What is up with all the Dilaudid?

Specialties Emergency

Published

Ok I know we have been through this before, but this is rediculous, why is it that everytime I wrk Er everyone has an order for dilaudid it seems like.Rod RN

Specializes in ED.

One of our docs loves dilaudid, hands it out to everyone. I tend to request morphine if a patient is really hurting, I am able to give more if need be. I have also heard there is no ceiling on morphine but there is on dilaudid. I personally wont give more then 1 or 2 doses of dilaudid, and I love toradol if there is no risk of bleeding.

My favorite pain medication is....... 650mg of APAP!

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Specializes in ..

Generally speaking, all of the opiate class medications work via the same mechanism / mu receptor and don't have a max dose as long as the patient's respiratory and hemodynamic status support giving more. The differences come from the onset, duration, and side effect profiles. As a Paramedic, I love fentanyl and prefer it over everything else. Its an immediate onset, can give it many different routes, works great to control pain, has much less side effects than morphine and is easy to titrate. And it seems from my own experiences that patient's get better relief with fentanyl.

I have nothing against morphine and Dilauded though and most of the ER's in my area are big on Dilauded. VICDRN... I think in general analgesia isn't properly prescribed and witness all the time very conservative dosing and a non-aggressive approach to relieving pain. I don't want to hi-jack the thread (may start a new one on the topic) but the lack of post-intubation analgesia in the ED drives me insane!!! Propofol and benzos do NOTHING for pain!

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

we use morphine and dilaudid pretty equally.sometimes fentanyl.it just depends on the dr and allergies.

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Specializes in ED.
I don't want to hi-jack the thread (may start a new one on the topic) but the lack of post-intubation analgesia in the ED drives me insane!!! Propofol and benzos do NOTHING for pain!

Yeah, it pretty much takes an act of god to get any analgesia for the people we tube in my ED. One doc will routinely order it if he performs the intubation, but unfortunately he has been called back to Iraq.

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Its barbaric to not medicate someone who is tubed, in this situation I would be more then willing to give as much dilaudid/ms/fent./demerol as they can handle.Rod Rn, Bsn

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Specializes in Emergency, Med/Surg, Vascular Access.

My ER is real big on customer service, so we give a crap-ton of dilaudid. We have one particular doctor who will write for Dilaudid 2 mg IVP, then 2 hrs later another 2 mg IVP. I have started holding half the dose when he does that "for sufficient analgesia; pt. states feeling 'much better.'" lol I just don't feel comfortable giving that much at once. I don't understand why none of our MDs will write for 0.5 mg dilaudid...depending on what they're there for, of course, 0.5 mg dilaudid should be plenty for many pts., and if not, give 'em another 0.5! I don't understand the mentality of starting out with 2 mg.

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My ER is real big on customer service, so we give a crap-ton of dilaudid. We have one particular doctor who will write for Dilaudid 2 mg IVP, then 2 hrs later another 2 mg IVP. I have started holding half the dose when he does that "for sufficient analgesia; pt. states feeling 'much better.'" lol I just don't feel comfortable giving that much at once. I don't understand why none of our MDs will write for 0.5 mg dilaudid...depending on what they're there for, of course, 0.5 mg dilaudid should be plenty for many pts., and if not, give 'em another 0.5! I don't understand the mentality of starting out with 2 mg.

We have a doc like that that orders 50 mg Phenergan IVP all the time. I just give what I think they can tolerate. If the order is 2 mg and it's an opiate naive individual, I'll push 1 mg and see what happens. Dilaudid 2 mg IVP on an opiate naive individual is a hell of a push.

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Specializes in Emergency.

Well since i work as a supervisor and deal with complaints. I give my two cents. When I get a pt who complains that " the doctor didn't give me anything for pain". But then I check the chart and more often than not there is clearly Tylenol or Motrin ordered, I generally explain to them that these are in fact pain medications and that it appears from the documentation that you have refused them. I further go on to state that the ED physician's are independent practitioners and I cannot tell them how to practice medicine. I generally go on to explain that if they have a license and privileges at my hospital I will be more than glad to get them anything they want.

But as it is I think we are finally actually treating pts pain

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Specializes in SNF, LTC, MED/SURG, ER.

That is a good question.

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