No pain meds in ER??

Specialties Emergency

Published

So, how does everyone feel about the New Jersey hospital that decided to pull pain meds out of their ED?

Actually, I had seen it on TV.

Is this the video that you are referring to?

[video=youtube;b1hpPO30G-U]

Up Vote Up Vote ×
Specializes in Emergency Department.

On the EmCrit podcast, I heard that an ER went opiate-free for 24 hours (or something like that) and apparently did very well and had high pain-control satisfaction scores. I don't recall what they used (if they said) but no opiates. They were apparently studying whether or not they could do a full 24 hours without any opiates. My recollection is that this wasn't a US-based ED so they may have been able to use medication other than what's commonly available in the US for non-opiate pain control or they may have done a fair amount of public education about the study so there may have been some patient self-selection to avoid that particular ED.

Up Vote Up Vote ×

Maybe I'm a dummy, but eliminating just diluadid but still using morphine and fentynal. What gain is that? Its just a slight push to go from morphine to heroin and street heroin is cheap as opposed to illicit oxy and diluadid. I was asking one of my regular OD'ers whats up with the surge of OD's and he told me that it used to be that a person had his one dealer and you got to know your product and used right dose. Now there's a flood of product and dealers so there is no quality control so today's fix might be totally different from tomorrow's.

Pain control is one of my hospitals prime directives plus I think they push that in RN schools- usually first question out of the students doing clinicals "how's your pain?". I spend time explaining to patients that the goal is acceptable level of pain and not totally pain free. Getting hurt hurts.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

The ER that I went to with abdominal pain several times 1 year ago today talked to me about using the ER for pain meds.....I was admitted 3 days later in critical condition in heart and kidney failure in Septic shock from liver abscesses that contained over 4 (yes I said four) liters (yes liters) of pus. My children and husband were told to prepare for my funeral. I continue to recover. I developed skin ulceration's from micro hemorrhages with skin that sloughed off of my hips groins and buttox leaving deep Stage 4 wounds/breakdown.

Multiple debriedments later several wound vacs later as I screamed enough to peel wallpaper from unbearable pain....You bet I deserve pain relief.

I am allergic to morphine.

Did I deserve to have my pain adequately treated? You bet your behind I did.

Am I now a heroin addict? Absolutely not!!

It sickens me to see the ill patient punished because of the behavior of addicts and the derelict physicians who over prescribe. Punish the MD's not the ill incapacitated patient who lives in pain.

Grrrrrrrrrrr...........this really angers me.:madface:

Up Vote Up Vote ×
Specializes in Telemetry.
The ER that I went to with abdominal pain several times 1 year ago today talked to me about using the ER for pain meds.....I was admitted 3 days later in critical condition in heart and kidney failure in Septic shock from liver abscesses that contained over 4 (yes I said four) liters (yes liters) of pus. My children and husband were told to prepare for my funeral. I continue to recover. I developed skin ulceration's from micro hemorrhages with skin that sloughed off of my hips groins and buttox leaving deep Stage 4 wounds/breakdown.

Multiple debriedments later several wound vacs later as I screamed enough to peel wallpaper from unbearable pain....You bet I deserve pain relief.

I am allergic to morphine.

Did I deserve to have my pain adequately treated? You bet your behind I did.

Am I now a heroin addict? Absolutely not!!

It sickens me to see the ill patient punished because of the behavior of addicts and the derelict physicians who over prescribe. Punish the MD's not the ill incapacitated patient who lives in pain.

Grrrrrrrrrrr...........this really angers me.:madface:

Been worried about you, so happy and relieved to see you posting here.

I will be very happy if researchers can come up with new pain relievers that actually reduce pain and still allow patient to function, and it wouldn't create a "high" for those not in pain. I mean, I'm not holding my breath but I remember they were researching plants and other things from the ocean as possibilities. It would be a game changer for sure.

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

We have started using ketamine for analgesia. I have also had migraine patients experience relief using Ofirmev, which is IV acetaminophen. That stuff is legit!

Up Vote Up Vote ×
We have started using ketamine for analgesia. I have also had migraine patients experience relief using Ofirmev, which is IV acetaminophen. That stuff is legit!

Yay to IV acetaminophen!

Boo ketamine which makes me hallucinate.

Up Vote Up Vote ×
The ER that I went to with abdominal pain several times 1 year ago today talked to me about using the ER for pain meds.....I was admitted 3 days later in critical condition in heart and kidney failure in Septic shock from liver abscesses that contained over 4 (yes I said four) liters (yes liters) of pus. My children and husband were told to prepare for my funeral. I continue to recover. I developed skin ulceration's from micro hemorrhages with skin that sloughed off of my hips groins and buttox leaving deep Stage 4 wounds/breakdown.

Multiple debriedments later several wound vacs later as I screamed enough to peel wallpaper from unbearable pain....You bet I deserve pain relief.

I am allergic to morphine.

Did I deserve to have my pain adequately treated? You bet your behind I did.

Am I now a heroin addict? Absolutely not!!

It sickens me to see the ill patient punished because of the behavior of addicts and the derelict physicians who over prescribe. Punish the MD's not the ill incapacitated patient who lives in pain.

Grrrrrrrrrrr...........this really angers me.:madface:

I'm so sorry for what you and your family have been through.

I hope you continue to make a good recovery.

Up Vote Up Vote ×
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
The ER that I went to with abdominal pain several times 1 year ago today talked to me about using the ER for pain meds.....I was admitted 3 days later in critical condition in heart and kidney failure in Septic shock from liver abscesses that contained over 4 (yes I said four) liters (yes liters) of pus. My children and husband were told to prepare for my funeral. I continue to recover. I developed skin ulceration's from micro hemorrhages with skin that sloughed off of my hips groins and buttox leaving deep Stage 4 wounds/breakdown.

Multiple debriedments later several wound vacs later as I screamed enough to peel wallpaper from unbearable pain....You bet I deserve pain relief.

I am allergic to morphine.

Did I deserve to have my pain adequately treated? You bet your behind I did.

Am I now a heroin addict? Absolutely not!!

It sickens me to see the ill patient punished because of the behavior of addicts and the derelict physicians who over prescribe. Punish the MD's not the ill incapacitated patient who lives in pain.

Grrrrrrrrrrr...........this really angers me.:madface:

Esme,

I have been reading this site for several years and only joined last December. I have, however, followed your comments for a long time and before you became so ill. It is a relief to hear from you again. It was distressing to me when some, not all, of my colleagues used to label some patients as "drug seeking". Sickle cell patients as well as others. Pain is complex, and I got angry when some nurses and providers used the term inappropriately, IMO. I am an experienced ED nurse and realize that some patients do go from ED to ED for pain meds. That is being addressed. With studies in the late 90s finding that some patients in EDs and inpatients in the hospital were under treated for procedural pain, the pendulum swung too far the other way. What about the heroin addict with an open femur fracture? He deserves to be treated for pain too. So there is much still to be studied and to be done.

Oh...I must stop as this is an emotional issue.

Continued best wishes from a stranger, Esme.

Up Vote Up Vote ×
Come to think of it, the last time I was in the ER, for an asthma attack, I happened to have a headache as well. They gave me 4mg of morphine IV push for it. They were also hoping to help my dyspnea discomfort, which it did. It probably was excessive, though.

This is the main problem. I think things need to be addressed with the prescribers. I get so annoyed when my patient has some minor pain complaint and the doc orders morphine as a first med. Seriously some dang Tylenol will work just fine or at the most some Tylenol #3. And it's usually not even because the patient requested it. We still way over use dilaudid in our er.

Up Vote Up Vote ×
We have started using ketamine for analgesia. I have also had migraine patients experience relief using Ofirmev, which is IV acetaminophen. That stuff is legit!

I've had patients tell me the iv acetaminophen worked better then the other iv pain meds they were getting. Yet we hardly ever use it. Go figure.

Up Vote Up Vote ×
Specializes in Telemetry.

There cannot be a one size fits all solution with pain. And our approach(es) need to be multi faceted.

Up Vote Up Vote ×
+ Add a Comment