New Jersey hospital implements amazingly effective solution for ED overcrowding

[hoot504]

http://pix11.com/2016/03/28/new-jer...irst-in-u-s-to-end-use-of-opioid-painkillers/

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[The Knife & Gun Club]

Seems like a logical solution...but does that also mean if someone comes in with a bad fracture or other trauma they won't give opiates?

If I were to roll into the ER with a badly broken leg or something, I would like some morphine ASAP

(Pardon my ignorance, I'm barely beyond pre-med level)

 

[hoot504]

If I were to roll into the ER with a badly broken leg or something, I would like some morphine ASAP

Let's get you feeling better sir. Have you heard of Tramadol?

 

[The Knife & Gun Club]

Let's get you feeling better sir. Have you heard of Tramadol?

Ah yes, fondly known as the "Prison Toilet Bowl Wine" of Painkillers. Only the finest!

 

[The Knife & Gun Club]

Dumb question but isn't tramadol actually more addictive in reality than opiates? I seem to remember that from a neuro class I took years ago

 

[Cinematographer]

Dumb question but isn't tramadol actually more addictive in reality than opiates? I seem to remember that from a neuro class I took years ago

...

 

[The Knife & Gun Club]

I thought there was something about the SSRI component making it harder to quit once you get hooked?

Obviously I could be (probably am) wrong...

 

[Cinematographer]

I thought there was something about the SSRI component making it harder to quit once you get hooked?

Obviously I could be (probably am) wrong...

Wut. This is getting better and better (and by better I mean worse)

 

[The Knife & Gun Club]

*[quickly retreats to the safety of the pre-allo section]*

 

[Adamb83]

Rotated there as a student. They have an EM, fellowship trained pain management doc who is there to train the residents in nerve blocks, trigger point injections, epidurals and other good stuff. As I understood it, they haven't eliminated opioids completely, but just eliminated them as first line treatment.

 

[Adamb83]

Dumb question but isn't tramadol actually more addictive in reality than opiates? I seem to remember that from a neuro class I took years ago

Tramadol is a weak Mu agonist. Much weaker than morphine (1/6000th). It has some metabolite activity that may aid in analgesic effects. It does have SNRI activity but that should not contribute to it's abuse potential. On last month's episode of EMRAP, they had a really good review of tramadol. Since you're an M1, I'll assume you don't have EMRAP. In summary, not great for pain, increases the risk of seizures, and minor abuse potential (although it does exist).

 

[gman33]

Great, they are still going to use opioids for chronic pain, the one place where it is least appropriate.

 

[emergentmd]

Sounds like a fine plan.

Dude with broken leg gets tylenol and toradol
Dudette with chornic migraine, Fibro, RSD, IC gets dilaudid?

 

[deleted109597]

Great, they are still going to use opioids for chronic pain, the one place where it is least appropriate.

That's not at all what the plan is. Acute things can get it, but they'll try other things first. Chronic pain, they'll do almost anything possible to prevent opioid use.

 

[gman33]

That's not at all what the plan is. Acute things can get it, but they'll try other things first. Chronic pain, they'll do almost anything possible to prevent opioid use.

It might not be the plan, but that's what the article states.

 

[gman33]

I commented on this issue in another thread.

I think we are almost at the point where these drugs should be eliminated.

 

[deleted109597]

It might not be the plan, but that's what the article states.

Media. "Always right."

The creators of the program don't like the sound bites.

 

[gman33]

Media. "Always right."

The creators of the program don't like the sound bites.

Got it. All I had to go on was the article, which didn't make any sense.

Do they press ganey at that site?
That would be an interesting case.

 

[Vandalia]

Got it. All I had to go on was the article, which didn't make any sense.

Do they press ganey at that site?
That would be an interesting case.

It is like my undergraduate engineering degree; "It doesn't matter how you do, it is how you do relative to everyone else." (I had one class where the highest grade at the end of the semester was 29%.)

If everyone at the place is gets terrible scores, it really doesn't matter.

 

[Vandalia]

Tramadol is a weak Mu agonist. Much weaker than morphine (1/6000th). It has some metabolite activity that may aid in analgesic effects. It does have SNRI activity but that should not contribute to it's abuse potential. On last month's episode of EMRAP, they had a really good review of tramadol. Since you're an M1, I'll assume you don't have EMRAP. In summary, not great for pain, increases the risk of seizures, and minor abuse potential (although it does exist).

I attribute 95% of its effectiveness to the placebo effect. (At least in the short term. It might have some intrinsic value long term due to the SNRI activity.) It is interesting that for a subset of the patient population, it is a lot more acceptable now that it is a controlled substance.