If you have a patient-controlled pain relief pump that is giving you thirty micrograms of fentanyl every five minutes with an optional bolus of one hundred micrograms of the same drug every hour, and you've been taking advantage of that bolus every hour on the hour for the past twelve hours, and you've also been taking more than one hundred milligrams of baclofen and more than one hundred and twenty milligrams of oxycontin and various other milligrammage of narcotics twice or three times daily, please do not try to get me to believe that you are going into withdrawal because I have removed your fentanyl patch, which expired three days ago.
Because I will look at you and say, "Really?"
Then, when you do not respond, I will say, "Really?"
And when you tell me that you're feeling queasy and you want Phenergan, because ondansetron doesn't work for you, I will say, "Of course it doesn't."
It has been a long week.
8 comments:
How is this person even alive?
I think ao.
Mom
I hear ya. Seems like we get one of these patient's every month....you cannot ever get them "comfortable", pain is always a 7 on a 0-10 scale. But, next door, in the room next to him will be somebody who just had open heart, with chest tubes and kabillion lines...who doesn't want anything for pain. Go figure.
Man, that amount of opiates would kill me dead. Amazing how zofran doesn't seem to work as well as phergen for these drug seekers?
Yes, I hate Phenergan with a passion after we had to have it on hand for a guy who got it--get this--PRN.
Oh, I just wanted to kill the docs...and he was snowed all the time. Probably explains why his arse would look like a roadmap by the time we got the crater in the middle healed.
Thank goodness we got him out alive. He's now bugging people closer to his home and family.
It's frustrating when we get pushed to the point we have such a sarcastic defense mechanism.
I'm just as guilty... whew boy am I ever.
Let me just say that I work in ortho. Not your regular ortho. The ortho that usually cares for patients who have been implanted, explanted, implanted, explanted and on and on. Im wondering why the docs havent just fussed the bleepin joint already, and given the patient some modicum of a life. But I digress. All this implanting/explanting is what in the begining...painful. So, it starts off inocent enough, and before you know it, its oxycontin 120mg tid with oxycodone 20mg every 4 hours in between, and a fentanyl pain pump with clinitian doses. The line between breathing and not breathing is imperceptable because the patient is so tolorant. Not to mention coping skills by the patient that are sorely lacking. All topped off with the Jacho requirement of documenting and controlling pain. please.
I deal with people like this all the time. I work PACU so I'll frequently get patients that have been taking opioids for a while. The ones that really make me say "FML" are the methadone users. They will take enough IV stuff to kill a horse. I am not exaggerating one bit.
And as far as Phenergan -- I LOVE it. A drug that makes them NOT puke and they also get really sedated/sleep and don't complain anymore? It's a really cool drug.
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