Might be a dumb question but

is ordering fluids in the er just a routine standard of care for docs or something? almost every patient we see docs order a liter of fluid right off the bat, regardless of any vitals that might indicate a need for it.

if an IVP med is ordered, theres a liter of fluid ordered with it.

sometimes pts will ask me why are they receiving fluids, and I end up having to give some vague answer like "in case we may think you're a bit dehydrated" or "it aids in circulating the medication we gave you into your system a bit easier" or if I'm giving a bp med i'll say "just in case you're sensitive to it and your pressure ends up bottoming out" but honestly I have no clue, and I don't get a straight answer when I ask the docs about it

anyone have any insight?

If you ask a straightforward question, and can't get a straight forward answer, you pretty much got the answer. IVF is entirely overused in most ERs, though yours sounds a bit extreme.

We do lots of stuff in the ER with no real indication or evidence.

IV meds when PO will do.

Overuse of antibiotics despite overwhelming evidence of the damage.

Studies that don't change the outcome, e.g. a strep on a kid who looks streppy enough to be treated regardless. because of false negatives.

XRing most toes, rib injuries without SOB, etc...

It really frustrates me when I have to do something that isn't really indicated. I work hard to gain trust, and patients believe I am doing what is right for them, even when I am not. But, I pick my battles, and save the confrontations for the big stuff.

Or, sometimes I might take a bit of a different approach.

"The doctor thinks you will feel better if I put a needle into your arm and give you IV fluid, which will work almost as well as you drinking like your body is designed."

Followed by:

"The patient is refusing IV. How about if I do a PO challenge. If he can't drink, I'll push the issue a bit."

Yeah I'm not sure, and I agree; sometimes I don't know what to tell people. Sometimes if the patient seems cool enough I'll make a little joke about how the IV hydration is the best part of coming to the ER or something like that and we'll all have a good laugh about how we drink too much coffee and soda.

We really do do a lot of things that are designed for patient satisfaction (I.e. I came all the way to the ER for my xyznonemergentcondition give me IV meds and antibiotics and dilaudid) and things in the interest of time-saving (IV meds vs PO for example).

Lol... the floor version of this is everyone gets protonix PO Q AM

Lol... the floor version of this is everyone gets protonix PO Q AM

I thought the rationale was ton prevent stress ulcers and gi bleeds? I remember a proposition to stop this practice to help prevent cdiff but the pushback with bleeding ulcers was overwhelming.

It's just that it appears to be a bit overprescribed.

Changed my mind. Might post later.

Lol... the floor version of this is everyone gets protonix PO Q AM

That's actually evidence based though (PU prophylaxis).

My guess, and take this with a grain of salt as I've never worked acute care, is so that patients have a sense that something is being done. Just from my many personal ED visits.

OK...let me try to explain this again. In no way do I mean that there are no medical GI benefits of protonix. What I am trying to say is that I've seen it prescribed to people that are there for something totally unrelated, like cellulitis of their leg for example. Then the patient would ask me why they are getting the medication if they have no GI history and I have found myself stumbling for an answer just like the original poster. Where I used to work anyway, PO protonix tended to be overprescibed to people that did not have any GI issues. From the research that I have seen, this blanket recommendation for ulcer prophylaxis is more for critical, ICU patients and not for the typical medical floor patient with no GI issues or GI history.

Duplicate post, sorry

Lol... the floor version of this is everyone gets protonix PO Q AM