Pain Management Advice?

[Groove]

That ish is crazy, groove. Is it really too much to ask that we be allowed to use clinical judgement in the use of opiods? We go from one extreme to the other.

Yeah, what's funny is that there's an older...well not really, my age I guess...40s (middle age?! yikes) doc at this site who overheard the conversation and proceeded to give a fatherly lecture to me about the new "evidence based" approaches to analgesia and how virtually everything else is superior to hydromorphone in every way and how it activates a certain gene that makes a person sell all their belongings and camp out in ER waiting rooms for hours, screaming and harassing staff in order to obtain half a milligram doses, etc.. (I'm exaggerating). I cut him off since he doesn't know me yet and kindly let him know that...yeah I know all of that but....you hear that scream down the hallway? That's my guy with a full on snapped femur in traction, covered in sweat and about to pass out from pain. It somehow seemed appropriate in this case...

Anyway, I'm sure plenty of you know what I'm talking about...

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[turkeyjerky]

You just started at a new hospital right? That's one of the worst things about it, dealing with sanctimonious a-holes who don't know your background and assume the worst.

 

[RustedFox]

I don't disagree with you at all man and wasn't directing my post at you Wilco. All the mentions of dilaudid reminded me of ordering it several shifts ago at my new job for a legitimate case/pt and the charge nurse and pharmacist came up and stood over me with judging eyes and sternly educated me about how dilaudid was not allowed in the ED under any circumstances and I should basically be ashamed of even thinking of ordering it for someone. Keep in mind I rarely order opioids as it is... I didn't mind changing it to morphine but I just remember feeling incredulous and looking around for a camera filming me on some covert episode of the twilight zone. I just shook my head, smiling under my mask and was reminded of how times change. That was fresh on my mind when reading all these posts. Hell, I don't disagree with the dilaudid free policy but it's funny to me how we single out dilaudid as such a dirty drug...immoral and completely unfit to wear the mantle of analgesic. It's the new Hester Prynne of the drug world. All in the span of a few years. Crazy times we live in, lol.

So you had two non-physicians telling you how to medicine.
This is where we're at now.

 

[WilcoWorld]

Yeah, what's funny is that there's an older...well not really, my age I guess...40s (middle age?! yikes) doc at this site who overheard the conversation and proceeded to give a fatherly lecture to me about the new "evidence based" approaches to analgesia and how virtually everything else is superior to hydromorphone in every way and how it activates a certain gene that makes a person sell all their belongings and camp out in ER waiting rooms for hours, screaming and harassing staff in order to obtain half a milligram doses, etc.. (I'm exaggerating). I cut him off since he doesn't know me yet and kindly let him know that...yeah I know all of that but....you hear that scream down the hallway? That's my guy with a full on snapped femur in traction, covered in sweat and about to pass out from pain. It somehow seemed appropriate in this case...

Anyway, I'm sure plenty of you know what I'm talking about...

Did he provide you any citations?

This may belong in that other thread, but I am annoyed how often someone will say "evidence based" but when you ask to see the evidence they either point you to some policy or reference a podcast, rather than actually producing a peer-reviewed paper that scientifically addresses their claim even tangentially.

 

[Groove]

Did he provide you any citations?

This may belong in that other thread, but I am annoyed how often someone will say "evidence based" but when you ask to see the evidence they either point you to some policy or reference a podcast, rather than actually producing a peer-reviewed paper that scientifically addresses their claim even tangentially.

Agreed. Heh, it reminds me of this guy I used to work with who was nearing retirement and loved listening to EMRAP. Which...I commend him for, putting some effort into staying up to date on literature and whatnot. However, this guy would completely change his practice based on these low powered single prospective observational studies with like...an N of 5. He'd read about some study from penguin island about a cohort of 4 penguins that say...didn't show improved mortality with aspirin after an NSTEMI and he'd stop giving people aspirin. I'm exaggerating of course but it was hilarious to me. People love to listen to a podcast referencing a "study" and suddenly it's one of Joseph Smith's golden plates and given as an example of "EBM".

 

[southerndoc]

Yeah, what's funny is that there's an older...well not really, my age I guess...40s (middle age?! yikes) doc at this site who overheard the conversation and proceeded to give a fatherly lecture to me about the new "evidence based" approaches to analgesia and how virtually everything else is superior to hydromorphone in every way and how it activates a certain gene that makes a person sell all their belongings and camp out in ER waiting rooms for hours, screaming and harassing staff in order to obtain half a milligram doses, etc.. (I'm exaggerating). I cut him off since he doesn't know me yet and kindly let him know that...yeah I know all of that but....you hear that scream down the hallway? That's my guy with a full on snapped femur in traction, covered in sweat and about to pass out from pain. It somehow seemed appropriate in this case...

Anyway, I'm sure plenty of you know what I'm talking about...

Maybe I'm a softie, but I give propofol to put people with femur fractures in traction.