Pain Control

I don’t think the pain management problem will ever be solved. I am referring to the problem of patients not getting the appropriate dosage of pain medicine to alleviate their pain. I am so tired of having to hound the nurses to actually GIVE THE DAMN MEDICINE to the patient. Just a thought, pretend that old man or woman in the gurney is your mother or father. Ask yourself ARE THEY COMFORTABLE? DO THEY NEED MORE PAIN MEDICATION? Yes I am yelling. What the fuck is wrong with you nurses?

The other day I wrote an admission order the usual way I order morphine. “For severe pain Morphine 2-6 mg IV q ½ hour prn. The doctor read this and refused to sign the admission orders (My privileges don’t extend to writing admission orders although I do on a daily basis). He wanted me to amend the order to read “max morphine 10 mg over 3 hours.” I thought, will this order serve the patient? I have given as much as 55 mg of morphine to kidney stone patients in an hour. Morphine lasts about one hour when given IV. The literature says it lasts 3 to 4 hours when given IV. I would like to give the doctors who wrote those books a jack-booted spike-collared kidney stone and 2 mg of morphine for the pain every three hours and see if they amend the “3 to 4 hour” order. Screw the half-life of the drug, is the patient having pain? It becomes a problem giving too much Demerol because the metabolite causes the patient to see pink elephants, but morphine does not.

If the patient is sitting up in bed sweating and complaining of pain after 20 mg of morphine, then I am not worried about them suddenly stopping breathing. I will do one of two things. Give more morphine, or write an order to give Dilaudid.

One pain control study I read gave an equivalence chart. Six mg of morphine IV was given the equivalence of 1 gm of Tylenol. I disagree with this only in that each patient is different. I have never had a patient stop breathing after giving morphine, but I have had a 17 year-old patient stop breathing after only one mg of Ativan IV.

Last night I wrote an order for Demerol IV. I hate Demerol but the patient had a bad experience with morphine and I did not want to jump directly to dilaudid. The patient had cholecystitis and needed pain control. I ordered Demerol 25 to 50 mg IV PRN. The nurse gave Demerol 25 mg IV and left the room. About ten minutes later I asked the nurse if she had given the Demerol. The patient had received 50 mg of Demerol earlier in the evening for her abdominal pain by her previous nurse. This new nurse stated that the patient was still in pain but was having trouble breathing after the second round of Demerol, she refused to give any more pain medication.

Ok several problems with this. If the patient was having problems breathing after a dose of medication the nurse should have come and let me know immediately. She did not. If the patient did not receive adequate pain control after the dose I ordered, the nurse should have come and told me about it. She did not. What she told me when I tracked her down was she was not going to give any more pain medication to this patient because the patient was having trouble breathing.

I was pissed. I went in to re-evaluate the patient. I asked the patient. The nurse told me you are having trouble breathing, is that true.

Patient, Ya, holding a guarding hand over her RUQ, my stomach hurts so bad I can’t breath.

I went out and told the nurse to give the patient some pain medication NOW!!! Stupid bint!!!

links: digg this    del.icio.us    technorati    reddit