Friday, May 15, 2009


A year goes by so quickly.

It was around this time last year that I was hobbling myself (because of a broken patella) to citywide ED orientation. I was so excited about getting into the ED and learning so much.

Today, I wouldn't call it excited- more settled but still glad to be there- and feeling much more confident.

I still don't know a lot, and I'm learning everyday. However I now can look after all my patients on my own and help out my teammates. I have seen chests cracked open, people go into Afib right in front of my eyes, and septic patients tank as I work desperately to help them get better.

I have learned about more medical conditions that I have never heard about before. Who know what labyrinthitis was when they were in nursing school?

I'm starting to feel more part of the team, versus that 'new grad'. To those just graduating, I'm no longer the new grad. People are actually going to go to ME for help and for advice. Scary.

Thank you so far for your support. In the last few months I have been so swamped at work, and feeling fairly overwhelmed that I didn't feel I had anything to contribute to this blog. I just wanted to get away from work. Now I'm starting to get back into it (I guess vacation can do that!).

Yours at the bedside,

Tuesday, May 5, 2009

Pain control

In nursing school they teach you that pain is a subjective experience and that we as nurses are to do our best to help our patients in pain.

I wonder if they were prepared for a case like this:

30 year old person comes into the ED with 'epigastric' pain. They have been worked up extensively for this pain and have diabetes, but no medical condition that affects the abdomen specifically. Already referred to a pain specialist, the patient was on 500mcg of fentenyl patches changed every 2 days, 10 oxycodone controlled release BID PO, as well as a PCA pump with hydromorphone which gives 10mg/hr as well as potentially 2 patient initiated boluses of 5mg/hr prn. This patient, because of the investigations and interventions, also had a J tube and was on dialysis for renal failure.

We had nothing in the ED that would really touch her additional pain. Giving 5 of hydromorph every hour (per MD order) seemed pointless, the patient would settle for 5 minutes and then act up by slamming their body against the side rail and screaming. THe patient had no problem getting out of bed to get to the commode. Some of this I'm sure is behavioural and some of it could be actual pain, but this seems to be an extreme form of drug seeking.

At what point should we be treating the behaviour versus the 'pain'?