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Old 05-11-2013, 03:23 PM   #1
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Treatment at ER

Hope it is OK to post this here.

This is the only forum I have ever used so far.

My daughter has had pain in her rib area for the last 2 weeks.

She saw the PA at our local clinic.

She is really good and usually right on the money with her diagnosis.

They did an x-ray and told her that it was pnemonia so they gave her an antibiotic, an inhaler, and a few Lortabs for the pain.

That was on Tuesday.

Last night she called me from work in tears because the pain was so bad and said it was on the right side under her ribs.

I immediately thought gallbladder because that is how mine presented when I had it.

Took her to the ER and I must say they didn't seem concerned in the least.

Gave her a shot of Toradol and did blood work.

The doctor came back in an hour and said the blood work looked perfect so he was going to send her home.

He asked how her pain was and she said it was a 7.

He said he found it hard to believe that the Toradol didn't help at all and left the room.

Next a nurse came in with her discharge papers.

Needless to say she was so upset to be going home in the same pain she went in there with.

Told her to make an appointment first thing in the morning with my MD.

She saw him this morning and he did another x-ray and said he saw no pnemonia but was concerned about either gallbladder or a blood clot in her lung due to the symptoms she was still having and since the antibiotic the PA gave her doesn't seem to be helping.

He told us to head to Hospital Admissions so he could admit her for a gallbladder scan and a CAT scan.

Said he was appalled that the ER didn't even attempt to control her pain and thought that needed to be addressed ASAP and thought admitting her at this point would be the best way to handle that as well.

I asked why the ER couldn't have done the tests last night and given her pain meds instead of making her suffer.

He said they should have and if anything like this ever happens again, to have them page him and he will handle it.

Told us that some of the ER docs just won't give strong pain meds unless you have a bone sticking out or a missing limb or something.

Anyway, I am thinking about having her write a letter to the hospital administrators to complain about her treatment last night.

We have had problems there before.

I figure if everyone that had less than adequate treatment at this ER would complain, maybe things would change.

Thanks for reading this and please keep her in your prayers.

I read this Forum all the time and have just started posting here.

There seem to be some truly wonderful, knowledgeable folks here and I want you to know that I appreciate each and everyone of your posts.

They are so helpful to me. Sorry this was so long.

Hope everyone is having a pain free weekend.

 
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Old 05-11-2013, 03:47 PM   #2
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Re: Treatment at ER

I do not know a lot about different strengths and such of pain meds, but is lortab not a decent pain medication?

I DO know several ER docs personally. I am certainly NOT saying your daughter was not in pain, but yes, they are very hesitant to give pain meds especially when there is no obvious diagnosis. They just do not do it any more. I went to the ER with a horrendous pain in my head and as soon as I said I took 2.5mg of methadone, they assumed I was in withdrawal. When he figured out I was not and why i was in pain management, he offered morphine, which i declined because the toradol worked.

Anyway, do what you need to do, but most of the people who go to er's looking for pain meds really are addicts and that is what has created that problem.

I hpoe she is feeling better now.

 
Old 05-11-2013, 04:19 PM   #3
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Re: Treatment at ER

Yes, the Lortab did help her but she only got 10 of them so that didn't last long.

I also understand like you said that they didn't have a diagnosis but she was so obviously in pain I thought they could have given her a little morphine or something, she couldn't even hardly converse with them because of the pain.

Part of the reason I was thinking about her lodging a complaint was because we know so many friends and family that have had a less than pleasant experience at this ER. I just wish they would make a few changes for the better.

I also understand about the drug seekers. I have read a couple of blogs that ER docs have online. I guess there are people who come in weekly wanting pain meds. Maybe I am wrong, I don't know. At the time, I just thought they could have been a little more compassionate toward her, but then I am seeing it thru a mother's eyes. We never want to see our babies hurting.

Thanks for the reply!

Take care.

 
Old 05-11-2013, 05:28 PM   #4
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Unhappy Re: Treatment at ER

Dearnbraves, I hope that your daughter has something easily diagnosed & fixed & not a clot, pneumonia or gall bladder disease that requires surgery, God forbid! Why does a diagnosis have to be obvious in an ER to get treated? Every diagnostic department is open & at their disposal to find the diagnosis; the ER dr can look for a true diagnosis with the same tests that will be ordered as an inpatient. I it is scary to me to call someone stable & send them on their way just because they had a normal ekg, basic bloodwork, urinalysis & chest xray, for example & the physical assessment & voice of the person is ignored, the 5th vital sign, the pain scale, "Im in pain" & to have your pain relieved" is listed as a patient right in the paperwork given by the hospital to all patients!

Last edited by gmak; 05-11-2013 at 05:45 PM. Reason: wording

 
Old 05-11-2013, 08:08 PM   #5
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Re: Treatment at ER

gmak,

Thanks for your reply.

I was wondering the same thing as you.

Why couldn't they have just investigated a little further with a scan or something rather than let her go home and suffer thru the night?

The doctor said they could have and should have in his opinion.

There is a new development in all this.

I went to the Hospital about 6:00p.m. to see her and the nurse was in her room putting a hot compress on her arm.

It seems that when they did her CAT scan, the contrast leaked out of the vein and into the tissues of her arm.

Her arm is swollen to about twice it's normal size and is causing her much pain.

I asked the nurse what the treatment is for this (called Contrast Extravasation) and she said hot packs to try to break up the dye but beyond that she does not know.
She said they did not think her arm would swell this much so they are going to ask the Radiology Dept what to do.

I looked it up online and it said that in rare cases skin necrosis can occur and plastic surgery may be needed! Yikes!

Anyway, cross your fingers that hers will start resolving itself and the swelling will start to go down.

Thanks to everyone for your support.

Will keep you updated on the situation.

Take care.

 
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Old 05-12-2013, 08:20 AM   #6
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Re: Treatment at ER

Once i had an "infiltrated" iv & swollen arm because i have frail veins & the CT scan machine pushed the dye in superfast & blew my vein & it started to hurt bad. The ct tech didnt turn it off or anything but it wouldnt drip anymore anyway. It turned red & tender was sore for about a week or so after the swelling went down. I think mine was mostly filled with normal iV fluid , will pray for her! Let us know how she is progressing. Poor thing!
I hope that you can have a good mothers day despite your baby being in the hospital!

Last edited by gmak; 05-13-2013 at 07:42 AM.

 
Old 05-12-2013, 04:54 PM   #7
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Re: Treatment at ER

It's unfortunate what your daughter went through, but that is pretty much the prevailing attitude among ER staff. If you ask for pain medication, they consider you to be a DSP. I live in Rochester MN, home to one of the world-famous clinics, and their idea of pain control is to tell yourself it doesn't hurt. They are extremely conservative when it comes to pain control. I go to a local, smaller clinic and ever-since I changed, my pain has been well managed by my doctor. The smaller clinic also has a local hospital, and their ER is very gracious when it comes to treating pain. I have some friends who are doctors, and they tell me that most physicians receive only about 8 hours of training in pain control, and it's drilled into their heads to be very conservative. That's a good approach with known drug seeking patients, but for John Q Public that happens to go to the ER once in a blue moon, it's the wrong way to treat the situation. Compounding the problem is the DEA. Their agents try to play doctor and second guess real doctors. There are no easy answers. I hope your daughter gets to the bottom of the problem and recovers quickly.

 
Old 05-12-2013, 05:10 PM   #8
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Re: Treatment at ER

i think that the ER docs are treating the immediate problem and while he gave her enough lortab (10?) to hopefully see her through to a more thorough workup that takes place outside of the ER - as it did. Unless someone is admitted then and there, it might seem reasonable to give someone enough pain med to see them through the night until they can get further treatment outside the ER with their own doctor. If she needed more than 10 pills for the night or day, perhaps the situation was so serious that she should have been admitted then and there.
I do know how hard most ER docs work and have respect for them.

I hope she is feeling better by now - getting sick and being in pain is very stressful. My pain relief when I wrecked my shoulder, which has resulted in a salvage replacement, devastating loss of function and chronic pain, was a bag of frozen peas. So, I can understand both sides, and give you both a big hug!

 
Old 05-12-2013, 05:16 PM   #9
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Re: Treatment at ER

I agree Galana - the ER docs work VERY hard, and I too have a lot of respect for them. I've noticed that the geographical area has a lot to do with how acute pain is handled. In the midwest, it's a conservative approach; in the south, they're a little more liberal. Much of it has to do with where the doctor trained, and the prevailing attitude at the school. And I do fault the DEA for some of the negative attitude toward pain control. They have every doctor in the country worried that a goon squad will crash through their office windows and accuse the doctor of over-prescribing. Many doctor's careers have been destroyed over nothing more than a whim on the part of the DEA. Several were cleared, but not before the government completely ruined the doctor.

 
Old 05-12-2013, 11:53 PM   #10
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Re: Treatment at ER

galalena,

The doctors at the ER gave her NO pain meds at all.

She got the 10 Lortabs from the PA at our clinic the following day.

That was part of my problem with what they did.

I thought either they should have given her enough meds to get thru til she could see the PA the next day or further investigate what was causing her pain. Instead, they just sent her home to suffer thru the night.

Like I said before, there are some really good ER doctors at this ER, but there are some that just have very little compassion at all.

So it is the luck of the draw when you go there.

By the way, she is supposed to be getting out of the hospital tomorrow afternoon as long as nothing else happens.

Her arm looks much better so I think it will be allright.

Will post more tomorrow after she gets home.

Thanks for your posts everyone.

 
Old 05-13-2013, 08:47 AM   #11
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Re: Treatment at ER

If she had a diagnosis of pneumonia , pain medications are not a normal part of the treatment protocol especially because pneumonia tends to make it difficult to breathe and pain medication makes the respiratory issues worse.
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Old 05-13-2013, 10:11 AM   #12
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Re: Treatment at ER

OK - I was confused on when she got the lortab. I do know how reluctant ER docs are to give out pain meds, though, as others have said, when they don't know the cause of the pain (ie, not obvious broken limb, etc). And I have been there, as I said, on the receiving end of the same kind of treatment. And have heard many times the doctor's side - so so many people coming in for drugs and drugs only. It is a bad situation and there is no good resolution. Heck, we can't even easily get pain meds from our pain docs without a long process and frustration! It is unforuntately the state of medicine today.

 
Old 05-13-2013, 11:27 AM   #13
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Re: Treatment at ER

I remember when I went to the ER for a gall bladder attack (i didn't know what it was at the time) I didn't ask for medication, but I did wish to be seen. I ended up waiting for an HOUR when the ER was EMPTY, completely freaking empty. Finally my husband went up to the desk and cursed out the nurse and took me to another ER, to which i was admitted within an hour, and ended up having my gall bladder removed the next day. I never asked for pain meds, just something for the nausea and cramps. We did call the other ER when I was released and gave them heck. I guess my point is its not just the doctors on staff that are jerks, remember the first impressions and triage come from the nurses.

 
Old 05-13-2013, 01:48 PM   #14
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Re: Treatment at ER

If a patient says they are in pain, the 5th vital sign, it is their right to receive pain relief & to be believed because no one else can feel what they are feeling, people only have one way to communicate that is by language, assessment of the patient by the nurse & then the dr to give a single pain pill or a single injection that is an appropriate dose for the level of pain reported by the patient & in accordance with the physical assessment unless contraindicated & then no one needs to send them home with pain medication & that would cut down on illegal transfer of or abuse of narcotics & imho drug seekers would avoid the ER knowing the financial cost for a single dose of medicine would not be worth it but for those really hurting the cost is worth it if in an
emergent state of pain.

 
Old 05-16-2013, 09:12 AM   #15
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Re: Treatment at ER

Just wanted to let you know that the contrast dye issue resolved itself and she is just fine.

Her diagnosis was pleurisy and I am thankful that is wasn't anything worse.

She is feeling much better thank goodness.

Thank you to everyone for your replies and all the support you offered thru this ordeal.

I can't tell you how much it meant to me.

There are truly some wonderful, knowledgeable people here and I really appreciate each and every one of you.

Thanks!

 
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