How to treat?

[uRNmyway, ASN, RN]

Hey all, I was wondering if you wonderful people could give me some insight as to how things are done in your ED.

The ED at the hospital I work for seems really quick to Willy-nilly bust out the opiates for anything and everything. Sometimes I very much disagree with their choice of treatment, but oh well, I'm just a lowly ADN nurse, what do I know right?

My question is this: in cases where a patient comes in with acute pain, etiology unknown, who admittedly has pretty extensive history of illegal drug abuse, both injected and inhaled, and has been in recovery for x amount of years, do you attempt other pain relief methods? Or just go straight for the good old Dilaudid?

I'm really trying to bring about some change where I work, I just seem to encounter more obstacles than I anticipated, and I would greatly appreciate your experience and insight on this. Thanks!!

ETA. Ugh, unintended double entendre on second read through. That's what happens when you post before your first cup of Joe.

[thelema13]

If the patient is truly recovering from their addiction, you should not give opiates because they are an addict, and the patient should state that as well, having known first-hand. You will just substitute one addiction for another. Give tylenol and have them follow up with PCP. There are plenty of non-narcotic pain remedies out there. In the ED, we have to deal and address with the emergency and we look for evidence to support our diagnosis, and too often the physicians give opiates because they work fast and make the patient happy (re: Press Ganey). Toradol and phenergen work well together, if your hospital still uses inapsine, talk to the docs about it. It's great for migraines/ super whiny pain seekers. Very closely related to haldol, and actually I just read an article about ED physicians using haldol/toradol/NS bolus for pain control.

[RescueNinjaKy]

I am also curious, Wouldn't you be worried about eps with haldol? Would low dose methadone with Tylenol work?

[uRNmyway, ASN, RN]

I am also curious, Wouldn't you be worried about eps with haldol? Would low dose methadone with Tylenol work?

I've heard of people relapsing due to methadone, if they were not taking it anymore/at all at the time. Guess it might be a case by case on that one.

[Anna Flaxis, BSN, RN]

Toradol IM.

[zmansc, ASN, RN]

First, if the pt told me he was a recovering addict, or for some reason I knew this, and the pt did not want opioids, then I would not give them to him. I would advise the provider that the pt does not want that pain killer. Just because a med is ordered, doesn't mean I give it, your the RN, you have to agree with the order or you get clarification/refuse it.

BTW, I'm mildly offended by the "I'm just a lowly ADN RN". Your the RN, there is nothing lowly about it. It's your license, and your job is to protect the pt from orders that shouldn't be followed. There isn't a shift that goes by that I don't question an order from a provider. This would be an order I would question.

---- OFF SOAPBOX ----

[amoLucia]

BTW, I'm mildly offended by the "I'm just a lowly ADN RN". Your the RN, there is nothing lowly about it. It's your license, and your job is to protect the pt from orders that shouldn't be followed. There isn't a shift that goes by that I don't question an order from a provider. This would be an order I would question.

---- OFF SOAPBOX ----

I was kinda of put-off by that also. I've an ADN and I never dumb-downed it. I'm wanting to think that OP was just trying to be sarcastic. The rest of the post was of interest.

[uRNmyway, ASN, RN]

I was kinda of put-off by that also. I've an ADN and I never dumb-downed it. I'm wanting to think that OP was just trying to be sarcastic. The rest of the post was of interest.

Of course I was being sarcastic. I do not think I am any less of a nurse than a BSN nurse, I have the experience to back it up, just haven't had enough drive to register in school yet. However it seems that many people within healthcare kind of put less stock in your words or opinions if you don't have that golden BSN.

I just have to work a bit harder to prove myself it seems.

But no, fellow ADN or diploma or whatever nurses, I am not in any way putting down your degree or education levels! Promise.

[amoLucia]

To OP - Promise acknowledged.

As I said, I kinda figured you WERE being sarcastic, but with the never-ending controversy re the push for BSN, one can never tell.

I've been cocoon-ed in LTC for a long time, so some of the issues that come up for you folk in other areas of nsg are eye-openers and quite informative. Currently, there's a thread in Corrections Forum about upper and lower bunk assignments for inmates.

Like who'd have thunk it !?!? Never to old to learn about something new!

[Dumbledore'sArmyRN]

In some instances, I think it is best to leave it up to the patient. If a patient is in recovery and not actively using, I believe it should be there choice whether or not they receive opiate analgesics. Ketorolac is a great drug but there are certain conditions- traumas, surgical bellies, etc. that opiate analgesics are needed. Generally speaking, I think that my nursing judgment is usually appropriate in deciphering what severe pain is. Just because a patient is a recovering addict, does not mean that they should suffer in severe pain.

[sweetdreame, BSN, RN]

I once worked with the Press-Ganey-obsesesd ER Medical Director who practiced as an ER physician as well. He would prescribe 3mg of Dilaudid once or twice a week for this patient who came in with "migraines" because the patient would absolutely raise hell if she didn't get it.

The patient would become LIVID if her drug dealer wasn't on duty that day because the other physicians wouldn't even consider giving her such a high dose! The patient, of course, had no insurance. All she had to do was come into the ER wearing sunglasses and acting all pitiful and she could get her drugs legally and for FREE! Its amazing what Press Ganey does for the patient population. I will never forget such complete mismanagement of that patient's illness. Very very sad.