Dave ARNP

One of the newer treatments that's been extremely successful is Enbrel. I've seen quite a few news segments on it lately, so I would say that's what you're daughter saw. Enbrel is an injection formulation, which was (and I beleive is only) approved for RA. It's useage for psoriasis is still off label (again, to my knowledge). I've seen some great results with it, but it's rather expensive. Another good option is Neoral. Also seen very good results with this. For mild psoriasis, topical Ultravate is decent. -Dave

I think the better idea here would be to use a medication other than Tylenol. Since you've not said what you're treating, it's kinda hard for me to speculate. I will say that the first thing generally done here would be start a COX-2 agent, (I prefer Celebrex) and use Vicodin PRN. Ideally, 400mg of Celebrex to start, then 200mg QD, with Vicodin PRN. If you'll elaborate a little more on the source of pain you're trying to treat, I can make a few more suggestions for you to take to his MD. -Dave

By my figuring, I'm worth $86.76 qhr, at 50hrs a week. I can certainly live with that. :D -Dave

Aww... I feel loved Angelbear -Dave

If the doc had but to walk one day in that poor mans shoes..... The order for pain meds would be enough to kill an elephant. -Dave

Firstly, let me apologise for the poor care you received by those who proclaim to practice pain managment. The care you received is so far below standard that it's not even funny. I don't have the pleasure to dealing with anesthesia residents, although the family practices ones I get can be quite trick. To berate a patient for chosing a method of anestheisa other than the one the provider chose is obsurd. Not enough money in the world to keep me awake during an ortho case. To answer your questions, no you are not a bad patient/person/nurse because you were "hard to put to sleep". Secondly this is NOT the best that we can do at eliminating a patients pain. With todays advances, surgery can be quite painless. People just can't be afraid to make it so. Glad to have you on the board! Hope you decide to make it your home! --Dave

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Personal attacks? Yea... Ok. Beleive that would be your department. I'm not going to explain anything to you. I have patients and people who need and deserve my time. You meet none of that four criteria. -Dave

Don't worry guy... This is just HER opinion. And you know what they say about opinions. -Dave

That sorta of careless disreguard is the reason we have patients who don't bother comming in for their illness. I certainly hope you aren't that dangerous with your real life practice of medicine. -Dave

I know, it's a dark place isn't it. That thread was mentioned to me and I went over and looked at it. Seems that they're so scared of NP's at the moment, they need to come see where we hang out. They're really not worth our time. -Dave

Accuracy of Emergency Nurses in Assessment of Patients' Pain Posted 12/18/2003 Kathleen Puntillo, RN, DNSc; Martha Neighbor, MD; Nel O'Neil, RN, MS; Ramona Nixon, RN, MS Abstract and Introduction Abstract Pain is a common complaint in Emergency Departments. Inpatient studies have shown discrepancies between patients' and nurses' pain assessments. The accuracy of emergency nurse assessments of their patients' pain has not been well investigated. Using a 0 to 10 numeric rating scale (NRS), researchers asked patients to rate their pain intensity in triage. Separately, the triage nurse was asked to rate the patient's pain. This process was repeated with the same patients but different nurses after patients were taken back to a clinical area within the Emergency Department. At triage, patients' average pain intensity score was 7.5 ± 2.2. The triage nurses' ratings were significantly lower at 5.1 ± 2.4 (p http://www.medscape.com/viewarticle/465817