Rationale for PO Vicodin in ED?

[Melina]

I will be starting nursing school in the fall, and in the meantime, I am a volunteer in my local ED. We had a patient who presented with an ankle fracture that he had been walking on for several days. Of course, it was markedly swollen, and there were large, but thankfully unpopped fracture blisters. He appeared to be a chronic alcoholic, and it is possible he was intoxicated at the time. It wasn't on the board, and I didn't smell alcohol (didn't snuggle, though), but he had heavy eyelids and was slightly unfocused, slurred speech. I know when you drink for long enough, you start to act like this even when sober.

Anyway, when I went in to check on him, he asked if he could have another Vicodin, even though he wasn't supposed to get one for another 10 minutes, because the pain was real bad. He was really calm about it (I would have been a huge baby!) I told the nurse, who ended up having to wait another 1/2 hour, because the doc went in and poked around.

My question is, what is the possible rationale for giving PO Vicodin instead of IV pain meds for an obvious "objective" injury? I would think even a nerve block of some kind would be more humane. I wanted to ask but I was too chicken because the nurses are all so busy. Any opinions?

~Mel'

[fleur-de-lis, BSN, RN]

Did they do a tox screen? Did he have IV access? I'm still a student, so I don't have any solid ideas, but wondered about the above.

[caliotter3]

The few times I've been in the ER and severe pain was involved, when I was given a pain med, I got both PO and IV meds. What I remember the most was the waiting time to get something once I was told that I would be given a med. No idea about the rationale, however, when I was continually told how busy they were as an excuse for waiting, I didn't seem to notice a very busy atmosphere. I felt I was being fibbed to. I avoid the ER if I can. Have actually left without being tended to more than once. If I'm bad enough to get to the ER, I'm bad enough to be seen at some point in time. I can stay at home to go without care.

[Melina]

He probably did have access, because they always do basic labs. I don't think he had a positive tox screen, because it wasn't posted, and usually it is written next to the C/C. I didn't even think he may have had both IV and PO meds. Is that common?

caliotter3: one of my duties as patient liaison is to communicate patients' pain states to their nurses. Inadequate pain management is a big concern to me as a future nurse, and it bothers me that many nurses don't seem to take pain seriously. Nurses at my ED are usually good at staying on top of it, they just get caught up in doing other things, and some patients are hesitant to use their call button.

[twinmommy+2, ADN, BSN, MSN]

He probably did have access, because they always do basic labs. I don't think he had a positive tox screen, because it wasn't posted, and usually it is written next to the C/C. I didn't even think he may have had both IV and PO meds. Is that common?

caliotter3: one of my duties as patient liaison is to communicate patients' pain states to their nurses. Inadequate pain management is a big concern to me as a future nurse, and it bothers me that many nurses don't seem to take pain seriously. Nurses at my ED are usually good at staying on top of it, they just get caught up in doing other things, and some patients are hesitant to use their call button.

Did you say before that he was slurring his speech? That would be one reason for a Dr. to only give him po pain meds.

[rgroyer1RNBSN, BSN, RN]

He might not of had access, I know we dont do labs on simple FX's, Im one of the er and sicu assistant NM's and supervisors, and generally for an uncomplicated fx all we do is give a po pain med, or IM pain meds, x-rays, splint, and tell them to follow up with ortho and maybe some teaching to walk with crutches or not bearing weight on affected limb,.

Are most common treatment for fx's are- PO vicoden, PO flexeril, and PO Naproxen or Motrin, and x-rays and splint, depending on the doc sometimes we will give like 30 of Nubain IM or 50 of Demerol IM, 50 to 100 of Norflex IM, and 60 of Ketorolac IM (Toradol), splint, and x-rays, and discharge.

[canoehead, BSN, RN]

If a patient is going to go home we give a dose of the po med they will use at home, and then we know that it is effective for the pain before we send them out.