A 32 year-old female signed in for migraine. She was from out of town. She had several allergies. The PA said he'd give her a shot and she asked politely what he was going to give. He told her Dilaudid and Vistaril. She politely declined stating she did not want narcotics as they made her sick and loopy. She apologized for taking up our time and asked if she could instead have a couple liters of saline and Toradol, Compazine and Benadryl.
You betcha!
First time I've ever seen that happen before.
Sunday, January 11, 2009
Subscribe to:
Post Comments (Atom)
27 comments:
That's what we predominantly give in our ED - the compazine really knocks the kiddos out.
WOW, a migraine patient, that knows what works...not to be confused with the patient who says they have a migraine.
De-lurking to say that 1) I enjoy your blog! and 2) I suffer from migraines, and IF (that's a big IF) I have to go the ER, Toradol is what I want - no narcotics. I don't have a medical background, but I do know one thing - narcotics do NOT work for migraines!
It's a sign of the Apocalypse
I don't like narcs either for either migraines or my back pain that no one seems to be able to diagnose. Narcs make me loopy and nauseated and wear off rapidly and I'm too scared of them to want any more any time soon. The Toradol,takes the edge off nicely and lasts a long time and I'm able to actually do things while I feel better.
I'm glad it doesn't happen often.
Sometimes the patients will not want heavy drugs such as those listed in the post. I have seen people who would rather an alternative natural treatment.
De-lurking too! Love your blog. I'm glad that there are still some people that can do the right thing. Those few shining lights go a long way in making us appreciate our jobs more.
People who truly suffer from migraines typically do know what works and majority of times it is toradol, compazine and benadryl. Those drugs or combos there of are usually our first line migraine treaters as well. Of course you do get those who come in with their sunglasses on, hair all messed up, clothes from the dirty laundry who just "put on the show" to try to score something and then get pissed when you give them toradol or anything less than demerol and phenergan. Koodos to this girl who stood up, knew what worked and asked for it. It goes to show there really are legitimate people out there and not all are drug seekers!!
The Anti-Sumd00d has been found!
Never understood the attraction people have for narcotics, still don't... They've never really done anything for me, but make me nauseated. Was hospitalized in mid October for an bad abscess (which I went to see my PCP for first, and she sent me to the ER.) located in a very sensitive place, and they gave me 5 mg of morphine for a dressing change an hour or so before I was finally (In the ER for 24 hours - 16 hours of it on one of those torture devices they call a gurney - before they called to have real hospital beds brought down for everyone stuck in the ER. Was not a happy camper at all.) brought to a room.
The first thing I did after they settled me in the room was vomit up all my lunch, then couldn't eat dinner because I was still nauseated, and the next morning vomited up all the gastric juices which was all I had left in my stomach. Then it was finally time for some anti-nausea medication. After all that fun, I won't touch morphine, or any other medication in the same family, again. *shudders*
If you read this, great.
I just wanted to say thank you for this blog. I have been thinking about a career change to nursing. Your blog has been a source for learning what the job is really like, which is an influence on my decision. Very much appreciated, thanks again.
Chris again de-lurking - I agree with one of the previous posters. I don't get the "lure" or narcotics either. I don't like the feeling, don't like the nausea, and they never seem to help the pain I'm having - perfect example is when I've had some dental work done, and was given a rx for Vicodin - did nothing for the pain, made me sick to my stomach, woozy - yeah, thanks, I can do without that! I guess I'm a low risk for addiction, ha. I enjoy yoru blog - it's one of many I read as I consider the nursing career (stop laughing right now...)
If I screw up and run out of migraine meds and have to go to urgent care, (haven't had to go to the ER yet!) I always just ask for imitrex. That's what works for me and what I have from home. Thankfully, that's only happened twice in 16 years since I started getting them.
If you really have a migraine, waiting in a loud, bright waiting area is torture! I have to be to the point of seriously considering drilling my skull open before I'd go to either urgent care or the ER.
My boyfriend has prescription tablets of compazine for his migraines, as well as taking benadryl... those and toradol are what they gave him when he was in the ER for a migraine... i had hoped they'd give him something stronger, because he seems to have a high natural tolerance for a lot of meds- takes a lot for them to actually do anything. Compazine + aleve + benadryl does it for him when he has a migraine when it's ok to sleep.... he's yet to find a good combo to kill the pain during the day when he needs to be able to work though- as he gets them every day, he doesn't really have the option of just sleeping through them all.
That said... when he was given shots of toradol and reglan this summer when he was in for a migraine... it did NOTHING. The benadryl they gave him knocked him out and made him sleepy... but when he woke up again, the pain was still there.
So... I'm glad that woman knew what works for her pain. Some people aren't as lucky to HAVE something that works.
In the 2X that I have ever had to go to the ER for a migraine, I ask the same thing, and it works I feel better after about 30 min.
We should have more Toradol-seekers in the ER!
You sure that you weren't dreaming...?
I am not a big fan of toradol alone, but the rest of that combo added to it is typically a winner for true migrains. Where I work, i have seen a steroid added to that combo.
Whenever I go to the ER for my migraines I immidiately request and toradol and compezine. One time my mother drove me 2 hours with a horrible migraine back to our local hospital (from another state) cause she was afraid of me not getting treated and them thinking I was drug seeking... The nurse back home just laughed and said the only 'drug seekers' that request toradol either are experienced with migraines or bad hiccups, and that it's no big thing.
Now, as for the benedryl with it... will that stop the wanting to rip out the IV and run home? I always get really over-antsy when I have the saline/toradol/compazine mix, so much so that I avoid help with my severe migraines until it is entirely too horrible.
I hate having to go to the ER for my migraines, but it happens. Toradol hasn't worked for me, but I've been willing to try it. I tried it alongside the triptans to boost the anti-inflammatory power. Frankly, I am open to anything they want to try - but when I go, I usually really need fluid and Zofran first - because my anti-emetic suppositories didn't work (Compazine through IV gives me dystonic reaction). I generally really want Decadron. I want to try Lidocaine alongside Magnesium, but so far many doctors just want to give me the anti-nauseant and some pain meds to scoot me out. While I'm grateful for the decrease in pain, I want to try something that will end the pain, NOT just mask it.
Toradol-Wonderful; Benadryl-Fabulous; Compazine-Awful.
I like the Toradol- Reglan-Decadron version better. I hate narcotics for migraines due to the fact that I get a hangover with them. When I was admitted a while back for complications due to my lap choley, I got a migraine and asked the surgeon for my usual (the above meds) and he actually scoffed at me and wouldn't order it. Grrrr.
Smart lady! I am now 38 and have had migraines since the age of 20. I have standing orders at the "Infusion Center" in Minneapolis. However, there hours are 8-4:30, so unfortunately I cannot control when I get a migraine. But the great thing is the Infusion Center gives me a 4 to 5 drug cocktail consisting of Benadryl, Decadron, Zofran, Ativan, and something else I cannot recall. ALL non-narcotic. Hate it when I have had to occasionally go to ER for migraine, they just dope you up. Last time they gave me a pain shot and begged them to only give me half of it. Guess what it was... Morphine. All it did was make me throw up! I already had my head in the garbage can! I think the ER's should come up with there own little COOL migraine protocol like the Infusion Center has. They administer mine over a two hour period and it knocks you out within 10 minutes. THe only side effect really is amnesia and someone has to be with you the rest of that day. Who wouldn't want amnesia after a migraine!! But I have never had a BETTER treatment!!!! Of course I have hard core meds at home for ocassional use, but they don't always work and I am a mom of three. THanks for knowing what is good!!
I wonder if this patient works in the medical field by any chance...
I would love to be able to take something like Torodol, but in front of the ER docs eyes I had a violent raise in blood pressure, vomiting,instant diarhea and nausea...I was given decadron to calm it and then had a mild reaction to that,. The end result was what I hate most and that is demerol and visteril but it worked to quell a blinding migraine with vomiting, Not everyone is fortunate enough to take the torodol, although I wish I could.
Yep I also go the IV route. I've had migraines since I was 12. ER visits used to consist of demerol/phenergan combo which meant i needed someone there with me. About two years ago I was able to get a decadron/toradol/zofran combo with a saline drip. Worked wonders. This is now what I ask for when needed. I think once more migraine patients get educated in this new protocol, you guys will see the number of people asking for narcotics diminish significantly.
i've suffered from migraines since i was 9, yes 9. i've tried just about every rx for home treatment. i can't take imitrex due to severe heart palpatations and difficulty breathing. And i don't like to take narcotic rx for them cause of the rebound effect and fear of dependency.
At home fioricet and phenergan are my first line of defense. Fioricet is the only rx for migraines that i've not built a resistance to. Others work for a while then just stop. If it gets to the point that i have to go to the ER i've usually gotten so dehydrated from vomitting they put me on IV fluids and a "migraine cocktail" of toradol, demerol, and compazine. Toradol by itself doesn't work, and demerol by itself only takes the edge off and makes me MORE sick to my stomach. The 3 combined will almost always knock out the pain and break the rebound cycle. i've never heard of benedryl as a help for migraines. i will DEFINITELY try that at home.
Post a Comment