Tuesday, March 24, 2009

A disturbing trend.....local or national?

I want everyone in the US who reads this to respond if possible.  In my hospital we are trying to find out if this is a trend in our hospital or something national.  So, please respond!!!

  Our hospitalists are giving out huge amounts of pain meds these days.  I remember when I started nursing (10 years ago) we gave out demerol (wow!) and morphine only.  To give diludid was a rarity and it was reserved for someone with chronic pain or someone in intense pain that demerol or morphine didn't work for.  These days demerol isn't used and morphine is even going by the wayside except for cardiac patients.

  For our chronic pain patients and really everyone we are giving out diludid like it is candy.  For those that come in with acute pain they will get anywhere from 0.5-2 mg IV q 4-6 hours depending on their age & size, etc.  But for those that are our chronic pain patients we are giving anywhere from 2-8 mg IV q 2-4 hours!!!!  Yes that's right we sometimes are giving 8mg of IV diludid q3h!!  That's enough to kill an elephant!  But the patient that was getting it last week was complaining that it wasn't enough!  What???

  This is becoming disturbing to us nurses and we were talking about it the other day.  We are surprised about several things: 1) the doctors are ordering doses this high, 2) the pharmacists are allowing us to administer doses this high and 3) patients are tolerating doses this high without complications.  

  So my question for those out there reading this is........

Is this happening out there or just here?

Wednesday, March 4, 2009


The other morning I head to the ER and they ask me if I had heard about the PCI that is coming in.  Knowing that it is my job to open the cath lab when a PCI arrives, I ask what they are talking about.  Apparently, they got an EMS patch that they were responding to a chest pain call and when they got there and did the initial EKG it was for a man that was actively having an anterior MI. It looked like a pretty big one by the EKG they had faxed over....with tombstones and recriprocal changes.   

We had just gotten slightly over a foot of snow within the last day that had just ended in the last several hours.  When the EMS got the guy into the ambulance and started for the hospital it got stuck in the snow!!

From what I hear it was approximately 30 min that they were stuck in the snow before finally digging themselves out.  We aren't sure why they didn't just dispatch another ambulance since the poor guy was actively infarcting his heart the entire time.  They were finally pulling into the ER bay as I was leaving for the day so unfortunately I'm not sure how he made out.  Maybe a future update.........................

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