Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!
Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!
Won't pushing antiemetics cause those weird dyskinesthias? Someone gave me Phenergan IV-probably a little too fast and for the next few hours I was unable to hold still- they gave me 62.5 mg Benadryl IV, 2 mg Ativan IV to get me to stop banging the siderails and tangling myself up in my IV!! Scared the carp out me and my hubby. I NEVER push antiemetics fast just because of that ( and I have had Phenergan before)- I've seen it happen to people getting Reglan IV as well--doesn't sound like a great high or buzz to me-Anne
Won't pushing antiemetics cause those weird dyskinesthias? Someone gave me Phenergan IV-probably a little too fast and for the next few hours I was unable to hold still- they gave me 62.5 mg Benadryl IV, 2 mg Ativan IV to get me to stop banging the siderails and tangling myself up in my IV!! Scared the carp out me and my hubby. I NEVER push antiemetics fast just because of that ( and I have had Phenergan before)- I've seen it happen to people getting Reglan IV as well--doesn't sound like a great high or buzz to me-Anne
Maybe that "carp" you had in you was the real problem LOL
Once I had a post-nephrectomy patient who insisted pain was 10/10 several days postop, while eating, sleeping, relaxed expression, etc. Her urologist came and told her "10/10 means if you had a gun at your bedside you would shoot yourself. Now what is your pain?" I forget the answer but it was quite a bit lower!
Specializes in LTC, CPR instructor, First aid instructor..
Don't you just love it when pts list allergies to Tylenol #3, Toradol, Darvocet? What other choices are there but the heavy duty!
Sounds a lot like me. Only, I'm not allergic to toradol, just most narcs. I am currently on 25mcg Fentanyl, and Dilaudid, 2 mg q4h, plus Pamelor, an antidepressant for the pinched nerve in my groin. Narcs won't touch it, and an ER nurse who treated me one time told me I surely don't have to worry about becoming addicted. I agreed with her.
Im going to put my 2 cents in to this thread. Its been here a while and now I feel I have something to add.
We get so many patients now that claim this long list of allergies to various pain meds any where from NSAIDS to narcs that the doctors dont completely believe the list so the expore things deeper.
When they have someone claim allergy to something that is just a common side effect they prescribe something to combat that and give the med. For example one person claimed allergy to morphine. What he described was it makes me hot and dizzy which happens if its given to fast. We ended up giving him benadryl just in case he was actually allegic and morphine with no ill effects. Recently I have given GI cocktail and pick your NSAID to pts who claim allergy but just describe stomach upset.
Noticed this ER doesnt get nearly as many F/F pain patients as others I have worked in.
Specializes in LTC, CPR instructor, First aid instructor..
Im going to put my 2 cents in to this thread. Its been here a while and now I feel I have something to add.
We get so many patients now that claim this long list of allergies to various pain meds any where from NSAIDS to narcs that the doctors dont completely believe the list so the expore things deeper.
When they have someone claim allergy to something that is just a common side effect they prescribe something to combat that and give the med. For example one person claimed allergy to morphine. What he described was it makes me hot and dizzy which happens if its given to fast. We ended up giving him benadryl just in case he was actually allegic and morphine with no ill effects. Recently I have given GI cocktail and pick your NSAID to pts who claim allergy but just describe stomach upset.
Noticed this ER doesnt get nearly as many F/F pain patients as others I have worked in.
Rj
The following are the meds and the reactions this patient has gotten from them:
1. Niacin - Anaphylaxis, which set me up for so much itching, in 1997, I still get pruritis from most narcs in spite of taking Benedryl, 50mg and Atarax with them. The following are those meds:
2. Oxycontin - Puritis so severe I had to be treated in the ER with 1509mg Atarax and 50mg Benadryl before I got relief.
3. Morphine - Pruritis with projectile vomiting in spite of being given Benadryl and Compazine
4. Fentanyl - anything above 50mcg gives me pneumonia. I should know. I was hospitalized with it on two different occasions. The first time I was on it, I was treated in the ER and discharged with clear lungs, even though I my homecare nurse told me I looked like a pufferfish.
The second time was last December. It was so bad then they took numerous xrays, then the doc looked at me with disbelief in her eyes, and said, "You have full blown pneumonia with cracles in both lungs.
5.Topamax - Altered personality. I became an obnoxious grouch who wanted only to stay in bed and sleep. Earle58 will verify this one.
6. amoxicillin - Rash
7. Solu-Medrol - PE and Steroid Induced Myopathy. I had an out of body experience with this one, and wound up with a crooked right foot.
8. Mysoline - Ataxia, headache, and vomiting
9. Vioxx - Hypertension
You should not be so quick to place everyone in the same category. It's upsetting.
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Won't pushing antiemetics cause those weird dyskinesthias? Someone gave me Phenergan IV-probably a little too fast and for the next few hours I was unable to hold still- they gave me 62.5 mg Benadryl IV, 2 mg Ativan IV to get me to stop banging the siderails and tangling myself up in my IV!! Scared the carp out me and my hubby. I NEVER push antiemetics fast just because of that ( and I have had Phenergan before)- I've seen it happen to people getting Reglan IV as well--doesn't sound like a great high or buzz to me-Anne