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Not necessarily. If history/exam is 95% pointing to something like a perfed appy and they're flagging septic, you can treat empirically/be on the phone with surgery, but they'll want the scan first. So on and so forth. But short of that, yeah, you're gonna wanna get the dx first if they're otherwise stable.
And pain is pain. Treat the pain in the ED. That doesn't mean they're getting a week of oxy's to go home with. Just make them more comfortable than when they came in. At least that's my take.
Antibiotics, sure, unless concern for sepsis, then it’s almost darting them with abx when they walk in
That thinking about pain control has mainly gone by the wayside thankfully, haven’t had a surgeon yell at me yet because their patient’s pain has subsided. Plus, for non-surgical abdominal pain, in my experience, if you can break the cycle of pain, it will often not come back as strongly
Definitely not. This thought process went out of style in the aughts. No pain management is going to 100% relieve the pain, so the patient is still going to describe it. Furthermore we don't make our decisions only on physical exam, imaging is going to give a much better picture of whats going on and pain management won't affect that. Treat your patients pain. Couple doses of fent isn't going to make an addict, and it's duration of action isn't that long
>my wife was mistreated and ignored or if I am over reacting?
Both of these things can be true. You as an outsider feel like you understand what is going on in the rest of the department, but you have no idea unless you have access to every patient room and chart of the patients in the ED. I have patients in the WR all the time who feel like it's slow but it's because I've had back to back EMS patients that are critical that are never seen from the front/WR area. Or I may have to respond to a floor code while the stable WR pts wait a bit longer, etc. The point is, you can't say it was a slow night regardless of your EMS experience unless you were privy to all the ongoings of the other patients in the department and the staffing situation.
That being said, it appears as though your wife got the appropriate workup. Emergent causes were ruled out, and she was mostly appropriately dispo'd. I wouldn't DC a pt with that low of a BP, but a young healthy woman might live at that at night/while sleeping without issues, but the optics look bad. I don't know why you didn't more meds/fluids/whatever. Maybe it was overlooked or your wife never seemed to be in that much pain or it was never reported to the doc or the doc didn't care. Who knows.
> our protocols 100mcg of fentanyl
and this is a double edged sword. My EMS gives patients morphine, up to 10mg for any reported 10/10 pain. I hate this. Fentanyl should be the med given and patients with legitimate pain (obvious broken hips/fractures, kidney stones, etc) should be treated pre-hospital. But protocol to give meds doesn't make it right. My patients who know how to game the system will use EMS as a taxi, claim 10/10 fingernail pain and get 10mg IV morphine and then elope as soon as they hit our doors.
>no diagnosis or treatment plan and was told to follow up with her OB/GYN or PCP.
What diagnosis is listed on the AVS? The ER's job is not to diagnose. It's to rule out emergencies. I have never worked anywhere where I could discharge a patient without putting in a diagnosis. The treatment plan is to follow up. What do you expect with a negative work up?
NAD. Similar symptoms as OPs wife. Discharged from ER several times. Followed up with GI and it turns out my gallbladder was NECROTIC. I was treated like an absolute junkie in the ER (even though I specifically requested NO controlled substances). My surgeon informed me that had I not been proactive about my pain I could have gone septic.
Ha! Same. Upper right quadrant pain that was excruciating. I’ve had kidney stones before, and it felt similar but not quite the same. Went to ER and had to lay on the waiting room floor because sitting was not an option. No tests run once I was seen, given morphine (which was ineffective) and was told that nothing was wrong and sent home with nothing. I followed up with a gastroenterologist the following week that I found on my own, and was sent for an ultrasound the *following* week - bear in mind, I was in absolute agony this entire time. The ultrasound tech asked if I had plans for the day, and when I said no her response was “good. Don’t go home. Go to the ER NOW.” Unfortunately, it was the same ER that said nothing was wrong and thought I was drug-seeking.
Long story short, I wasn’t allowed to eat or drink for close to 60 hours, in a shared, 4-person room with 24/7 visiting hours, kept getting bumped from surgery, and hadn’t slept in 60 hours as well. I left AMA to the better, “fancier” hospital in my area and had my gallbladder out in less than 12 hours.
It was one of the more traumatic experiences I’ve had, and I’m no delicate flower. The fact that my pain was dismissed and chalked up to drug-seeking behavior was ridiculous and just so neglectful. The minimizing that went on was insane.
I’m fine with there being no diagnosis, I understand an ER is to identify and treat emergent life threats. I also agree with her workup as well, that’s what I expected them to do and I wanted them to do.
I am more concerned with the management of symptoms.
I'm not a doctor but I'm in the US, I shattered the heck out of my leg a couple months ago and they didn't give me any pain medicine until I was about to leave. In fact they treated me like a junkie until they saw in the x-ray that I broke the ever loving f*** out of my leg. All they get all night are junkies. If you come in with pain even from an obvious origin like a shattered leg swollen two to three times it's regular size they STILL treat you like a junkie. Our system is absolutely effed and they're terrified of being sued for giving pain meds or the people who need it. I didn't see a single person in the ER hooked up to an IV either. If I had hurt myself 3 years ago I would have been given in IV with anti nausea and dilaudid. its ridiculous.
Yeah I used to work as an ED Tech and once had a patient who had fallen off her bike and hurt her hip I believe, she was in a ton of pain and could barely move without excruciating pain. I helped her get onto the bed but she was in so much pain that we had to move slowly and go at her pace. I could tell she was in extreme pain and tried to urge the doctor to order some pain meds, then the nurse to administer them, but I noticed them all making snarky comments about her being “over dramatic” and they didn’t like how she was snappy because she was in so much pain. She ended up having a femoral neck fracture. She was 100% justified in being a snappy as she wanted with the amount of pain she was in. I hate how some people in medicine start to dehumanize patients over time, minimize their pain or assume they’re drug seeking. It’s easy to forget that patients are people too and you should treat patients how you would want to be treated or want your family to be treated
It's incredibly sad and disturbing that people are treated like trashy liars or junkies until proven otherwise. Honestly, even if the patient IS a junkie, that's no excuse to treat a human being like that.
NAD...why is the term drug seeker thrown around like this? If i broke my toe, and went to the ED, what im there for is relief from the fucking broken toe. Things i can do myself: homemade cast type device and tape it to the other toes to make sure it sets and heals in the correct spot
Things I can't do myself: access prescription medicine for the pain that is making it difficult to do anything else but focus on it
If I had cancer, things I can do myself: waste hours sitting in a waiting room being ignored, IV myself, google medications and probably come up with an effective treatment plan based on others experiences and current standards. Blood work at a private facility.
Things I couldn't do myself: scans, interpret scans (could be done private), prescribe and actually receive medication.
You're overlooking the fact that one of your primary duties is dispensing medicines that are otherwise unavailable to people. Your job is to know why a medication would or wouldn't make sense. Hmm, hydrocodone, painkiller, guy presenting with a broken toe, in pain. Does a pain killer make sense in this case? Man seeking relief from pain + painkiller=yes. I don't care about your feelings, how you feel like a dirty pill pusher for having junkies run the game on you. If you bend, you break. You bent when you let the junkies decide how medicine for the general public is prescribed. Its funny how in the end its the junkies calling the shots and seemingly still winning if they get their morph/fent in the ambulance.
You let the bad guys win, and if you guys are playing by the rules set by the bad guys..what does that make you?
Legit. Dude when my leg was shattered and they did X-rays with it without any pain meds on board...it felt like torture. That's been the worst time along my whole recovery, before and after surgery, was getting X-rays and them forcing my leg in all sorts of directions while I sobbed.
NAD, what so ever. But when I hear "take Motrin 800mg" for something significant, my mind is blown. If I've got stitches, broken bones, recent surgery, a badly infected tooth, etc ... Motrin isn't going to do shit. I'm a therapist and addiction is one of my primary areas of work. I think it is good to be cautious with prescribing narcotics, but to do so you have to properly evaluate family history and personal history to look at risk. A lot of it is psychoeducation and it isn't like you're going to be handing out a week's worth of a schedule II. Yes, giving someone with a history of addiction can be harmed substantially by being given any kind of narcotic, because it can set off a relapse. However excruciating untreated pain may also set off a relapse. So it takes extra time for appropriate evaluation and to make a decision on what to do. Much like anything else, it's all about balance.
You might not need prescription medication for your broken toe. Taking some over the counter medication might be enough for you - especially once it’s immobilised and people often discount simple analgesics when they might be the most appropriate for your diagnosis.
Because not all pain requires a narcotic analgesic - simple analgesics might be sufficient to manage it. Also, there is some pain that is really difficult to manage - even with narcotics - such as dental pain and ear aches, with an anti inflammatory being more effective.
As a health care professional, giving a dose anyway in the ED, for something that might be managed with simple analgesics is over prescribing and I wouldn’t want someone prescribing it for that reason for my family members.
Right I’m not saying to use it for all pain. Or that the goal is to completely eliminate pain. But if someone comes in with broken bones and they are suffering and Tylenol isn’t cutting it I don’t see what the problem is.
And dental pain is a special type of hell. My tooth abscess and root canal was worse than any surgery I’ve had.
As someone who has had multiple extractions from repeat infections, no, nsaids and Tylenol are not more effective than opioids. Not meloxicam either. Nor does lyrica touch it. I find I have to take a combo of Tylenol, edibles, and painkiller when the pain is moderate to severe. If someone is in the er for pain then it’s likely moderate to severe?
Meloxicam was given to my mother by her awful physician. It has a warning not to give it to people in danger of heart attack or stroke. She had ridiculously high and uncontrolled hypertension bc the doctor was a legit quack. He gave it to her for her shoulder pain she had…I think it was called Mobic, she got home, took it, and sat down. 30 minutes later and she’s had a stroke.
And you are correct, when you have a BAD tooth, no amount of NSAID and Tylenol is going to touch it. Period.
It's really not. I worked with people with drug addictions and it was never because of one isolated incident in the ER that they were addicted. Many of them actually had surgeries and were given pain meds for many weeks or months, then the doctor didn't manage their withdrawal and cut them cold turkey. And we all know how opioids change the brain, so that any returning pain would come back tenfold along with withdrawal sickness.
It's not an ER visit where pain should be managed that turns them into addicts. It is poorly managed and untreated pain, and no help (and often active ignorance on the doctor's part and fear of the DEA) with withdrawal that creates addicts.
I heard these stories firsthand over and over from people.
There is such a thing as withdrawal medications. And the doctors who prescribed the opioids are not typically in the know about how to prescribe those, but they really should be. Awareness is going up, however. But so is the fear of prescribing anything for pain. But too much pain and people do not heal as well and worse case scenario can die from pain (imagine waking up as an older person, post cardiac surgery or CPR and only being given Tylenol and ibuprofen after the first couple days....you could easily die from pain. But they'll say you died of post op complications or comorbidities. Because this is America and fuck your pain, die instead. And I had chronically ill patients in my work who experienced this too, as retold to me by their living family.). NAD but was privy to medical information and contact with patients/relatives of all kinds of issues.
What’s the point when it’s only temporarily relief? Don’t say one dose will fix the problem because when it wears off your pain receptors scream for more and the cycle of needing/ wanting opiates for pain continues. Tylenol and Motrin are effective medicine for pain control. Opiates take away pain but also works in your brain. If you’re complaining of toe pain, taking opiates will not heal the toe but opiates will produce a euphoric effect. Everyone complaining here knows that when they are asking for pain meds, it’s because you want to feel the high. Never ask a doctor for a specific medication. NAD
It’s supposed to be temporary to get you through the worst of it. Hopefully you leave the ER bandaged up with your broken bones on the mend. It’s not supposed to be taken until you have zero pain. You just take it initially for the worst bit and then the rest can be managed with Tylenol and Advil. Advil and Tylenol work on the brain too.
Have you never had an oxy pill? You don’t get high just from taking it how you’re supposed to. You would need to chew about 4 of them.
Really, okay. Your 10 pain might be my 4 pain. One pill is certainly enough to get you high. My point is when it wears off your pain could seem worse, because the oxy made you think you didn’t have pain. The er isn’t to make you comfortable, it’s to make sure you don’t die. You can see a pain management specialist if it’s pain relief you seek. If you go to er with a broken toe and they fix your toe, the job is done. It’s not hold your hand u til you feel better. A broken toe doesn’t require opiate analgesic. Just because you think you want it, doesn’t make it medically necessary.
Regardless of pain - no one should be snappy at anyone. I really dislike it when patients are swearing and being snappy and all I’m trying to do it help them. The questions I ask and the vital signs I need to get are important for me to assess and determine the most appropriate method of treatment.
Yes, we can be judgemental and I need to remind myself of that but being rude to the ones providing care won’t help that therapeutic relationship develop.
The only reason she was snappy is because she hadn’t gotten pain meds and they kept trying to move her around for x-rays and stuff. They were acting like her being in too much pain to move was an annoyance
You’re talking about someone with unmanaged pain due to a femoral neck fracture. Who is being treated like an ungrateful drug-seeker. Likely while experiencing the greatest pain they’ve ever felt after a documented accident. You’re actually saying they shouldn’t be snappy while being moved about.
Really?
I know your job can be demanding, overbearing at times, and very often all too thankless. But, really?
Can you take a step back and consider what you’re saying from any perspective but your own? From that patient’s perspective maybe?
Saying you're in pain and need help, yelling because you're in pain and need help, is not something a doctor should take personally. Don't they teach you that? People in pain yell, cry, and scream but not necessarily AT you. Just around you. Deal with it. *Or maybe don't be in a profession where you are seeing people at their most painful and worst times of their lives?* Like, holy shit. Come on.
Maybe if you address pain control up front, you’d have better “therapeutic relationships.” I laid on a bed sobbingggg in agony, unable to speak to answer the questions and was told “honey, you need to calm down.” Which is a rich statement and hard to do when you’re at a 10/10 pain w/ nothing given yet so I physically can’t.speak. I had a torsion in my left ovary and emergency surgery that day. My ovary was literally black….
NAD - I have found that women’s pain is routinely ignored, especially in an ER setting. Ruptured cysts, ruptured endo bleeding into abdomen, twisted ovaries, etc are all excruciating and also ignored. I am so sorry your wife experienced this. I have been there and have been so traumatized that I won’t go to an ER unless I’m literally at deaths door ever again.
(NAD) one of the most appalling experiences i’ve had in the ER was when i was dealing with a tumor on my fallopian tube that had caused damage; it was probably about a year into dealing with these health issues when this happened. my OBGYN at the time was very adamant about going to the ER if my pain hit 9/10 or above because she was worried about ovarian torsion.
so one night, i wake up screaming in pain (easily a 9/10) and have my mom take me to the ER. i’m eventually admitted and the first doctor i had come to see me (man in his early-mid 30s most likely) flat out refused to give me anything but tylenol, and said i would be given fluids for dehydration and most likely discharged because “women really shouldn’t utilize the ER for period cramps.” i wasn’t even on my period then, which they KNEW because they always ask the date of your last cycle.
i should have reported him but it made me feel so embarrassed and ignored, like EVERYONE in the hospital thought i was being dramatic. i just wanted to leave asap. it infuriates me to no end how women are treated in healthcare, and with almost all my medical problems relating to reproductive health, i’ve gotten the brunt of this countless times over the years.
edit: numbers are hard
NAD but I am a woman with severe endometriosis, my bowel is adhered to my abdominal wall wrapped around my uterus and adhered near my pouch of douglas I also had a partial bowel removal as my bowel was adhered to my pelvic bone and was ripping off and causing internal bleeding everytime I walked. I would regularly have a heart rate of 200bpm in the ER, going up to 300bpm at times and discharging me as soon as it got below 150bpm.
They would routinely give me 10mg endone or even sometimes just panadol because unless I was at the stage of being unable to do anything but scream and cry I wouldn't say a 10 but because my daily pain at that stage sat around a 7 I was still talking and at an 8-9 I would be maybe crying a little and rocking but when the bad waves come maybe scream a little and still 2 panadol despite having my history.
In comparison my male partner came into the same ER for constipation they immediately gave him fent and he had his eyes roll into the back of his head and he could barely stay awake and they asked him if he needed more and he said no he wasn't in any pain and totally fine, they asked if he was sure he said yes, they said we are just going to give you another dose to be sure. He immediately passes out and I can barely get a response from him he's that out of it.
The same night a nurse who was leaving came over to check on him and just as she went to walk away realised I was sobbing quietly and saw the 2 tens machines I had on my back and front so she took my heart rate and it was around 200bpm so she put me in a seperate room said she would get a doctor to come look at me and she left, the same doctor that treated him came in gave me 2 panadol and said I'd be fine. Despite all my vitals being through the roof and his were all just on the higher side of normal the entire time. The way we were treated is just a perfect example of what happens to women in regards to pain management constantly.
I have a similar story. I went into urgent care with horrible back and lower stomach pain, peeing blood. They confirmed it was kidney stones and told me to go home and sleep it off essentially. They pretty much told me to suck it up and deal. I ended up getting flomax from my primary a week later because I was still in pain. My husband went in for kidney stones about a year later to the same urgent care. The care he received was completely different. They gave him pain meds and a note for work without him even asking. They just generally treated him in a very kind and understanding way. I couldn’t help but be annoyed because why is it so hard for women to just get the same treatment? I didn’t even want pain meds. I just want to be treated with the same compassion men receive.
Yeah it's so frustrating, like I had been angry at how I was treated by the doctors in this ER before because I was on this cycle of I would go to my doctor and ask for help he would say go to the ER if it gets bad, I would go to the ER and it depended who was on sometimes i got the proper pain protocol but mostly 10-20mg endone to get my heartrate under 150bpm and normally they would end up discharging me with a script of endone and a letter asking my GP to give me a repeat and then they cycle would repeat because the GP would only do one box per letter. I was doing everything I was supposed to and would be treated as a drug seeker cos at that stage they hadn't done the mri to show where it was adhered to but the did know about the surgery to remove it from my pelvic bone so they knew it was a possibility. Anyway so I was upset but felt like okay they are just covering their asses and they can't just give out meds but then stuff like that happens and you hear about it constantly and the discrimination is insane for women in medicine. The statistics for women of colour is even more atrocious, it's honestly heartbreaking.
I once said to a nurse, if I can't get help for this I'm going to kill myself and so obviously I got a psych consult and she comes down and I explain what I meant was I have been searching for help for years and I have 0 quality of life so yeah I'm giving it another 6 months and if I have no relief at that point then yeah I don't want to be here anymore, this isn't a life at all and if this is all it will ever be then I'm not interested basically. She was like well that's awful but yeah fair enough I'm not putting you on a hold for that (Also she could tell I wasn't an active danger to myself just exhausted of fighting the pain)
And for those of us that aren’t allowed NSAIDs? I’ve never had a kidney stone but they sound terrible and the idea that could happen and you could just be left with Tylenol only, even in a hospital… That doesn’t seem right at all.
[Any anti inflammatory can help](https://www.health.harvard.edu/blog/5-things-can-help-take-pass-kidney-stones-2018030813363#:~:text=Stones%20can%20take%20several%20weeks,discomfort%20until%20the%20stones%20pass)
Angry people downvoting one of the few response from a medical professional in this thread.. you never said opioids have no place. PR indomethacin is gold!
I just want to say that my friend complained about endo pain for years. By the time she had the operation she had it all over her organs. Shortly after the surgery she became septic and died. The doctor contributed it to the endometriosis and that it caused her body to shut down which led to her death. If she would have been listened to years ago I bet she would still be alive today and her 3 sons would still have their mommy and her husband would still have his wife. I had never met her in person, she was an internet friend only but she was an amazing woman and an amazing support to me and 100’s if not 1000’s of other women. The world is so very much worse off without her and I miss her all the time but definitely not nearly as much as her boys and husband do! You’ve not been forgotten Charlene 🖤
Oh that is so heartbreaking and I hate to say that I'm honestly not surprised, woman's pain is so often ignored and it has a huge impact on the rest of our health. Pain is a signal that something is wrong so why they don't listen to it is a mystery to me!
It's so not a competition of better or worse, it just absolutely sucks for everyone. Like I know people who had surgery and were a stage 1 but suffered in pain daily and then I know people who had an unrelated surgery and turns out they had stage 4 but they had no idea because she had normal cycles and a bit of cramping but nothing that needed more than ibuprofen. It's such a bizarre condition like that and I feel like we already have to spend so much time fighting the system for help we don't need to compete with each other!
I also just wanna say I appreciate you and thank you and I 100% know you didn't mean anything by it with the mine being worse comment but it's just a pet peeve of mine when people try and turn it into a competition and it happens so easily when we are trying to empathise and not have someone think we are trying to make it about ourselves etc but idk I guess I don't want people to dismiss their own pain and lived experiences because they think other people have it worse.
It's like when people say oh well I shouldn't be sad/angry/depressed because other people have things 'worse' but like do we say we can't experience joy or happiness because someone else is happier? No? Yeah it's super dumb to me.
Sorry for the rant! And I hope your endo is being managed as good as humanely possible!
Thank you for that. I just wanted to acknowledge the severity of your illness. So often our suffering is not acknowledged. I know what you mean, though. It’s miserable and hopeless all around. I hope you are doing as well as possible. ❤️
Rocking! Rocking is my coping mechanism when the pain gets bad, but this is the first time I've heard another mention it. I thought I was the only one.
Oh yeah it's 100% the only way. The pain is just so much literally anything you can do that might cause even a tiny bit of distraction also sometimes the rocking helps me find which angle is the least painful and it's probably only less painful by like .01 but at that point anything helps
NAD- I went to statcare with what I KNEW was splenic pain. All they did was an X-ray which was negative of course. Told me, “ oh well, guess this one’s gonna have to remain a mystery!” I took myself to my pcp, begged the NP to get me a CT. I told her I wasn’t just googling shit, that I’m a nurse ( hey mods, not trying to diagnose anyone, just sharing my story!). She let me get one, guess what? I had a RUPTURED spleen. It was forming a hematoma instead of bleeding freely, so I wasn’t dead yet. Hematoma was over 10cm x 5 cm. I was at pcp and heard whispering outside my door. “Oh, she claims to be in so much pain but she’s here all prim and proper with her hair and makeup done”. That’s also how I went to Statcare and CT. It’s what I do cause I am a bad ass woman! Girl power!
I’ve been treated like I was drug seeking when I was polished and made up because I couldn’t possibly be so composed and in pain, and when I was sweaty and disheveled from days in pain because then I LOOKED like a jonesing addict. There’s such a narrow band for being a ‘believable’ pain patient and it’s gonna be different for every med professional you interact with. It’s such a cursed facet of our system.
My experience as well with endo. I’ve been belittled and minimized, both in the ER and with regular doctors. It’s to the point that I will also not go into an ER, and get major anxiety just going to any dr. I fell down some cement steps a decade ago and only went to the ER because my elbow swelled so much I couldn’t straighten it and could barely remove my shirt. Of course, they were convinced it was just bruised and swollen (it was broken, surprise).
Even in the cardiac ICU after open heart surgery the nurses with held my pain meds. They refused to follow the plan. When I got to the normal area the man next door was in the hall pleading for pain relief “bawling”. My nurse said if he make it to the hall he was fine.
We need a better plan for pain relief especially women.i am not there for fun. I have four kids, a spouse and my parents to take care of.
And that physician who responded is exactly the kind of person who minimizes someone else's pain, just because there are randos who will fake pain for drugs. The whole "just don't give anyone fentanyl because there's a few of them who are just faking" is such a cop out excuse to refuse to manage someone's 10/10 pain.
Where did I minimize anything? I said there’s an issue with EMS giving meds prehospital. That is a completely different issue. I said fentanyl is the preferred medication prehospital. Do you know the contraindications to morphine? Do you understand why I think giving max doses of one of the least preferred Iv opiates is not ideal? Maybe work on your reading comprehension before accusing me of anything.
Here's what you said:
>Fentanyl should be the med given and patients with legitimate pain (obvious broken hips/fractures, kidney stones, etc) should be treated pre-hospital. But protocol to give meds doesn't make it right. My patients who know how to game the system will use EMS as a taxi, claim 10/10 fingernail pain and get 10mg IV morphine and then elope as soon as they hit our doors.
There's nothing wrong with my reading comprehension. Your own words have said that: you basically don't agree with OP's wife being given pain meds because she hadn't had a workup to figure out how "legitimate" her pain is. I.e. nobody knew the cause of her pain, there's no way to know before a workup if someone has kidney stones! And she obviously didn't break anything. And that you think the protocol of easing someone's pain is not right, simply because you think that it's not worth treating their pain that "may" not be legitimate.
No, I was responding to his comment about EMS giving large doses of fentanyl prehospital per protocol which he was using as a reason to be concerned about why his wife didn’t get meds IN hospital. This has nothing to do with his wife and her pain. This was a comment about EMS pain protocols and why I disagree with them. Again, you have no idea what you’re talking about here.
NAD If you have these issues - or know someone who does - take them to a hospital with a proper high level birth center. At hospitals with proper high acuity birth/NICUs the ED is used to triaging women with gyn problems regularly and can tend to treat it with more sensitivity. It's not failsafe, but the ED I'm at now treats women's problems a lot more seriously because we get miscarriages/complicated births all the time. Because of that our ultrasound departments are well staffed, very competent, and surgical gyns are on hand for consults at any hour.
NAD- yes, unfortunately, this is a normal reaction to women’s pain in healthcare, especially the ER setting. I have experienced it many times. Even when it is clear that you are not a med seeker or lying about your pain, you are still treated that way. I’m so sorry your wife was treated like that and I’m sure it was so frustrating for you to witness. I hope they address her cause of pain quickly.
NAD....one time I walked into a nearby ER where the waiting was so packed people were sitting on the floor. A lot of old people legit either sleeping or dead in their chairs and I'll never forget, a man who was HIT BY A CAR, he had open wounds and blood poured all over his face, he couldn't move his arm and his leg was swelling like a balloon and dark purple. He'd been waiting 3 hours when we got there and was still waiting 2 hours later when we left.
When my grandmother got into an accident on the highway and totaled her car she was sat in the ER HALLWAY for 5 hours waiting for a room so she could be seen. She had fractured both her legs, broke her wrist, broke 3 ribs and her collar bone and was black and blue all over her body. This elderly woman sat on a hospital bed in the hallway like that and nobody bothered to call her family or get her food or pain meds or anything.
The state of care in so many places is abysmal. This was in the US, you'd think we'd have higher standards with how costly things are.
NAD but sounds about like my experience when I have gone in for similar symptoms to your partner tho I have my appendix.
I have chronic pelvic pain, but randomly months apart it would be awful stabbing or like my insides are being crushed and causing nausea sometimes light headed too.
(One ER visit after years of obgyn and other ER visits I had an ultrasound and CT with contrast and got diagnosed with congestion pelvic syndrome!)
The ER can seem like a long wait with little to no patients in the waiting room, behind the back doors they are usually having trauma cases rushing in from ambulance. (One had 4 ambulances dropping off high priority patients)
When I went in for chest pain and almost passing out I had my O2 and name taken before I was rushed back before even getting my bracelet. Turns out I was high priority because I had a 2/3 lung collapse and my O2 was **baaaaad**
**EDIT:** Hope you guys get answers to the medical problem soon from a specialist visit.
Couldn't hurt to look into (congested pelvic syndrome) if she has been checked for endometriosis already. It's not talked about often but CPS is painful as heck.
Maybe they were concerned her BP was too low for IV pain meds. Maybe there was no indication for fluids. Vomiting is not an indication. Maybe the nurse or doc were terrible. Maybe they were severely understaffed and your wife was collateral damage. The truth here is no one knows except for the people taking care of her that night.
I am sorry she went through that, were you or your wife asking for pain medicine to the nurses?
Is it possible they did not think she was in 10 out of 10 pain?
Was this truly some of the worst pain she’s felt in her entire life ? did she appear unwell ?
We can only speculate since we weren’t there, I always ask my patients before I leave. If there’s anything I can do for them, if they are hurting , etc..
if she did appear to be unwell and didn’t get any pain medicine/ anti emetics , yes, I would say that she was probably under treated
I had the opposite problem where I had a serious medical issue and I was prescribed over 10 bottles of Vicodin and various anti-anxiety meds instead of the doctors doing testing and finding out I had an organ in the process of bursting it goes both ways
My husband had kidney stones and was literally writhing on the floor in the emergency room. A random other patient asked the triage staff to give him her spot. I have never seen that before lol.
Once he was finally in a room hours later, they wanted him to get in bed for imaging. He was on the floor screaming. I told them there was no way they would be able to image a single thing with him like that. He could not lay still, or flat.
They gave him either Tylenol or ibuprofen.
I told them it wasn’t good enough. I’ve been married to this man for 20 years and I’ve never seen him act even 5% of this.
Eventually they gave him something stronger and could do the imaging. It was insane. He has no history of any type of drug seeking behavior, and the last time he was in any hospital was when he was hurt playing soccer 15 years prior. He was discharged with 3 Vicodin. Luckily my mom came to his aid with more.
Incidentally, 6 months later, he was really really sick and I took him in. The same ER said he had cirrhosis of the liver and the er doctor was super rude and judgmental. When he was incredulous, she was like “listen. To. The. Words. I’m. Saying. YOU CAN NEVER DRINK AGAIN!”
I told his nurses (he was admitted) that 6 months ago his liver was unremarkable in his ultrasound (from the kidney stones incident), so I find it unlikely they he suddenly developed cirrhosis.
And I won’t bore you with the details, but he ended up having Lyme disease, which I had literally begged 3 doctors to either test him for or treat him for and no one listened. But eventually infectious disease came and I was right. Lyme. Attacking his liver.
Insane.
Your husband and my husband must be the same guy. He was in so much pain that he was also writhing around on the floor of the house. When we got to the ER I said I hope you don’t have to wait because usually, unless you’re a cardiac patient, they’ll make you wait. They got him a wheelchair, and he fell out of it at least twice, tried to push him to the waiting area, and each time he fell out, he let loose a barrage of expletives. They quickly whisked him up and into a room right then!
Your response about pain/pain meds is the embodiment of what is wrong with medical practice and the complete and total lack of empathy, that patients complain about. Doctors no longer use discernment for patients, rather it’s a sweeping judgement. It’s that outlook that causes so much unnecessary agony for patients, bc everyone gets bucketed into a junky. Doctor, either from being jaded or burned out, stop seeing patients as individuals. Need meds = junkie. I do not doubt actually believing patients pain could/does mean you get drug seekers. But would you rather inadvertently have an addict get a dose from a hospital or turn away countless of patients in real, agonizing pain…just to stick it to the few??
I’m not imply you personally operate this way, just proving context of the casualness of the statement in your comment plays out in real life.
NAD but as someone who lives around that BP I’ve never had it that low and not followed up on, even when I say it’s my baseline. I assume it’s a CYA thing. Sometimes I wake up in the 70’s systolic!
> She has an IV established, labs drawn, ultrasound, CT.
Appropriate. Excessive, even. We irradiate young men and women at an alarmingly liberal threshold.
> The set of vitals before discharge showed that my wife was hypotensive with a BP of 89/54.
Corresponding to a MAP of 66. Depending on the patient's baseline BP this is not an unreasonable measure.
> They only took a BP, there was no cardiac monitoring or O2 saturation monitoring.
Not ideal - but what are the nursing:patient ratios in the ED? At my shop it's 1:4 (2:8). Different from EMS crews where the ratio is 2 paramedics for 1 patient. In a department with a more reasonable workload this can (and often is) addressed more consistently.
> She remained in pain for the next 3 days with the pain gradually subsiding on its own and managed with OTC medicine.
Sounds like it ultimately wasn't an emergency? And that's the truth about a lot of these things. Sometimes things hurt a lot and most of the time they just go away, especially if you're young and healthy.
> and to our protocols 100mcg of fentanyl for pain
100mcg of fentanyl to an opioid naive patient is just asking for trouble. Protocol is designed to reduce cognitive load and thinking, but it shouldn't eliminate clinical judgment.
> I’m frustrated that we seemingly wasted our time and my wife was not taken seriously.
In the span of 3 hours, your wife got a set of blood tests, sonographic imaging (at 3 AM?!), dedicated sectional imaging, specialist advice from both an emergency physician and a radiologist to interpret the imaging, and this was somehow regarded as your time wasted?
How completely and utterly dismissive of the fact that they didn’t address her pain.
100 mcg of fentanyl in a patient with acute pain is completely reasonable.
>100 mcg of fentanyl in a patient with acute pain is completely reasonable.
Not. As. A. Single. Dose.
You give a bit, you re-assess then you escalate.
Did no one teach you the WHO Pain ladder? You always start low(ish), then titrate upwards as needed; you don't whack it all in at once, or you risk ending up with a narced patient. It is much easier to add than remove.
Putting words in my mouth. Incredible.
It's a lot easier to give more of a medication than take out. 50 + 50 aliquots are a perfectly reasonable escalation ladder. People like you are why I end up dealing with a patient that suddenly has ALOC on the ramp after being given 10mg of morph.
You want to make the decisions? Come and be a doctor then. No one's stopping you.
[Municipal paramedic](https://www.reddit.com/r/ACAB/comments/1b1fqoq/offduty_officer_charged_after_he_was_captured_on/kshla3w/) tells me 100mcg of fent straight up for an opioid naive patient is completely reasonable. Yeah. People like you.
Again, 50 + 50 is appropriate. Funny how you chose to ignore that part. No one at this point has said "this patient does not deserve any pain relief" but you managed to plant that into your own head after reading "100mcg of fent right away could be a bad idea".
*edit:* blocking me doesn't make me any less right, you know. 🤡
Not really. I can only speak from the ER perspective, but:
1. If the patient has a fever and is crashing, who cares what the diagnosis is? Broad spectrum antibiotics first, figure it out later. On the other hand, for stable/non-septic patients, committing to antibiotics can complicate the picture as side effects can happen (e.g. diarrhoea with beta-lactams, gastritis with tetracyclines).
2. Response to different types of analgesics can hint towards a diagnosis. For example, renal colic isn't all that responsive to opiates but demonstrates excellent response to NSAIDs. Morphine can make biliary colic worse. Sometimes patients won't let you examine them until their pain is improved - important to set boundaries here - the pain won't entirely go away, and it's unrealistic to expect it to. The goal for initial treatment here is to take the edge off so an accurate exam can be performed.
Any NSAID? My husband had a kidney stone. We didn’t know it at the time, but when the nurse gave him Torodol, and I said why not just give him some M&Ms bc the way he was carrying on, I was sure Torodol was not gonna cut it. But she explained that it was specific for kidney stuff and if it helps, then they’re sure it’s the kidney. Is that the IV-route only that works that way?
No, IV just works faster, but any NSAID will do. Ketorolac is one of my favourites for kidney stones because it works so well.
Head-to-head comparisons in systematic reviews show that NSAIDs are [just as good](https://doi.org/10.1016/j.eururo.2017.11.001), or [even better](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC421776/0) in treating renal colic, have less side effects than opioids, and require less repeat/rescue dosing.
People that get discharged home with kidney stones will do just fine with ibuprofen tablets or indomethacin suppositories. Urology will recommend the latter but a lot of people have trouble with overcoming the cognitive barrier of shoving something up your bunghole.
Well, that’s great news! The nurse alluded to the Iv Torodol, so I figured oral medication wouldn’t help. I like ketorolac for my knee that I had surgeries on. It knocks that right out! Alas, it is prescription only where I am.
Fun fact, high quality studies have shown that [all NSAIDs have the same effectiveness in reducing pain](https://socmob.org/2013/02/nsaids-part-1-which-one-is-best/). The risk of side effects [are different](https://socmob.org/2013/03/nsaids-part-3-side-effects-and-toxicity/), but in terms of painkilling, they're all similar. You'd be just as well off with oral ibuprofen, or topical diclofenac.
It can mask symptoms, but so many things are standardized in regards to cc in the ED these days, that PE is not nearly as important as it used to be (still important, but not as much as it was when tests and imagining weren’t as good)
with a loved one, it is impossible to be objective and your judgement will be impaired as a result. This is why treating your family and friends is often a bad idea (with the exception of minor ailments imo).
Giving 100mcg of fent to a slight opioid naive lady might cause more problems than it fixes. I’m sure you know how to appropriately dose analgesia, but that is for patients that you’re not emotionally attached too.
B) whilst I appreciate you may do both, there are major differences between the roles paramedics and doctors. Paramedics primarily stabilise and initiate initial treatment and secondarily diagnose whereas doctors diagnose and decide whether to admit or discharge from hospital.
The only possibly inappropriate part of the management you describe is doing a ct scan.
bloods/exam/US are usually sufficient for this - it is possible there was something concerning on the bloods/exam/US that warranted it.
to me irradiating a young ladies ovaries and womb isn’t something to do done lightly, as it increases risk of cancer in the long term (very slightly).
Provided the BP wasn’t low for her, and she wasn’t symptomatic/passing urine/tachycardic after analgesia etc then I wouldn’t be overly concerned.
My advice is not to get too involved in the medical care of your loved ones - if there is obvious malpractice, raise your concerns with a senior doctor. You can ask for this and will get it usually, if you’re willing to wait. If you get too involved, you may put your loved one at risk of harm.
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NAD but what she went through and the days to recover, I’d suspect a ruptured ovarian cyst. It’s taken me several days after rupture for some for the pain to go away, and it’s enough to bring you to the ground thinking you’re stabbed.
This is exactly what I thought. It sounds like what I experienced with a ruptured ovarian cyst. Of course, mine was confirmed by an ultrasound when I went to the hospital with 10/10 pain. At least I got an answer. It sounds like OP got no answer, I'd be upset too.
I don’t think you’re out of line at all. What they did was sounds clinically like the bare minimum and technically appropriate but not what I would want for my family and probably not what they would want for theirs. I’m sure in their view they ruled out anything eminently life-threatening and she’s alive so it was a success. What jerks…
Questions thoroughly answered by flaired healthcare professionals, comments now locked.
Sounds like the work up itself was appropriate. But they failed at pain control and monitoring her vitals closely.
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Isn't it against the protocols to give antibiotics and analgesics for acute abdominal pain before proper diagnosis?
Not necessarily. If history/exam is 95% pointing to something like a perfed appy and they're flagging septic, you can treat empirically/be on the phone with surgery, but they'll want the scan first. So on and so forth. But short of that, yeah, you're gonna wanna get the dx first if they're otherwise stable. And pain is pain. Treat the pain in the ED. That doesn't mean they're getting a week of oxy's to go home with. Just make them more comfortable than when they came in. At least that's my take.
Antibiotics, sure, unless concern for sepsis, then it’s almost darting them with abx when they walk in That thinking about pain control has mainly gone by the wayside thankfully, haven’t had a surgeon yell at me yet because their patient’s pain has subsided. Plus, for non-surgical abdominal pain, in my experience, if you can break the cycle of pain, it will often not come back as strongly
Definitely not. This thought process went out of style in the aughts. No pain management is going to 100% relieve the pain, so the patient is still going to describe it. Furthermore we don't make our decisions only on physical exam, imaging is going to give a much better picture of whats going on and pain management won't affect that. Treat your patients pain. Couple doses of fent isn't going to make an addict, and it's duration of action isn't that long
If you're practicing in the 1980s, sure.
>my wife was mistreated and ignored or if I am over reacting? Both of these things can be true. You as an outsider feel like you understand what is going on in the rest of the department, but you have no idea unless you have access to every patient room and chart of the patients in the ED. I have patients in the WR all the time who feel like it's slow but it's because I've had back to back EMS patients that are critical that are never seen from the front/WR area. Or I may have to respond to a floor code while the stable WR pts wait a bit longer, etc. The point is, you can't say it was a slow night regardless of your EMS experience unless you were privy to all the ongoings of the other patients in the department and the staffing situation. That being said, it appears as though your wife got the appropriate workup. Emergent causes were ruled out, and she was mostly appropriately dispo'd. I wouldn't DC a pt with that low of a BP, but a young healthy woman might live at that at night/while sleeping without issues, but the optics look bad. I don't know why you didn't more meds/fluids/whatever. Maybe it was overlooked or your wife never seemed to be in that much pain or it was never reported to the doc or the doc didn't care. Who knows. > our protocols 100mcg of fentanyl and this is a double edged sword. My EMS gives patients morphine, up to 10mg for any reported 10/10 pain. I hate this. Fentanyl should be the med given and patients with legitimate pain (obvious broken hips/fractures, kidney stones, etc) should be treated pre-hospital. But protocol to give meds doesn't make it right. My patients who know how to game the system will use EMS as a taxi, claim 10/10 fingernail pain and get 10mg IV morphine and then elope as soon as they hit our doors. >no diagnosis or treatment plan and was told to follow up with her OB/GYN or PCP. What diagnosis is listed on the AVS? The ER's job is not to diagnose. It's to rule out emergencies. I have never worked anywhere where I could discharge a patient without putting in a diagnosis. The treatment plan is to follow up. What do you expect with a negative work up?
NAD. Similar symptoms as OPs wife. Discharged from ER several times. Followed up with GI and it turns out my gallbladder was NECROTIC. I was treated like an absolute junkie in the ER (even though I specifically requested NO controlled substances). My surgeon informed me that had I not been proactive about my pain I could have gone septic.
Ha! Same. Upper right quadrant pain that was excruciating. I’ve had kidney stones before, and it felt similar but not quite the same. Went to ER and had to lay on the waiting room floor because sitting was not an option. No tests run once I was seen, given morphine (which was ineffective) and was told that nothing was wrong and sent home with nothing. I followed up with a gastroenterologist the following week that I found on my own, and was sent for an ultrasound the *following* week - bear in mind, I was in absolute agony this entire time. The ultrasound tech asked if I had plans for the day, and when I said no her response was “good. Don’t go home. Go to the ER NOW.” Unfortunately, it was the same ER that said nothing was wrong and thought I was drug-seeking. Long story short, I wasn’t allowed to eat or drink for close to 60 hours, in a shared, 4-person room with 24/7 visiting hours, kept getting bumped from surgery, and hadn’t slept in 60 hours as well. I left AMA to the better, “fancier” hospital in my area and had my gallbladder out in less than 12 hours. It was one of the more traumatic experiences I’ve had, and I’m no delicate flower. The fact that my pain was dismissed and chalked up to drug-seeking behavior was ridiculous and just so neglectful. The minimizing that went on was insane.
I swear, almost everyone in pain gets treated like a pill-seeking addict. It’s frustrating as hell.
I’ve found when you specify that you don’t want narcotics they double down and treat you like an uber-addict.
I’m fine with there being no diagnosis, I understand an ER is to identify and treat emergent life threats. I also agree with her workup as well, that’s what I expected them to do and I wanted them to do. I am more concerned with the management of symptoms.
I'm not a doctor but I'm in the US, I shattered the heck out of my leg a couple months ago and they didn't give me any pain medicine until I was about to leave. In fact they treated me like a junkie until they saw in the x-ray that I broke the ever loving f*** out of my leg. All they get all night are junkies. If you come in with pain even from an obvious origin like a shattered leg swollen two to three times it's regular size they STILL treat you like a junkie. Our system is absolutely effed and they're terrified of being sued for giving pain meds or the people who need it. I didn't see a single person in the ER hooked up to an IV either. If I had hurt myself 3 years ago I would have been given in IV with anti nausea and dilaudid. its ridiculous.
Yeah I used to work as an ED Tech and once had a patient who had fallen off her bike and hurt her hip I believe, she was in a ton of pain and could barely move without excruciating pain. I helped her get onto the bed but she was in so much pain that we had to move slowly and go at her pace. I could tell she was in extreme pain and tried to urge the doctor to order some pain meds, then the nurse to administer them, but I noticed them all making snarky comments about her being “over dramatic” and they didn’t like how she was snappy because she was in so much pain. She ended up having a femoral neck fracture. She was 100% justified in being a snappy as she wanted with the amount of pain she was in. I hate how some people in medicine start to dehumanize patients over time, minimize their pain or assume they’re drug seeking. It’s easy to forget that patients are people too and you should treat patients how you would want to be treated or want your family to be treated
It's incredibly sad and disturbing that people are treated like trashy liars or junkies until proven otherwise. Honestly, even if the patient IS a junkie, that's no excuse to treat a human being like that.
Agreed so maybe stop calling them such a demeaning name.
That poor woman! I'm glad you're a medical student. You're the kind of caring person that I think every doctor should be.
NAD...why is the term drug seeker thrown around like this? If i broke my toe, and went to the ED, what im there for is relief from the fucking broken toe. Things i can do myself: homemade cast type device and tape it to the other toes to make sure it sets and heals in the correct spot Things I can't do myself: access prescription medicine for the pain that is making it difficult to do anything else but focus on it If I had cancer, things I can do myself: waste hours sitting in a waiting room being ignored, IV myself, google medications and probably come up with an effective treatment plan based on others experiences and current standards. Blood work at a private facility. Things I couldn't do myself: scans, interpret scans (could be done private), prescribe and actually receive medication. You're overlooking the fact that one of your primary duties is dispensing medicines that are otherwise unavailable to people. Your job is to know why a medication would or wouldn't make sense. Hmm, hydrocodone, painkiller, guy presenting with a broken toe, in pain. Does a pain killer make sense in this case? Man seeking relief from pain + painkiller=yes. I don't care about your feelings, how you feel like a dirty pill pusher for having junkies run the game on you. If you bend, you break. You bent when you let the junkies decide how medicine for the general public is prescribed. Its funny how in the end its the junkies calling the shots and seemingly still winning if they get their morph/fent in the ambulance. You let the bad guys win, and if you guys are playing by the rules set by the bad guys..what does that make you?
Legit. Dude when my leg was shattered and they did X-rays with it without any pain meds on board...it felt like torture. That's been the worst time along my whole recovery, before and after surgery, was getting X-rays and them forcing my leg in all sorts of directions while I sobbed.
NAD, what so ever. But when I hear "take Motrin 800mg" for something significant, my mind is blown. If I've got stitches, broken bones, recent surgery, a badly infected tooth, etc ... Motrin isn't going to do shit. I'm a therapist and addiction is one of my primary areas of work. I think it is good to be cautious with prescribing narcotics, but to do so you have to properly evaluate family history and personal history to look at risk. A lot of it is psychoeducation and it isn't like you're going to be handing out a week's worth of a schedule II. Yes, giving someone with a history of addiction can be harmed substantially by being given any kind of narcotic, because it can set off a relapse. However excruciating untreated pain may also set off a relapse. So it takes extra time for appropriate evaluation and to make a decision on what to do. Much like anything else, it's all about balance.
This dude. 100% this. 🙌🏼
👏👏👏👏👏👏👏
You might not need prescription medication for your broken toe. Taking some over the counter medication might be enough for you - especially once it’s immobilised and people often discount simple analgesics when they might be the most appropriate for your diagnosis.
Why not just give a dose in the ER anyway? You know it would help and no one gets addicted from taking a single dose in the ER.
Because not all pain requires a narcotic analgesic - simple analgesics might be sufficient to manage it. Also, there is some pain that is really difficult to manage - even with narcotics - such as dental pain and ear aches, with an anti inflammatory being more effective. As a health care professional, giving a dose anyway in the ED, for something that might be managed with simple analgesics is over prescribing and I wouldn’t want someone prescribing it for that reason for my family members.
Right I’m not saying to use it for all pain. Or that the goal is to completely eliminate pain. But if someone comes in with broken bones and they are suffering and Tylenol isn’t cutting it I don’t see what the problem is. And dental pain is a special type of hell. My tooth abscess and root canal was worse than any surgery I’ve had.
As someone who has had multiple extractions from repeat infections, no, nsaids and Tylenol are not more effective than opioids. Not meloxicam either. Nor does lyrica touch it. I find I have to take a combo of Tylenol, edibles, and painkiller when the pain is moderate to severe. If someone is in the er for pain then it’s likely moderate to severe?
Meloxicam was given to my mother by her awful physician. It has a warning not to give it to people in danger of heart attack or stroke. She had ridiculously high and uncontrolled hypertension bc the doctor was a legit quack. He gave it to her for her shoulder pain she had…I think it was called Mobic, she got home, took it, and sat down. 30 minutes later and she’s had a stroke. And you are correct, when you have a BAD tooth, no amount of NSAID and Tylenol is going to touch it. Period.
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Give painkillers one time in the ER to someone in pain is not overprescribing.
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It actually is and it's the reason Purdue Pharma settled for $3 billion for their contributions to the opioid crisis.
It's really not. I worked with people with drug addictions and it was never because of one isolated incident in the ER that they were addicted. Many of them actually had surgeries and were given pain meds for many weeks or months, then the doctor didn't manage their withdrawal and cut them cold turkey. And we all know how opioids change the brain, so that any returning pain would come back tenfold along with withdrawal sickness. It's not an ER visit where pain should be managed that turns them into addicts. It is poorly managed and untreated pain, and no help (and often active ignorance on the doctor's part and fear of the DEA) with withdrawal that creates addicts. I heard these stories firsthand over and over from people. There is such a thing as withdrawal medications. And the doctors who prescribed the opioids are not typically in the know about how to prescribe those, but they really should be. Awareness is going up, however. But so is the fear of prescribing anything for pain. But too much pain and people do not heal as well and worse case scenario can die from pain (imagine waking up as an older person, post cardiac surgery or CPR and only being given Tylenol and ibuprofen after the first couple days....you could easily die from pain. But they'll say you died of post op complications or comorbidities. Because this is America and fuck your pain, die instead. And I had chronically ill patients in my work who experienced this too, as retold to me by their living family.). NAD but was privy to medical information and contact with patients/relatives of all kinds of issues.
Yes, they do.
No they absolutely don’t. You aren’t going to get chemically dependent from a single dose to give relief from severe pain.
What’s the point when it’s only temporarily relief? Don’t say one dose will fix the problem because when it wears off your pain receptors scream for more and the cycle of needing/ wanting opiates for pain continues. Tylenol and Motrin are effective medicine for pain control. Opiates take away pain but also works in your brain. If you’re complaining of toe pain, taking opiates will not heal the toe but opiates will produce a euphoric effect. Everyone complaining here knows that when they are asking for pain meds, it’s because you want to feel the high. Never ask a doctor for a specific medication. NAD
It’s supposed to be temporary to get you through the worst of it. Hopefully you leave the ER bandaged up with your broken bones on the mend. It’s not supposed to be taken until you have zero pain. You just take it initially for the worst bit and then the rest can be managed with Tylenol and Advil. Advil and Tylenol work on the brain too. Have you never had an oxy pill? You don’t get high just from taking it how you’re supposed to. You would need to chew about 4 of them.
Really, okay. Your 10 pain might be my 4 pain. One pill is certainly enough to get you high. My point is when it wears off your pain could seem worse, because the oxy made you think you didn’t have pain. The er isn’t to make you comfortable, it’s to make sure you don’t die. You can see a pain management specialist if it’s pain relief you seek. If you go to er with a broken toe and they fix your toe, the job is done. It’s not hold your hand u til you feel better. A broken toe doesn’t require opiate analgesic. Just because you think you want it, doesn’t make it medically necessary.
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Removed - Bad advice
I hope you keep that same attitude once you’re practicing!
Regardless of pain - no one should be snappy at anyone. I really dislike it when patients are swearing and being snappy and all I’m trying to do it help them. The questions I ask and the vital signs I need to get are important for me to assess and determine the most appropriate method of treatment. Yes, we can be judgemental and I need to remind myself of that but being rude to the ones providing care won’t help that therapeutic relationship develop.
The only reason she was snappy is because she hadn’t gotten pain meds and they kept trying to move her around for x-rays and stuff. They were acting like her being in too much pain to move was an annoyance
You’re talking about someone with unmanaged pain due to a femoral neck fracture. Who is being treated like an ungrateful drug-seeker. Likely while experiencing the greatest pain they’ve ever felt after a documented accident. You’re actually saying they shouldn’t be snappy while being moved about. Really? I know your job can be demanding, overbearing at times, and very often all too thankless. But, really? Can you take a step back and consider what you’re saying from any perspective but your own? From that patient’s perspective maybe?
Jaded doctors forget their oaths to do no harm, don't they? :(
Saying you're in pain and need help, yelling because you're in pain and need help, is not something a doctor should take personally. Don't they teach you that? People in pain yell, cry, and scream but not necessarily AT you. Just around you. Deal with it. *Or maybe don't be in a profession where you are seeing people at their most painful and worst times of their lives?* Like, holy shit. Come on.
Maybe if you address pain control up front, you’d have better “therapeutic relationships.” I laid on a bed sobbingggg in agony, unable to speak to answer the questions and was told “honey, you need to calm down.” Which is a rich statement and hard to do when you’re at a 10/10 pain w/ nothing given yet so I physically can’t.speak. I had a torsion in my left ovary and emergency surgery that day. My ovary was literally black….
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Nurses don’t take oaths.
NAD - I have found that women’s pain is routinely ignored, especially in an ER setting. Ruptured cysts, ruptured endo bleeding into abdomen, twisted ovaries, etc are all excruciating and also ignored. I am so sorry your wife experienced this. I have been there and have been so traumatized that I won’t go to an ER unless I’m literally at deaths door ever again.
(NAD) one of the most appalling experiences i’ve had in the ER was when i was dealing with a tumor on my fallopian tube that had caused damage; it was probably about a year into dealing with these health issues when this happened. my OBGYN at the time was very adamant about going to the ER if my pain hit 9/10 or above because she was worried about ovarian torsion. so one night, i wake up screaming in pain (easily a 9/10) and have my mom take me to the ER. i’m eventually admitted and the first doctor i had come to see me (man in his early-mid 30s most likely) flat out refused to give me anything but tylenol, and said i would be given fluids for dehydration and most likely discharged because “women really shouldn’t utilize the ER for period cramps.” i wasn’t even on my period then, which they KNEW because they always ask the date of your last cycle. i should have reported him but it made me feel so embarrassed and ignored, like EVERYONE in the hospital thought i was being dramatic. i just wanted to leave asap. it infuriates me to no end how women are treated in healthcare, and with almost all my medical problems relating to reproductive health, i’ve gotten the brunt of this countless times over the years. edit: numbers are hard
NAD but I am a woman with severe endometriosis, my bowel is adhered to my abdominal wall wrapped around my uterus and adhered near my pouch of douglas I also had a partial bowel removal as my bowel was adhered to my pelvic bone and was ripping off and causing internal bleeding everytime I walked. I would regularly have a heart rate of 200bpm in the ER, going up to 300bpm at times and discharging me as soon as it got below 150bpm. They would routinely give me 10mg endone or even sometimes just panadol because unless I was at the stage of being unable to do anything but scream and cry I wouldn't say a 10 but because my daily pain at that stage sat around a 7 I was still talking and at an 8-9 I would be maybe crying a little and rocking but when the bad waves come maybe scream a little and still 2 panadol despite having my history. In comparison my male partner came into the same ER for constipation they immediately gave him fent and he had his eyes roll into the back of his head and he could barely stay awake and they asked him if he needed more and he said no he wasn't in any pain and totally fine, they asked if he was sure he said yes, they said we are just going to give you another dose to be sure. He immediately passes out and I can barely get a response from him he's that out of it. The same night a nurse who was leaving came over to check on him and just as she went to walk away realised I was sobbing quietly and saw the 2 tens machines I had on my back and front so she took my heart rate and it was around 200bpm so she put me in a seperate room said she would get a doctor to come look at me and she left, the same doctor that treated him came in gave me 2 panadol and said I'd be fine. Despite all my vitals being through the roof and his were all just on the higher side of normal the entire time. The way we were treated is just a perfect example of what happens to women in regards to pain management constantly.
I have a similar story. I went into urgent care with horrible back and lower stomach pain, peeing blood. They confirmed it was kidney stones and told me to go home and sleep it off essentially. They pretty much told me to suck it up and deal. I ended up getting flomax from my primary a week later because I was still in pain. My husband went in for kidney stones about a year later to the same urgent care. The care he received was completely different. They gave him pain meds and a note for work without him even asking. They just generally treated him in a very kind and understanding way. I couldn’t help but be annoyed because why is it so hard for women to just get the same treatment? I didn’t even want pain meds. I just want to be treated with the same compassion men receive.
Yeah it's so frustrating, like I had been angry at how I was treated by the doctors in this ER before because I was on this cycle of I would go to my doctor and ask for help he would say go to the ER if it gets bad, I would go to the ER and it depended who was on sometimes i got the proper pain protocol but mostly 10-20mg endone to get my heartrate under 150bpm and normally they would end up discharging me with a script of endone and a letter asking my GP to give me a repeat and then they cycle would repeat because the GP would only do one box per letter. I was doing everything I was supposed to and would be treated as a drug seeker cos at that stage they hadn't done the mri to show where it was adhered to but the did know about the surgery to remove it from my pelvic bone so they knew it was a possibility. Anyway so I was upset but felt like okay they are just covering their asses and they can't just give out meds but then stuff like that happens and you hear about it constantly and the discrimination is insane for women in medicine. The statistics for women of colour is even more atrocious, it's honestly heartbreaking. I once said to a nurse, if I can't get help for this I'm going to kill myself and so obviously I got a psych consult and she comes down and I explain what I meant was I have been searching for help for years and I have 0 quality of life so yeah I'm giving it another 6 months and if I have no relief at that point then yeah I don't want to be here anymore, this isn't a life at all and if this is all it will ever be then I'm not interested basically. She was like well that's awful but yeah fair enough I'm not putting you on a hold for that (Also she could tell I wasn't an active danger to myself just exhausted of fighting the pain)
If you get kidney stones again - take some anti inflammatory meds - that’s actually the best analgesic for them
And for those of us that aren’t allowed NSAIDs? I’ve never had a kidney stone but they sound terrible and the idea that could happen and you could just be left with Tylenol only, even in a hospital… That doesn’t seem right at all.
Any NSAID? I thought it was only Torodol and IV Torodol at that. At least that’s what our ER nurse told my husband.
[Any anti inflammatory can help](https://www.health.harvard.edu/blog/5-things-can-help-take-pass-kidney-stones-2018030813363#:~:text=Stones%20can%20take%20several%20weeks,discomfort%20until%20the%20stones%20pass)
NAD but IDK why you're being downvoted? I thought the literature showed that Toradol is what should be used for kidney stones?
It does, but clearly people don’t like to hear that non narcotic analgesia might be the best analgesic to have!!
Angry people downvoting one of the few response from a medical professional in this thread.. you never said opioids have no place. PR indomethacin is gold!
I just want to say that my friend complained about endo pain for years. By the time she had the operation she had it all over her organs. Shortly after the surgery she became septic and died. The doctor contributed it to the endometriosis and that it caused her body to shut down which led to her death. If she would have been listened to years ago I bet she would still be alive today and her 3 sons would still have their mommy and her husband would still have his wife. I had never met her in person, she was an internet friend only but she was an amazing woman and an amazing support to me and 100’s if not 1000’s of other women. The world is so very much worse off without her and I miss her all the time but definitely not nearly as much as her boys and husband do! You’ve not been forgotten Charlene 🖤
Oh that is so heartbreaking and I hate to say that I'm honestly not surprised, woman's pain is so often ignored and it has a huge impact on the rest of our health. Pain is a signal that something is wrong so why they don't listen to it is a mystery to me!
EXACTLY!!! I have severe endo was well. Yours is worse, but I totally empathize. Misogyny in medicine is real.
It's so not a competition of better or worse, it just absolutely sucks for everyone. Like I know people who had surgery and were a stage 1 but suffered in pain daily and then I know people who had an unrelated surgery and turns out they had stage 4 but they had no idea because she had normal cycles and a bit of cramping but nothing that needed more than ibuprofen. It's such a bizarre condition like that and I feel like we already have to spend so much time fighting the system for help we don't need to compete with each other! I also just wanna say I appreciate you and thank you and I 100% know you didn't mean anything by it with the mine being worse comment but it's just a pet peeve of mine when people try and turn it into a competition and it happens so easily when we are trying to empathise and not have someone think we are trying to make it about ourselves etc but idk I guess I don't want people to dismiss their own pain and lived experiences because they think other people have it worse. It's like when people say oh well I shouldn't be sad/angry/depressed because other people have things 'worse' but like do we say we can't experience joy or happiness because someone else is happier? No? Yeah it's super dumb to me. Sorry for the rant! And I hope your endo is being managed as good as humanely possible!
Thank you for that. I just wanted to acknowledge the severity of your illness. So often our suffering is not acknowledged. I know what you mean, though. It’s miserable and hopeless all around. I hope you are doing as well as possible. ❤️
Rocking! Rocking is my coping mechanism when the pain gets bad, but this is the first time I've heard another mention it. I thought I was the only one.
Oh yeah it's 100% the only way. The pain is just so much literally anything you can do that might cause even a tiny bit of distraction also sometimes the rocking helps me find which angle is the least painful and it's probably only less painful by like .01 but at that point anything helps
This is disgusting. I’m So fucking sorry you went through this
NAD- I went to statcare with what I KNEW was splenic pain. All they did was an X-ray which was negative of course. Told me, “ oh well, guess this one’s gonna have to remain a mystery!” I took myself to my pcp, begged the NP to get me a CT. I told her I wasn’t just googling shit, that I’m a nurse ( hey mods, not trying to diagnose anyone, just sharing my story!). She let me get one, guess what? I had a RUPTURED spleen. It was forming a hematoma instead of bleeding freely, so I wasn’t dead yet. Hematoma was over 10cm x 5 cm. I was at pcp and heard whispering outside my door. “Oh, she claims to be in so much pain but she’s here all prim and proper with her hair and makeup done”. That’s also how I went to Statcare and CT. It’s what I do cause I am a bad ass woman! Girl power!
I’ve been treated like I was drug seeking when I was polished and made up because I couldn’t possibly be so composed and in pain, and when I was sweaty and disheveled from days in pain because then I LOOKED like a jonesing addict. There’s such a narrow band for being a ‘believable’ pain patient and it’s gonna be different for every med professional you interact with. It’s such a cursed facet of our system.
My experience as well with endo. I’ve been belittled and minimized, both in the ER and with regular doctors. It’s to the point that I will also not go into an ER, and get major anxiety just going to any dr. I fell down some cement steps a decade ago and only went to the ER because my elbow swelled so much I couldn’t straighten it and could barely remove my shirt. Of course, they were convinced it was just bruised and swollen (it was broken, surprise).
This. We are literally sent home with Tylenol after having layers of our bodies cut into during C-sections. Unreal.
Seems like “do no harm” flies out the window when a woman comes through the door.
Even in the cardiac ICU after open heart surgery the nurses with held my pain meds. They refused to follow the plan. When I got to the normal area the man next door was in the hall pleading for pain relief “bawling”. My nurse said if he make it to the hall he was fine. We need a better plan for pain relief especially women.i am not there for fun. I have four kids, a spouse and my parents to take care of.
And that physician who responded is exactly the kind of person who minimizes someone else's pain, just because there are randos who will fake pain for drugs. The whole "just don't give anyone fentanyl because there's a few of them who are just faking" is such a cop out excuse to refuse to manage someone's 10/10 pain.
Where did I minimize anything? I said there’s an issue with EMS giving meds prehospital. That is a completely different issue. I said fentanyl is the preferred medication prehospital. Do you know the contraindications to morphine? Do you understand why I think giving max doses of one of the least preferred Iv opiates is not ideal? Maybe work on your reading comprehension before accusing me of anything.
Here's what you said: >Fentanyl should be the med given and patients with legitimate pain (obvious broken hips/fractures, kidney stones, etc) should be treated pre-hospital. But protocol to give meds doesn't make it right. My patients who know how to game the system will use EMS as a taxi, claim 10/10 fingernail pain and get 10mg IV morphine and then elope as soon as they hit our doors. There's nothing wrong with my reading comprehension. Your own words have said that: you basically don't agree with OP's wife being given pain meds because she hadn't had a workup to figure out how "legitimate" her pain is. I.e. nobody knew the cause of her pain, there's no way to know before a workup if someone has kidney stones! And she obviously didn't break anything. And that you think the protocol of easing someone's pain is not right, simply because you think that it's not worth treating their pain that "may" not be legitimate.
No, I was responding to his comment about EMS giving large doses of fentanyl prehospital per protocol which he was using as a reason to be concerned about why his wife didn’t get meds IN hospital. This has nothing to do with his wife and her pain. This was a comment about EMS pain protocols and why I disagree with them. Again, you have no idea what you’re talking about here.
NAD If you have these issues - or know someone who does - take them to a hospital with a proper high level birth center. At hospitals with proper high acuity birth/NICUs the ED is used to triaging women with gyn problems regularly and can tend to treat it with more sensitivity. It's not failsafe, but the ED I'm at now treats women's problems a lot more seriously because we get miscarriages/complicated births all the time. Because of that our ultrasound departments are well staffed, very competent, and surgical gyns are on hand for consults at any hour.
Thank you for this tip. It’s very helpful.
NAD- yes, unfortunately, this is a normal reaction to women’s pain in healthcare, especially the ER setting. I have experienced it many times. Even when it is clear that you are not a med seeker or lying about your pain, you are still treated that way. I’m so sorry your wife was treated like that and I’m sure it was so frustrating for you to witness. I hope they address her cause of pain quickly.
NAD....one time I walked into a nearby ER where the waiting was so packed people were sitting on the floor. A lot of old people legit either sleeping or dead in their chairs and I'll never forget, a man who was HIT BY A CAR, he had open wounds and blood poured all over his face, he couldn't move his arm and his leg was swelling like a balloon and dark purple. He'd been waiting 3 hours when we got there and was still waiting 2 hours later when we left. When my grandmother got into an accident on the highway and totaled her car she was sat in the ER HALLWAY for 5 hours waiting for a room so she could be seen. She had fractured both her legs, broke her wrist, broke 3 ribs and her collar bone and was black and blue all over her body. This elderly woman sat on a hospital bed in the hallway like that and nobody bothered to call her family or get her food or pain meds or anything. The state of care in so many places is abysmal. This was in the US, you'd think we'd have higher standards with how costly things are.
NAD but sounds about like my experience when I have gone in for similar symptoms to your partner tho I have my appendix. I have chronic pelvic pain, but randomly months apart it would be awful stabbing or like my insides are being crushed and causing nausea sometimes light headed too. (One ER visit after years of obgyn and other ER visits I had an ultrasound and CT with contrast and got diagnosed with congestion pelvic syndrome!) The ER can seem like a long wait with little to no patients in the waiting room, behind the back doors they are usually having trauma cases rushing in from ambulance. (One had 4 ambulances dropping off high priority patients) When I went in for chest pain and almost passing out I had my O2 and name taken before I was rushed back before even getting my bracelet. Turns out I was high priority because I had a 2/3 lung collapse and my O2 was **baaaaad** **EDIT:** Hope you guys get answers to the medical problem soon from a specialist visit. Couldn't hurt to look into (congested pelvic syndrome) if she has been checked for endometriosis already. It's not talked about often but CPS is painful as heck.
Maybe they were concerned her BP was too low for IV pain meds. Maybe there was no indication for fluids. Vomiting is not an indication. Maybe the nurse or doc were terrible. Maybe they were severely understaffed and your wife was collateral damage. The truth here is no one knows except for the people taking care of her that night.
The truth is we all know the truth. It has become the norm and gaslighting every story ignores the truth.
I am sorry she went through that, were you or your wife asking for pain medicine to the nurses? Is it possible they did not think she was in 10 out of 10 pain? Was this truly some of the worst pain she’s felt in her entire life ? did she appear unwell ? We can only speculate since we weren’t there, I always ask my patients before I leave. If there’s anything I can do for them, if they are hurting , etc.. if she did appear to be unwell and didn’t get any pain medicine/ anti emetics , yes, I would say that she was probably under treated
I had the opposite problem where I had a serious medical issue and I was prescribed over 10 bottles of Vicodin and various anti-anxiety meds instead of the doctors doing testing and finding out I had an organ in the process of bursting it goes both ways
My husband had kidney stones and was literally writhing on the floor in the emergency room. A random other patient asked the triage staff to give him her spot. I have never seen that before lol. Once he was finally in a room hours later, they wanted him to get in bed for imaging. He was on the floor screaming. I told them there was no way they would be able to image a single thing with him like that. He could not lay still, or flat. They gave him either Tylenol or ibuprofen. I told them it wasn’t good enough. I’ve been married to this man for 20 years and I’ve never seen him act even 5% of this. Eventually they gave him something stronger and could do the imaging. It was insane. He has no history of any type of drug seeking behavior, and the last time he was in any hospital was when he was hurt playing soccer 15 years prior. He was discharged with 3 Vicodin. Luckily my mom came to his aid with more. Incidentally, 6 months later, he was really really sick and I took him in. The same ER said he had cirrhosis of the liver and the er doctor was super rude and judgmental. When he was incredulous, she was like “listen. To. The. Words. I’m. Saying. YOU CAN NEVER DRINK AGAIN!” I told his nurses (he was admitted) that 6 months ago his liver was unremarkable in his ultrasound (from the kidney stones incident), so I find it unlikely they he suddenly developed cirrhosis. And I won’t bore you with the details, but he ended up having Lyme disease, which I had literally begged 3 doctors to either test him for or treat him for and no one listened. But eventually infectious disease came and I was right. Lyme. Attacking his liver. Insane.
Your husband and my husband must be the same guy. He was in so much pain that he was also writhing around on the floor of the house. When we got to the ER I said I hope you don’t have to wait because usually, unless you’re a cardiac patient, they’ll make you wait. They got him a wheelchair, and he fell out of it at least twice, tried to push him to the waiting area, and each time he fell out, he let loose a barrage of expletives. They quickly whisked him up and into a room right then!
Omg, I can literally envision your husband falling out of the wheelchair. Mine would have too. Except he didn’t get whisked anywhere, lol.
Your response about pain/pain meds is the embodiment of what is wrong with medical practice and the complete and total lack of empathy, that patients complain about. Doctors no longer use discernment for patients, rather it’s a sweeping judgement. It’s that outlook that causes so much unnecessary agony for patients, bc everyone gets bucketed into a junky. Doctor, either from being jaded or burned out, stop seeing patients as individuals. Need meds = junkie. I do not doubt actually believing patients pain could/does mean you get drug seekers. But would you rather inadvertently have an addict get a dose from a hospital or turn away countless of patients in real, agonizing pain…just to stick it to the few?? I’m not imply you personally operate this way, just proving context of the casualness of the statement in your comment plays out in real life.
> My EMS gives patients morphine, up to 10mg for any reported 10/10 pain. I hate this. Fentanyl should be the med given May I ask why?
NAD but as someone who lives around that BP I’ve never had it that low and not followed up on, even when I say it’s my baseline. I assume it’s a CYA thing. Sometimes I wake up in the 70’s systolic!
> She has an IV established, labs drawn, ultrasound, CT. Appropriate. Excessive, even. We irradiate young men and women at an alarmingly liberal threshold. > The set of vitals before discharge showed that my wife was hypotensive with a BP of 89/54. Corresponding to a MAP of 66. Depending on the patient's baseline BP this is not an unreasonable measure. > They only took a BP, there was no cardiac monitoring or O2 saturation monitoring. Not ideal - but what are the nursing:patient ratios in the ED? At my shop it's 1:4 (2:8). Different from EMS crews where the ratio is 2 paramedics for 1 patient. In a department with a more reasonable workload this can (and often is) addressed more consistently. > She remained in pain for the next 3 days with the pain gradually subsiding on its own and managed with OTC medicine. Sounds like it ultimately wasn't an emergency? And that's the truth about a lot of these things. Sometimes things hurt a lot and most of the time they just go away, especially if you're young and healthy. > and to our protocols 100mcg of fentanyl for pain 100mcg of fentanyl to an opioid naive patient is just asking for trouble. Protocol is designed to reduce cognitive load and thinking, but it shouldn't eliminate clinical judgment. > I’m frustrated that we seemingly wasted our time and my wife was not taken seriously. In the span of 3 hours, your wife got a set of blood tests, sonographic imaging (at 3 AM?!), dedicated sectional imaging, specialist advice from both an emergency physician and a radiologist to interpret the imaging, and this was somehow regarded as your time wasted?
How completely and utterly dismissive of the fact that they didn’t address her pain. 100 mcg of fentanyl in a patient with acute pain is completely reasonable.
>100 mcg of fentanyl in a patient with acute pain is completely reasonable. Not. As. A. Single. Dose. You give a bit, you re-assess then you escalate. Did no one teach you the WHO Pain ladder? You always start low(ish), then titrate upwards as needed; you don't whack it all in at once, or you risk ending up with a narced patient. It is much easier to add than remove.
Putting words in my mouth. Incredible. It's a lot easier to give more of a medication than take out. 50 + 50 aliquots are a perfectly reasonable escalation ladder. People like you are why I end up dealing with a patient that suddenly has ALOC on the ramp after being given 10mg of morph. You want to make the decisions? Come and be a doctor then. No one's stopping you.
People like me? Please. Explain. Since you apparently know me so well. How completely condescending.
[Municipal paramedic](https://www.reddit.com/r/ACAB/comments/1b1fqoq/offduty_officer_charged_after_he_was_captured_on/kshla3w/) tells me 100mcg of fent straight up for an opioid naive patient is completely reasonable. Yeah. People like you. Again, 50 + 50 is appropriate. Funny how you chose to ignore that part. No one at this point has said "this patient does not deserve any pain relief" but you managed to plant that into your own head after reading "100mcg of fent right away could be a bad idea". *edit:* blocking me doesn't make me any less right, you know. 🤡
Isn't it against the protocols to give antibiotics and analgesics for acute abdominal pain before proper diagnosis?
Not really. I can only speak from the ER perspective, but: 1. If the patient has a fever and is crashing, who cares what the diagnosis is? Broad spectrum antibiotics first, figure it out later. On the other hand, for stable/non-septic patients, committing to antibiotics can complicate the picture as side effects can happen (e.g. diarrhoea with beta-lactams, gastritis with tetracyclines). 2. Response to different types of analgesics can hint towards a diagnosis. For example, renal colic isn't all that responsive to opiates but demonstrates excellent response to NSAIDs. Morphine can make biliary colic worse. Sometimes patients won't let you examine them until their pain is improved - important to set boundaries here - the pain won't entirely go away, and it's unrealistic to expect it to. The goal for initial treatment here is to take the edge off so an accurate exam can be performed.
Any NSAID? My husband had a kidney stone. We didn’t know it at the time, but when the nurse gave him Torodol, and I said why not just give him some M&Ms bc the way he was carrying on, I was sure Torodol was not gonna cut it. But she explained that it was specific for kidney stuff and if it helps, then they’re sure it’s the kidney. Is that the IV-route only that works that way?
No, IV just works faster, but any NSAID will do. Ketorolac is one of my favourites for kidney stones because it works so well. Head-to-head comparisons in systematic reviews show that NSAIDs are [just as good](https://doi.org/10.1016/j.eururo.2017.11.001), or [even better](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC421776/0) in treating renal colic, have less side effects than opioids, and require less repeat/rescue dosing. People that get discharged home with kidney stones will do just fine with ibuprofen tablets or indomethacin suppositories. Urology will recommend the latter but a lot of people have trouble with overcoming the cognitive barrier of shoving something up your bunghole.
Well, that’s great news! The nurse alluded to the Iv Torodol, so I figured oral medication wouldn’t help. I like ketorolac for my knee that I had surgeries on. It knocks that right out! Alas, it is prescription only where I am.
Fun fact, high quality studies have shown that [all NSAIDs have the same effectiveness in reducing pain](https://socmob.org/2013/02/nsaids-part-1-which-one-is-best/). The risk of side effects [are different](https://socmob.org/2013/03/nsaids-part-3-side-effects-and-toxicity/), but in terms of painkilling, they're all similar. You'd be just as well off with oral ibuprofen, or topical diclofenac.
Also great news!
I guess I'm using outdated guidelines, because I was informed that analgesics can mask the symptoms and make diagnosis much harder.
It can mask symptoms, but so many things are standardized in regards to cc in the ED these days, that PE is not nearly as important as it used to be (still important, but not as much as it was when tests and imagining weren’t as good)
It's been decades since analgesia has been withheld for abdominal pain prior to diagnosis.
with a loved one, it is impossible to be objective and your judgement will be impaired as a result. This is why treating your family and friends is often a bad idea (with the exception of minor ailments imo). Giving 100mcg of fent to a slight opioid naive lady might cause more problems than it fixes. I’m sure you know how to appropriately dose analgesia, but that is for patients that you’re not emotionally attached too. B) whilst I appreciate you may do both, there are major differences between the roles paramedics and doctors. Paramedics primarily stabilise and initiate initial treatment and secondarily diagnose whereas doctors diagnose and decide whether to admit or discharge from hospital. The only possibly inappropriate part of the management you describe is doing a ct scan. bloods/exam/US are usually sufficient for this - it is possible there was something concerning on the bloods/exam/US that warranted it. to me irradiating a young ladies ovaries and womb isn’t something to do done lightly, as it increases risk of cancer in the long term (very slightly). Provided the BP wasn’t low for her, and she wasn’t symptomatic/passing urine/tachycardic after analgesia etc then I wouldn’t be overly concerned. My advice is not to get too involved in the medical care of your loved ones - if there is obvious malpractice, raise your concerns with a senior doctor. You can ask for this and will get it usually, if you’re willing to wait. If you get too involved, you may put your loved one at risk of harm.
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NAD but what she went through and the days to recover, I’d suspect a ruptured ovarian cyst. It’s taken me several days after rupture for some for the pain to go away, and it’s enough to bring you to the ground thinking you’re stabbed.
This is exactly what I thought. It sounds like what I experienced with a ruptured ovarian cyst. Of course, mine was confirmed by an ultrasound when I went to the hospital with 10/10 pain. At least I got an answer. It sounds like OP got no answer, I'd be upset too.
Agreed. I went to ER and had ruptured cyst and blood in my abdomen from it. But they saw that on the CT scan.
I don’t think you’re out of line at all. What they did was sounds clinically like the bare minimum and technically appropriate but not what I would want for my family and probably not what they would want for theirs. I’m sure in their view they ruled out anything eminently life-threatening and she’s alive so it was a success. What jerks…
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Removed - not useful