So the last 8 days of my life have probably been the worst 8 days of my life. It started 8 days ago while I was fishing with the abrupt onset of a horrible headache on the right side of my head. Irronically I got called into work for a stat C-section so I took a few motrin and fought through it. The next day the headache was still there so more motrin and I worked a 12 hour shift. By that night, the headache was getting worse. By sat. evening it had gotten even worse. It was still unilateral and it's focal point was at the base of my skull and radiated up the right side just shy of my temple. Sunday was basically unbearable so Sunday night I went to my local ED to make sure I didn't have a bleed. I drove myself so I informed them I wouldn't be able to take anything for pain. I had a negative CT and the ER doc wanted to do an LP. I had no fever, no stiff neck, no nausea and had delt with an LP headache about 4 years ago so I politely refused. He offered me Lortab and I declined and requested Tramadol so I could still function. He also wrote for neurontin and tegretol thinking it may be trigeminial neuralgia. I saw my PCP on monday and she told me to hold off of the heavy neuro drugs so I only filled the Tramadol. She checked me and gave me a consult for a neurologist and wrote for steroids. I scheduled an appointment with them for Wednesday. Tuesday night was my worst night. Tramadol and 800 of motrin with 650 of acetaminophen wasn't touching it. I was also nauseas. I decided to go to the ED at the hospital my neuro has privledges incase they admited me for pain and obs. When I got to the ED, I gave them my history. They put me in a room and the doc asked me a few questions.
Here is where the offensive part starts. The Doc comes in and asks me questions. I give him my history. He offers LP and I decline again. He says he will start an IV and give me something for pain and I also asked for Zofran. Nurse comes in and gives Toradol 30mg and Zofran. Fine with me. Then, I don't see anyone for about an hour. I'm still in terrible pain. Nurse comes back in and I ask for water. She says she needs to check. 30 min. go by and she stick her head in to say she still is waiting for doc to tell her if I can have water. One hour later, another nurse comes in (this is not shift change by the way) with a glass of water and discharge papers. I'm baffled. I ask what this is all about and he responds that I didn't want an LP. No plan, no labs, no regards for my pain as far as I'm concerned. I ask him that if they are so concerned about a brain bleed and want to do an LP, than why did they give me toradol. He tells me that's not the only reason they do an LP and that they also check for meningitits. I promptly reply that I have no symptoms of meningitis. He looks at me baffled and leaves to get doc. While I'm sitting in the room, I hear someone in the hallway say "the medical professionals always know the right things to say to get them." Now I'm in severe pain and ****** off. The doc comes in and asks me what I want him to do. I tell him to help me figure out what is wrong with me and help me figure out how I'll survive through the night. He says he can give me a couple of pills and writes a script for 6 percocets. Fine. Get me the hell out of here.
I have never been so offended in my life. I plan to write a letter to the president of the hospital which happens to be in the same system that I work. I am not a drug user. I actually hate the things and still have 4 of the 6 percocet left, not to mention about 25 tramadol left. I have been taking Fioricet and motrin for the last 3 days with tegretol. Turns out I have Occipital Neuralgia which is a headache worthy of suicide. Today I received an Occipital Nerve Block. It is helping quite a bit. I'm not 100% but at least I'm not debilitated. So much for being a drug seeker. It's unfortunate that in today's society there are some many people addicted to these things but it's not fair to assume that everyone that comes in complaining of pain is drug seeking. I would love to see those nurses or that doc experience the pain I have experienced for 8 days and then tell me I was drug seeking.
Since it is obvious that the ER nurses are the only ones offended here this post is for you.
#1 I waited 3 days to go to the ER because it is only a place for emergencies and I didn't feel this headache was of that magnitude until Sunday night. This was under constant guidance with my Step-Father who is a General Practitioner of 35 years.
#2. I didn't fill the scripts of neurontin and tegretol under the advice of my PCP (Primary Care Provider.) Just following doctors orders.
#3. I never once asked for any type of drugs. I only asked for someone to help me. My second trip to the ER was because I was at a point where I thought that I would either die or kill myself because of the pain.
#4 If one of you can please explain to me any indication as to why I should have received an LP, than I'm all ears. I still can't think of an idication.
#5 The comparison of a patient refusing a digital exam was weak at best. There would be a clear indication to do one. She is infact pregnant. No guessing there. In that situation, we would do an ultrasound to determine fetal position and let her continue to labor while we convinced here of the importance of a digital exam. I had no one inform me of the importance of an LP. It was clearly a CYA for the ER doc. The first ER doc was perfectly fine with not doing one.
#6 All I wanted was relief. The tegretol I'm on now is basically for nothing. The neurologist cut the dose to 1/6th of what the ER doc wrote. The nerve block is doing everything. And the neurologist and an anesthesiologist who specializes in pain management both said a big NO to the neurontin.
These ER nurses made unjustified assumptions as are the nurses above. It is letter worthy, because if it happened to me, it is happening to many others. If you are so jaded on being an ER nurse, than get the h*ll out of the ER. The are plenty of other nurses out there who would love you job.
You had a head CT. You refused an LP not once, but twice. The previous LP in your history says to me that you've probably had some kind of unexplained headache and/or neuro s/s at least once before. You had an appointment with the neurologist for the next day, so there was a plan for further evaluation/continued care in place.
At my large hospital the next step might have been CTA and/or MRI -- but this may not have been available at the ED where you presented.
I'm not sure what there is to be offended about.
Admission for headache without other neuro s/s? Not happening where I work.
And as another poster pointed out -- LPs are not to diagnose bleeds, but to check for meningitis.
I hope you continue to follow up with your neurologist and also discuss with him/her what is the plan for continued care and return/exacerbation of symptoms. Good luck to you.
Oh, and if I presented to L&D and attempted to dictate my care there, in a specialty area I know next to nothing about, that might be considered offensive, no?
I had an LP 2 years ago when the whole swine flu thing was going around because of extreme bilateral headache, 102.9 oral temp, and stiff neck. All indications of possible meningitis. I have had nothing like this. LP is for menigitis and for checking to see if there is a bleed that has been present for at least 12 hours or that may be so small that CT won't show it. I may not be an ER nurse, but I'm not an idiot either. I read and research a lot.
Another thing I would like to say is that this hospital is in the network of hospitals that I work in. I have actually spent some time in their special care nursery and do not want to be labeled as the nurse who is a "drug seeker." I have thought about employment in the hospital in OB a few times. This letter will not only bring light to nurses doing what we were all taught not to do in nursing school, but will contain all of the records of this experience so I can now save face that a few wrong assumptions have created.
Since it is obvious that the ER nurses are the only ones offended here this post is for you.
#1 I waited 3 days to go to the ER because it is only a place for emergencies and I didn't feel this headache was of that magnitude until Sunday night. This was under constant guidance with my Step-Father who is a General Practitioner of 35 years.
#2. I didn't fill the scripts of neurontin and tegretol under the advice of my PCP (Primary Care Provider.) Just following doctors orders.
#3. I never once asked for any type of drugs. I only asked for someone to help me. My second trip to the ER was because I was at a point where I thought that I would either die or kill myself because of the pain.
#4 If one of you can please explain to me any indication as to why I should have received an LP, than I'm all ears. I still can't think of an idication.
#5 The comparison of a patient refusing a digital exam was weak at best. There would be a clear indication to do one. She is infact pregnant. No guessing there. In that situation, we would do an ultrasound to determine fetal position and let her continue to labor while we convinced here of the importance of a digital exam. I had no one inform me of the importance of an LP. It was clearly a CYA for the ER doc. The first ER doc was perfectly fine with not doing one.
#6 All I wanted was relief. The tegretol I'm on now is basically for nothing. The neurologist cut the dose to 1/6th of what the ER doc wrote. The nerve block is doing everything. And the neurologist and an anesthesiologist who specializes in pain management both said a big NO to the neurontin.
These ER nurses made unjustified assumptions as are the nurses above. It is letter worthy, because if it happened to me, it is happening to many others. If you are so jaded on being an ER nurse, than get the h*ll out of the ER. The are plenty of other nurses out there who would love you job.
#1--you never mentioned that your SF (the GP with 35 years experience) was involved in the OP.
#2--following Dr's orders: you seem to pick and choose which Dr's advice you will/want to follow
#3--You DID ask for a particular drug! Go back and read your first post! I forget now, but it was Tramadol or Tegratol I believe...
#4---I can only venture to guess it was to r/o possible problems.
#5--got nothing, LOL
#6--They were offering you things for pain. You refused and requested YOUR choice of Rx....
You had a CT, you refused an LP, seldom is an MRI an emergency procedure, you refused the pain meds the first doctor offered, and wrote, and did not fill the scripts he wrote. You got the tramadol, and the Zofran the you DID ask for.
I do not think that you are a drug seeker, I am just asking what did you want them to do?
Since it is obvious that the ER nurses are the only ones offended here this post is for you.
#1 I waited 3 days to go to the ER because it is only a place for emergencies and I didn't feel this headache was of that magnitude until Sunday night. This was under constant guidance with my Step-Father who is a General Practitioner of 35 years.
#2. I didn't fill the scripts of neurontin and tegretol under the advice of my PCP (Primary Care Provider.) Just following doctors orders.
#3. I never once asked for any type of drugs. I only asked for someone to help me. My second trip to the ER was because I was at a point where I thought that I would either die or kill myself because of the pain.
#4 If one of you can please explain to me any indication as to why I should have received an LP, than I'm all ears. I still can't think of an idication.
#5 The comparison of a patient refusing a digital exam was weak at best. There would be a clear indication to do one. She is infact pregnant. No guessing there. In that situation, we would do an ultrasound to determine fetal position and let her continue to labor while we convinced here of the importance of a digital exam. I had no one inform me of the importance of an LP. It was clearly a CYA for the ER doc. The first ER doc was perfectly fine with not doing one.
#6 All I wanted was relief. The tegretol I'm on now is basically for nothing. The neurologist cut the dose to 1/6th of what the ER doc wrote. The nerve block is doing everything. And the neurologist and an anesthesiologist who specializes in pain management both said a big NO to the neurontin.
These ER nurses made unjustified assumptions as are the nurses above. It is letter worthy, because if it happened to me, it is happening to many others. If you are so jaded on being an ER nurse, than get the h*ll out of the ER. The are plenty of other nurses out there who would love you job.
I truly hope you don't have to suffer like this again. I also believe you could benefit from being a little more self critical.
#1 You present new information, previously not disclosed, to discredit previous posts. How complete a hx did you give while at the ER?
#2 following Dr. orders selectively when you feel like it.
#3 you refused the help offered
#4 because you follow Dr's orders (see #2), because your alternative was to die or kill yourself (I really don't like this statement)
I'm not an ER nurse and I certainly wish you well, but I truly believe you had misfortune, not bad care.
Personally I wish nurses will act like a patient for once when they go for medical treatment instead most act like they know more than the doc and want to treatments their way.
You know...I tried that once last year. Presented to ER with calf pain. History of DVT/PE 13 years prior and strong family history of factor V. Explained the calf pain felt like that same cramping/heavy feeling I remembered from years ago. Ultrasound was negative. They didn't bother with a d dimer (but they did do a pregnancy test even tho I had my tubes tied 12 years prior in that very hospital). They gave me a script for Motrin and sent my one my way. The pain in my leg was just the dull cramping, heavy feeling so I decided maybe they were right - no clot and not worth raising a stink over that they should have at leave also done the d dimer.
Next day..can't even walk now without severe pain (think..feels like someone is fileting the muscle from the bone in my calf), PCP orders second US at different outpatient clinic that shows a total occulsive clot from ankle to mid thigh and d dimer results of 4000.
I almost let myself die acting like a patient rather than a nurse!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
since it is obvious that the er nurses are the only ones offended here this post is for you.
#1 i waited 3 days to go to the er because it is only a place for emergencies and i didn't feel this headache was of that magnitude until sunday night. this was under constant guidance with my step-father who is a general practitioner of 35 years.
#2. i didn't fill the scripts of neurontin and tegretol under the advice of my pcp (primary care provider.) just following doctors orders.
#3. i never once asked for any type of drugs. i only asked for someone to help me. my second trip to the er was because i was at a point where i thought that i would either die or kill myself because of the pain.
#4 if one of you can please explain to me any indication as to why i should have received an lp, than i'm all ears. i still can't think of an idication.
#5 the comparison of a patient refusing a digital exam was weak at best. there would be a clear indication to do one. she is infact pregnant. no guessing there. in that situation, we would do an ultrasound to determine fetal position and let her continue to labor while we convinced here of the importance of a digital exam. i had no one inform me of the importance of an lp. it was clearly a cya for the er doc. the first er doc was perfectly fine with not doing one.
#6 all i wanted was relief. the tegretol i'm on now is basically for nothing. the neurologist cut the dose to 1/6th of what the er doc wrote. the nerve block is doing everything. and the neurologist and an anesthesiologist who specializes in pain management both said a big no to the neurontin.
these er nurses made unjustified assumptions as are the nurses above. it is letter worthy, because if it happened to me, it is happening to many others. if you are so jaded on being an er nurse, than get the h*ll out of the er. the are plenty of other nurses out there who would love you job.
i'm not an er nurse and freely admit that i don't know enough about your situation to advocate for or against the suggested treatment. you've had several posters who are er nurses respond, and most of them seem to agree with one another. that would indicate to me that they know what they're talking about.
if you go to the er looking for help and then want to direct the care you're given, you ought to expect that the people who are trying to help you will have opinions about that. they expressed those opinions -- mildly, i thought -- outside your room rather than in your face. unless your real complaint is the glass of water -- and a mighty silly complaint that would be -- you have nothing to complain about. thank goodness you finally recieved the relief you need. you might, instead, write a letter to that er staff thanking you for their help toward that end.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
another thing i would like to say is that this hospital is in the network of hospitals that i work in. i have actually spent some time in their special care nursery and do not want to be labeled as the nurse who is a "drug seeker." i have thought about employment in the hospital in ob a few times. this letter will not only bring light to nurses doing what we were all taught not to do in nursing school, but will contain all of the records of this experience so i can now save face that a few wrong assumptions have created.
i cannot believe you're serious. if you think writing "this letter" will further your desires of employment within this hospital, you are wrong. people are going to assume that the "wrong assumptions" were indeed correct and besides that, you're a troublemaker. don't want to work with one of those.
I'm a little confused Nick. In light of a negative CT and no LP it would be pretty difficult for an ED physician to make a diagnosis since they are not neurologists. In fact, many people with vague complaints such as HA or abdominal pain and normal exams leave the ED without a definitive diagnosis. I can pretty much guarantee you an occipital nerve block is not in the repertoire of the ED physician. He may never have even heard of your diagnosis. I'm not trying to be snarky but what exactly did you want them to do that they didn't do?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
since it is obvious that the er nurses are the only ones offended here this post is for you.
well, if you didn't intend it to be offensive to ed nurses you wouldn't have posted it in the ed nurses forum....
#1 i waited 3 days to go to the er because it is only a place for emergencies and i didn't feel this headache was of that magnitude until sunday night. this was under constant guidance with my step-father who is a general practitioner of 35 years. ok...i'll buy that
#2. i didn't fill the scripts of neurontin and tegretol under the advice of my pcp (primary care provider.) just following doctors orders. you didn't say that at first but i'm just as guilty of "nurse heal thyself"
#3. i never once asked for any type of drugs. i only asked for someone to help me. my second trip to the er was because i was at a point where i thought that i would either die or kill myself because of the pain. they were wrong making these comments and i think we as nurses need to be reminded that there are people that come to the ed with a headache that really have one. but you did enter the ed saying "i won't have this. i won't take that, give me xyz" and most edmd's really have an issue with that.
#4 if one of you can please explain to me any indication as to why i should have received an lp, than i'm all ears. i still can't think of an indication. 1) head bleed, not all bleeds show up on ct. 2) meningitis, not all meningitis patients come in looking septic and looking "typical" 3) we work with the general public and go by "standards of care and treatment" so we can cya in patients who have a history or physical examination that may be suggestive of serious pathology, the choice of an imaging study versus lumbar puncture depends on whether the most likely suspected diagnosis is an intracranial lesion/sah or an infection. a noncontrasthead ct is the diagnostic test of choice in patients suspected of the former.lumbar puncture (lp) should always be performed in patients with suspected sah in whom the ct scan is normal. one of the tragedies of contemporary emergency care is that those patients with sah most amenable to treatment are those most frequently misdiagnosed as initial presentation. such patients generally appear less ill and do not have neurologic deficits;misdiagnosis stems from a lack of appreciation of the range of possible presentations of patients with sah [[color=#007760][color=#1982ab]5].
#5 the comparison of a patient refusing a digital exam was weak at best. there would be a clear indication to do one. she is infact pregnant. no guessing there. in that situation, we would do an ultrasound to determine fetal position and let her continue to labor while we convinced here of the importance of a digital exam. i had no one inform me of the importance of an lp. it was clearly a cya for the er doc. the first er doc was perfectly fine with not doing one. as an ed nurse i thought the digital exam was a pretty good comparison. ... emergency medicine is not your speciality and therefore you couldn't be familiar with the "standards of care" coming in and clearly stating what you will and will not have done based on previous experience is pretty common and human. the first ed doc was perfectly fine because it was the first presentation....the second edmed was onto because by report it is you second presentation for the same complaint and a new presentation for the new md and he needs to cya....standards of care and all.
#6 all i wanted was relief. the tegretol i'm on now is basically for nothing. the neurologist cut the dose to 1/6th of what the er doc wrote. the nerve block is doing everything. and the neurologist and an anesthesiologist who specializes in pain management both said a big no to the neurontin. tegretol has can be used in neuralgia type pain and has been proven to be quite effective. http://facial-neuralgia.org/treatments/drugs/carbamazepine.html
carbamazepine is an anticonvulsant (epilepsy medicine) and is . generally the first medication to be tried in treating trigeminal neuralgia, atypical trigeminal neuralgia and glossopharygeal neuralgia. for typical tn, initial pain relief is often fast and quite adequate. carbamazepine is so effective that it has sometimes been used as a marker for determining whether a patient has tn: if a patient does not respond to carbamazepine, then he probably does not have tn. however, this is not a completely certain marker. carbamazepine may not be as effective for atypical trigeminal neuralgia.
dosages dosages are adjusted for each person individually, but usually vary between 200-1200 mg /day.
these er nurses made unjustified assumptions as are the nurses above. it is letter worthy, because if it happened to me, it is happening to many others. if you are so jaded on being an er nurse, than get the h*ll out of the er. the are plenty of other nurses out there who would love you job. yes they made assumptions and that is wrong. but i think we all have beeen guilty of sterotyping at one time or another. i myself have secretively rolled my eye at one patient or another and came to juf=dgement and it was wrong. as a patient i now relize that we as nurses need to be very careful in our tired, overowrked world' to not judge so swirtfly or harshly because it's a different story on the other side of the fence........there but for the grace of god go i......
i am sure op that you have had those moments that you have rolled your eyes and had ungenerous thoughts and quite possibly said them out loud . to another team member and thought we weren't heard....let me tell everyone from a patients standpoint. "we hear everyword" we have nothing else better to do but listen to you. op maybe this walk on the patient side will help you understand you patients a little better as far as your letter it may go a long way to helping you feel better but i can tell you from being on the "inside" so to speak that "another letter" for "another unhappy rn" (as heard from a "senior" management lips myself) "complaining about something?" "what else is new....next"
patients with headache constitute up to 4.5 percent of emergency department visits [1,2]. the differentiation of the small number of patients with life-threatening headaches from the overwhelming majority with benign primary headaches (ie, migraine, tension, or cluster) is an important problem in the emergency department. failure to recognize a serious headache can have potentially fatal consequences.
a careful history and physical examination remain the most important part of the assessment of the headache patient; they enable the clinician to determine whether the patient is at significant risk for a dangerous cause of their symptoms and what additional workup is necessary.
I'm an ER nurse. We see this all time and I'm used to it. Pt's ask for water while being worked up. I head to the kitchen to get a little bottle and pass by a STEMI rolling in. What to do? Water or go work the STEMI? Nurses who don't work the ER do not understand the flow or the prioritizing that goes on all day, every minute of the shift. The MD has the final word on what is done to a patient. The ER is not the floor. We do try our best with blankets, water, slippers and other comfort measures but sometimes it's impossible when there are higher level emergencies going on. The original poster was not happy with her diagnosis or her treatment and the so called comments outside the room. A negative CT for a bleed bumps her down in acuity. It's now just an undiagnosed headache that is not life threatening. If she worked with me, all day long all we see is drug seekers dictating their care. Does this mean you are? No, but the ER mantra is "We will make you comfortable, we will refer you to your doctor or specialist and we will send you home alive." Having no other neuro symptoms or deficits is considered just a headache in our books. Sorry, but I don't see where anybody did anything that is considered reportable to any higher ups. Should the staff not have made the comment they did? Who knows, they could have been talking about anybody, maybe the patient next door?
On another note, had an ex nurse call risk management because she was waiting too long out in the waiting room. She'd been triaged as a level 3, chronic leg infections with pins. The waiting room was totally full. She felt it was unsafe. Well, you have a leg infection, multiple doctors but she was unhappy she had been discharged days before and felt she needed to be readmitted. Turns out, once re worked up in the back, she was sent home again with home health. Perceptions and expectations don't make it mean the patient is right.
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NickB
199 Posts
Since it is obvious that the ER nurses are the only ones offended here this post is for you.
#1 I waited 3 days to go to the ER because it is only a place for emergencies and I didn't feel this headache was of that magnitude until Sunday night. This was under constant guidance with my Step-Father who is a General Practitioner of 35 years.
#2. I didn't fill the scripts of neurontin and tegretol under the advice of my PCP (Primary Care Provider.) Just following doctors orders.
#3. I never once asked for any type of drugs. I only asked for someone to help me. My second trip to the ER was because I was at a point where I thought that I would either die or kill myself because of the pain.
#4 If one of you can please explain to me any indication as to why I should have received an LP, than I'm all ears. I still can't think of an idication.
#5 The comparison of a patient refusing a digital exam was weak at best. There would be a clear indication to do one. She is infact pregnant. No guessing there. In that situation, we would do an ultrasound to determine fetal position and let her continue to labor while we convinced here of the importance of a digital exam. I had no one inform me of the importance of an LP. It was clearly a CYA for the ER doc. The first ER doc was perfectly fine with not doing one.
#6 All I wanted was relief. The tegretol I'm on now is basically for nothing. The neurologist cut the dose to 1/6th of what the ER doc wrote. The nerve block is doing everything. And the neurologist and an anesthesiologist who specializes in pain management both said a big NO to the neurontin.
These ER nurses made unjustified assumptions as are the nurses above. It is letter worthy, because if it happened to me, it is happening to many others. If you are so jaded on being an ER nurse, than get the h*ll out of the ER. The are plenty of other nurses out there who would love you job.