Epidural drips and Demerol sensitivity

meownsmile, BSN, RN · Mar 31, 2005

I think once i found out that the Demerol had caused him to code in the ICU i wouldnt even think about giving it to him. Usually subsequent reactions are more serious so even though it was cut in half he could still have a reaction the same as he did with the original dose.

I think i would have tried to have him use some guided imagry to distract him from some of the pain, breathing excersises whatever it took, but id stay away from giving him the demerol.

Furthermore, i would probly encourage him to refuse to take it if he were ever to have need for pain control again at a later date.

Mimi2RN, ASN, RN · Mar 31, 2005

I had a patient the other day who had had an abdominal surgery and was on an epidural drip when he came to our floor from the ICU. He had demerol ordered for break-through pain, and when the pain was bad enough he couldn't stand it, he finally asked for some more pain control. We had gotten very little report from the ICU staff, but I did hear that he was very sensitive to narcotics. I pushed the demerol slowly through his running IV, and then watched him closely. Within minutes his repirations were down to 4 and we had to Narcan him.
Later, I found out that the amount of demerol I had orders to give him was the exact same amount that had been given to him in the ICU and caused him to code. I was very surprised that the anesthesiologist hadn't decreased the dosing or changed medications after the first event. I was even more surprised when he merely cut the ordered dose in half and put a note to "push slowly" for further breakthrough pain. I'm pretty new to nursing, so I guess I am wondering, is this normal? Are nurses frequently expected to choose between controlling a patient's pain and keeping them breathing?! :stone

Why can't he have a different medication? Of course he's going to have breakthrough pain, but it's ridiculous to subject him to the same med that stops him from breathing.

I have been given demerol and morphine, both meds make me vomit for hours, usually until the next day. I have told the anesthesiologists what happens, and they have given me meds to control it, which haven't worked.

During my last surgery, I was given Fentanyl. No problems, I couldn't believe i felt so good. Each time, I was also given Versed, I was told I might be reacting to that. Obviously, I was right the first time, it was the morphine or demerol.

So get the poor guy's med changed. Fentanyl can be used in an epidural, instead of the Demerol. If he's had abdominal surgery, he's going to hurt. How about using Toradol? That might make all the difference.

Mimi2RN, ASN, RN · Mar 31, 2005

Something else: remember that you are the patient advocate. It doesn't hurt to call the doc and ask if they meant to order something else as the patient reacts to the med he was given. If he insists, he can always come and give it himself. The anesthesiologist is always inhouse for epidurals.

mimi

darcieg · Apr 4, 2005

Thanks for the thoughts! I did end up 'discussing' the med order with the doc a lot. He was adamant that a smaller dose of demerol would be the best (the pt had various reactions to other drugs too) as long as it was pushed very slowly. I finally just said 'okay' but I did not give him any more on my shift and I advised the same for the next shift. I just felt bad that the pt's pain was not really controlled. We tried relaxation techniques too, but he didn't have much patience for that :icon_roll . I was off for a few days after that and I never did hear what was done for his pain the rest of the time. It's just one of those cases that sticks in my head.

nursenatalie, ADN, RN · Apr 5, 2005

Our anesthesia docs always order toradol first for breakthrough pain and if that doesnt help then IM demerol. IM doesnt hit them as hard and I have only given it once cause the toradol usually helps

Lawnurse · Apr 5, 2005

He coded taking demeral and they didn't tell you??

And then ordered for you to give him MORE demerol?

:eek:

Who else have you reported this to?

IMHO, the aneth. is very lucky and fortunate you knew what you were doing with the narcan and we able to bring him back. He wrote an order for a drug he *knew* caused this patient to code. Even if you had malpracticed him by not giving narcan, he is still partially at fault for knowingly ordering it in the first place and causing the code.

I know nurses hate to confront doctors, but you should point out this out to him. You saved his butt.

barefootlady, ADN, RN · Apr 5, 2005

Please file an incident report and an adverse reaction report on this patient. Call his attending and report everything that happened. DO NOT give more Demerol. Report this incident to the HN of ICU for not getting a report on how patient reacted to first dose of Demerol.

This is very poor care by physician and by ICU nurses. NO Way would I be caught up in this mess without documenting every thing that goes on. He may have residual damage from the ICU incident, so document, document, document.

There are just too many pain medications out there to use to avoid this type of problem. Please consult with the pharmacist, he will give you some ideas on what type of pain med would be a better alternative for this patient.

I hope this works out for you without you getting yelled at or blamed for anothers lack of good judgement.