pain in the ed

[MAGIK GIRL]

i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick.

our er uses the pixis and computerized mar's. the doc orders a drug, you have to wait, wait, wait, and then go to the pixis, get a witness for a waste (if you don't need all of the pre measured dose), and then give the pain patient his dose. never mind the fact that on the way to the pixis you have 6 other things that suddenly need to be done and that pain patient has sent each of his 6 visitors individually at 5 minuet intervals to complain that the 2 hour er stay is rediculous and that he missed his dinner and wants you to fix him something to eat.

by the time you get to the patient, the award winning draumatic preformance is simply breath taking!

now i know that some pain is true. but if i have a kidney stone, an acute appendix, labor pains, or chest pain, the er nurse shouldn't have to come out to the smoking area, tell me to put out my cigarrette, put down my big mac and accompany her to a room where my vs are 120/80 - 70 - 16!

thanks for allowing a "newbw" to vent!

[ERKev]

Originally posted by gwenith

Once again I will ask all posters to show respect for each other. As health professionals we do not like to contribute to addictive behaviour that is deleterious to the person - on the other hand pain is what a person says it is - hence the dichotomy.

We are torn between wanting to help and to act in an efficient and timely manner to relieve pain and not contributing to an addiction that will cause more problems for the patient

Gwenith! We need nurses like you in Detroit!

My posts, while I have "taken to task", somewhat, the advanced practice folks, it is solely because they seem to forget that others have valid experience which is appropriate to draw upon. Certainly we are, most of us, in this to make a difference in whatever way we can. Don't throw your (not you, Gwenith) credentials in my face and attempt to denigrate my experience and compassion.

Yes, we need not to be TOO judgemental with our patients. And, true, with chronic pain, we may mistake some tolerance of the pain as a lack, thereof. But, I feel, as you, that we all truly care about pain control.

But, there are the junkies that come in and need an EJ or central line placed 'cuz they've used up everything else. And they slip out for a smoke after getting doesed or complain that our turkey sandwiches are too dry, or "why can't I get a meal, rather than a snack?", etc... The abusers....

No, don't be too judgemental, but open the eyes and see what is there, yes?

PS: Just took my wife to the local ED tonight for bad tooth pain... Very slow to deal with her, but they ultimately DID give her the appropriate relief.:)

ERKev

[MAGIK GIRL]

Originally posted by ERKev

Gwenith! We need nurses like you in Detroit!

My posts, while I have "taken to task", somewhat, the advanced practice folks, it is solely because they seem to forget that others have valid experience which is appropriate to draw upon. Certainly we are, most of us, in this to make a difference in whatever way we can. Don't throw your (not you, Gwenith) credentials in my face and attempt to denigrate my experience and compassion.

Yes, we need not to be TOO judgemental with our patients. And, true, with chronic pain, we may mistake some tolerance of the pain as a lack, thereof. But, I feel, as you, that we all truly care about pain control.

But, there are the junkies that come in and need an EJ or central line placed 'cuz they've used up everything else. And they slip out for a smoke after getting doesed or complain that our turkey sandwiches are too dry, or "why can't I get a meal, rather than a snack?", etc... The abusers....

No, don't be too judgemental, but open the eyes and see what is there, yes?

PS: Just took my wife to the local ED tonight for bad tooth pain... Very slow to deal with her, but they ultimately DID give her the appropriate relief.:)

ERKev

:) hi erkev!

i am glad your wife was given relief.

:) hi gwenith!

none of my posts were meant to be taken personally by any one on this bb.

we as humans are lucky to have been builtwith our very own bb inside. it is our sence of humor. truley, if we did what we did day in and day out and couldn't joke about it in some aspect, we would explode. so please take my posts for what they were intended...intended for venting (and never being judgmental)! thanks to all of you! you have made my world more fun!

magik girl

[MAGIK GIRL]

Originally posted by Dragonnurse1

Get a grip people. Each of us who has worked in ED need a chance to vent. And to Magicgirl (spelling may be wrong) AMEN Sister.

There are certain physical truths about pain. If someone of average size and weight presents with 120/70 HR 60-80 and resp 12 - 16 and a O2 sat 99 - 100% do not tell me you are experiencing the worst pain in your life. And before anyone challenges me I have suffered with migraines for 33 years, my daughter started having migraines at 16 and my middle son at 5. Yes 5 years old. You can look at some people and see the pain, some only show by vitals. After 10 years I learned our drug seekers well. I was also the one that many doc's asked to go take a look at the patients and chat with them to determine whether pain was real or were they new seekers.

But I digress. We should be able to vent without fear of being judged.

It is hard to have empathy when your sickle cell patient comes in having a "crisis" but manages to stand up and throw a fit because we would not give her a weeks worth of her pain pills after all without them she wouldn't be able to get her crack.

:) dragonnurse, thank you!!

venting keeps me off meds! lol! but it does keep me sain and from taking my sometimes not so nice job home.

have a great holiday, magikgirl (and don't worry, i can't spell anyway!)

[athomas91]

i actually think that we all have very good points - on both sides - and it is primarily attributed to what we see/ what we do.....

i truly think we - in a way- we are arguing two sides of the same coin

yes the majority of er patients c/o of pain are in pain

yes - we see those who are lying just for the narc's

so - i think perhaps discussing how nursing as a profession should deal w/ this is a better avenue

- should we just medicate everyone until they rate pain 0/10?

- even to the point of intubation?

- is it wrong to feed addictions?

- how do these things affect our views, our empathy?

- how do return visits, etc effect insurance premiums or

hospital bills?

- who is responsible for health?

i think that these questions stimulate so many answers, yet so many other questions that perhaps our focus should be health promotion - and what we need to do to encourage those promoting strategies.

[MAGIK GIRL]

Originally posted by athomas91

i actually think that we all have very good points - on both sides - and it is primarily attributed to what we see/ what we do.....

i truly think we - in a way- we are arguing two sides of the same coin

yes the majority of er patients c/o of pain are in pain

yes - we see those who are lying just for the narc's

so - i think perhaps discussing how nursing as a profession should deal w/ this is a better avenue

- should we just medicate everyone until they rate pain 0/10?

- even to the point of intubation?

- is it wrong to feed addictions?

- how do these things affect our views, our empathy?

- how do return visits, etc effect insurance premiums or

hospital bills?

- who is responsible for health?

i think that these questions stimulate so many answers, yet so many other questions that perhaps our focus should be health promotion - and what we need to do to encourage those promoting strategies.

BRAVA!!!!!!!

[CCU NRS]

Originally posted by Rapheal

I just have to say it. Sorry but I have to say it.

I feel sorry for my patients who are in pain. Pain is subjective and I will administer the patients pain meds based on what they say it is.

BUT-

In healthcare their is an allocation of resources. My TIME is a scarce resource. So when a person who has chronic pain issues and has PRN narcotics ordered starts DEMANDING that they need their pain medication NOW, and will cause such a ruckus if it is not delivered within minutes of their request it may become a problem. The problem may be that the little old lady down the hall has developed a heart arythmia or pulmonary congestion. She may not be screaming for help- in fact she may just lay there getting worse until you the nurse intervene.

That poor little old lady needs help now. She may not have the ability to call the NM and start screaming for help NOW. So then I have a decision to make. Sometimes my decision is not a popular one. Sometimes the person who can scream, can be demanding will do so at the expense of another, more fragile, more vulnerable patient. Hence- this nurse, or anothe nurse in the same position may feel frustrated. Resources should not be doled out based on the aggressiveness of a patients' demands.

There I have said it. I hope to not appear unsympathetic to our patients who are in pain. And although pain is the 5th vital sign, it may cause a life altering condition and not a life threatening condition. And I as a nurse will put a life threatening concern first. So some patients may have to be in pain a little longer than we both would like. We both end up frustrated, but sometimes that is just the way it is.

Claps hands vigorously and then jumps to feet in encore!!!!!!!!!!

[CCU NRS]

Originally posted by Erin RN

Couple of things to think about:

1. Although pain is not "life threatening" in itself it can be indicative that something life threatening is going on..hence the 5th VITAL SIGN.

True Story: We had a guy some in to the ER that was a "frequent flyer" complaining of abdominal pain. Of course we all rolled our eyes, saying, "whats new". We gave him Donnatol and Lido..of course the pain was still 10/10 again rolling of the eyes..we knew he wanted the "good stuff". The staff taking care of him put him on the low priority list due to his past history and our predjudice against him..Finally after sitting in a room for several hours the MD scanned his belly just in case. He was perforated and had to go and have an emergency appy. The surgeon screamed at us when she came in over the amount of time we had basically let him stew. He ended up in the ICU for over a week with a systemic infection and brought a suit against the hospital maintaining that IF the ER staff would have taken him seriously then he would not have become septic. Would he hve? It is unknown BUT try to defend your actions in depostition on that one..."Um well he is usually full of crap so I figured this time was no different...A plantiff atty would tear you a new one for that. Now I know I am going to hear variations of the little boy that cried wolf here but a BIG part of nursing and critical thinking is based on remaining OBJECTIVE to the patient at hand. That is part of our responsibility as healthcare providers. By not doing so, the staff in our ER put a patient at high risk..not something any of us were proud of.

2. As far as the patients that come in over and over for narcs and the fact that we as nurses think it is bull..the MD is ordering these. If the supply dried up they would no longer come. Maybe rather than complain and complain about the patients go speak to your MD group or refuse to give them. I have seen more than one nurse say, "NO". I told an MD "No" once since the pt was so completely gorked and her resp were so slow in my judgement it would not have been safe to give her anymore. After I told the MD her vitals etc he agreed.

I no longer work ER and am glad when I read these types of theads. I used to be the same very judgemental and the pt basically had to "prove" to me that he/she was really deserving of that pain medication. It is sad really. Bottom line is the seekers are not going to go away so I agree with the NM "give em what they want and get em out"..wasting emotion and time on being "mad" at the pt only serves to take away from the nurse.

Erin

Basics assess the Pt not the chart but I can see how in an ER as you described that exact situation must occur (the seeking not the Appy) thousands of times a day across the United states.

[CCU NRS]

Well my two previous posts were just spur of the mooment barvos as it were. When this subject gets rollong there are really some very masterful ways to make a point. There are ways that are sort of finesse. They are both creative and offered from the perspective of the author. I finally read the entire thread. Things really get heated and then one person is offended and the ball starts rolling and MAN!

What I see here is the total lack of Unity that we as a profession should endeavor to promte, nurture, and pray for!

We are all individuals most assuredly. We are all providing care in a manner that we personally deem appropriate. We all have some things that we would love to change about our porfession. We all obviously work in a HIGH stress environment. We should all try to undesrstand and support our brothers and sisters in our chosen field. We should discuss with an eye toward education and temperence. We should LEARN to get along.

wiping the tears from my eye as the screen blurs

[Uptoherern, RN]

you may have been taught that pain is what ever the patient says............but. having been a nurse for umpteem years, my bullshit detector is fine tuned. If a patient is moaning when I'm in the room, and laughing on the phone, when I'm standing outside the room, then I'm not sympathetic at all. for all of you who have never worked er.... get off your soap box, it ain't flying here.

[athomas91]

*standing ovation*

[Sarah Kat]

Originally posted by harry Krishna

What ever happened to the great Existential Philosophy of being responsible for one's own actions? I truly believe that our society has become enablers for people's circumstances they end up in. It seems we no longer blame people for the disasters that {thru their own choices and actions} they get themselves in to.

HK

Liberals AND conservatives have both played their parts in creating such a "nanny culture" that we live in. We all cry about how we wish people would take responsibility, then we complain about people not being smart (or educated) enough to make their own decisions.

I really don't think we can have it both ways...

[CCU NRS]

Education:

Explaining the 0/10 pain scale (esp. with those you feel may be less than honest about their pain) assess pain as usual and ask if you could demonstrate something slightly painful for them to compare it to. To help us better understand if your pain is continually at this level.

Explain that when people are coming out from anesthesia we have certain little things we do that make the brain respond to painful stimuli. Explain that what you are about to do is somewhat painful but it only hurts for a second. Take your ink pen and roll it across their cuticle and apply brief but firm pressure. Then ask then what they rate the pain of this procedure. There are several you may want to experiment with which one gives you best results. You can apply pressure to the eyebrow by pushing on the bone at that point above the eye. You can pinch the cartiledge of the ear and there is always the good old sternal rub!!!

Too Bad we could never really do these things. You may be able to sort of slip it in on someone that is willing to participate. :chuckle