I never have. However, when I was an intern (almost 20 years ago), rotating on neurology, there was a status migrainosus pt on service, and she was just miserable. Not a bad pt - just a mess. It was a bummer. I wasn't managing, so, I don't recall what they were doing.
I dunno man, "cool water washing over my neck and turning an almost unbearable, intense pain into a very tolerable, dull ache" sounds pretty euphoric to me. In fact, I think that you wrote that quite well!
Your Neurologist either a) doesn't have privileges here or b) can admit you and do it themself.
Dude, spot on, and here's the true story: pt comes in with this, to SC hospital. The letter is from NC neurologist. The kicker? We went to med school together. I was thinking to myself, "Dude, really?"
Man, if someone is in REAL pain, trust me, getting high is the LEAST thing on their mind, lol. I never thought I'd stoop low enough to actually ask a nurse for pain medication in my life but that was my one exception after a few painful injuries. I think those were my first words waking up from the surgery. I croaked "Nurse....do you have anything for pain?" I'm almost ashamed that I voiced those words but damn does that stuff work when you need it! I think the surgeon had some complications....the fellow said they had my neck spread open for 3.5 hours. (I'm not condoning opioids for migraines of course....)
Agreed. I'm not a big opioid/narc dispenser in the ED but I give them for legit cases... It's funny that none of us would even be talking about any of this 10-15 years ago. We have the opioid police at my hospital audit the ED docs every month and I try to stay buried in the middle of the bell curve.
No shame at all getting pain meds in the PACU!
my go to tends to be reglan/toradol/Valium, works well for most.
Sorry, "SCA"?
maybe you're right. Lately it's been unclear exactly what my job role is. It used to be finding and treating emergencies, but lately it seems more like symptoms relief doctor. Historically I've been concerned with the overall health of the department - like could the 75yo abdominal pain in the lobby be an appy or AAA? by making them wait 2 more hours in the lobby for the bed occupied by this migraine patient, while I putz around trying VPA, propofol, haldol, magnesium infusions, etc is the lobby pt with belly pain going to perf their appy or have a ruptured AAA? Is that justifiable that I made them wait for this pain control case? If the lobby is empty, of course let's get these symptoms better, but at some point you have to prioritize. I realize that our jobs have slowly morphed away from treating emergencies into "fix my symptoms now" doctors, but I like to pretend that's not the case and prioritize needs over wants.
I am not saying that the 70s patient with abdominal pain is less important. I just don't think the migraine patient is the type of patient we should be diverting our resources away from. They are miserable, we can make them better. There are probably many other areas where we spend a lot of time/effort that we could cut back on. Agreed that old people with abdominal pain are probably not that group though.maybe you're right. Lately it's been unclear exactly what my job role is. It used to be finding and treating emergencies, but lately it seems more like symptoms relief doctor. Historically I've been concerned with the overall health of the department - like could the 75yo abdominal pain in the lobby be an appy or AAA? by making them wait 2 more hours in the lobby for the bed occupied by this migraine patient, while I putz around trying VPA, propofol, haldol, magnesium infusions, etc is the lobby pt with belly pain going to perf their appy or have a ruptured AAA? Is that justifiable that I made them wait for this pain control case? If the lobby is empty, of course let's get these symptoms better, but at some point you have to prioritize. I realize that our jobs have slowly morphed away from treating emergencies into "fix my symptoms now" doctors, but I like to pretend that's not the case and prioritize needs over wants.
maybe it's just the places I work. at any time of day there are usually 2-3 elderly patients with abnormal vitals in the lobby for 1-2+ hours waiting for a bed. most of the time I feel like it's a 1:1 exchange, every minute I spend treating symptoms from non-emergent pathology in the back (migraine, GERD, peripheral vertigo, nausea, etc) I make one lobby person wait that same amount of time to be worked up and/or treated. eventually somebody is gonna die in the lobby at some point, or have an preventable open appendectomy, or ruptured AAA, or ICH from a fall/syncope. thank you to whoever brought up the aliem tricks of the trade - I'm going to try the SPG block, seems quick and easy and might provide relief
Sickle cell anemia maybe?
I tell them “no, I’m not giving you Benadryl IV, but I can give you a PO dose.” Not sure what’s getting you flummoxed about sickle cell patients. Just because you feel bad for a patient doesn’t mean we have to comply with unnecessary treatments.
This is why our field is so hard and frankly many of us are miserable. The stupid ethical battle that plays out every 15 minutes. Treat bad pain, or workup the potentially sick patient, and guess what you can’t do both because of beds or nurse ratios or pharmacy shortages or violent psych patients or whatever. Tough gig. Lately I’ve been like Dr DJO - giving miserable non emergencies the boot since I can’t risk the elderly abdominal pain croaking. And patients hate it.
Sick Crotchety A-hole
You’re right the study I’m referencing was the one from Headache last year, similar efficacy but different adverse event rates.
