No pain meds in ER??

Bob Loblaw · Apr 1, 2016

IV Tylenol is over $1000/dose. Insurance comanies decline to pay that price if there are less costly analgesics available.

Jensmom7, BSN, RN · Apr 1, 2016

Come to think of it, the last time I was in the ER, for an asthma attack, I happened to have a headache as well. They gave me 4mg of morphine IV push for it. They were also hoping to help my dyspnea discomfort, which it did. It probably was excessive, though.

Actually, in Hospice we use Morphine as much for respiratory distress as we do for pain. I've given Roxanol 10mg SL every hour for respiratory distress. Usually works well.

ShaneTeam · Apr 1, 2016

Is this the video that you are referring to?
[video=youtube;b1hpPO30G-U]

That was very good, but it wasn't the piece I had seen. It was only a 30 sec byte while they were sitting on the couch.

Boomer MS, RN · Apr 1, 2016

Actually, in Hospice we use Morphine as much for respiratory distress as we do for pain. I've given Roxanol 10mg SL every hour for respiratory distress. Usually works well.

As I "liked" the comment, one size does not fit all. Here is yet another example. We need to be better educated. Physicians too. And I'm married to a surgeon!

Anonymous865 · Apr 1, 2016

ERs (and hospitals in general) are funny places. Sometimes you have to fight to not be given a narcotic, because you don't think you need it. Sometimes you get no pain meds (not even Tylenol) when you are reporting a pain of 9.

I've been a patient in the ER when I was experiencing the worst pain I have ever had and when asked my pain level reported an 8 or 9. I was given nothing not even Tylenol the entire 8 hours I was in the ER. I was admitted for surgery. After the surgery, the surgeon told me that based on what he found during surgery, he was surprised I hadn't been in excruciating pain prior to surgery. I told him I was. He was surprised. Apparently they had been documenting my self-reported pain of 8 or 9 and documenting their assessment of "NAD."

Another time I was in for multiple broken bones. I kept telling them it was uncomfortable but I did not need anything for the pain. They insisted on giving me a narcotic.

The first example was 1000 times more painful than the broken bones, but they could see the breaks. They couldn't see the pain, and I didn't act like I was in pain. I didn't act like I was in pain, because I was raised to "use your words" and "just because you feel bad does not mean you have to put on a show."

My mother swears that narcotics make her pain worse and that Tylenol is a wonder drug for pain. As her POA I have a battle keeping people from giving her narcotics. I'm seen as the mean, neglectful family member for insisting on Tylenol instead of a narcotic. I'm told I don't know what I am talking about when I say narcotics make her pain worse.

For me Tylenol and Tramadol have as much effect as a witch doctor chanting over me, but ibuprofen works wonders. For severe pain, a low dose of hydrocodone works great, but never, ever, ever give me dilaudid again! Once was enough.

Until there is an objective test to determine pain level and what pain med is effective for that individual, I don't know what the answer is. I don't want to encourage a narcotic addiction, but I do want pain managed.

That Guy, BSN, RN, EMT-B · Apr 1, 2016

Typical ******** of punishing people because others can't handle it.

sailornurse · Apr 1, 2016

:shy:

Thanks. I love learning new things to read up on. :)

Hey Far, since you're a school nurse, the ADHD meds come to mind.

Harmonyx Releases Genetic Test for ADHD Medications

blondy2061h, MSN, RN · Apr 1, 2016

IV Tylenol is over $1000/dose. Insurance comanies decline to pay that price if there are less costly analgesics available.

Yes, my hospital limits stock and restricts its use to strict NPO patients d/t cost. I have had IV Tylenol before, though, and was impressed that it did help.

canigraduate · Apr 1, 2016

It's genetics. They can do some testing it's genetics they use a saliva swab to see if you do or do not metabolize certain medications pain medications opiates , ADHD antidepressant meds that's been going on for about the last 5 to 7 years.

Yeah, this is really cool. I had it done and found out I am unusually susceptible to anticoagulation, but resistant to ADHD meds.

I have a normal response to opiates, which makes me happy to know. I had an aunt who had the red headed resistance to opiates and anesthesia. She freaked the anesthesiologist out when she asked him why she could feel the surgery.

I caught this story on Facebook the other day, and I think it's a step in the right direction to reduce dependence. I just hope they don't exercise it without due respect for the chronic pain or the traumatic injury patients who need opioid pain relief.

canigraduate · Apr 1, 2016

Hmm, I wonder how effective IV Tylenol is vs suppository vs oral. Someone should do a study.

The hospital I work for hardly ever uses dilaudid unless the patient is allergic to morphine. We use a lot of IV Toradol and PO oxy/norco or ibuprofen/Tylenol. We have our drug seekers, but they are rare. They usually come in looking for benzodiazepines instead of narcs.

ShaneTeam · Apr 1, 2016

The ER that I went to with abdominal pain several times 1 year ago today talked to me about using the ER for pain meds.....I was admitted 3 days later in critical condition in heart and kidney failure in Septic shock from liver abscesses that contained over 4 (yes I said four) liters (yes liters) of pus. My children and husband were told to prepare for my funeral. I continue to recover. I developed skin ulceration's from micro hemorrhages with skin that sloughed off of my hips groins and buttox leaving deep Stage 4 wounds/breakdown.
Multiple debriedments later several wound vacs later as I screamed enough to peel wallpaper from unbearable pain....You bet I deserve pain relief.
I am allergic to morphine.
Did I deserve to have my pain adequately treated? You bet your behind I did.
Am I now a heroin addict? Absolutely not!!
It sickens me to see the ill patient punished because of the behavior of addicts and the derelict physicians who over prescribe. Punish the MD's not the ill incapacitated patient who lives in pain.
Grrrrrrrrrrr...........this really angers me.

Hello Esme! I'm so sorry you went through that. My prayers go out to you and yours.

Rocknurse, MSN, APRN, NP · Apr 1, 2016

We have started using ketamine for analgesia. I have also had migraine patients experience relief using Ofirmev, which is IV acetaminophen. That stuff is legit!

I've seen ketamine abused...young men hallucinating and having to be held down by 6 people. Not fun. I've also seen post-op open heart patients literally levitating off the bed in pain after giving them IV Tylenol because it didn't touch their pain.