Pt demanded a stronger pain med - page 5
:angryfire I'm a little steamed. The other night I had a pt present with an "ankle sprain." Yep, that's it. When I went to discharge this "fine, upstanding, well-groomed" individual :no:, his... Read More
Jan 28, '07Joined: Apr '01; Posts: 1,243; Likes: 833The patient was lucky to get the t#3, (one of the most useless pain medications out there). In my facility the patient would have gotten a prepack of 6 vicodin (We dont carry apap#3) and told to take scheduled Ibuporophen and use the vicodin for breakthrough pain. In simalar situations I've actually had security escort the patient out of the ER. They are more than welcome to go somewhere else and wait in that ER for who knows how long.
Jan 28, '07Occupation: ER nurse, nursing instructor Specialty: Critical Care/Teaching ; Joined: Jul '06; Posts: 210; Likes: 74THANK GOODNESS, I am not the only nurse who hates seeing drug-users.
The sad reality is, and the pro-testers can protest all they want about pain being subjective. And, yes pain IS SUBJECTIVE, but when the VS are normal, they are texting on the phone, laughing with their friend....THEY DO NOT NEED NARCOTICS.
We are really looking out for their best because, when they use pain meds that they don't need, their pain receptor sites get use to response over time and then when they really do have pain, NOTHING WILL WORK!!!
My most hated pain med: tie between demerol/dilauded
and 90% of our surveys we get back are from guess who? People who did not get appropriate pain relief. Now, i always try to be a good nurse, please my patients, however, i am not going to go against my ethic principles to please administration. Because the sad truth is an RN is not replacable. In 2006, for every RN a hospital hired, 4 RNs quit/retired/fired/died.....
And another issue with pain meds is what kind of society are we creating that NOBODY CAN EVER HAVE ANY PAIN....pain is natural. Is is pleasant, NO but part of life. I don't mean to be so cold-hearted, but I hate seeing taxpayers dollars feeding the addiction.....
sorry that is my venting soapbox ....thanks for your time...
Jan 29, '07Occupation: Pediatrics Specialty: Peds ; Joined: Dec '05; Posts: 386; Likes: 11Quote from AnjannWith Migraines, the way I can tell what's up is how the patient reacts to being administered a Triptan. Because if you are a true Migraine sufferer, no narc will kill any migraine the way a triptan will and they are always so relieved to feel better.
I have a hx of migraines and the only med that truly helped was Imitrex (one of the triptans in case someone's not familiar). Unfortunately, my HTN is no longer under control and stays quite high so I can't use it anymore.
In February of last year I began experiencing abd pain. At first I just figured I was ovulating from the location but over a couple of days it became so bad that I could not walk or even straighten up without excrutiating pain. I broke down and went to a local ER because at that point I figured it was a large ovarian cyst and knew that our urgent care doesn't have ultrasound that would be needed to dx it. I was right in my self-dx. The doctor and nurses were awesome though I'm sure it was quite obvious that I was in some serious pain. I got through the whole ordeal with 4 hydrocodone 5/500's and Advil.
Jan 30, '07Occupation: RN Specialty: 10 year(s) of experience in ICU,ER ; Joined: Jul '03; Posts: 614; Likes: 299Quote from TrudyRNDoes anyone else see the irony here? :chuckleI would have NOT.... have been.... judgmental, I would NOT have taken what you seem to have taken, which is a one-size-fits-all, holier-than-thou attitude.
Jan 30, '07Joined: Jun '06; Posts: 7,199; Likes: 7,935yup....
having had a recent ankle sprain myself....fell at a local store...amb ride to local ED....actually after the initial pain, didnt hurt too much as long as it was elevated.....wasnt given ANYTHING for pain, ibuprofen was suggested.
my only objection is/was, is that nsaids reduce inflamation, thus i would think interfere with healing, perhaps APAP would be a better choice.
PS. i am allergic to codiene....pretty little "sunburn" rash over nose, and fine petichael rash across back, and i swear it didnt do anything for the dental pain i was in.....havent ever taken any other narc....Last edit by morte on Feb 6, '07
Jan 30, '07Specialty: 4 year(s) of experience in ER, Long Term Care, Asst Living ; Joined: Jan '07; Posts: 12; Likes: 1I saw plenty of that when I worked at an ER on the Coast of NC as a PCT. The amazing thing is the ER docs in a couple cases let loose on one patient in a very nice manner. They were being such pain in the butts he gave them a 4 pack of what we prescribed and then proceeded to take 4 pills off his script he wrote. They also started handing out a flyer that stated "As medical Doctors we are NOT REQUIRED to prescribe any medication we feel is not necessary this includes Narcotic Painkillers" and gave them to our frequent flyers.
Jan 30, '07Joined: Feb '03; Posts: 309; Likes: 33Pain is what the patient feels. It is not up to you to decide whether their pain is real.
I was an ED nurse >15 years and gaurded the narcotics in my holier than thou attiude until I discovered pain for myself.
I was distressed to read your post. Unfortunately there are many nurses with the same attitude.
Jan 30, '07Specialty: 4 year(s) of experience in ER, Long Term Care, Asst Living ; Joined: Jan '07; Posts: 12; Likes: 1Please dont mis-interpret what I said as being callous or negative. I indeed am an advocate for pain management however it seems that alot of people view the ER as their own personal dispensary for Contolled Substances. Having been in a situation where I was out of work due to a very serious back injury and was on heavy pain meds and controlled substances I understand the meaning of being in significant pain (After injuring my back the MD had me on 10/500 percocets plus Zanaflex in the daytime and Valium 20-30mg at night). I also have to admit that during that time I was totally unable to recall most of what went on for a 6 week period of my life which to this day scares me. Like I said Im not against pain management when appropriate especially having seen patients badly burned, both while in the field working EMS and also in a facility setting, it just comes down to what is appropriate at the time and whether it matches the nature of the injury/trauma vs unreasonable requests for Sch II narcotics just because somebody thinks they are "owed" it.
Jan 30, '07Occupation: utilization review Specialty: 38 year(s) of experience in Case Management working from home ; From: PA, US ; Joined: Jun '05; Posts: 778; Likes: 239I am on the fence with this one. On the one hand, I despise drug seekers and addicts. I could never work in the Er I give you ER nurses so much credit because I would have to let loose on them.
On the other hand, I have had chronic and severe pain before and when you have unrelieved pain, it is the most horrible feeling. I have at times considered becoming a heroin addict when my PCP did not "believe" my severe pain and did not prescribe adequately. Finally, a pain clinic did the trick.
However, when in severe pain, I don't think about talking on the cellphone, eating, laughing, or anything else. I just want relief.
Feb 6, '07Occupation: registered nurse Joined: Oct '02; Posts: 361; Likes: 197i'd have taken the request a lot more seriously if it came from the patient, rather than his wife. it's his pain, after all.
Feb 6, '07Occupation: ED Nurse Joined: Mar '03; Posts: 49; Likes: 2Quote from rjflynWe STILL don't give pain meds until the MD assesses. Too many walk out after getting "fixed."Yes abd pain is a major work up. At least now a days we are a little more patient friendly. I can remember when belly pains didnt get pain meds until the surgeon/ob doctor saw them as you didnt want to mask that pain.
Feb 6, '07Occupation: Nurse Specialty: Spinal Cord injuries, Emergency+EMS ; From: UK ; Joined: Feb '07; Posts: 1,051; Likes: 523the responses seen are proportionate, although interestingly no one mentioned involving the shift leaders ( medical and /or nursing) as well as Doc who saw the patient ( though if the doc who saw the patient was an attending / staff specialist or Consultant it's not necessarily going to add muchginvolving anothersenior doc)
from a Uk point of view i'd probably do the same and generally people with sprains tend to get advised paracetamol, NSAIDs and rest/ ice/compression/ elevate -
that said i'm likely to have given them co-codamol 30/500 at assessment (under the PGD) if it's sufficiently painful to want X - raying under the 'can't weightbear 'bit of the ottawa rule.
were i work we don't go stronger than 30/500 on the PGDs (maybe i'm wrong and the NPs can give oral tramadol on PGD) certainly no parenterals are on the PGD listLast edit by ZippyGBR on Feb 13, '07 : Reason: spelling and grammar
Feb 10, '07Occupation: CCU Heart/Emergency Nurse Specialty: Emergency Nursing, Critical Care (Heart) ; From: US ; Joined: Jun '06; Posts: 14; Likes: 5They are told to follow up with their PCP, but they don't. They just return in a week or so telling you "I was here last week for the same thing, I'm not sure what you did, but whatever it was, it didn't work."
GOOD POINT! Another thing that bothers me, and is no fault of the patients, is the fact that in my area the doctors are so overrun with patients that you can't get in to see one of them for at least a month. At least its that way with most of them. I hate that for our patients (and me, when I need to see my doctor). I can empathize with a pt who has tried to get in to see his/her doctor but couldn't so they're now at the ER. That is what I'm there for, right?