Bedside surgery with no sedation

[Kiwi]

I witnessed a very sad incident yesterday. My elderly client was undergoing an EGD/ PEG tube placement, and received no sedation or pain management during the procedure. I was in a difficult situation (still a student). The nurse assisting the Gastroenterologist asked how much medication to give the patient, and he said casually "Don't worry about it." This patient was in the ICU because she had just experienced a stroke and was not able to communicate, so she wasn't a typical anxious surgical client - nevertheless her HR was in the 160s during the surgery and her BP went to 192/87. After the procedure her face was red and there were some tears from her eyes. This patient broke my heart - after the procedure my nurse preceptor and I brought her 2mg Versed and 4mg Morphine, which calmed her significantly.

Why would a surgeon not allow sedation/pain management for such a procedure? How would you have handled this situation?

[Kiwi, BSN, RN]

From where did the order for the morphine and versed come?

My client had standing orders for morphine and versed from her primary physician, not the Gastroenterologist. If I had it to do over, I would have overidden the Gastroenterologist's orders to not give meds. I feel very bad about it - but I am a student, and still learning.

[begalli]

ether - as a student, it's NOT your fault. Don't beat yourself up over this. I wouldn't want that GI RN anywhere around me. A very poor example for learning. I'm assuming your preceptor wasn't aware of what was going on. If she knew, imo, she's just as guilty as the docs.

Whew! What an awful learning experience, but a learning experience none-the-less.

:icon_hug:

Good Luck in the remainder of your clinicals!!

[mitchsmom]

This thread made me think of something sort of related...

My dh went to an ortho doc who removed his external fixator with no pain relief (not even a "you might want to take Tylenol beforehand"). I didn't think that was too pleasant (3 screws unscrewed from his bone and then pulled the rest of the way out) but I don't know if that's SOP for orthopedics or what. Anyone happen to know?

And, of course, the OP's story is awful. I hope I don't come across that or I hope at least that I can talk the doc into something when the time comes. Maybe I'll be prepared for it after reading this...

[chimama]

It ALL comes down to patient advocacy. I believe that to be our number 1 responsibility. I would get the incident documented, even anonymously. Atleast get a paper trail started, he/she will only do it again and again, unless someone atleast brings attention to it.

If patient advocacy is the issue then why don't we name names and places?Who was this doc? Where did this torture session take place?Does stating the truth with names and places violate some kind of forum rule?I have always wondered why don't we just say who did it and where instead of all these vague references.I would like to know who I need to protect my family from. The names of sexual predators are published...why not the names of patient abusers? :uhoh21:

[Toby's mum]

SHAMROCKY

I recently witnessed a surgeon re-threading a CVC line via a med/surg bedside with no topical anesthesia. The poor patient was howling in pain. When asked why the surgeon chose not to use anything to numb the area, he said the lidocaine stick would hurt more than what he was doing. I'm not sure whether this is accurate or not. It didn't seem that way given the patient's reaction. I was also surprised that he re-threaded the line without a CRNA present--what if the patient in pain jerked awkwardly and the line pierced the lung--there would be no readily available resuscitation equipment. I guess they would have gotten the patient to the OR, but precious time would have been lost.

[ktwlpn, LPN]

You all know darn freaking well that these same physicians would not let you trim their toenails without some morphine prior to....sheesh...When I was a new lpn in med-surg I watched the vascular guy debride a pt's foot-he removed the dressing and went into this crazed "mad scientist" mode-he was scraping and squeezing and mumbling-"Let's just see what we have here-hmmm" No-don't worry about anesthetic-I'm just looking around...next thing we heard a "plunk" -he had amputated a few toes----and was cutting into healthy flesh because the patient was holding onto the bed rails and shaking.Then he began irrigating and squeezing the foot from heel to toe --it was nasty..Before the RN realized what was up it was too late----then the bozo left without writing an order for pain control..The surgeon did not answer our pages so we had to get orders from the house doc.......We found out the next day that the old guy crashed after our shift and died that night in the unit....No one is getting near me or mine with so much as an NG tube without some kind of sedative.... :angryfire

[apaisRN, RN, CRNA]

It's hard when you're new or inexperienced. I remember times as a new ICU nurse when I wish I had acted differently in such situations. Now, I don't know if I'd be assertive enough to refuse to help, but I would definitely go up the chain from the intern to the resident to the fellow to the attending. If they were ALL assholes, I hope I'd swallow my fear of confrontation and do something.

[jeepgirl, LPN, NP]

Report it. It's a cruel and inhuman practice. At least if it is reported, he will get questioned and can defend his practice. But on the surface it is uncalled for. She could have the versed afterwards but not before? That's stupid. He's just figuring that she won't be around long enough in good enough shape to tell anyone about it.

[blondebritbrat]

oh thats awful! My mom was in a bad motorcycle wreck almost two years ago with a collasped and punctured lung. They had to intubate her and my mom was so out of it that they had to do it in the ambulance on the way to the hospital and I don't think that she got any pain medication for it beforehand either because of the way she talks. She says she remembers being intubated and she was in so much pain because basically her leg had been severed at the accident site since the car came in contact with her leg. It was just hanging on by like a piece of tissue from what I understand from her boyfriend at the time who was driving the motorcycle. But she said that she was pretty out of it but she could remember them talking about it but the situation was so critical they didn't have time to do the pain medication.

[curleysue]

What does it take for doctor these days to properly medicate a patient for pain or for a procedure. Maybe having a med student go through a procedure without ANYTHING! I don't know, its so not fair for them.

I had a port a cath placed not too long ago and they didn't use any anesthetic or pain meds, nothing. I felt everything. Oh course its nothing compared to what some of you guys have gone through with surgery but it was so scary. I cannot imagine that happening when I was having a surgery.

This is an epidemic with doctors these days. Undermedication in the hospital discharge. Although a lot of people have ruined it for us by abusing medicaitons I still am appauled that doctors are so stingy.

I guess I could go on and on about it but I won't just some thoughts for everyone. Take care... Curleysue