Dear Katelyn @heytherekatelyn-blog - Tumblr Blog

sixpenceee

The chromatophores in a squid are controlled by nerves that fire randomly when the squid dies. (Source)

lacydior-deactivated20160919

THIS IS SO GROSS OMG IT MADE MY SKIN CRAWL

sixpenceee

The worn marble steps at the Leaning Tower of Pisa. This is the result of 500 years of walking.

teesadutta

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lordsvader-deactivated20170716

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cardiacattack-deactivated202106

The thing I don’t like about the 1-10 pain scale is when people say “10 being the worst pain you’ve ever felt in your entire life” …..then get upset when people say 10.

If you mean 10 is like being hit by a truck, say that. If you mean 10 is like being set on fire, say that. If you mean 10 is like you can’t imagine possibly being in more pain, say that! But the worst pain I’ve ever felt in my entire life?? To some people, they legitimately HAVEN’T felt pain worse than getting their toe stubbed or something. Who has actually been hit by a truck, or set on fire, or had their arm sawed off, or any of those other examples we like to use? Not that many people. So if you’re saying “the worst pain you’ve ever felt in your entire life” as your frame of reference, this probably IS that person’s 10! Unless they’ve had surgery or something before, this probably IS the worst pain they’ve ever felt! Don’t get all pissy over it!

boluscoffeestat-deactivated2020

This is why I have dropped the “worse pain you’ve ever had in your life” or I add things like “you’ve been dropped into a pool of razor blades” or “we’re setting you on fire.” The latter clearly is pretty inappropriate with burn patients.

sarcasticbabywhispererjess

I usually go with 10 is “the worst pain you could possibly imagine”. If they still go with 10, but appear to be laying there comfortably, HR WNL, BP not elevated, not guarding or grimacing (though some people are extremely stoic, so this isn’t always going to be a reliable indication of pain), etc, I’ll go on, “So, you couldn’t function or think about anything other than this pain? Like if someone ripped your arms off an started beating you with them… that’s probably 10/10.” (Note, this is not a common example I’d give because not everyone loves my sense of humor, although they should.) Usually at this point they’ll think about it and go with 9/10 or something slightly lower.

I honestly believe some people think I won’t take their pain seriously or treat it unless they say it is 10/10. That’s just silly. I’ll toss you a couple Percs or a little IVP Dilaudid for a 3/10, if they’re due and you’re vitals are stable enough. I don’t want my patients to be uncomfortable, but I also want them to be honest. Let’s talk about realistic goals. If there is something going on that is going to cause you pain (eg. crush injury or SBO), we’re not going to get you to a 0/10… pain is your body telling you something is wrong and to get you to 0/10 I’ll probably kill your respiratory drive (not a big deal for my tubed patients, obviously). If you are mostly comfortable and able to function at 2/10, but it’s time for your pain medication, I won’t make you wait until you’re at a 7/10 to treat it. If we know that if you go an hour past when you can have more pain medication the pain quickly gets out of control, I’ll keep you safely loaded up. I even make arrangements with my patients, “If you’re asleep when it’s time for your pain medication, do you want me to wake you up or let you sleep?” Most people want me to wake them up, but there are a few that prefer to get all the sleep they can (it’s a precious commodity in the hospital, especially the ICU).

Well, that went on longer than planned. Whoops. Just my two cents.

boluscoffeestat-deactivated2020

I think there are just patients who have completely unrealistic expectations about how their pain is going to be managed, and some of these are the ones who you have to get stern with. Like, sorry ma’am/dude, you just got hit by a fucking car/have traction or have an ex-fix on your leg which looks like a damn medieval torture device/had your stomach cut open from your crotch to your chest – it’s not that I want you to be in pain, but we can only do so much to manage your pain and do so safely. I can’t narc the hell out of you when you’re hypotensive and we can’t figure out why. I can’t narc the hell out of you when you’re slurring your words and are falling asleep mid-sentence. I hate it when we end up having docs who are really stingy with the meds too, especially with a patient who clearly needs it. Had a burn patient recently boarding with us and both our ICU resident and our unit pharmacist thought 1 of dilaudid was appropriate for their daily huge dressing change where we’re freaking sloughing their skin off. I mean are you actually serious? How would you like it if I pulled off your skin layer by layer. What the hell!? Do you want to give this patient PTSD from these dressing changes? I had another doc the other day who took away my patient’s PCA because she didn’t think she needed it. Really? You’ve had this patient on your list for like 20 minutes, haven’t even examined her. You see her on paper, not in person. You haven’t had to deal with her screaming, moaning, crying, swearing, and begging for more pain medications. Give me back her PCA orders or so help me God I will be page you every five minutes for more pain medicine. And then I’ll go to your chief and your attending and make your life hell.

It’s a delicate balance unfortunately that you have to experiment with. Definitely glad that we have a really good pain service that we work with. They often come up with some really good ideas for some more complicated patients.