i am wondering how are headaches/migraines treated in your ers?
in our er docs mostly give narcotics and antiemetics. as an ex-neuro nurse i was very surprised by that, because our neurologists absolutely will not give narcs because it causes rebound headaches. upstairs we did mostly dhe protocol, caffeine, depakote, reglan loading protocol if all of the above didn't work, quiet room, icepacks, darkness, hydration and oxygen,etc.
the er docs explained to me that "we don't have time to do all that, we want to stop the pain and get the person home" (with a lortab prescription usually). none the less, the patients stay at least 4 hours even if they get narcotics, then they come back 2 days later because the pain is back and the neurologist can not see them this week.
If it's truly a new-onset or a headache unlike anything the patient has ever had before, most of our docs and PAs won't give pain meds until they see a CT. (Real life story, sorta-kinda related in topic: 2 days ago one of our housekeepers died as a result of an aneurysm that was never diagnosed, had been having a few headaches recently... so sad!!) They may give Reglan or Compazine, Benadryl, etc prior to CT, and then Toradol after CT.
If it's a patient that is a frequent chief complaint of "migraine," they tend to give an IM of toradol and maybe some compazine/phenergan/reglan/zofran, and print out the discharge instructions at the same time they're putting in med orders. :-P Very seldom do they give out narcotics -- some give a d/c rx of toradol 10mg po.
Hello...I'm new here and don't want to make anyone mad, but I have been reading post for the past couple of days and this is the second time I've heard reference to Droperidol. I have given this drug before, and I'm not saying anything negative about anyone else that gives it. However, Droperidol was black boxed almost ten years ago. The reasoning behind the black box as irreversible cardiac arrythmias and death. Here's my question: If a physician orders Droperidol and you give it with negative consequences (death). Are you responsible? You gave the right drug, right dose, right route, right patient, right time, but you gave a black boxed drug. If anyone knows the answer to this question I would be grateful for the education.
Patient Care I had to take exams to get a license,some PCT's are taught to do everything LPN's and RN's can do. Clinicals were at a hospital on a telemetry unit for 300 hours, with 300 hours in palliative care in Hospice.
Maybe those in question are not licensed to pass out medicines, maybe they are PCT's or worse, but the only difference between a NCPCT( Nationally Certified PCT with a license) with 25 years of experience (and legally certified to pass hospice meds under pt and doctors orders) and a LPN or even RN is :a PCT is not allowed to pass out meds, and can perform nursing routines like IV's, catheters only if it is legally in that agency's policies etc. is which I hope the above people who are giving out medicines that are addictive and dangerous and illegal remeber.
Please forgive me for finding those statements incredibly offensive. There is much more to nursing than "passing out meds" and starting IV's and foleys. Do you know how a med works, why it works, why you need to give it, the side effects, administration techniques, and desired outcomes? Do you know how to accurately and completely assess a pt who comes into an ER c/o chest pain? Because believe me, it isn't always cardiac. What about a pt c/o GI pain? Because THAT COULD BE cardiac. Can you go into every possible route with your assessment and ask the right questions to determine the correct diagnosis? Considering how only nurses are legally allowed to assess a pt and taught how to correctly assess, I'm going to assume the answer is no. Can you anticipate meds, tests, and treatments for various illnesses? Do you know what to look for with dig toxicity? I never treat techs badly, but don't presume that working as a tech for 25 years trumps the knowledge of a nurse.
By the way, I'm not trying to be rude in my above post and I always treat techs with kindness and consideration. I definitely value them and their importance to the team.
Hello...I'm new here and don't want to make anyone mad, but I have been reading post for the past couple of days and this is the second time I've heard reference to Droperidol. I have given this drug before, and I'm not saying anything negative about anyone else that gives it. However, Droperidol was black boxed almost ten years ago. The reasoning behind the black box as irreversible cardiac arrythmias and death. Here's my question: If a physician orders Droperidol and you give it with negative consequences (death). Are you responsible? You gave the right drug, right dose, right route, right patient, right time, but you gave a black boxed drug. If anyone knows the answer to this question I would be grateful for the education.
I can understand your concern.
But think about the meds we routinely give in the ED such as insulin gtt, Labetalol, Levophed, Mag Sulfate, Dilantin, blood products, thrombolytics, narcotics, etc. ... any of these and many others have a significant potential for harm. Always administer as per standard drug guides and your facility's P&P, ask questions of pharmacy when you feel you need to, and monitor your patient appropriately.
Hello...I'm new here and don't want to make anyone mad, but I have been reading post for the past couple of days and this is the second time I've heard reference to Droperidol. I have given this drug before, and I'm not saying anything negative about anyone else that gives it. However, Droperidol was black boxed almost ten years ago. The reasoning behind the black box as irreversible cardiac arrythmias and death. Here's my question: If a physician orders Droperidol and you give it with negative consequences (death). Are you responsible? You gave the right drug, right dose, right route, right patient, right time, but you gave a black boxed drug. If anyone knows the answer to this question I would be grateful for the education.
The drug is still approved by the FDA, if it was that unsafe, if would be taken off the market. The study that found droperidol to be "unsafe" has many flaws- see here: LINK
Problems from droperidol administration are usually from doses that are much higher than what is given regularly in the US. It can cause prolonged QT or Torsades, BUT this is almost always when given at a higher dose than any ER patient in the US will receive, or when given with non-compatible medications. Usually, patients get only 1.25mg in a dose, and not more than 1-2 doses. Most hospital policies state that patients only need to be on a cardiac monitor if they receive a dose greater than 2.5mg- and doses this large aren't really given in American emergency rooms.....
I have never had any patients have an adverse reaction to droperidol. All medications have risks and side effects. I can think of a lot of medications given in the ER that have the potential to be a LOT more dangerous than droperidol......
Patient Care Technology thank you, its too new for most places, some hospital staff think PCT 's are C N A's, wrong.I had to take exams to get a license,some PCT's are taught to do everything LPN's and RN's can do. Clinicals were at a hospital on a telemetry unit for 300 hours, with 300 hours in palliative care in Hospice.I worked as soon as I graduated since I acquired my PCT license as soon as I could, was told I was hired because of my PCT license, and from a great school that has as a teacher an RN for 18 years who made sure her students knew their business and ethics.Maybe those in question are not licensed to pass out medicines, maybe they are PCT's or worse, but the only difference between a NCPCT( Nationally Certified PCT with a license) with 25 years of experience (and legally certified to pass hospice meds under pt and doctors orders) and a LPN or even RN is :a PCT is not allowed to pass out meds, and can perform nursing routines like IV's, catheters only if it is legally in that agency's policies etc. is which I hope the above people who are giving out medicines that are addictive and dangerous and illegal remeber. Believe me I have been in the business of caring for the dying for over 25 years, and will continue for 50 more and not settle for ancient remedies like poor unethical wokers passing out illegal dangerous substances. I was not hired to keep my mouth shut, in fact my workplace has a zero tolerance for substance abuse and illegal use of prescribed drugs. What do you do? Do you have a job? I have had mine a long long time and get paid very well thank you please. I and my colleagues have only five pts at the most in a setting of only 70 pts at full house... a dream job compared to others. To get a PCT license, one needs to have a CNA License, it used to be called a certification, this year its changed, as did the CPR manuevers, ie 15 compared to 30 compressions etc. We answer to the pts first, with their doctors and nurses care plans followed , not according to our own preferences and such...
I have been looking around online, and have yet to find where a Patient Care Technician is "licensed." I have found many mentions of "Certified Patient Care Technician." Please do not confuse the two. Just saying, since you also seem very confused as to the differences between your role as a Patient Care Technician and a Registered or Licensed Practical Nurse.
From what I have found, there are several PCT programs, which are the equivalent of what my employer's Emergency Dept techs orientation training consists of minus the administration of breathing treatments.
For example, one educational program teaches PCTs to be able to:
-Differentiate the role and responsibilities of the patient care technician in each health care setting
-Demonstrate principles and techniques of Standard Precautions, Infection Control and related OSHA Standards
-Identify various safety and emergency principles as they relate to a health care facility
-Communicate effectively with patients, their families and other health care professions
-Properly access and document patient information
-Demonstrate proper body mechanics when lifting, moving and positioning patients
-Demonstrate proper techniques for obtaining vital signs, height and weight
-Demonstrate proper techniques when performing various diagnostic procedures such as EKG, spirometry and venipuncture
-Demonstrate entry-level office skills in the areas of reception, scheduling and word processing
And another program describes theirs as this:
This program will prepare you for an entry-level position as a patient care technician. Emphasis is on technical skills necessary to perform personal care to complex patients, implementation of selected portions of care plan including respiratory services, rehabilitation services, EKG, and phlebotomy under the supervision of registered nurses.
And their curriculum includes the following areas:
* Certified Nursing Assistant
* Phlebotomy
* Electrocardiogram (EKG)
* Cardio Pulmonary Resuscitation (CPR)
So... no, you are not doing almost everything a nurse does. You are doing about the same things as a lot of ED techs. If you think that drawing blood, inserting foleys, doing EKGs, performing CPR, and setting out a patients meds is nearly nursing you are VERY wrong. You could teach a lay person to do all of that. Essentially, being "certified to pass out meds" is basically being certified to read a prescription's directions and follow them. Most people who take meds at home do that every day without a certificate saying they can.
You don't assess your patients. You don't know the pharmacology behind the meds you give -- only that you give them this-many-times-a-day, for this-that-or-the-other. You aren't able to look at someone, listen to vague complaints, and have insight into their disease to recognize when they may be in renal failure, heart failure, or having a heart attack. And you probably aren't able to do a lot of other things that nurses do.
I don't mean to sound irritated, but quite frankly I am, because so many people think it's easy and they "do almost everything nurses do." They don't. I love ALL of our ED Techs, and I'd be perfectly happy if all of our ED techs started IVs right along with drawing blood, putting in foleys -- they can do ALL the technical stuff that nurses do -- it still wouldn't take away from the bulk of my job. ANYONE can be taught to do the hands on minute stuff. That is NOT nursing. And if you think it is, go to nursing school and get a real nursing license -- you're in for a rude awakening!
Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
Uor PCT's do some of that stuff but no meds, they are taught how to start IV's but only hep. locks, no fluids and thats only if there really the last resort eg-no RN's/LPN's or paramedics on floor.
Our docs usually give toradol, compazine, benadryl, and nubain all IM, if that doesnt work then you get O2, IV-f 1 L. NS WO, dark quite room, and maybe a little more nubain IV, and a CT, if that doesnt work and heaven help you if your trying to seek narcs, youll get a neuro consult, possibly an MRI, and an LP, then after all that you Might get some demerol or Diluadid, or MS, but this has deterred alot of are seekers, because who the he!* would like to get an LP just to be able to get a one time dose of narcs to get High, I dont know to many who would be willing for narcs bad enough to get an LP, but know there coming in with Abd. pain, back pain, and fake kidney stones, I actually caught one who thought he had a stone and sent him to the restroom for a UA, well he comes out the urines pretty bloody but I notice some blood on his finger, so I ask doc if I could cath him for a UA, well guess who signed out without a cath, and without narcs. period. Now Ive had real kidney stones in the past, and let me tell you if you have you dont care what they do as long as they get it resolved.
I've never heard of such a Patient Care Technician either. Sounds fishy....
Unfortunately, being in a "smaller" ED, a lot of the docs will give the standard 1-2mg Dilaudid and Zofran. One memorable one recently got a BOATLOAD of narcs, including 150mg Demerol IM, 2mg IV Dilaudid (3 times!) and a ton of Phenergan. She had already used her home Rx's of oxycodone and oxycontin. Pt hx showed way too many visits to our ED (1-2/week) and I'm sure if we could see all the other area hospitals records.....
There is no protocol for this ED, and that bugs me. Every migraine is not the same, but 1/2 of our pt's get CT's, some don't. There is no rhyme or reasoning to any of it, besides what the doc feels like doing.
Uh, what? This is definitely not the post to debate or do I every have the energy to debate the differences between your skill and mine. There is a huge difference between what you do and what an RN does. There is a MAJOR DIFFERENCE! That said, back to HA's. I wish my headaches were as easily cured as yours with relaxation techniques and deep breathing. Unfortunately for me, and many migraine sufferers, it takes more. Thankfully I have found a great prescription that does the trick for me. Don't get me wrong, when I am hurting, I'll try anything. If only I had a compassionate 4 year old hanging around......
alkaleidi
214 Posts
If it's truly a new-onset or a headache unlike anything the patient has ever had before, most of our docs and PAs won't give pain meds until they see a CT. (Real life story, sorta-kinda related in topic: 2 days ago one of our housekeepers died as a result of an aneurysm that was never diagnosed, had been having a few headaches recently... so sad!!) They may give Reglan or Compazine, Benadryl, etc prior to CT, and then Toradol after CT.
If it's a patient that is a frequent chief complaint of "migraine," they tend to give an IM of toradol and maybe some compazine/phenergan/reglan/zofran, and print out the discharge instructions at the same time they're putting in med orders. :-P Very seldom do they give out narcotics -- some give a d/c rx of toradol 10mg po.