When did we stop offering Tylenol first and start giving everyone a Norco? And not just any old Norco, uh uh now we give a Norco 10mg all the time. For ankle sprain or lacerations. What about Motrin? It's my drug of choice.
When did we stop titrating Morphine? In our ER the standard used to be Morphine 2mg IV every 5 minutes up to ten milligrams. Now the order is Dilaudid 1 mg every 10 minutes up to 4 milligrams which is almost three times the strength of the 10mg of Morphine.
What about non-pain med interventions like heat, cold, positioning, massage etc? Now everyone is on a Dilaudid Cadd in the hospital and Norco, Oxycontin, Morphine, Fentanyl and Methadone all the time.
Why are we turning into a nation of drug addicts? It won't be to many more years and our country will be easy to be taken over, we'll all be too stoned to put up a fight.
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- ERnursey
- A hardworking ER nurse trying to survive until retirement and if I can have little fun or have a positive impact on someone's life, all the better!
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11 comments:
Hear hear!!! I wonder at the huge amount of advertising dollars that tempt folks into asking their docs for drugs...every one of the ads say to "consult with your doctor". It always seemed to me that the doctor should tell the patient, not the other way around!
I think this is partially due to the expectation that there should be no pain. That, and this pain scale stuff that really seems like a cool idea until you start to use it on real people.
I agree, motrin is the bomb if your GI tract can handle it. For that matter, 1G of tylenol is pretty darn good for many things.
I actually heard a dr. explaining to a guy the other day that motrin is actually a really good drug even though you can get it OTC and it should be able to handle his pain at the prescribed dose (800mg q8h). I don't know if he ever convinced the guy it would be ok.
You know, I wish we were better at non-pharmacologic pain interventions, even if for my own sake. I've had an annoying viral respiratory infection followed by a bacterial pneumonia for the past three weeks, and still am coughing (although less) but even worse, still have that very unnerving combo of dyspnea and pleuritic chest pain. The only thing my doc has to offer for it is the combo phenergan/codeine cough syrup which does work, but I can't take it during the day because it really just puts me to sleep.
What I wish is that someone had some good non-drug (or at least non-narcotic) solution for this.
I think it comes down to the fact that most (at least of mine) patients come in with a med list that includes Lortabs, Percocets, Methadone, etc. Until I worked in the ER I thought that these meds were strictly prescribed after major surgeriesor whatnot. It blew my mind the first few weeks when patients would come inand say "I took one of my Lortabs before coming in and that did not help". With this, I guess it would look kinda silly prescribing someone on a fentanyl patch a gram of tylenol. I totally agree with you though, this should not be the norm and it speaks to what wusses we are in this country that we take a lortab 10 when we have stubbed ourpinky toe
Motrin 800mg TID is my drug of choice. It's helpeful for strains, sprains and abdominal surgurical pain. I love Motrin.
great point, dk. I remember when my father had heart surgery. I kept asking him if he needed pain medicine. He refused, because he expected to have some discomfort. I have to admit that sometimes I fall into the modern there-ought-to-be-a-pill mentality. I think that's why so many patients come to our office with a two-page list of medicines.
Ms.MOM @ MOMrants.com
This whole thing started when pain became the "5th vital sign" and every note must include an patient's assessment of pain on a scale of one to ten. When you have a record in which a nurse notes "pain 9/10", it becomes necessary for the physician to address that. Ordering Tylenol in the face of a patient stating "pain 9/10" just does not look good to someone reviewing the chart. That's what it's all about. The toothpaste is out of the tube. We can't put it back.
My kidney stone pts. swear by 30mg of Toredol IV. Works better than the narcs.
Agree with Annonomyous and have one to add. The colosual blunder by Healthcare in accecpting Pain as a Vital Sign and Pain is whatever the patient says it is regardless of how unaffected they appear by the reported pain. That along with the desire to produce high patient satisfaction scores. We'eve empowered the disfunctional. I worked with a midlevel provider recently that was near tears because a patient threatened to complain because she would not write him a Vicodin Rx for "back pain" that seemed to have little or no effect on his ability to walk, bend, move, ect. She wrote him for a muscle relaxer and a NSAID. Also, some ER groups are being offered bonuses for high scores which has many ED Physicians casting aside their principles and giving out pain meds like candy.
Toredol has worked just as well as narcotic pain meds for me, when i've had to go to the ER (ruptured ovarian cysts, let me tell you that is the worst pain i've ever been in.)
It's much easier to throw drugs at people than to properly treat and educate them, IMO that's why we see it used so much.
I visited this online pharmacythree days ago.I found out that these pain relief drugs: Butalbital-APAP,Fioricet,Motrin,Tramadol,Ultracet,Ultram are so cheap. Can you explain me how they managed to do this?
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