Does this scare anyone but me?!?!?!?!?

I understand the frustration however, I learned in nursing school that, "pain is what the patient says it is." It is not our position to judge a patient's pain based on how WE think they should be responding. I'm not saying that this was not a difficult patient but someone has to pick the high road. I have found that if a nurse listens to a patient, the demands usually subside. I'm not saying that I would have wanted to "snow" him however, I would have provided the facilities protocol (that may have started with Tylenol and moved on from there) while explaining to the patient that if this does not work, we will work together to get his pain managed. Remember, pain is made worse by anxiety so letting the patient know that they are being listened to often stops the craziness. If he was a head trauma, you KNOW they are not rational etc. and his demands have to roll off you back if you are waiting to medicate pending the result of scans.

I have to comment on this reply. My ED's (level I, 55 beds) pain management protocol is Tylenol, then Vicodin, then attempt to obtain MD order for narcotic management. Nursing can give Tylenol, Motrin, or Vicodin without an order. While it is a nice thought to tell this pt "we'll start with tylenol and move on from there until we get your pain under control" it isn't realistic in an ER setting. You cannot po medicate an MVC pt who hasn't been scanned/through Xray because you can't rule out possible surgical injuries. Also, I assume this pt was c-collared/BB/immobilized, and po pain meds are an aspiration risk at that point. Not to mention if that pt becomes nauseated and pukes, and can't clear his airway. If the MD is not going to order IV pain meds or narcotics then my hands are tied. I can do my best to verbally reassure the pt, but it sounds like this guy wanted narcotics....as evidenced by the fact that he grew wings and flew away when it was made known his only option was Toradol. Additionally, if our trauma patients don't have obvious ortho injuries, we typically don't medicate right away. Would hate for someone to develop an acute abdomen that was blunted by narcotics.

I'm not against medicating trauma/MVC patients, and I'm not against medicating the people that you may get a gut feeling on. But there are some very valid medical reasons for not medicating this pt off the bat. I also would rather give a drug seeker a fix than send someone home in pain without medication.

I told myself I wasn't going to get involved in the drug seeker debate aspect of this thread. :::going back to making dinner now:::

OMG, I can not believe I left this out....I was reading over and it dawned on me...not only did we give him the Toardol shot, but Vicodin and Robaxin scripts to take with him on d/c. Guess who still was not happy?

I would say more about him, but I don't want to get in too deep, seeing as how someone I know or that knows me or that ER may be on here. I will say that we had an encore performance about 2 hours later, though, minus the car.

Still, what gets me was the knife. I felt for that poor nurse, and the charge nurse seriously could have cared less. I would have gotten more vocal were it not for the fact that I am a student there. I did used to work there, and were I there as an employee, you bet your sweet bippy I'd be raising some sand over that incident. I'm very outspoken, runs in the family, but I try to tamp it down when I am a visitor.Still, it just steams my clams that they said that they would not even TRY to get this knife away from him. "He has a right to have it." Hah. His rights stop where my spleen starts. Thank you, I'll get off my soapbox now.

I am an RN in grad school for my ACNP. One of my clinical rotations this semester is in the ER of a local hospital. The other day, I was there, assessing a car wreck with the doc, whiny, crying "Gimme something for the pain, I gotta have something for the pain!" (I can not STAND drug seekers). Anyway, I digress. This guy refused to cooperate with the exam, refused to move his legs, got mouthy, was just a real peach in general.

As we were leaving, I happened to look down and, lo and behold, this guy has a Crocodile Dundee strapped to his belt (a BIG knife, in case you've never seen the movie). I nudged the doc, told the CT tech and the nurse, and told the charge nurse. She refused to take it from him! "We can't do that. He's not a psych case. We don't even search our psych cases."

My qustion is, acting the way he was, demanding what he was demanding, and with all you see in the news about poor nurses getting blown away for not giving people their Lorcets, does this bother you? Would you work here? The nurse that had to take this man to CT informed that charge nurse that if she got cut, she knew who she would be suing, and all the charge nurse said was, "Well, I'm sorry." Just curious as to the ER policies where y'all are.

I wouldn't take it from him either. I'm an RN, not a cop or security guard. I don't disarm pts. I also wouldn't have taken the pt to CT. No nurse should be expected to have anything to do with an armed pt. How rediculous.