pain in the ed

Specialties Pain

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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!

had a very well known pt come in last nite by ambo for pain rated 9/10 FROM HIS ECZEMA......the etoh of 400 apparently wasn't helping it......poor ems.....

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Originally posted by 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

:roll careful! the sternal rub can leave marks! LOL

true otherwise.

it is frustrating trying to explain the 0/10 scale to someone who just does not get it.

wong-baker face scale for all? lol

i wonder if the scale even matters. "has your pain gotten better since the pain med?" yes or no. leaves out the middle man. and we all know that if 3 nurses ask the same patient to rate pain 0/10, at 2 min intervals, they will all get a different number.

oh well!

mg

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Originally posted by erdiane

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.

well said

tough to argue above example

we've ALL seen it, rolled our eyes, taken a deep breath, and somehow moved on...Yes this patient sucks and will come back to do it again...Where do I find sympathy for this patient?

Please tell me how he's not wasting my time?

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Whenever I see the title of this thread, I keep equating it to the way a Brit might tell you that he came to the ed because he has a migraine; i.e.

Nurse- "What brings you to the ER today?"

Brit pt- "Pain in the 'ed."

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Originally posted by erdiane

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.

That happens everywhere, not just the ER.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

(When i see 'ED' i think of Viagra commercials.)

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Originally posted by Hellllllo Nurse

Whenever I see the title of this thread, I keep equating it to the way a Brit might tell you that he came to the ed because he has a migraine; i.e.

Nurse- "What brings you to the ER today?"

Brit pt- "Pain in the 'ed."

:roll :chuckle :roll :chuckle

I am imagining that heavy fake Cockney accent Dick Van Dyke did in Mary Poppins. "Pain in the 'ed, Mary!"

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Originally posted by hogan4736

well said

tough to argue above example

we've ALL seen it, rolled our eyes, taken a deep breath, and somehow moved on...Yes this patient sucks and will come back to do it again...Where do I find sympathy for this patient?

Please tell me how he's not wasting my time?

:) brava!!

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Specializes in Emergency Room/corrections.

so, what did we decide was the answer for the original question of this thread??

drive through percocet window?? not a bad idea, but unfortunately illegal in my state. :D I think the whole concept of pain in nursing is obviously a passionate one especially from those nurses who work in pain management.

Fortunately for me, I am not one of those nurses.. but I have been around the block or two and learned long ago that the patient doesnt have to prove to me that he/she is in pain, if they say they are in pain, then they are in pain. Short and simple. I think once you learn that you arent going to save the world and rehab all of the narcotic abusers, then your shift will go smoother and faster.

Sorry if I sound like I am patronizing the newer nurses.. We have chosen a career as a caregiver and so that is what we must do. When I worked med-surg and ICU/CCU I found that just being in the hospital creates pain and stress for some people, hence exacerbating whatever pain might be present for whatever problem.

But... I think this is a forum where we should be able to vent and complain without being persecuted..... just my two cents..

:)

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good post veetach - i agree -at work give 'em what they want - they leave much quieter - here i vent......:)

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veetach- i agree with you and i for one am thankful for a wallet to put my 2 cents in!

and you have to admit, some pts are really funny! think about your favorite story!

i wonder if the attorneys listen to all of these patients and take them seriously?! lol:chuckle

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Pain management: the eternal ER conundrum. I do not want anyone to suffer pain. However, I don't always believe that opiates/narcotics/whatever are the solution to some patients' pain.

I believe there is a difference between acute and chronic pain. Acute pain needs to be treated as quickly and as effectively as possible. Same with chronic pain, although these days many patients with chronic pain do not hit the ER, they are being well managed by the pain specialists and generally do not run out of their medication when their providers aren't available.

Drug seekers are also in pain. But it's not the pain that will be relieved by another 'script for Lorcet and Soma or another Demerol 100 mg injection. Do I have any great insights about how to treat these patients in the ER - unfortunately, no. I do know it is costing the health care system $$$$$$$.

I try not to be cynical, but it's difficult to believe a patient who has a bp of 48/37 and is so obtunded she can hardly speak, but says that her pain is a 10 (I actually cared for this patient on Sat -gave her 10 mg of Narcan before she totally woke up). It's difficult to believe the patient who says his pain is a 10 who literally jumps off the stretcher one nano-second after getting his shot and says can I sign my papers now so I can go home? (Gee, I think you might want to stick around to see if the med actually works.) It's difficult to believe the four people who carpooled to the ER together, each with a migraine, you guessed it they're all 10s. It's difficult to believe the woman who comes to the ER every Sunday after church for a Demerol shot for her 10 headache. I could go on and on, but you get the picture.

My very favorite drug seeker was a woman who came to our ER with a fax from her doctor's office in another state with instructions for the ER doc to prescribe a certain amount of dilaudid. I tried to find the out-of-state doctor, the office, anything - didn't exist. When I told the family member who had given me the fax, he kind of shrugged his shoulders, smiled and said, well, can I have the paper back anyway?

Drug addiction is devastating to the patient, family, community, health care system (prison system too) and I hate to think that I'm helping to facilitate it. I mean I wouldn't give a liter of water to a patient on dialysis because he was thirsty, I wouldn't give a bag of m&ms to a diabetic patient, I wouldn't give a gun to a suicidal patient...

If anyone has any great suggestions or solutions, please share them.

Thanks for listening.

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