shoes or you in mine this debate is going nowhere

IF you bothered to ready any of my posts in their entirety you would see that i actually know these people as well as the doc's know these people and we have evidence that they are selling rx on the street - they are not in pain they are ACTUALLY there for the narc's either for themselves or to sell...... believe it or not it actually does happen.... and believe it or not they actually threaten our lives when we don't give them that 8th dilaudid shot.......

i have all the empathy in the world for those in pain - you all have no clue what my life consists of - perhaps i myself have been a cancer patient..... i just post here at times to vent - to allow a small window into my world - i guess that is too much to ask of some.....

-the real slim shady....

oh - by the way - a little culture never hurts.....

culture is as culture does. i agree, a little culture never hurts! unfortunatley, not all of the people who reply to these threads are as open minded as you. open mindedness....... i think a great quality in an er nurse. you have to be open minded enough not to take every issue or complaint personally and open minded enough to have a sense of humor about things. after all, if we had no place to vent, like our fellow staffers or this bb then the work stress would follow us home..... and well, you know what can happen.

culture is a goooooooood thing! thanks athomas91! i like your thinking.

THE SOUND OF WATER SAYS WHAT I THINK. - lao tzu/tao te ching

:kiss

This is to athomas91 and avigail

I completely respect what you've had to say here. I am very disappointed when advanced practice nurses and similarly experienced nurses trash the views of other nurses. We each have a unique experience that should be considered and respected. Though we all appear to be coming from a patient advocate type of perspective, we indeed do have a lot of variance in them. This is good!

YES! We DO need to be nonjudgemental in our assessments of patients, including pain. But, this needs to be tempered with our EXPERIENCE. I am personally aware of a "sickler" whose a regular in our ED that has a script for (are you ready???) 3200mg of oxycontin q 8 hours!!! I am serious! She then expects this from us in ED for exacerbations. We were all stunned when the doc looked up records on said pt during a recent visit and found this rx! I fail to see how a human being could tolerate that much. This aside, the patient DID get enough IV pain meds to releave her symptoms, though no where NEAR what she was asking for. We all assume, this is a second income for her - keeping the local junkies fixed... Of course, Medicaid (WE) pays for this.

A person's perceptions and personal habits (drug use) do indeed have a drastic affect on their pain perception and how much it takes to get relief. I have no problems with ensuring a pt gets relief. In fact, my biggest problem is getting a reasonable order from a doc for pain control. How many times have you had a huge person with obviously severe pain get a rediculous med order, such as MS 2 mg IVP?

There's a happy medium here, some where. Trashing other nurses opins do not help.

athomas91 and avigail, read this as I am in agreement with you. And, to my learned colleagues that laud themselves over our "ignorant" views: get a life! You should learn to respect your colleagues as much as you respect your drug abusers.

'nuff said!

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"Discretion in speech is more than eloquence."

Sir Francis Bacon

:chuckle

erkev, i wish there was a smily for a standing ovation. but there is not so...... clap clap clap.

life is what you make it.

Thanks, Magik Girl!

Originally posted by MAGIK GIRL

:chuckle

erkev, i wish there was a smily for a standing ovation. but there is not so...... clap clap clap.

life is what you make it.

ERKEV - an er nurse w/ some insight..... thank you....

:D :D :D

Thanks, athomas:D

Nurses need to pull together....

[.

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Dave, who will gladly order medication based on what the PATIENT says their pain is. [/b]

Perhaps it is this attitude by Private Medical Practioners that create the multitudes of drug addicts who frequent their local E.R's. Once the patient becomes annoying or unable to pay for service they are dumped and then have no PMD to take care of them, so they become "slaves to the system" and their only solice is to go to their local ERs for medical attention and "drug fix"

Also from an altruistic point, our primary job as an RN (in my opinion) is to be a patient advocate. Confronting (in a tactful way of course) a patient on inapropriate narcotic use and ER abuse is

not out of the scope of being an advocate.

HK

Also, may I prempt the Moral Majority who may negativly respond to this: first off, I am not accusing Dave (1st or 3rd person) of being a bad practioner, I'm sure he is very good at what he does), secondly, if I (or others) post something negative about medicating patients or meds seekers, it doesn't mean that we are terrible nurses who should look for other lines of work. Open your minds a bit and see we may be coming from a different angle.

On the flip side of that..I worked ER for a long time and Yes. I have seen the seekers over and over again but if we were TRUE advocates we would help them get help instead we either medicate them or refuse them and send them out them out the door to the hospital down the street...then we complain about them?? Addiction is a disease..In my opinion the problem is us and our misconceptions as well as the fact that we tend to think this is the person's own fault. I would agree at one point they had a choice but as addiction progresses there is no longer a choice at least not in the patient's mind. So if we were TRUE pt advocates we would do more than complain about them (maybe we complain about them becasue WE feel helpless to help them??) ..however I have no idea what a feasable solution would be..anybody have any ideas?? Erin

Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by Erin RN

On the flip side of that..I worked ER for a long time and Yes. I have seen the seekers over and over again but if we were TRUE advocates we would help them get help instead we either medicate them or refuse them and send them out them out the door to the hospital down the street...then we complain about them?? Addiction is a disease..In my opinion the problem is us and our misconceptions as well as the fact that we tend to think this is the person's own fault. I would agree at one point they had a choice but as addiction progresses there is no longer a choice at least not in the patient's mind. So if we were TRUE pt advocates we would do more than complain about them (maybe we complain about them becasue WE feel helpless to help them??) ..however I have no idea what a feasable solution would be..anybody have any ideas?? Erin

It is difficult to try to change a lifetime of behavior during a visit to the ED on a full moon Saturday night...Or during a 3 dayy vacation on your med-surg unit whit a sky high census and acuity and no help.....We are HUMANS-venting is how we cope and isn't this an appropriate forum for that? We should be kvetching and supporting each other-not tearing each other down by being judgemental...Chronic pain is terrible for the patient and pain management is a wonderful field-we can all learn a lot right here from some of the members of this board....But dealing with druggy frequent flyers is also a challenging part of nursing-we can help each other out with that here also......
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