Treating pain in ER

Specialties Emergency

Published

Do you nurses typically see patients undermedicated in the ER for pain? I had the worst experience this past weekend. I have suffered chronic pain for about 10 years and at one time was on 600mg of oxycontin a day for about 5 years. I have weaned myself off of the oxycontin and now am on 120mg of roxycondone. I recently learned I have spinal stenosis in my lumbar, along with chronic kidney stones and neuropathy. So early sunday morning, after waiting over 8 hours for the pain to let up, I finally went to the ER. The ER doctor would only give me toradol and phenergan for nausea/vomiting ( I was also vomiting blood ). Finally he agreed to give me 1 ml of dilaudid (what a nice man. gag) which literally only took the edge off of my pain for about 15 minutes. Worst experence ever. I left in about the same pain I arrived in, only not vomiting. I made it a point to tell the Dr that I unfortunatelly have a high tolerance to pain meds, but he didn't care. Said chronic pain isn't treated in the ER. I thought if someone comes into the ER in chronic pain it must be treated, regardless of the cause. I wasn't asking or and RX or narcs, as I already had that at home, just wasn't working with this severe pain. Now I know the addicts probably mess things up for us who really need the relief, but shouldn't the doctor be able to tell the difference? Just curious about what you ER nurses see with regards to the subject. Thanks

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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Oh, just venting in general... Even though I'm just starting this journey (and later in life at that), I feel that I've learned a lot just being a patient. I've gotten a unique view of what is going on in a hospital because I am usually there for a long period of time & once the nurses realize that I'm not "needy", they tend to let their guard down a bit and chat with me as a person, not a patient. When it gets quiet, I tend to be the patient the nurses come to check on and just sit & talk with, I listen to their concerns (without the violating another patients privacy), they tell me about their families or dogs or how long they've been there & how tired they are, etc. So even though I've never done your job and couldn't really ever know what it is like for you until I do, I am trying to understand and learn as I go along. I'm a very "thoughtful" person, meaning I like to consider all points of view when I'm making a decision and that's why I visit this site. I'll admit, sometimes I'm shocked at what I read, but I've also learned a lot as well. Thank you for you well wishes, transplant is scary, waiting is scary and all that goes along with being sick a lot is scary & frustrating but it's always nice to hear someone wish me well :redpinkhe

Nursing is a really rough job and there are some days that if one more person does one more thing.......you're going to scream!!!!!!!!!!!!!:eek::eek::eek: I think a lot of people have this happy little fairy tale in their heads and are shocked when they hear even a small inkling at the truth. Dealing with the general public is extremely difficult.......let alone the general public scared, in pain, or mentally ill!

Real nursing isn't pretty it's ugly, messy and sometimes downright gross and nasty. BUt it can be just as special and rewarding. There is a lot of venting that goes on here and real honest feelings go down in print........it goes a long way to get it out of your system so one can return to nurse another day...;)

Transplant is scary.....and the waiting I think would be the hardest! Many prayers for you and the family that decides to give the gift of life........((HUGS))

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
And let's tell it like it is: There are also bad patients and bad families.

AMEN!!!!!!!!!!!!!!!!!!!

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Specializes in being a Credible Source.
Dealing with the general public is extremely difficult.......let alone the general public scared, in pain, or mentally ill!
Or high/down/trippin' on various substances, via the street or their local doc.
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keikei,

If you are such a wonderful, polite, non-demanding patient, then obviously when we're venting, we're not talking about you! That's what I, and probably others, find so annoying about your posts. If you don't match the kind of patient we're venting about, then it's not about you, so don't make it about you! I am perfectly aware that nice people exist! I have the pleasure of working with them on a regular basis! But I don't need to vent about them, and when I'm venting about the not-so-nice aspects of my work, I don't need to be lectured about how not everybody is like that and made to feel badly because I need to vent my frustrations. Nursing is HARD, it's grueling, it demands everything you've got if you're going to do it well, and for cr@p sake, let us nurses vent in peace without making it all about you!!!

Thank you.

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Specializes in being a Credible Source.
keikei,

If you are such a wonderful, polite, non-demanding patient, then obviously when we're venting, we're not talking about you! That's what I, and probably others, find so annoying about your posts. If you don't match the kind of patient we're venting about, then it's not about you, so don't make it about you! I am perfectly aware that nice people exist! I have the pleasure of working with them on a regular basis! But I don't need to vent about them, and when I'm venting about the not-so-nice aspects of my work, I don't need to be lectured about how not everybody is like that and made to feel badly because I need to vent my frustrations. Nursing is HARD, it's grueling, it demands everything you've got if you're going to do it well, and for cr@p sake, let us nurses vent in peace without making it all about you!!!

Thank you.

Point taken, gazer, but I should point out that venting is perhaps better done in a thread of your own creation or one specifically intended for that purpose rather than one like this one.
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Specializes in public health.
I am certainly not telling you what you have to do (I have no right to go that far)....however, I strongly recommend that you get a new PCP. If she sees the ED as the best place to treat your chronic pain, that I can't even tell you how misguided she is.

I agree - it's not my PCP, it's my nephrologist that does this. She only sees patients once a week because she is with a teaching facility which is also the same place as the ER where she sends me. They know I have a lot of kidney stones that are sort of lodged in there so they cause a lot of issues. Most of the time, I just deal with it. I told her I can live with 5 out of 10 pain and still function so that's sort of the agreement we have. But, there really is no option if I'm having severe pain from one of the stones & it happens to be a weekend, after hours or during a day when she is not in the office seeing patients, that's why she sends me to the ER to manage it. Sometimes, she just has me directly admitted & I don't go to the ER at all, but when it's for low potassium, she tries to have them manage it in the long-term ER department first, instead of admitting me. I don't know why, no-one in the ER seems to think it's weird so maybe they're used to it. Thankfully, it's not too often anymore, I've finally gotten in to a pain specialist, switched some meds around, I swim a lot more and that seems to help. I wish there were a way to just knock all of the stones out at once and be done with it, but it's not an option for me. I would completely agree with you if it were my PCP doing that!

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Specializes in public health.
How do you know so much about the other pts. around you? Why is it any of our business? Most importantly, what does it have to with your or the OP's chronic pain? Not judging people or their pain, but I lose a lot of respect for a pt that tells me that their problem is more important that the pt in the next room.

Because the "walls" and "doors" in the ER are curtains? Everyone can hear everything, there is no privacy at all and when you're lying in bed for 17 hours waiting for an IV to finish, you hear a lot of things.

I am having a conversation on here with other people, what I was explaining made sense to me. Sorry it didn't to you.

I can imagine it would be annoying if I were a nurse and someone tried to tell me that their issue was more important than other patient. But I hear it all the time. I imagine those are the same people out in public who think everything pertaining to them is more important than anyone else and their needs.

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Specializes in public health.
Nursing is a really rough job and there are some days that if one more person does one more thing.......you're going to scream!!!!!!!!!!!!!:eek::eek::eek: I think a lot of people have this happy little fairy tale in their heads and are shocked when they hear even a small inkling at the truth. Dealing with the general public is extremely difficult.......let alone the general public scared, in pain, or mentally ill!

Real nursing isn't pretty it's ugly, messy and sometimes downright gross and nasty. BUt it can be just as special and rewarding. There is a lot of venting that goes on here and real honest feelings go down in print........it goes a long way to get it out of your system so one can return to nurse another day...;)

Transplant is scary.....and the waiting I think would be the hardest! Many prayers for you and the family that decides to give the gift of life........((HUGS))

Oh, I don't doubt that at all! My neighbor is a cardiac nurse. She works LONG hours and the stories she tells me are eye openers sometimes! When I said I was shocked about what I read on here, it wasn't mean in a judgmental way, I meant it as in "I had no idea things like that even happened, that people even act that way" sort of thing. I have a friend who is an ER doc so her stories are from a physician point of view, much different from nursing. She isn't much help when trying to decide if this would be a good career choice :) My neighbor offers a much different picture, but again, she's in cardiac care and most of her patients are very old people, so they die a lot. She has a very unique outlook on life and she says it's all because of what she does for a living, sort of like anyone who deals with things that most people never see. It's not bad or wrong, just different. I just like knowing as much as possible (yes, even the gross & nasty, the ugly & messy) which is why I ask a lot of weird questions and read a lot. I respect honesty and certainly don't judge anyone when I can tell that they've just been having a rough time of it and need to get it all out with people who can relate. It's helpful to those of us who haven't experienced those things yet too.

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Specializes in public health.
keikei,

If you are such a wonderful, polite, non-demanding patient, then obviously when we're venting, we're not talking about you! That's what I, and probably others, find so annoying about your posts. If you don't match the kind of patient we're venting about, then it's not about you, so don't make it about you! I am perfectly aware that nice people exist! I have the pleasure of working with them on a regular basis! But I don't need to vent about them, and when I'm venting about the not-so-nice aspects of my work, I don't need to be lectured about how not everybody is like that and made to feel badly because I need to vent my frustrations. Nursing is HARD, it's grueling, it demands everything you've got if you're going to do it well, and for cr@p sake, let us nurses vent in peace without making it all about you!!!

Thank you.

I have no idea what you're talking about. I haven't lectured anyone or asked anyone to make anything about me. I didn't comment on a post you wrote or were participating in and yell at you for anything you wrote or felt, I don't even know you. I responded to the OP because I am dealing with similar issues, that's all. And like you, I was venting about some not-so-nice people (who sometimes are providing health care to me) that I come across in my life and it had nothing to do with you either.

I honestly have no idea why you're so angry with me, but if I bother you that much, please just ignore what I write. My intent here was to discuss something with other people who are experiencing similar issues I am experiencing, to learn from those who have experience as a nurse to give me some insight into what I as a patient can do to make things better for both myself & the person caring for me and from those who are willing to be frank & honest with me about their job because I was recently accepted into nursing school and have gotten mixed responses on whether or not it's a good career choice or not. I've read a lot of things on here that have shocked me but as I said before, not because I'm judging anyone, but because I had no idea those things even happened since I'm new to all of this. The same as you probably felt when you were new at all of it. Really, just ignore my posts if they upset you so much, you're obviously stressed out & angry over something and I don't want to add to it.

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Specializes in Emergency, Telemetry, Transplant.
I haven't lectured anyone or asked anyone to make anything about me.

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...

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Specializes in future OB/L&D nurse(I hope) or hospice.

This post has seriously gone south. The only reason I started it was because I truly wanted to know how chronic pain was treated in the ER. I have never had an issue with the ER nurses-EVER. I didn't understand about the ER and chronic pain. I will be honest, I still don't understand totally. Yea, I get that chronic pain should be treated by a pain specialist-but there are times when, for whatever reason, the pain gets so out of control and one gets very sick that I thought the ER was the place to go.

I guess I just thought pain was pain, no matter the source or cause and when it reaches a 10/10 one needs medical intervention because no pain pill I have at home is going to touch pain when it is 10/10.

For example, a friend of mine who has had a cervical fusion done and has very bad chronic pain was instructed by her pain doctor to go the ER should the pain get out of control. She did end up doing just that and the insurance wouldn't cover the visit. That is until she sent in a copy of the doctors transcription notes from the office visit in which he advised her to go to the ER. So, us as patients are only doing what our doctors tell us to do. Now I know what the protocal is regarding chronic pain and the ER.

I do want to apologize for some of the comments I made in anger and frustration on here. I absolutely don't think you ER nurses are there to treat only. I have the utmost respect for those of you that work with the public in their most vulnerable and "ugliest" moments. As mentioned earlier in this thread, I lost my mother on April 29th after her long battle with cancer and it has been very hard. Her hospice nurses were incredible!! When someone you love is taken, and in such a painful way, you realize what is important and what is not. I truly, truly am sorry for offending anyone I have. Many of the things I have said were said at the most difficult I have gone through in my life. Not an excuse, I know. I do want to thank you for sharing your points of view and giving me your most honest opinions (and I do mean brutally honest). I have learned so much. God Bless!:redpinkhe

Joann

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Specializes in future OB/L&D nurse(I hope) or hospice.
allEDdoctors?

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.

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