What Are The Rationales for these two treatments?

Nurses General Nursing

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Is it common practice to see IV fluids (normal saline) ordered on patients with chest pain. I've had a few chest pain come in my ED and some docs like to order fluids. My rationale was that it was to flush the kidneys of myoglobin IF it turned out that the patient was having an MI.

2nd what is your experience with treating headaches?

We usually give toradol 30 IV and reglan. Any rationale on that or other treatment modalities for MI and headaches?

If the chest pain and nausea being reported are not cardiac in origin, toradol (musculoskeletal pain) and reglan (gastric emptying) will take care of it. If cardiac, not so much.

I don't think you get enough myoglobin from a cardiac infarct to clog up kidneys. You see myoglobinemia and renal tubular dysfunction with big muscle crush, like a whole lower leg, and a really huge MI is the size of a dime. You'd better have a good IV established in case things go south in a hurry, though, and NS is as good as any and better than some. Watch the amount going in if CHF looks likely or imminent.

Yes I will say we have such a practice of (atleast what I've seen from alot of docs) of putting up IV fluids for just about everyone (non-CHF/RF patients of course) and of course for good reason. Alot of complaints warrant prophylactic fluids (abdominal pain, flank pain, fever, etcc..) but the IV fluids on a chest pain one has always boggled me.

As far as fluids for chest pain patients, it depends on the doctor. Some are content with just an IV lock, others order fluids at high rates. It depends on the cause of the chest pain.

For headaches, the cocktail of Benadryl, droperidol and toradol/dilaudid/morphine along with fluids really works well. Actually, I find that Benadryl and droperidol does more than dilaudid. Some doctors like to order toradol as part of their cocktail, others prefer a narcotic. If the doctor orders a narcotic as part of their cocktail, I first give Benadryl and droperidol and see how the patient takes that. If they still complain of a headache, then I give them the narcotic.

I haven't seen IVF for chest pain, and I did cardiac ICU and ED. We normally did labs, Nitro,Morphine, oxygen, and etc. Send them to CATH lab if needed. I'll be interested in this rational as well. Next time you work, ask the docs you work with and let us know. Each doc has their reason for certain treatments.

So far as headache, I've seen Benadryl, Toradol, dilaudid....

Specializes in CICU.

Certainly not an expert, but I am leery of fluids on cardiac patients... If they come up that way from the ER I get it clarified with primary/cardio soon.

I also agree with Do-Over, I'm thinking that if the pump is the issue, you don't want to make it work harder by giving more fluids. I did a google search and one person said to give fluids just in case the pt. becomes hypotensive due to the nitro. once again, never have ran fluids for a chest pain patient.

Don't like Toradol for headaches :no:, it can cause suddenly severe headaches, especially rebound - I'd like and MD to choose another med if the patient already has a headache especially.

Some caffeine and ASA do wonders...

Specializes in LTC, Medical, Telemetry.
I also agree with Do-Over, I'm thinking that if the pump is the issue, you don't want to make it work harder by giving more fluids. I did a google search and one person said to give fluids just in case the pt. becomes hypotensive due to the nitro. once again, never have ran fluids for a chest pain patient.

Bingo.

Typically, when I have seen fluid used in these situations, it is from a concern of potentially bottoming out the pt's blood pressure. An ounce of prevention is worth a pound of cure; it is much easier to give fluids first than to wait for them to drop and try to get them back up.

Specializes in ER, progressive care.

It just depends on the doctor. Maybe they order fluids if they suspect a right-sided MI...where you DO NOT want to decrease preload because those patients are preload dependent. Patients presenting with a RVMI usually look VERY sick, though.

For headaches, Tylenol, Norco, Dilaudid or Fioricet. Fioricet does wonders, it seems.

Specializes in Pediatric Cardiology.
It just depends on the doctor. Maybe they order fluids if they suspect a right-sided MI...where you DO NOT want to decrease preload because those patients are preload dependent. Patients presenting with a RVMI usually look VERY sick, though.

For headaches, Tylenol, Norco, Dilaudid or Fioricet. Fioricet does wonders, it seems.

Yup, I was going to say Fioricet too. Our patients LOVE Dilaudid though..

Specializes in Emergency, Telemetry, Transplant.

A couple of our docs seem to order fluids for everything. In most cases, however, we don't give maintenance fluids to someone with chest pain...just a saline lock. If the the pt is going to the cath lab--the cath lab wants the pt to have KVO fluids. That way if pressure bottoms out for some reason (such as NTG), the pt can be bolused with these fluids.

For headaches, it depends. If it is migraine in nature, it is usually a bolus, compazine, benadryl. Some add toradol, some a narcotic (boo!), sometimes a steroid, perhaps Reglan. Some will add valium (as a muscle relaxant) if there seems to be muscular component to it--such as a stiff neck with pain extending up to the head. A 'simple' headache--i.e. "I've had a dull HA for 3 days, light doesn't bother me, I'm not nauseated"--may just get tylenol, ibuprofen, or Percocet.

Of course, you can add CT, LP, etc. if indicated to rule out ICH, SAH, meningitis, etc.

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