Treating pain in ER

Butterfly0328 · Jun 16, 2011

So sorry for the "grammar" errors. It's very early and I didn't proof read before posting.

Esme12, ASN, BSN, RN · Jun 16, 2011

So sorry for the "grammar" errors. It's very early and I didn't proof read before posting.

Ah....the grammar police...:)

I am very sorry about your Mom.....My heartfelt condolances.....((HUGS)):heartbeat

Anna Flaxis, BSN, RN · Jun 16, 2011

Absolutely not. I have had some very good ER docs. This was just seemed cold and insenstive. Perhaps he was having a bad night. You never know what someone has been dealing with prior to them treating you, and even though they are the professional and should be acting as such, they are also human. I am over it, underststand it more and will give him the benefit of the doubt.

Exactly. They could have coded a child covered from head to toe with bruises, for example. You just don't know what that doctor had to deal with right before walking into your room. In the ED, we have to keep going. We don't get to take a break just because something terrible just happened. We keep going. And yes, we are human, not robots. Cold and insensitive is not equivalent to unprofessional. Doctors and nurses are not always going to have a warm and fuzzy bedside manner, and sometimes they can be more direct than you'd like.

As you now know, there are so many differences between acute pain and chronic pain, and EDs are more readily equipped to handle acute pain, not manage chronic pain. The ED doctor doesn't know you, doesn't know what has been tried and hasn't worked. Titrating analgesia to the non-opiod naive patient is time consuming and can present risks. If your PCP/specialist does not have a plan in place to address acute exacerbations of chronic pain (like maybe Phenergan suppositories and PO Dilaudid and/or Toradol, just as an example), then they are really failing you. Going to the ED should absolutely be a last resort, and in future instances where you find yourself in this situation, it would behoove your doctor to call ahead and speak with one of the ED doctors to let them know you are coming and give them your medical history and their recommendation for your treatment.

With all of this in mind, nobody should ever treat you badly while you are there. They might not be particularly warm and fuzzy and they might be really direct and upfront, but that's not the same as treating you badly.

I'm really sorry about your mother, and best wishes to you in your future endeavors.

Butterfly0328 · Jun 16, 2011

Thank you so much Esme12 & Stargazer. I am actually going to be changing doctors this next week. A friend of mine referred me to this doctor and I am very hopeful. After the incident with the ER, I was able to finally get ahold of my current PM doctor and he just seemed very irritated as if he were "bothered". My last office visit, while he was nice enough, he is not wanting to "work" with me on a pain management plan. I asked him about major flares such as the one in my initial posting and he totally beat around the bush, so to speak, and pretty much ignored my question. I prefer a doctor that will listen to my concerns and work with me as a team....after all, I know my body more than anyone and what usually works for me. I truly believe I need physical therapy in order to strengthen my core muscles in hope of the stenosis correcting itself. This new doctor doesn't just push the narcs. He approaches treatment from many angles in order to hopefully correct the problem without surgery etc. AND without the use of pain meds. I didn't wean myself off oxycontin just to go on another narc. I am really tired of taking narcs..

Anyway, thanks for the response and well wishes regarding my mother. I know she is in a much better place. :redpinkhe

keikei · Jun 16, 2011

Did you even read your own post about the potassium infusion?? I stopped counting at the 25th time you used "I." (still had about a third of the post to read/count...I pretty much gave up on it). You're right, not about you at all....
P.S. whether PCP or nephrologist, if you have such a chronic kidney condition, then a once-a-week doctor is probably not for you...

Yes, you're probably right. My experiences aren't important, OP, I am very sorry to have hijacked your post & if I have made it more difficult for you to get the answers you were looking for. When I shared, I was thinking it might help if you knew you weren't alone and that what you experienced happens to other people as well and that there are others that are confused. I'm a chatty person sometimes and I apologize for sharing too much or annoying anyone.

I will say one last thing: Many patients are sent to the ER by their PCP. So we are there because they told us to go. We're not trained medical professionals so we don't know what is serious and what isn't. So we call our doctors, describe our symptoms over the phone & they tell us to go to the ER. We are just trying to get care for a health issue & are following "orders". It's frustrating for the patient as well. With one exception, I've never been made to feel that I should have waited to see my PCP or that I didn't need to be there, they have instead said things like "it's a good thing you got here when you did". So I guess they felt it was the right reason to be there. What a doctor might feel is an emergency (for whatever reason) a nurse might feel it could have waited until office hours. We're caught in the middle. It's very frustrating.

PS: maybe you're not familiar with the care involved with renal patients. There isn't a lot that is done at office visits, most treatment require hospital care. So there really is no need for her to be available more than once a week to see patients to do the routine things like lab tests, medication refills, weight check and to discuss the results of lab tests. Everything else requires clinic care so I don't really get what you mean by that. I don't know anyone else with my disease who gets treated any differently, we hope to stay healthy as long as possible between hospital stays for sudden issues that crop up, but there really isn't anything else to be done. If you know something different, please share.

psu_213, BSN, RN · Jun 16, 2011

We're not trained medical professionals

Then maybe you should not leture people who are....

Butterfly0328 · Jun 17, 2011

Keikei- I am not upset with you at all!!! You have so very nice. I really am surprised that Psu thinks you are lecturing. That couldn't be further from the truth. Please look past his posts as they do not appear to be benefial and somewhat hurtful. I have apologized for my "not so nice" postings just as you have offered apologies for anything you have said that was out of line. All we can do is push forward knowing we have done all we can do on our end to explain the patients point of view just as others have given insight to the nurses point of view. I will pray for you and send well wishes. God bless and keep in touch. :)

edlove · Jun 19, 2011

This is in regards to the original post that started this thread...

As an RN in the ER, my main goal when I go to work is to save lives. Because of the ER enviroment, the staff is forced to prioritize care. As much as we would love to make everyone happy and comfortable, our main priority lays with the patients who will die if we don't act NOW. You say you weren't there for pain meds, but was else were you expecting the ER to do? All though extreme pain can be very frightening, our goal isn't to necessarliy stop the pain, but to correct the cause. If it is caused by a chronic condition that isn't going to kill you, there isn't much the ER can do. ER staff takes a lot of crap from chronic pain patients who are expecting a miracle from us. They also get mad when we don't treat them as a priority. The reality is, we just can't! I have to give my priority to the guy having an MI, acute resp. distress, shock and many other things. They will die if I don't!

So to answer your question, we try to do the best we can. And sometimes that best just doens't seem good enough to the patients. Sometimes there isn't a fix for your pain, at least not in the ER anyways. I have had patients stop breathing from strong narcotics (once even from 1mg of Dilaudid to a patient who has been on narcs for years!). So sometimes stopping the pain by flooding you with pain medication isn't worth risking you life .

r

So my question to you is: What do you expect the ER to do?

Butterfly0328 · Jun 20, 2011

i wasn't asking for an rx for narcs, as i already had that at home, just wasn't working with this severe pain.

looking over my original post, i realized i made a couple of mistakes. of course the reason for the er visit was to obtain pain relief. i totally didn't understand the deal with chronic pain, but i do now. i have a much better perspective and understanding thanks to all the replies. thanks,

joann

Butterfly0328 · Jun 20, 2011

Again, please know I do understand now why chronic pain is not supposed to be treated in the ER. I am obviously still learning, and what I have learned from this site has been incredible. Thanks again.

edlove · Jun 20, 2011

I also wanted to send my condolences to you for the loss of your mom. I too just lost my mom May 14th of this year from breast cancer. There is nothing like the loss of a mother.

Butterfly0328 · Jun 20, 2011

I also wanted to send my condolences to you for the loss of your mom. I too just lost my mom May 14th of this year from breast cancer. There is nothing like the loss of a mother.

You are so right. Sending my condolences as well. God Bless:redpinkhe