Monday, October 27, 2008

I'm Glad My Saline Cured Your Chest Pain

The other day I had a totally BS chest paineur with severe SOB which seemed to be triggered by medical professionals being within observational distance.  Every time I happened to walk quickly by the room and glance in, the patient was doing just fine, thank you very much, but when I would go check on her, suddenly the theatrics began.  No significant vital sign abnormalities, no ST segment changes or altered labs, no dysrhythmias, no decreased O2 sats, but one big stinking load of pain.

Per doctor's order, I gave her a half milligram of dilaudid, which instantly cured the pain and made her feel oh so much better.

For about 30 minutes.  Then the theatrics began again.  The doctor ordered 1 more milligram of Dilaudid.  I went in to give it and discovered that the IV line was questionable, and since she was getting admitted to rule out MI (no comment), she would need a new line anyway, as hospital policy dictates that pre-hospital lines have to be replaced on admission.  So I decided to save the admit nurse some effort and got my IV start kit and put a new 18 gauge in her other arm.  The whole time I was talking to her about this and that and everything else.  I love chatting with my patients - even the BS ones - because I love people.  This time, the conversation was quite a distracting one, and I forgot to flush the line after putting the extension tubing on.  We talked for another couple of minutes and then I remembered that I needed to flush the line, so I grabbed my saline syringe and flushed it out as we kept talking.

When I was done, I started reaching for my carpuject and the dilaudid, when the patient exclaimed, "whoa!  I feel so much better.  That is some really great stuff you just gave me!"

Eyebrows up.  "So your pain is better?"

"Try completely gone!  Thanks!"

"Okay, that is great to hear.  I'll come back and check on you in a little bit."  The Dilaudid is casually slipped back into the pocket and I'm out of there.

I don't know if I need to fill out an incident report over accidentally giving the patient Placebatrol instead of Dilaudid, but as long as it worked, right?

Incidentally, I did end up giving the Dilaudid to her an hour later as she was getting ready to go upstairs because "that medication doesn't seem to last long."

I felt guilty at first, but then I never made any claim that I was giving her a drug.  I merely flushed the line, and then prior to giving Dilaudid I assessed her pain and found it to be inconsistent with the need for narcotics at that time.

UPDATE: It has come to my attention that a comment made in this post was understandably misconstrued, thus changing the tenor of the post. I do not want this blog to be about nurses vs medics, and I have nothing but respect for almost every medic that I work with, so I have taken out the comment and offer my apologies to any who may have been offended by it.


Utok said...

Placebo works on my daughters, too. It is amazing what a Tums can cure,

EE said...
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MedicThree said...
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InterNetStar said...

I do hope you noted, with the physician, the patients "reaction of decreased pain" upon IV flushing.

Because to have ignored that little episode would make you less of a medical professional.


tracy said...
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Braden said...

Yes, I did tell the Physician, and charted the event meticulously. CYA medicine at it's finest.

For those who had their comments deleted, please know that I'm not trying to engage in censorship. I have never deleted non-spam comments before and hope not to in the future, however after much consideration, and since I edited the post to remove the comment that has been taken as offensive to medics and so I am also taking out the comments that expressed that offense. Partly to start over somewhat with the post, and partly because at least one of the comments included name-calling, and I do not want to have personal insults on my blog - whether against me or anybody else, and I try to catch myself if I head that direction as well.