ER Dogma
1) Everyone's pain is 10/10, get in line. If you aren't screaming, it isn't a 10.
2) Chronic back pain patients often forget their narcotic medications when they go out of town. And their doctor goes out of town a lot too, but he'll be back on Wednesday.
3) If you want me to take your upper respiratory infection more seriously, tell me that your temperature usually runs low. So when your temperature is 98.6, that is really a fever. In you. Because you know your body.
4) If three or more family members check in together with upper respiratory infections, they have Medicaid, thus no copay.
5) Riding a motorcycle while wearing shorts is a bad idea. Really.
6) The longer your list of allergies to medications, the more likely you are to have a psychogenic cause of your physical complaints.
7) If you think you have a "high pain tolerance," you probably don't. If you think that you have a low pain tolerance, you are likely correct. People with a high pain tolerance don't even mention that term.
8) If you are concerned about any symptom at all, I don't mind if you come to the ER. I'm happy to give you my advice, and I will not chastise you. Just understand that the longer you have had your symptom and the less obvious it is on examination, the less likely it is to cause you harm, the longer you will have to wait to be seen, and the less likely I am to be able to figure it out or make it better. No, I don't know what that little bump is. Bye.
9) It doesn't matter how slow the ER has been all day....as soon as the second doc leaves it's going to be crazy for the rest of the night.
10) If a physician hasn't returned a call after 30 minutes, as soon as I page a different physician they both will call back at the same time.
2) Chronic back pain patients often forget their narcotic medications when they go out of town. And their doctor goes out of town a lot too, but he'll be back on Wednesday.
3) If you want me to take your upper respiratory infection more seriously, tell me that your temperature usually runs low. So when your temperature is 98.6, that is really a fever. In you. Because you know your body.
4) If three or more family members check in together with upper respiratory infections, they have Medicaid, thus no copay.
5) Riding a motorcycle while wearing shorts is a bad idea. Really.
6) The longer your list of allergies to medications, the more likely you are to have a psychogenic cause of your physical complaints.
7) If you think you have a "high pain tolerance," you probably don't. If you think that you have a low pain tolerance, you are likely correct. People with a high pain tolerance don't even mention that term.
8) If you are concerned about any symptom at all, I don't mind if you come to the ER. I'm happy to give you my advice, and I will not chastise you. Just understand that the longer you have had your symptom and the less obvious it is on examination, the less likely it is to cause you harm, the longer you will have to wait to be seen, and the less likely I am to be able to figure it out or make it better. No, I don't know what that little bump is. Bye.
9) It doesn't matter how slow the ER has been all day....as soon as the second doc leaves it's going to be crazy for the rest of the night.
10) If a physician hasn't returned a call after 30 minutes, as soon as I page a different physician they both will call back at the same time.
Labels: medical
posted by scalpel at 4:35 AM
55 Comments:
Almost every thing you said is right on but Amen to this one....
"The longer your list of allergies to medications, the more likely you are to have a psychogenic cause of your physical complaints"
Does ER dogma cover events that occur in the your department during a full moon?
I'd like to add one more thing to your list about chronic pain: Chronic pain patients always seem to have a bad "toothache" that require the use of Vicodin and Tylenol #3.
Great post.
The full moon does seem to bring out the crazy in folks. You gave me an idea for my sidebar, too. Check out the moon phase generator I found.
I'll give anyone narcs for their first ER toothache visit, and even their second if they are nice. But to keep coming back for that is ridiculous. If they can afford my ER bill, they can afford a visit to the dental school.
Hey, Doc:
Love that moon phase generator. I'll check it before I go to work to see what kind of shift I'm going to have.
More dogma:
Saying the word "quiet" as in, "it sure is quiet tonight," will bring a flood of patients through your door.
Good list. Why is every headache a migraine? These patients have internet access. They should get creative and say they have a cluster headache - that would throw me for a loop.
I also enjoy, "I know exactly what this is (sinusitis/UTI/back pain/etc). I don't need an exam or tests or anything. Here's what I need [insert med(s) here].
I second every one of those (e)motions!
Fantastic!
I clicked on comments to say amen to #6, and found jordan had already done so. The whole list is right on.
Good Lord......do scalpel and Dr. A know I read the comments here from time to time?
Dr. A...you better have been joking there, or I might just have to kick your ass. ;)
Triple Kudos for #6.
Patient says: "I have a high pain tolerance".
I hear: "I want all the dope you have. I want to be numb 24/7, and resent having to talk to you to get dope."
I say: OK.
The rest is on target, as well, but this one hit a nerve.
GruntDoc
Corollary to:
"The longer your list of allergies to medications, the more likely you are to have a psychogenic cause of your physical complaints."
is:
"You know you are allergic to Haldol because..."
Dr A: “I also enjoy, "I know exactly what this is (sinusitis/UTI/back pain/etc). I don't need an exam or tests or anything. Here's what I need [insert med(s) here].”
Yeah, well, from a patient’s point of view, having to pretend to be an idiot to conform to a doctor’s idea of what a patient is can be tedious.
Dr: “So, what brings you here today?”
Me: “A urinary infection.”
Dr: “What makes you think you have a urinary infection?”
Me: “I have a fever, I’m peeing every twenty minutes, and it burns wwhen I pee.”
Dr: “Ok, let’s take a urine sample to check it out.”
Dr: “You have a urinary infection. How often do you have them?”
Me: “Never. This is my first one.”
Dr: [genuinely puzzled] “Then how did you know you had a urinary infection?”
Me: [genuinely puzzled at being asked this question] “I have a fever, I’m peeing every twenty minutes, and it burns when I pee. What else would you like it to be?”
Dr: [quizzical expression]
I mean, I know doctors have their routine for taking a patient history, and I know they need to see for themselves, but jeez it would be nice to get some credit sometimes.
"Yeah, well, from a patient’s point of view, having to pretend to be an idiot to conform to a doctor’s idea of what a patient is can be tedious."
Agreed. I've had multiple UTIs and find the symptoms pretty umistakable at this point. I'm fortunate to have doctors that will call in an RX without an exam, but I know a lot of people have to haul their sick selves in for an exam.
The graveyard is full of people who thought they knew what was wrong with themselves.
Just tell me your symptoms, let me examine you and order the tests I need to do, and you'll be better off. You don't come to the doctor to get an antibiotic. Any physician who doesn't take the time to listen to your smptoms and examine you, who simply accepts your self-diagnosis at face value, does not deserve the title.
Good list. I have asthma and my ER track record is spotty. Sometimes I get docs who work with me, who realize I have a chronic condition and that I know a hell of a lot about it. Other times, I get docs who, apparently, think I am retarded.
"So...you came back?" was the response I got from one ER doc when I returned to the ER the next day b/c my doc couldn't see me and I was backsliding.
I go to the ER when I've exceeded my self-care abilities and asthma management plan and when my docs can't see me, but _before_ I completely spasm shut. Some docs don't seem to get that. Some of them don't take me seriously until I stop breathing and I seek care just before I get that bad.
Hence my interest in your post, it's good to understand the other side. Because, after my last go round with the ER, it's clear I need to facilitate my care any way I can.
M
Patients with asthma should be allowed as much input into their treatment plan as they are comfortable with. The last question I ask every asthmatic patient is "do you feel comfortable managing this attack at home, or do you think you need to be in the hospital?"
I'll do everything in my repertoire to help you feel better and hopefully enable you to feel good enough to go home, but if you are uncomfortable doing so for any reason whatsoever, then I'll do everything in my power to get you admitted.
You can't screw around with asthma.
I go one farther on the allergies: 5 allergies equals a personality disorder, at least.
Often as not, it's a personality disorder that clashes with mine.
Despite ordering thousands of doses of IV Toradol over the course of my career, I've seen exactly one allergic reaction to it. Yet, strangely, many people claim to be allergic to this wonder drug.
An allergy to Toradol is like a flashing red light that signals "DRUG SEEKER!"
Then there are the comfortable looking people who say their pain is ten of ten. The next patient will be sweating, using accessory muscles, obviously in discomfort, and they'll say "I dunno, maybe a three?".
Which one do you believe?
As the spouse of someone who has lived with chronic pain for years, I'm disappointed by the attitude of some of the posts. People can and do have chronic pain that is not psychogenic. They develop a tolerance for painkillers and require strong ones at high doses. They've been taking them for years and develop various allergic reactions. They've tried the more esoteric ones because of the above, seeking relief and fewer side effects. Stop thinking you're God and the Drug Czar rolled into one and stop sniggering at your "obviously drugggie" patients. And by the way, some patients do know more about their condition than most doctors, because a) they've lived with it for years, b) they can read, and c) intelligence is not limited to those who had the wherewithal to attend medical school. You're not the only ones who know how to make a differential diagnosis. Get over yourselves.
98.6 degrees still isn't a fever, honey.
- God
Anon with chronically pained spouse.....
While I am but a junior member of the medical community, I think I can offer a rebuttal. While your spouse may have a legitimate cause for his/her chronic pain, the ED is not the place to treat it. There are anesthesiologists now who are specializing in pain management. These folks have a huge arsenal of treatment options for chronic pain such as nerve blocks, nerve stimulators, ..., and as a last resort, narcotics. They can prescribe narcotics, and monitor dosages and increase those dosages as the patient builds a tolerance - because the patient follows up with them in clinic; a luxury that the ER docs don't have (or want-it's an EMERGENCY room). Another excellent feature is the pain contract-signed by the patient stating that they won't get narcotics from any other source.
So don't accuse the ER docs of being 'Godly Drug Czars' when all the treatment options have not been explored. Because, unlike yourself and your spouse, there are people out there who do abuse narcotics and obviously seek out ER physicians to write the prescriptions for their weekend buzz. And unfortunately some ER docs still do...
EJ you make some good points, but someone experiencing breakout pain at night, seeking relief in the ER, what else? Pain management is not always successful and bliss and not everyone has completed a successful navigation down that path -- usually success comes after years of miserable struggle, misdiagnoses and mismanagement. Success often only comes to those who repeatedly refuse to accept the answers given to them by practitioners. So when they come in with strong opinions on what they need, please consider that in some cases those opinions are from hard-fought battles.
I went to ER w/ severe stomach pain, happens frequently, CT scan said Crohn's. Not getting much help from GI doc. ER doc said no more tests too much radiation, if I have an "episode" just go to ER and ask for pain management. I said "yeah right, like that's going to work" He laughed and said not to worry.
"Why does every headache have to be a migraine...." Speaking from a patients point of view when I go in to the ER with a "headache" it is a Migraine and I am there likely because it has been going on for days and none of my other meds have worked.
P.S. I hate being treated like a drug addict when I go in for a migraine, when all I am desperate for is some releif! If you can give that to me with out narcs than great! If not, well you tried now pass me the morphine!
Just remember, there are those exceptions to the rules. I suffer from severe migraines and have documented allergic reactions to several medications. I go to the E.R. only as a last resort for help with dehydration and pain. You have just clued me in to why I am treated so badly by some of the doctors and nurses. It is humiliating enough to go to the E.R. looking like you were drug off of the side of the street somewhere, but it is even more degrading and humiliating to be treated with no compassion and no respect. I find that the doctors don't like it when you have educated yourself about your condition and the meds that you can take. I am completely at the mercy of the docs and nurses and cannot even defend myself. Doctors and nurses that have had migraines treat me with the utmost care and I thank them so much, but with others I have to lay there and suffer in silence because the more I say the worse my treatment gets and the worse my migraine gets. How do I as a true migraine sufferer deal with this? I feel as though I have nowhere to turn when I truly need help.
p.s. I am not allergic to torado.
I mean toradol.
Kudos to that. I just recently was denied anything stronger than toradol for a kidney stone attack because the doc didn't see stones in my ureter, just in my kidneys. I also have several drug allergies including anaphylactic reactions to morphine and demerol and dystonic reactions to phenergan, reglan, and compozine. Nasty stuff. I have a long history of kidney stones. Two days after the attack I passed some "gravel". My urologist and my family doctor did not understand why this doctor was so hateful to me and denied me pain medication. They both agreed that I had had a kidney stone attack. I am a quiet patient and did not question the doc in the E.R. when he told me that it couldn't possibly have been stones. But I did plead with him to figure out what was wrong with me if it wasn't stones. He shrugged his shoulders and said "I don't know." My nurses even seemed visibly upset that this doc was treating me this way. My blood pressure was 151/102 when I arrived there and never got below 147/98. My norm is 110/70. Did he have the right to deny me pain medication? What are my rights as a patient? I have been so hurt by this and I am terrified that I could have to face this doctor in the E.R. again one day. My 18 year old daughter went with me that night and she will never go back again. It really upset her to see me in so much pain and the doctor not helping me. My husband feels guilty that he wasn't there, but we have 7 children, our youngest adopted child has several special needs and he stayed with them because it was so late at night. It has affected all of us. Doctors and nurses should never underestimate how there care of a patient can affect them even after they leave the E.R. Is it more harmful that the drug addict receive the drug that they are craving, or that the patient in severe pain not receive the medication that they need for pain? Unless a doctor is 150% sure that this patient is lying, then they should be given the benefit of the doubt. Plus, wouldn't I be in the E.R. far more than once every couple of months if I were there for drugs?
ER visits once every couple of months for narcotic-requiring conditions are a red flag. Allergies (especially anaphylaxis and not just itching) to morphine AND demerol (two totally different medications) are a red flag. Dystonic reactions are not uncommon, and if someone has a dystonic reaction to one such drug, the others are likely to cause the same reactions. Not necessarily a red flag, except for patients complaining of "migraines."
The bottom line is that if a patient comes in and specifically states that the only narcotic he/she can get is Dilaudid, and we see several visits in the medical record where a definite cause of pain is not identified, then yes, we are going to be very suspicious. I'll give anyone the benefit of the doubt once and sometimes twice. But we need to have something concrete to go on.
Sorry.
gotcha. So what can I do? I had the allergic reactions to morphine and demerol in the presence of doctors. One was after a shot of demerol in the family doctors office and one was during my c-section. Should I carry documentation of this when I go to the E.R? I don't want to have to pay the price for the dishonest people in the world. I already have a note from my neurologist on file in the local E.R. What else can I do? I hate the idea that I am not believed when I go in for help. My husband also gets very upset. Also, I still don't understand how you can be suspicious of a patient that is there only a few times a year. Wouldn't an addict be there way more often than that? And doesn't my extremely high blood pressure count for anything? I don't want to be guilty until proven innocent. I feel like crying everytime I think about the jokes you are making at my expense. Don't you see how hurtful that is?
Also, people that have conditions that cause them reaccurring pain have been exposed to a lot more medications than most people. So they do have more known allergies to medications. My mother, sister, brother, and I all have lots of allergic reactions to medications. And why is the dystonic reaction especially suspicious for migraine sufferers? Both my brother and I have this reaction. He had it to haldol. It is a horrible reaction that I would not wish on anyone, and it caused him severe anxiety for several days before he knew what was happening. Luckily, mine was caught in the hospital when I almost yanked my I.V. out and couldn't control some of my movements. I never again want to experience that!! If I were a drug seeker I would think that phenergan would be a great addition to the narcotic rather than zofran, which is very expensive and has no side effects.?Am I right? Am I making any sense? I am probably starting to aggravate you as much as your patients do, sorry, just trying to understand.
If you have a documented history of kidney (and ureteral) stones and come in with a typical presentation and blood (even microscopic) in your urine, it shouldn't be a problem.
Here are some factors which would decrease the likelihood of a patient getting narcotics:
1)The more red flags we see (new in town, doctor out of town, multiple allergies (especially toradol), lost/stolen prescription, no clinical evidence of disease, and others)
2) The more demanding, mean, and angry the patient is
3) High frequency of visits
4) Negative studies
5) Any evidence of lying or manipulation will cause a notation of DRUG SEEKER! to be placed in the chart and that patient will probably never receive narcotics from that ER ever again. If a patient tells me that he hasn't gotten any vicodin prescribed in two months and I call the pharmacy only to find that a prescription was filled last week, then that person is blacklisted.
We hate lying drug-seeking scumbags with a passion, and we do talk to each other, HIPPA be damned. It's too bad that occasionally patients in pain have to suffer on account of them.
I only mentioned dystonic reactions regarding migraines because phenothiaxines (compazine, reglan, droperidol) are the treatment of choice for migraines.
Oh, and if a patient has multiple ER visits for other painful conditions (toothache, "migraine," back pain, etc.) that is another big red flag. Drug seekers often move from one painful alibi to another. But all of their visits involve something that hurts REALLY BAD!!!!, and often they have little objective evidence of disease or injury.
Thank you for being so helpful with all of the information. Frankly, I'm glad about your HIPPA comment. HIPPA only protects the drug abusers and hurts the honest patients. I do worry that you have become so resentful of the drug seekers that you let your pride get in the way of being compassionate towards those that may be questionable. Please try to put yourself in my shoes and not let these bad experiences get in the way of compassion for real patients in real pain.
Frankly, I don't see treating pain as a high priority. My priorities are to keep people alive and to prevent disability (organ dysfunction) from disease or injury. Only then do I address pain issues.
Migraines are uncomfortable, but contrary to some websites and support groups they rarely (if ever) cause death or bodily injury. Same with kidney stones and chronic back pain. Life expectancy = normal. The only reason we care about these conditions at all in the ER is that for each of them there are life-threatening conditions that can mimic them; our primary goal in evaluating such patients is to rule out those other conditions. Pain control is secondary.
The true value of a CT scan for kidney stones in the ER is not to see how big your stone is, it's to rule out an aneurysm (or prove that you really have kidney stones at all). Same with MRI in back pain: it's rare we would find any herniated disc that would change our ED management. The history and physical exam and plain x-rays are usually sufficient to make a disposition.
I will however give cancer patients and sickle cell patients any medication they need at whatever dose they need to get them comfortable without hesitation.
I totally agree that patients with life threatening illnesses should be top on the list. I never have a problem waiting for treatment because I know that I should be last on the list. But consider this, Migraines and kidney stones cause such severe pain that a patient would do anything to relieve themselves of pain if they didn't think that they were going to get help from somewhere. Therefore, in some aspects it can be a life threatening condition. I can tell that you have never had either one of those conditions. Your bitterness really does scare me. I would never want to have you for a doctor or nurse. I have had both kidney stones and migraines and I cant think of many other things that cause that kind of pain severity. Thats why, before they knew what migraines were, people would beg their spouses to chop their head off!!! Sounds life threatening to me. How long could you live in that kind of pain? Where do you suggest people go in that kind of pain? Any pain medications that you may have at home are not going to help once your pain has reached that level, even if you can keep them down. I have been appauled by your cold hearted attitute, I think you have grown numb and need a new profession. And besides, even druggies deserve care and compassion. They are obviously sick too.
I would rather have 10,000 migraineurs hate me and think I'm the worst doctor in the world, vowing to never come see me ever again than to have one single patient die or not get the urgent care they needed because I was stuck in an argument with an annoying headache patient (or their mom - see Geico commercial, lol) over whether they were going to get one or two mg of Stadol.
As I said in the original post, I am happy to see all comers in the ED. If you come to me with pain and you are pleasant and cooperative, you will find that I will probably treat your condition more effectively than most other physicians you have encountered.
If you are demanding, mean, angry, or threatening, then you may leave empty-handed. Remember, you are coming to the ER to be evaluated for an emergency condition...not for your "usual" shot of narcotics.
Where should patients go when they are in pain? Come on in to the ER, I'll be happy to see you. Just be nice, and be prepared to wait, and we'll get along much better.
hey, back again. I would never expect to be seen for a migraine over a patient with a condition that requires immediate attention. I am probably one of the best patients that a doctor has ever seen. I am quiet (usually because I don't have a choice) and patient and and very respectful of the doctors. That is why it is so sad when I still get treated as a drug seeker. If a person comes in claiming to have a migraine and is able to argue and put up a fuss with the doctors then they don't really have a migraine. They only things that I do ask for immediately are an icepack and a "throw-up" bag. Otherwise, I know that I am last on the list and expect to be. Just please turn out the lights and shut the door before you leave the room. Thanks
Also, please don't assume that just because my room is quiet that I am asleep. I am just dealing with the pain the best way that I know how, but I promise you that I couldn't possibly be sleeping, you are very welcome to come in and check on me. And better yet, offer me a dose of pain medication. That would be great.
I had to laugh when you said that migraines were "uncomfortable".
Can you say "OPIOPHOBIA"?
Of all the physicians in my large emergency medicine group, I am the only one who carries a triplicate pad to work every shift. And I use it.
Can you say "fallacious?"
Or is it fellatios?
so what if a patient HAS actually had a reaction to toradol as I have? I have tricuspid valve regurgitation as well as antiphospholipid antibody syndrome - I was once given toradol for a migraine and my heart went insane. Beating completely off rythm and so fast I thought it was going to burst out of my chest. Unfortunately I also have a history of kidney stones which is how I found out about my allergy to IVP dye and zithromax(I was taken to the hospital for severe reaction); as well as once having an ovarian cyst rupture - WAY more painful than the stones - which is how I found out about my allergy to compazine; and herniated discs - Mobic(to put it kindly, it cleaned out my colon...), demerol (found out after my percutaneous discectomy when a giant hive broke out at the injection site and a nurse told me I was allergic to demerol too). I've undergone an immense amount of work trying to get my life back as I'm only 27 and the mother of 3 kids. 6 months of PT which did nothing but cause more damage, I also did an ESI which didn't work, as well as a percutaneous discectomy last week which relieved some pressure on my hip but my back and leg have found no relief - the nurse in the procedure room stated that my discs were 'a lot tighter than we expected'. So when I go into a hospital - or if I ever do in the future, what do I say to doctors who believe my allergies are psychogenic if I ever need to be seen due to the severity of the pain and inability of my lone doctor to do anything in the middle of the night? There were several times where the pain became so severe this past weekend - my doctor's phone system was down that I thought of going in to the ER but wanted to try to ride it out... with my history how do I not come off as a drug seeker? I don't like being treated like a criminal.
Unfortunately, with that sort of history there is little chance that you will not be looked upon with suspicion, and I doubt there is anything you can do about it other than to be as nice as possible to all of your caregivers.
That stinks. I do my best to stick to my pain contract. I did seek treatment last month for adnomyosis but want to get my back situation under control before getting a hysterectomy as my gyn is recommending - plus I need some time to really get used to the idea. I am always very respectful of my care providers, very respectful and very patient. Unfortunately I've had more than my share of bad health and I do educate myself of my health conditions. I had begun an education in medicine myself before becoming pregnant with our first daughter - I decided to put the medical career on the back burner as I didn't feel I could do both the way I really wanted to - with excellence - so I chose my family. I have 3 very young kids - 6, 4 and 2 so getting the situations actually resolved rather than just covered up is of the utmost priority for me. I CAN do certain things, just not without extreme pain - though there are a few things that I physically can not do. My reactions were very real and very severe. I WISH I could take NSAID's as they actually did help the pain - the problem with that of course though, are the side effects. Just know that there are some people who do have very real reactions and they aren't crazy and making up their pain.
Maria, I am with you. I have chronic pain for which I am on 500mg of morphine a day. Yeah, you read that right. Even that doesn't take my pain away, and I know I will always have some degree of pain.
I have done the PT, the ESI's, the facet blocks, and everything else asked of me. I did the discogram, which proved my 4 lumbar discs with annular tears present. My surgeon refused to do surgery on 4 levels. So did the other 2 surgeons I saw for 2nd and 3rd opinions.
My nursing career was sidelined. This didn't all happen at once. It built up over time.
Oh, and to make all the docs happy, I can't take Toradol. Or any NSAID's. They make me blow up like a balloon. Every time. Even my internist nor his specialist could figure it out. My legs were so edematous they were sure I had a blood clot, but the venogram was negative.
And to be a further PITA, I have migraines. And when I get a bad one, and I'm vomiting every 15 minutes, I'll need some IV rehydration eventually. I can't do that at home, although I wish I could...I'd do anything to avoid going to the ER.
You'd think after the 3 times I've been to the ER in the last 5 years, they would have WROTE in the chart that I have documented injuries that cause my pain, my migraines, etc....and they have verified such with all my doctors. I even have my little form from my pain doctor that says "Pt is on X amount of this drug, has XYZ diagnosis, and does NOT have an addiction problem".
I'm only in my 30's, so my life is pretty much tortured. Thank God I have caring and understanding doctors in the office.
I understand chronic pain is NOT best managed by the ER. However, when the pain is out of control, or perhaps you sustained an additional injury (like falling and breaking your arm, for example) that needs attention and adequate pain control. Or, perhaps the pain is just not being contained by the PRN meds, and you call your pain doc on Saturday night at 11pm. Where do you think he's gonna tell me to go? Hmmmm. To the ER!!!
It is sad that the drug addicts affect how legitimate patients are treated. I'd rather some dope head score a hit than a legitimate patient have to suffer, any day.
And as far as being "mean" or "aggressive", sometimes when you're in a whole lot of pain, the last thing you are worried about is being cordial. Although I try my best.
But usually I am screwed and waiting in the ER until my internist or pain doctor shows up. Because they always do. We've worked together and in this small town, we're friends. Once they show up, the ER docs are tripping over themselves to make sure I'm taken care of. And it shouldn't take another physician showing up to get that kind of care. Unfortunately, in my area, it does.
All it takes is a split second for your life to change. That's all it did for mine. I wouldn't wish my pain on anyone. As much as people want to call me an addict or a junkie or whatever.
"I'm allergic to tordol, but not to that "D" word what is it diloudid, or ya dilaudid or that medication that is 7.5 times stronger than morphine......." (:
IF you cannot pronounce it you should not request it.
From ER Murse
WOW I would be in a coma with all that crap onboard can you say intubation
Oh ya don't forget about the 10/10 ABD pain eating fire cheetos and drinking a Mt Dew. Come on IF YOU HAVE ABDOMINAL PAIN DON'T EAT OR DRINK. That is like puting gasoline on a forest fire!!!!!!!!!!! NOT a good idea.
Deep thoughts by Murse
If you have a legitimate problem that may take you to the emergency department let me give you a word of advise. Have you primary care physician write out the preferred way to care for you on a prescription and carry that note with you. At the bottom the physician should write; "please fax this prescription to my office every time the patient receives treatment". This prevents you from getting mistreated and also allows your family physician to track your illness. If you are truly legitimate; most people aren't, this won't be problem.
Toradol is a wonder drug. It keeps the drug seekers away, right?
Ok Oh great Gods of meds I have one for you.
Daughter wakes up with fever and overall "fever" pain I give her 400 mg of advil. She feels better even great until 9PM when docs are closed. Then fever returns 101.6 and terrible back pain. I am thinking sound like kidney infection (no prob urinating or burning) but what if it is something more serious apendicitis maybe? I am not a doc. I give her 4oo mg of advil & head to ER because I love my child and would not want to overlook something serious. Get to triage of course temp is norm because of meds & triage nurse offers meds for pain we decline becauseof course she is feeling some better (cont back pain)doc gets urine nurse blows two veins for i/2 inch blood in tube (needs 2 tubes). she is sure it is not enough but sends it anyway. At 3 AM daughter is in extreme pain ****8**** I have been very patient its Friday people are drinking and fighting and bleeding all over ER. I politely ask for some advil which did not seem to be a prob a triage. At 4;15AM I again politely with more urgency ask for advil. At 4:45 daughter is writhing in bed I am geting upset because she does have a very high pain tolerance and I am having to beg for advil that I could have walked across the streeet and purchased by now, which is what I should have done. I come out of her room and ask same nurse what the prob with the advil is and she holds up the packet and non chalantly says oh I have them here I will bring them in just a second to which I reply I would really appreciate it because now she is in tears. Guess what happens next male nurse comes in and says we need to get one more tube of blood we did not have enough of the second sample.. He hits vein first try and fill vial completely, very nicely tells me 20 mins will have lab back & script for cipro is ready keep giving advil for pain. Give me 20 mins and he was true to his word. We arrived at 9PM and left at 7 am. Like I said I understand Friday nights and of course it was a full moon.
If there is anyone on here that can give me a reasonable explanation on why it took 3 hrs for me to get 800 mgs of Advil I would love to hear it. Save the excuse, "we have to make sure what we are dealing with" Advil was offered in triage but I had just given her some so we were good.
And I know it is terrible to say but it really ticks me off that my daughter has to suffer in pain for 3 hrs in an ER for nothing that she has inflicted on herself so that the drunk emos two doors down can visit with their friends and start more fights at the ER (by the way county cops had to be called because hospital security was so understaffed they would not come out until county showed up.
Don't become so jaded by the addicts that you neglect the needy and yes we have insurance. I know most if not all of you are more educated than I am but we bleed the same and we love our children and it hurts us when they are sick and we are at the mercy of an arrogant NURSE not doctor NURSE who if she had been walking any slower with that damn Advil I would have requested someone check her pulse. I just want to make it clear I was very patient aand understanding up until the point we had been waiting 3 hrs on Advil.
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