Medication tidbits an ER nurse should always know

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Hi all...I am currently doing an externship in the ER and even though I can't administer medications, I've picked up on a lot of important facts you have to remember about certain medications from watching my preceptor. Things like potassium and any other electrolytes always go on a pump with the pt on the monitor, bentyl is never given IVP, always put older people on a spo2 with narcs, IV antibiotics can make people hypotensive. I was just reading another thread about inapsine sending people into prolonged QT and arrhythimas which is something I've never heard even though we've given our pts inapsine. So I want to know...what are those things I should ALWAYS think about when giving certian meds? I'm sure theres a ton more out there!

Specializes in Emergency Nursing.
But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it and I know the pt will be so thankful I just got them high.[/quote']

Ok, but how do we know that? If pain "what the patient says it is" and if people living with chronic pain are able to sleep with it except when it flares into breakthrough and otherwise might not show vital symptoms, how do we know?

All I know is that I didn't become a nurse to be a judge. If I wanted to be a judge I'd have gone to law school, and if I'd wanted to be a cop, I'd have gone to the academy. Patient safety is one thing. Would I give dilaudid to someone who was in severe respiratory depression just because it was ordered? Of course not. But that's not what we are talking about here. Here we are talking about nurses who take it upon themselves to decide when and how much pain medication the patient needs.

As for the real seekers: the IVDA's who hop from hospital to hospital, our docs don't give them anything but Tylenol or Motrin, maybe Toradol if it's flank pain this week.

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Specializes in Emergency Nursing.

But I feel like I've derailed the thread with my rant. Sorry about that folks. I yield.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it, and I know the pt will be so thankful I just got them high.

while I don't always mix it in a IVPB I never push it fast...that is not how the PDR says it can be given.

Dosing:

IV: (opiate naive) Start: 0.2 - 0.6 mg q2-3h prn. Pain, acute: 1-2 mg IV (slow - over 2-3 min) q3h prn.

If they complain that is too bad.

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Specializes in LTC, MDS, ER.

I drew up Valium and put it in a 10 cc syringe of saline. Immediately it precipitated, turning into a nice cloudy mixture. I had to waste the syringe and put the second dose in a 3 cc syringe. I had no precipitate in the pts line when I flushed with saline after giving it. Hth.

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Specializes in LTC, MDS, ER.

Artemis Safe Dose Pro iPhone app is my go to app for double checking peds meds before giving them. I've caught overdosages with it. You just enter how many kgs they weigh, the med you're giving, and it tells you how many mgs to give, and figures out the mls to give based on different strengths of the med available.

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Specializes in Emergency, Med/Surg, Vascular Access.

Regarding the dilaudid, which I realize has been beat to death already, forget all the stuff about drug seeking, chronic vs acute pain, getting a high or not getting a high. Shouldn't even be a consideration. Best practice is to push over AT LEAST 2 mins. If it makes me uncompassionate to not 'push it fast', I'm totally cool with that, whether the pt is in real pain or not.

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Specializes in ED, trauma.
But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it and I know the pt will be so thankful I just got them high.[/quote']

This.

She wanted IV Benadryl with dilaudid and morphine. Pushing slow won't hurt the patient.

If they are stable I will push as directed by the drug guide for my facility.

Most of these patients I have encountered already have low blood pressure or decreased respirations from drugs on board already. Why would I push it just to make the patient happy? Should we start administering heroin too? All in the name of customer service right?

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Specializes in ED, trauma.

while I don't always mix it in a IVPB I never push it fast...that is not how the PDR says it can be given.

Dosing:

IV: (opiate naive) Start: 0.2 - 0.6 mg q2-3h prn. Pain, acute: 1-2 mg IV (slow - over 2-3 min) q3h prn.

If they complain that is too bad.

Exactly! We aren't supposed to push fast and minor risking my license for their high!!! Push as directed and no faster!

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Specializes in ED, trauma.
Regarding the dilaudid which I realize has been beat to death already, forget all the stuff about drug seeking, chronic vs acute pain, getting a high or not getting a high. Shouldn't even be a consideration. Best practice is to push over AT LEAST 2 mins. If it makes me uncompassionate to not 'push it fast', I'm totally cool with that, whether the pt is in real pain or not.[/quote']

Exactly! Very well said!

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