Hi, it's been awhile. Hope you guys are keeping on keeping on. I've been doing fairly well, but my asthma has been requiring more vigilance to keep it fully under control lately, and it doesn't seem to take much to get me sick. I had to go to the ED for an exac recently, though, and while most of the visit was routine, the way pain was addressed on a completely non-pain related visit kinda shocked me. Is this just the way things are now?
The full story:
The weekend right before Halloween I managed to sprain my back trying to work on my new house. When I went in to see my PCP he noted that I was wheezing a bit more than normal, we made a note that next visit I needed to get my PFTs redone, and I learned the power of Toradol for the first time (the shot took a bit to start working but within half an hour I could have kissed that doctor). When I'd had orthopedic pain before he'd written Celebrex and it worked well, so he wrote that as well as some Flexeril... and Vicodin, which may have been the mistake.
Over that next week my back slowly got better, but my breathing got much worse -- I had to use my rescue inhaler twice the first night on it. I had also been fighting nausea all week -- coughing too much does it to me, plus I'm sure the narcs added their contribution. I only needed the Vicodin at night by the end of the week, so that's the only time I was taking it, but by Sunday night I had the full-on crud and was running a fever hacking puking all night.... and my doctor was already booked up for the entire day on Monday when I got through. I made an appointment for the next day but I guess I sounded bad because I got a callback 15 minutes later from my doctor, who asked me a few questions, had me use my rescue inhaler six times in a row... then told me to go to the ER because I still wasn't able to speak in complete sentences. Fortunately a friend was able to drive me, I really didn't trust myself behind the wheel, and I was right -- O2 sat 87 in triage.
The triage nurse learned about the back problem because of my current medications, but when she asked my pain levels I said "Maybe a 2 but it's not on my radar at all right now." It wasn't. Everything seemed pretty standard after that -- saline lock, blood, UA, they did a chest x-ray and then a resp tx... I was still pretty wheezy after but I did respond some.
Then this is when it started to get weird, or at least it felt odd to me.
The doctor apparently ordered fluids and Zofran, and another resp tx for after the fluids were started, but also Ativan. And I got the feeling the nurse was uncomfortable with the dose ordered of Ativan, or at the very least she was trying to do her best not to snow me completely with it (I don't know what amount was ordered but I'm only 5'1 and 130 lbs, doesn't take much for me)... she pushed the Zofran but she spaced the Ativan out in the line so it wouldn't knock me straight out. As it was, I could barely finish the second resp tx. I won't deny I needed the rest, and I was happy to sleep without struggling to breathe or struggling not to puke, but I'd never been sedated in the ER before.
After a few hours the doctor woke me up and listened to my breathing, said that the chest xray and labs were all good (yay!) but he wanted me to follow up with my doctor... He wrote Phenergan and Cipro, then said that he thought I should have an antibiotic and steroid shot as well, and that the nurse would be in. I was still pretty dazed. When the nurse came in, she said, "By the way, the doctor was worried about you, he said you were crying out in your sleep." I said I didn't know why, that "my back hurts a little, but..." and started to say I had meds at home for that. She cut me off. "Well, this morphine will fix that."
?????????
I was *extremely* surprised, and the only thing I could think of to say in response to that was "Well, if you're going to do that I'm doubly glad that my friend was able to drive me today." I accepted the medication... I figured it meant I wouldn't have to take any of my home medication the rest of the night, and knew I wouldn't be behind the wheel. After that and the Rocephin/Decadron my friend came and picked me up, took me home and put me to bed, then went and got my scripts filled for me -- I was barely able to keep my eyes open on the way home.
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When I followed up with my PCP I asked about getting a home nebulizer so that I can give myself breathing treatments if I need to instead of having to go to the ER, and he seems to think it's a good idea, so hopefully I won't have to go back to the ER for a long time.
But is it standard to administer narcs in a situation like that? Honestly, I would have been happier with Toradol now that I've had it once and know how well it works -- I don't like the nausea and sleepiness from narcs. It just seems backwards to have gotten an anti-inflammatory shot when I was in absolute agony and narcs when I wasn't even c/o of pain as my reason for being there.
No offense to the OP, but you're talking aspects of your own medical care and treatment (and not a neutral clinical question), which is actually not appropriate for this forum per the Terms of Service. I suggest a moderate please review this thread.
If that is your reasoning, click on "report" in the first post.
No offense to the OP, but you're talking aspects of your own medical care and treatment (and not a neutral clinical question), which is actually not appropriate for this forum per the Terms of Service. I suggest a moderate please review this thread.
The OP is not asking for tx advice, which would violate our TOS. It's different to discuss a possible rationale for the treatment of a problem that has since resolved. We learn things that way. I give toradol frequently to my postpartum moms and was not aware of its ability to exacerbate asthma s/s. Good to know.
BTW, thanks for caring about the TOS. We appreciate that.
Thanks for all your thoughts, and I hadn't thought about Toradol possibly adding a contribution to the exac.
My PCP said the cxr was okay except for a bit of cloudiness in the lower right lung that may be scarring from pneumonia when I was younger. He didn't hear any sounds indicating it was more than just scarring in that area. I'm going back for a followup in December and he wants to take another cxr when I am fully well and not having symptoms to use as a base to compare from in the future, hopefully I'll find out about the approval for a home nebulizer then.
I don't know about any visits... I was just meaning the almost what I would call aggressive or CYA thing about pain. I mean, I appreciate it, and I'm glad to know that if I'm ever really in need of that kind of pain relief that it'll be available. And I have to admit that I did subjectively feel like I was breathing better after it. But I've had several ER visits for exacs in the last decade and that's the first time I've ever been given that.
Take care of yourselves, and I'll keep reading your threads and being happy that I'm wanting to do psych nursing instead of the ED...
Spidey's mom, ADN, BSN, RN
11,305 Posts
If that is your reasoning, click on "report" in the first post.