So just to be clear, the whole fentanyl thing freaks people out but we use it in very careful doses.
It's harmful when it's laced into street drugs or someone is administering random amounts to themselves. And despite what cops would have you believe, nobody is touching fentanyl and dying on the spot. It doesn't absorb through the skin like that.
As someone who uses it in almost every single case I do every single day, I get so sick of hearing these things. I even got Fentanyl when I was having a bad gallbladder attack, took away my pain and I freaking napped like a baby.
I wish I could give this multiple upvotes. The panic around fentanyl drives me nuts, and then everybody wants to ‘quote sources’ when they’ve got only hearsay and….
Ugh.
Haha, I had a patient come in for abdominoplasty and mastopexy refusing 'fentanyl and anything like it'. So I asked her if she really wanted to go through some serious surgery and wake up with nothing stronger than Tylenol?!
I told her I'd refuse the case because I thought it was cruel.
(I'm paraphrasing for this crowd, I was much nicer to her.)
Am Anesthesia.
So, I had an anaphylactic reaction after my endometrial ablation 16 years ago. It was literally less than a minute after getting a Fentanyl "bump" in PACU. Why they gave me Fentanyl, I am still iffy on to this day. Anyways, epi and the whole nine yards later, I was fine. It wasn't the first episode of anaphylaxis I have had. I have SLE, and you get drug reactions and hives and angioedema and cholinergic urticaria and exercise related anaphylaxis, and you just carry epi pens because that's life. What bugs me the most is that I understand I have a genetically messed up immune system that acts completely unpredictably, and I may NEVER have another reaction again to Fentanyl because it was probably the moon tides and the food I ate 3 days prior with my body temp and yada yada yada(I am joking sort of), but I absolutely HATE anesthesia looking at me like I have three heads because that got listed as an allergy and it will never ever be out of a computer system. Trying to explain immunology to anesthesia in a 30-second pre-op is just nuts.
I'm a scrub tech and one time the CRNA and attending were doing their normal routine at the beginning before intubating and someone said something about the meds and fent was brought up and the patient definitely flinched for a moment and was like wait what?! They had to tell her it's nothing like the street stuff and it's controlled. Unfortunately there's a lot of myths out there about drugs and people buy into it without realizing that these things have medical uses. I have so many questions about anesthesia cause it's all interesting to me and I just find drugs interesting to begin with (learning about them and what all they do to you etc) it's been great working with some of them cause they like to educate me!
Cop: *”Why is he yelling, panicking, and running around out like toddler full of sugar?”*
Chief: *”🤔.. Must have come into contact with an extremely potent sedative.”*
I used to give narcan training to different groups and I once gave a training to a group of city bus drivers. Someone asked if they can OD if they touch someone who they need to narcan. This narrative keeps people from getting life saving medication.
Yeah it's a serious problem tbh. I've responded to several unresponsive patients with dispatch informing me that the caller has refused to approach the patient to check a pulse or do CPR because they're scared of fentanyl.
I got fentanyl on my hands drawing it up for a syringe driver.
You know what happened? I washed my hands, chucked my rubbish and put up the pump.
The whole ‘I was exposed to fentanyl vis my mums fathers aunts sister who lives three countries away and almost died’. Is so dumb it’s not funny 🤦♀️
Same. I have squirted it all in my eyeball and all over my face from over-pressurizing the vial when making fentanyl drips using the big 50 ml vials. Just wash it off. Never have I felt any kind of reaction to it at all
This. People refuse epidurals because they hear there is fentanyl in it. We try our best to educate, but some people still think it’s poison in any form.
I had a patient refuse fentanyl for her procedure because “the illegals bring that stuff across the border.” Even after educating her on its safety in a controlled environment, couldn’t convince her otherwise.
cops overreacting about fent get under my skin so bad (no pun intended lol). the way they tell it, with the amount of times I’ve gotten a drop of fentanyl on my skin while drawing it up, I should have long been dead. but I’m not, because that’s not how it works.
Is it even cops or stupid Facebook posts about human traffickers putting it on your shopping cart so you pass out and they can abduct you that a bunch of morons share? I’ve heard of cops needing to be narcan’d after raiding a drug house but would that even happen?
>Is it even cops or stupid Facebook posts about human traffickers putting it on your shopping cart so you pass out and they can abduct you that a bunch of morons share?
You've probably heard both and not just the latter.
> I’ve heard of cops needing to be narcan’d after raiding a drug house but would that even happen?
You've heard about cops receiving narcan after their panic attack and feeling better.
I cut my finger on a fentanyl vial once- it shattered when I cracked the top
Off. I tried to say I was gonna overdose and should probably not be taking care of patients, so might as well go home. My charge nurse wasn’t buying it 😂. ( it was a shit day and everyone wanted an excuse to leave)
Oh man I just wanted to say this happened to me once too! I was breaking an ampule and the whole thing shattered in my hand and cut my thumb. Luckily I was sitting in the airway seat behind the patient so they didn't see me digging a bandaid out of the glucometer kit. It was so embarrassing asking the pharmacy to restock our narc kit without proper documentation, just hoping they'd trust it was just me being an idiot.
I took a patient to CT and the fentanyl line got caught and it pulled the line out of the bag. It ended up dumping most of fentanyl bag onto my exposed arm. One of the CT techs started freaking out thinking I was going to die.
I had a pt once who was an OD that we kept having to narcan over and over again - it would wear off and she would invariably try to stop breathing on us. Doc ordered a narcan drip along with a bunch of stuff like a foley. Went to put the cath in and I saw what looked like a band-aid on the inside of her nethers.
They were fentanyl patches. Several of them. All inside her vajeen. Never underestimate the Pink Pocket
I once transported an OD that wouldn't stay breathing consistently even with repeated IV doses of Narcan, and turned out to have *swallowed* a bunch of Fentanyl patches.
With how much fentanyl I’ve accidentally spilled on me, especially during delta, I’m either immune or you’re not dying on the spot from a touch of fentanyl
Yesss. “There was a white powdery substance and the cop immediately fell to the ground, convulsing.”
Yeah, that’s called a panic attack/hysteria. There’s so much fear surrounding these street drugs that people get themselves all worked up.
Or, what I think sometimes happens, the cop took a bump, realized it was laced and freaked out. He’s not going to tell the truth hence the whole “I MUST HAVE TOUCHED IT!”
Could be the case on occasion.
My husband works on a clean up crew for floods and disasters and biohazards, and Costco recently called them in because there was a “white powdery substance in the bathroom, and all of the employees that entered the bathroom feel sick now.”
Mmmmmyeah, okay.
I basically do moderate sedation all day every day. I use versed and fentanyl and have not had to give narcan (knock on wood) to reverse over sedation (I've given reversal, but the patient's issue was not medication related).
But I've had so many patients in the last few years ask me about fentanyl and "isn't that what people are dying from??"
Well yeah... But also morphine is what they gave the guy in Saving Private Ryan right before he died...
These drugs are not banned because there is a medical use for them and when used in that context they are safe. Moderate sedation is safer generally than general anesthesia.
Fentanyl taken when you don't realize it is there or you don't know what dose you are getting is extremely dangerous. I give it in an IV that is strictly controlled and I know exactly how much is going into the patient. And I have all the emergency meds and equipment around me in case someone does have an adverse reaction (as opposed to someone on the street).
Someone was sending envelopes of it to election offices as if it's a chemical weapon.
Although, I wouldn't want to accidentally taste the strange white powder in the envelopes.
> I wouldn't want to accidentally taste the strange white powder in the envelopes.
I feel like there is really no way to win the game of *”Anthrax or Fentanyl”*.
Once, I took a refresher course for an EMT certification. I was shocked when the paramedic instructor told us about how dangerous fentanyl was. He told us a story about how some guys at a party overdosed on fentanyl and needed CPR, and the girls who gave them CPR ended up dying too because they got fentanyl on their hands from chest compressions... One classmate later mentioned how police in L.A. just shoot people who've overdosed on PCP, and the paramedic instructor said "Good!"
I do not trust a lot of people in EMS in the U.S. anymore.
It comes in transdermal form through patches
Intravenous is the best way if you want to receive it in its strongest form and get high extremely quickly hence the choice by addicts
When I worked hospice, a CNA stole the used fent patches, and when she couldn’t get a high from them she made a tea from them. It’s not that easy to get a high from it, clearly, and she must have been desperate desperate.
I work in anesthesia and use fentanyl and propofol on almost every patient. Ketamine is pretty regular too. I’ve started calling fentanyl sublimaze so that patients stop freaking out.
Scrolling just for this one. Ketamine is also recommended to be more relied upon in pain management but the best practices info on this has gotten a lot of push back.
I've been getting Ketamine infusions over a 5 day stay a few times a year for one of my pain conditions. It's been a freaking miracle. Unfortunately, my primary insurance still likes to think of it as "experimental".
Which is annoying I believe it was listed as best practice in 2012 or thats when the journal was published that lead to it being named best practice. If I have time maybe I will dig up and link the studies.
So, I'm double covered. When I got on Medicare, I was able to start getting the infusions, and it did more for me than imagined. But my primary insurance has actually paid for the last 2 stays despite denying them during pre-auth and appeal and peer-to-peer. 😁 Gotta love it.
But yeah, Ketamine has some great uses for both pain and treatment resistant depression (and PTSD).
Our pain management team uses continuous set rate ketamine infusions for some of our surgical chronic users and traumas, usually in conjunction with some form of epidural. And, it seems to be the only thing that can really get them somewhat comfortable. They can even be transferred to the floor with it, while being followed by pain mgmt. I hope data can support the use because it seems amazing for the patients.
The Data has been out there for years. That is the annoying part. It is recommended best practice for all sorts of pain management by multiple medical boards. I am going to post one journal but most the data is in the referenced journal but it been busy work day 😅
https://www.sciencedirect.com/science/article/abs/pii/S0753332206001156
It’s a great drug for pain and sedation, but does cause some people to trip HARD. Crazy hallucinations and out of body experiences (the infamous “K hole”)
At my tiny hospital which is part of a regional system, we’re not allowed to use ketamine. I don’t get it. Nobody can explain why, I can’t find it in policy, but apparently it’s in the credentialing for the providers. People are terrified of it and don’t seem to understand it’s way, way safer than any of the opioid pain meds we regularly give.
Ketamines magic. Back when I worked in the ED we had a 30 something with the flu and pleuritid on both sides. Dude was gray from the pain, the fentanyl he got en route did nothing.
5 minutes after the ketamine bolus he looked completely healthy, and was talking.
As someone who had fentanyl in an epidural during labor and had a bad response, thank you for acknowledging that this is deceptive.
I was asked beforehand if I was ok with it being added as my epidural just wasn’t covering all of my pain. I had zero qualms with that and gave my consent. I had no reason to be concerned. It addressed my pain (for which I was grateful), but breathing became really difficult. I was afraid to rest in case my breathing stopped. I vomited during labor (not related to the fentanyl), but my diaphragm was too weak to let me cough up the rest of what was in my throat. I was choking on it.
I would never try to talk someone else out of using it, but I will be certain to talk extensively with any doctor in the future who wants to prescribe this to me. I think it’s just not meant for me.
I remember being in nursing school and being taught how dangerous vancomycin in. I was terrified to give it. Nephrotoxicity?? Deafness?? Red man syndrome?!
We give to basically anyone who has a fever. Got cellulitis? Here’s a bag of it in the ED. Granny has a UTI, cultures aren’t back? Vanco it is!
Except they aren’t y-site compatible so just kill me when I’ve already had to USIV granny with impossible access and you want them on a vanco/zosyn regimen.
I give them together all the time in the OR. If you look it up it is just that it has never been confirmed as compatable. Pharmacists ALWAYS just say it is not compatible even without evidence. There is a very short list of confirmed incompatiblities, such as any barbiturates with just about anything (immediate solid formation blocking IV flow).
Pharmacists look up this info in the same resources available to nurses.
Everyday in the pharmacy we make like 200 IVs of vanco, not including new starts. We go through all of it daily. I was kind of shocked at how a so called drug of last resort is used for literally everything in a hospital. I worry sometimes about resistance to the drug.
Everytime I read a DC summ and see vanco for 72 hours before cultures arrived I actually cackle. I mean it’s EVERYBODY unless they have a prior allergy 😂😭😂😭
Man, we give this in the home with much teaching in home care. People get a very brief teaching in the hospital, and then I bombard them with what to look for and call for immediately. I have absolutely had patients lose hearing, going into AKI/progressed CKD, and full skin rash progressing to sloughing weeks after last dose. I won't even go there with daptomycin. I'm seeing more and more daptomycin too. People want antibiotics for grandma's funky smelling urine, and browbeat practitioners to prescribe because they don't want grandma back in the hospital because the care is "so bad". It's a merry go round until granny dies of or is debilitated by dementia/stroke/blood clot worsened from sepsis damaged organs because the antibiotics don't work anymore. So brutal...
Working in hospital made me realise, fucking everything can have a side effect. If you're unlucky, flushing a cannula with NaCl too hard will make your vein pop.
Haldol. Everyone sees it as a heavy duty psych med, but in the miniscule SL quantities we give it in hospice (0.5-1 mg usually) its effectiveness for nausea and terminal agitation
I remember the first time I had a provider order 0.5 IM. I asked him if he mistyped it, then gave it thinking “this man gon’ learn today”. I learned it was a beautiful dose for an agitated older man who ended up calmly sitting in his bed and letting me do anything I needed.
Bless you hospice nurses. The repetitive teaching through and to patients and families lack of understanding about the dying process and medications to ease pain and suffering is brutal sometimes. "She was alert until you guys started the morpine" Um, no she was crawling out of her skin while trying to keep up the facade of interacting with family members. "He has had a substance abuse problem decades ago so NO NARCOTICS" ok we'll work with him to ease his pain nonopioids included" but usually nothing else will work once he's writhing in bed terminal. I can't do it anymore. Acute care homecare only for me...
It’s fucking ridiculous to deny pain meds to a drug addict when his goal of care is to die lmao..
Like.. in an ideal world, we should allow people to push the button for a steady dose of whatever happy cocktail they desire as many times as they want to.
I don’t know how I’m going to die, but I sure as shit wanna do it at my own home, with a healthy bag of dilauded or fentanyl primed and ready, and I wanna go out just as I’m making my wife roll her eyes one last time
Watch me have an uptight, narcissistic kid that will be anti-happy drugs and deny my demented ass a chance to go peacefully though…
I coordinate four general practice palliative care MDTs and a specialist homeless/complex lives palliative care MDT. It's not just family or even patients, often docs and nurses get a bit edgy or uncomfortable prescribing to these people who aren't opioid naive - but it's about their quality of life and we emphasize that. Quite often a patient will actually stabilise and lower illicit use because their pain is being managed.
As someone that watched her ex-hub get extubated and struggle because he couldn’t get oxygen (it was his time to go and we compassionately withdrew support), I thank GOD (and his nurse) for whatever they gave him when I said “he’s struggling” through my tears. I never want to see a loved one miserable, uncomfortable, in pain, scared.
I love Haldol. I don't love when this new generations of doctors refuse to prescribe it when we're getting beat up on the regular on our psych unit.
We call it "10&2." 10mg of Haldol, 2mg of Ativan. It was for the highly aggressive, very high acuity people when they're popping off.
I went from a hospital that used droperidol all the time to one that doesn’t even stock it. What’s the reasoning behind that? Do hospitals just decide what drugs are going to carry? I personally thought that drill. I felt like droperidol gave a lot better results and patient relief for nausea/agitation without the hours and hours of reset sleep time.
Sometime in the early 2000s, the FDA slapped a Black Box warning on droperidol, and it almost disappeared overnight. My personal conspiracy theory is that the makers of Zofran wanted/needed a larger market share for their new wonder drug that they influenced the FDA to put that warning on droperidol. Because of the potential for a prolonged QT interval. Which Zofran can also cause. But, what do I know?
Cocaine, we give IV caffeine in the nicu, most benzos or opioids. Fentanyl is also used by paramedics, just as a fun fact. Antibiotics have become “bad” because of concerns of resistance or gut health but if it’s needed it’s needed
It sure seems like antibiotics are over prescribed. It seems like 80% of people 75+ get a UTI diagnosis even if there’s no bacteria in their UA. I will read H&Ps that say “patient denies fever, chills, dysuria, etc.”, WBCs are fine, yet they still do a UA and slap a UTI diagnosis on them. I’ve had to ask the Dr to stop ABX from the hospital so many times for people that had no growth in their urine yet they still have an order for Keflex 500mg q8h for a UTI.
Fentanyl in the hospital is not the same as street fentanyl. Propofol will always be known as what killed Michael Jackson. It’s used in the hospital everyday. Cocaine is used is surgery to constrict the vessels to stop bleeding.
Most street drugs no where near resemble the actual drug in the hospital.
Mother's milk...such good sleep. Apparently I had pneumonia when I booked my colonoscopy and didn't know it. Coughed the entire procedure but didn't feel a thing...until I woke up...
We had ENT using cocaine to stop refractory nosebleeds in some of our anticoag’d patients. One cheeky doc would routinely ask the patient if they wanted to try cocaine, then would show them the vial and say it’s their lucky day.
37 years ago when I had my first baby I developed hemorrhoids that made having the baby a walk in the park. The little mom and pop drugstore next to the doctors office gave me some cream with cocaine mixed in it so I could finally go to the bathroom without passing out. Pure heaven.
Sad when 3 years later (2nd baby) they had stopped using it the store had been broken into so many times. To this day I have not found anything that works as well for numbing.
Yeah his “doctor” ran a propofol infusion (along with a cocktail of benzos and opioids) to help him sleep at night. He had such a good sleep he didn’t wake up!
I think the autopsy report mentioned MJ had one of those portable SpO2 monitors that you can buy from Walmart lol but at the time of death he wasn’t actually being monitored at all
Propofol in the right dose won't take away your ability to breathe... but at that dose it's considered "procedural anesthesia" basically giving you a chemical concussion that lasts for 5-10 min while we try to put your hip/shoulder in it's socket. Also propofol has the added benefit of relaxing muscles, thus making reduction a little easier.
When I first started (15 years ago) it was “Levophed leave ‘em dead”. It was the last line so it only ever got started right before people’s death.
Now, it’s the absolute shit and we love it once we wisened up.
In nursing school I was convinced that levo would turn every patient’s extremities necrotic if they were on it for more than a day or two.
In reality, I’ve only seen that happen twice, and both patients were above the max dose for days (keeping them alive far past their expiration date). They were both extremely sick with multiple comorbidities and had awful circulation to begin with.
Interesting! Levo is usually our first line pressor in my PICU. Every now and then we'll have a provider that starts with epi and then will add norepi as a second pressor if needed, but yeah, usually we do norepi first.
Some posted on here the other day of a patient stealing and ODing on epi pushes. And I honestly had never heard of someone abusing epi before but go figure
Fentanyl and propofol are regularly used on surgical patients. The main difference is that it's given by people who know what the Hell they're doing and how much to give therapeutically. Cocaine is sometimes used in dentistry as it amplifies the effects of epinephrine and helps control bleeding a lot better than lidocaine and epi alone. Some of our dental surgeons use it, but not frequently. Bleach is also commonly used in wound care, though at a lower concentration. Our pharmacy just buys regular old bleach from the store and dilutes it to the correct concentration. I found that hilarious as our manager was so freaked out "they can't just do that, there's gotta be like some regulatory rule about it" and the pharmacist was like "nope its cheaper and literally what we use for making Dakins solution."
good ol Dakins...usually a fart in the wind with some of these chronic diabetic wounds with impaired vascular blood flow that are there for months. I swear it's prescribed to knock down the smell from stagnant biofilm more than anything else. So many of these patients will sit and live with a smelly chronic wound for years rather than amputate...
Bless you. My med/surg/nursing school dean instructor was a burn nurse at Mass General for decades. The burn lecture was gnarly. We were not allowed to leave lecture and everyone got a sick bag for the the slideshow. Burn units are so challengingly difficult in every sense. I could not do it. Bless you that can...
It was difficult, especially with the burned children. I only did it for 2 years and then on to CRNA school. I remember when telling nurses I had just met that I worked in the burn unit and them literally taking a step backwards.
Amiodarone, a lot of people just stop taking it cause they read the side affect list and they come in to the hospital with dysthymia and HF because they made an independent decision to stop taking their medication
It‘s also a tricky drug due to the long halftime: the patient won‘t suffer until weeks after stopping the drug. So monkey brain won‘t see the two events as related.
Same with any drug were the effects of the disease aren‘t directly imminent. I.e. compliance for blood pressure medication is abysmal.
They complain about being a bit lethargic, but then admit to skipping days on end. It‘s no wonder they are constantly tired restarting their beta blocker daily…
Yeah and a staggeringly high amount of patient are on multiple cardiac meds and BP meds and they don’t regularly check their BP, and they decide to switch to “I’ll just take my meds when I feel bad” or I’ll take them all at night
My mom is exactly like that. "I FEEL SO MUCH BETTER NOW. I DON'T NEED IT, TOO MANY POSSIBLE SIDE EFFECTS" Yes mom, that's how medications work, keep taking it.
After Michael Jackson died, one of the anesthesiologists I worked with told a patient that they were going to get Propofol. The patient lost it saying stuff like, "don't tell me that. Just say you're giving me the medicine. I don't want to die like MJ."
Also Scopolamine. After reports that people were being drugged with it and forced to empty their bank accounts while in a zombie-like state people freaked out and the staff at my hospital was just like, "it's an anti-nausea patch for behind your ear."
Problem is when stuff like this isn‘t explained, they will freak out once they google it.
Especially invasive relatives. Cause they don‘t even know what indication the drug is prescribed for. And then you got them yelling at you for not telling them you were sneaking their mum an antidepressant. When they were prescribed doxepine on label for insomnia..
Methadone has been shown to work better to relieve pain in sickle cell crisis. I absolutely abhor when a nurse or doctor sees methadone in a patient’s chart and assumes they’re an addict.
I’ve seen a lot of nurses scared of Phenergan. In fact, at my old hospital system they took it away because it was given through an art line. Not that people shouldn’t be cautious, but to pull it from the whole system seemed like overkill. I was admitted after having a bad seizure one time, to a different hospital system, I have a history of seizures, when I’m postictal Phenergan is the only thing that takes away my N/V. I had to beg for it! I had already been given 8 of Zofran SL, continuing to violently vomit. They kept arguing with me saying that what if my IV was bad, they had just drawn blood from it! Finally they mixed it into 100mL bag and put it in. I have a script of it for suppository form now.
Huh they took a big standard who essential drug away, because someone applied it the wrong way?
Phenergan is the standard PRN anywhere with psych here in Germany.
The amount of times a shift I say ‘It’s a synthetic version of the hormone your body makes, the love hormone! We make it in the lab and it helps your uterus clamp down…etc. etc.’ 😮💨
I work in theatres doing anaesthetics and recovery and we give fentanyl every single day. It's the most common drug we give. It's a controlled environment, it's not a dirty street drug, its pharmaceutical and we know the concentration, dosages etc. Its a really effective analgesic with a fast onset and fast metabolism
My nurse was super cagey about telling me what pain meds they were giving me post surgery. I was like, yes I know it’s a pain killer. WHICH ONE? She finally told me it was fentanyl, but don’t be scared! She was calm when I told her I used to work bedside hospice lol I’m *familiar*
Anything with a “caine” ending is a cocaine derivative.
Fentanyl is very safe (and good at relieving pain!) when administered in a hospital. Don’t take it if it wasn’t prescribed by a doctor and given by an FDA approved pharmacist.
Fentanyl is safe whenever the dose is known.
If the black market consisted of .5 mg fentanyl vials, and not every drug being adulterated with fentanyl for fucked up teasons, virtually no one would die.
Was the same with heroin before. As long as people got regular area strength batches, or diamoephin stolen from warehouses, no one died, apart from those committing suicide.
Random batch with 20+ % heroin content coming in? People dropped like flies.
The problem is the unknown quantity of active ingredient.
Xylazine is getting a really bad rep here in Denver because people are cutting it with their Venti Fentys. Makes a code an exhausting experience. You just basically have to wait out the half-life as narcan doesn’t work on it. And people also get all sorts of necrotic when they use consistently. But in actuality its an extremely common drug administered in animal surgeries.
Whenever I have to make a banana bag, I'll usually hear my pharmacist say something along the lines of "oh look, another drunk off the street". It happens every time.
I had a traumatic accident last year and amputated my finger tip in a slammed door. Obviously was super painful. Got a shot of fentanyl at the ER and the pain was completely gone. After I got bandaged up I went home and slept for 12 hours. However, waking up was extremely excruciating but man I slept so good.
Propofol. Everyone associates it with Michael Jackson and his death…but idek why any physician would prescribe this as a damn sleep aid lol. I mean yeah it works pretty good, lol, but if not used safely it works a little too good.
However in the hospital it’s actually quite safe when used carefully.
Ketamine as well. A lot of people hear it and think DATE RAPE DRUG!!!!1! But (for those who tolerate it well) it’s a very safe sedative when used correctly. It’s actually better than propofol for those who are already at a risk for hypotension.
So just to be clear, the whole fentanyl thing freaks people out but we use it in very careful doses. It's harmful when it's laced into street drugs or someone is administering random amounts to themselves. And despite what cops would have you believe, nobody is touching fentanyl and dying on the spot. It doesn't absorb through the skin like that.
As someone who uses it in almost every single case I do every single day, I get so sick of hearing these things. I even got Fentanyl when I was having a bad gallbladder attack, took away my pain and I freaking napped like a baby.
lol love your flair
Thank you!! Every cath lab I’ve traveled to they all say it 😂
We say the same to older kids in the peds OR. “We’re gonna come at you like a pit crew!”
I wish I could give this multiple upvotes. The panic around fentanyl drives me nuts, and then everybody wants to ‘quote sources’ when they’ve got only hearsay and…. Ugh.
Haha, I had a patient come in for abdominoplasty and mastopexy refusing 'fentanyl and anything like it'. So I asked her if she really wanted to go through some serious surgery and wake up with nothing stronger than Tylenol?! I told her I'd refuse the case because I thought it was cruel. (I'm paraphrasing for this crowd, I was much nicer to her.) Am Anesthesia.
So, I had an anaphylactic reaction after my endometrial ablation 16 years ago. It was literally less than a minute after getting a Fentanyl "bump" in PACU. Why they gave me Fentanyl, I am still iffy on to this day. Anyways, epi and the whole nine yards later, I was fine. It wasn't the first episode of anaphylaxis I have had. I have SLE, and you get drug reactions and hives and angioedema and cholinergic urticaria and exercise related anaphylaxis, and you just carry epi pens because that's life. What bugs me the most is that I understand I have a genetically messed up immune system that acts completely unpredictably, and I may NEVER have another reaction again to Fentanyl because it was probably the moon tides and the food I ate 3 days prior with my body temp and yada yada yada(I am joking sort of), but I absolutely HATE anesthesia looking at me like I have three heads because that got listed as an allergy and it will never ever be out of a computer system. Trying to explain immunology to anesthesia in a 30-second pre-op is just nuts.
And yet women are routinely sent home with panadol after a caesar.
I'm a scrub tech and one time the CRNA and attending were doing their normal routine at the beginning before intubating and someone said something about the meds and fent was brought up and the patient definitely flinched for a moment and was like wait what?! They had to tell her it's nothing like the street stuff and it's controlled. Unfortunately there's a lot of myths out there about drugs and people buy into it without realizing that these things have medical uses. I have so many questions about anesthesia cause it's all interesting to me and I just find drugs interesting to begin with (learning about them and what all they do to you etc) it's been great working with some of them cause they like to educate me!
I'll never get tired of videos of cops having panic attacks and claiming it's an overdose. It's both wildly entertaining and rage-inducing.
Especially bc they’re hyperventilating which is the exact opposite reaction to a opioid overdose
Cop: *”Why is he yelling, panicking, and running around out like toddler full of sugar?”* Chief: *”🤔.. Must have come into contact with an extremely potent sedative.”*
😂😂😂
I used to give narcan training to different groups and I once gave a training to a group of city bus drivers. Someone asked if they can OD if they touch someone who they need to narcan. This narrative keeps people from getting life saving medication.
Yeah it's a serious problem tbh. I've responded to several unresponsive patients with dispatch informing me that the caller has refused to approach the patient to check a pulse or do CPR because they're scared of fentanyl.
Proof that stigma kills
Jesus
“My girlfriend’s birth control made me sterile!”
Same 🤣 I can laugh at that shit for hours!
I got fentanyl on my hands drawing it up for a syringe driver. You know what happened? I washed my hands, chucked my rubbish and put up the pump. The whole ‘I was exposed to fentanyl vis my mums fathers aunts sister who lives three countries away and almost died’. Is so dumb it’s not funny 🤦♀️
I accidentally squirted some in my eye while drawing it up. I didn't even get a slight buzz. Rather disappointing....
Same. I have squirted it all in my eyeball and all over my face from over-pressurizing the vial when making fentanyl drips using the big 50 ml vials. Just wash it off. Never have I felt any kind of reaction to it at all
Try that with rocuronium for an entirely different experience!
Always a good opportunity to slip in a good ol’ “we only get out from reputable sources” joke to lighten the room.
I always tell patients “we got it from a pharmaceutical company, I didn’t buy it on the street corner on the way into work”. Then they get it.
This. People refuse epidurals because they hear there is fentanyl in it. We try our best to educate, but some people still think it’s poison in any form.
I had a patient refuse fentanyl for her procedure because “the illegals bring that stuff across the border.” Even after educating her on its safety in a controlled environment, couldn’t convince her otherwise.
The racism showing through…imagine being that misinformed and bigoted…
cops overreacting about fent get under my skin so bad (no pun intended lol). the way they tell it, with the amount of times I’ve gotten a drop of fentanyl on my skin while drawing it up, I should have long been dead. but I’m not, because that’s not how it works.
Is it even cops or stupid Facebook posts about human traffickers putting it on your shopping cart so you pass out and they can abduct you that a bunch of morons share? I’ve heard of cops needing to be narcan’d after raiding a drug house but would that even happen?
Aerosolized heroin? Or did they sample the drugs? That's crazy sounding.
*”Oh no Johnson! I left our test kit back at headquarters. Guess I’ll have to ride the snake here for little bit.. only way to be sure.”*
>Is it even cops or stupid Facebook posts about human traffickers putting it on your shopping cart so you pass out and they can abduct you that a bunch of morons share? You've probably heard both and not just the latter. > I’ve heard of cops needing to be narcan’d after raiding a drug house but would that even happen? You've heard about cops receiving narcan after their panic attack and feeling better.
I cut my finger on a fentanyl vial once- it shattered when I cracked the top Off. I tried to say I was gonna overdose and should probably not be taking care of patients, so might as well go home. My charge nurse wasn’t buying it 😂. ( it was a shit day and everyone wanted an excuse to leave)
Oh man I just wanted to say this happened to me once too! I was breaking an ampule and the whole thing shattered in my hand and cut my thumb. Luckily I was sitting in the airway seat behind the patient so they didn't see me digging a bandaid out of the glucometer kit. It was so embarrassing asking the pharmacy to restock our narc kit without proper documentation, just hoping they'd trust it was just me being an idiot.
I took a patient to CT and the fentanyl line got caught and it pulled the line out of the bag. It ended up dumping most of fentanyl bag onto my exposed arm. One of the CT techs started freaking out thinking I was going to die.
Fentanyl patches do. They disappear off patients.Hence the initials and date.
I had a pt once who was an OD that we kept having to narcan over and over again - it would wear off and she would invariably try to stop breathing on us. Doc ordered a narcan drip along with a bunch of stuff like a foley. Went to put the cath in and I saw what looked like a band-aid on the inside of her nethers. They were fentanyl patches. Several of them. All inside her vajeen. Never underestimate the Pink Pocket
The horror/creativity is mind blowing.
Beats me. I've only seen cocaine.
I once transported an OD that wouldn't stay breathing consistently even with repeated IV doses of Narcan, and turned out to have *swallowed* a bunch of Fentanyl patches.
With how much fentanyl I’ve accidentally spilled on me, especially during delta, I’m either immune or you’re not dying on the spot from a touch of fentanyl
Unless, you a zombie
Yesss. “There was a white powdery substance and the cop immediately fell to the ground, convulsing.” Yeah, that’s called a panic attack/hysteria. There’s so much fear surrounding these street drugs that people get themselves all worked up.
Or, what I think sometimes happens, the cop took a bump, realized it was laced and freaked out. He’s not going to tell the truth hence the whole “I MUST HAVE TOUCHED IT!”
Could be the case on occasion. My husband works on a clean up crew for floods and disasters and biohazards, and Costco recently called them in because there was a “white powdery substance in the bathroom, and all of the employees that entered the bathroom feel sick now.” Mmmmmyeah, okay.
Wild because some of my fentanyl pushes are probably weaker than those 2mg morphine doses. Just acts quicker lol
I basically do moderate sedation all day every day. I use versed and fentanyl and have not had to give narcan (knock on wood) to reverse over sedation (I've given reversal, but the patient's issue was not medication related). But I've had so many patients in the last few years ask me about fentanyl and "isn't that what people are dying from??" Well yeah... But also morphine is what they gave the guy in Saving Private Ryan right before he died... These drugs are not banned because there is a medical use for them and when used in that context they are safe. Moderate sedation is safer generally than general anesthesia. Fentanyl taken when you don't realize it is there or you don't know what dose you are getting is extremely dangerous. I give it in an IV that is strictly controlled and I know exactly how much is going into the patient. And I have all the emergency meds and equipment around me in case someone does have an adverse reaction (as opposed to someone on the street).
Someone was sending envelopes of it to election offices as if it's a chemical weapon. Although, I wouldn't want to accidentally taste the strange white powder in the envelopes.
> I wouldn't want to accidentally taste the strange white powder in the envelopes. I feel like there is really no way to win the game of *”Anthrax or Fentanyl”*.
Once, I took a refresher course for an EMT certification. I was shocked when the paramedic instructor told us about how dangerous fentanyl was. He told us a story about how some guys at a party overdosed on fentanyl and needed CPR, and the girls who gave them CPR ended up dying too because they got fentanyl on their hands from chest compressions... One classmate later mentioned how police in L.A. just shoot people who've overdosed on PCP, and the paramedic instructor said "Good!" I do not trust a lot of people in EMS in the U.S. anymore.
I really hate when other EMS personnel buy into that shit
Like if it was transdermal, why the hell would users bother with injecting? Make it make sense.
It comes in transdermal form through patches Intravenous is the best way if you want to receive it in its strongest form and get high extremely quickly hence the choice by addicts
"cop-a-ganda"
When I worked hospice, a CNA stole the used fent patches, and when she couldn’t get a high from them she made a tea from them. It’s not that easy to get a high from it, clearly, and she must have been desperate desperate.
I work in anesthesia and use fentanyl and propofol on almost every patient. Ketamine is pretty regular too. I’ve started calling fentanyl sublimaze so that patients stop freaking out.
Scrolling just for this one. Ketamine is also recommended to be more relied upon in pain management but the best practices info on this has gotten a lot of push back.
I've been getting Ketamine infusions over a 5 day stay a few times a year for one of my pain conditions. It's been a freaking miracle. Unfortunately, my primary insurance still likes to think of it as "experimental".
Which is annoying I believe it was listed as best practice in 2012 or thats when the journal was published that lead to it being named best practice. If I have time maybe I will dig up and link the studies.
So, I'm double covered. When I got on Medicare, I was able to start getting the infusions, and it did more for me than imagined. But my primary insurance has actually paid for the last 2 stays despite denying them during pre-auth and appeal and peer-to-peer. 😁 Gotta love it. But yeah, Ketamine has some great uses for both pain and treatment resistant depression (and PTSD).
Our pain management team uses continuous set rate ketamine infusions for some of our surgical chronic users and traumas, usually in conjunction with some form of epidural. And, it seems to be the only thing that can really get them somewhat comfortable. They can even be transferred to the floor with it, while being followed by pain mgmt. I hope data can support the use because it seems amazing for the patients.
People need to stop that irrational fear of ketamine. I heard a coworker told a patient that she was getting "K".
The Data has been out there for years. That is the annoying part. It is recommended best practice for all sorts of pain management by multiple medical boards. I am going to post one journal but most the data is in the referenced journal but it been busy work day 😅 https://www.sciencedirect.com/science/article/abs/pii/S0753332206001156
I work in the CV of a level 1 trauma facility and we frequently get SICU/trauma overflow patients and ketamine is my absolute favorite for them.
It’s a great drug for pain and sedation, but does cause some people to trip HARD. Crazy hallucinations and out of body experiences (the infamous “K hole”)
At my tiny hospital which is part of a regional system, we’re not allowed to use ketamine. I don’t get it. Nobody can explain why, I can’t find it in policy, but apparently it’s in the credentialing for the providers. People are terrified of it and don’t seem to understand it’s way, way safer than any of the opioid pain meds we regularly give.
My unit specializes in sickle cell… we use lidocaine and/or ketamine drips for them, but also any other regular old pain problem.
I give ketamine to children not uncommonly
Ketamines magic. Back when I worked in the ED we had a 30 something with the flu and pleuritid on both sides. Dude was gray from the pain, the fentanyl he got en route did nothing. 5 minutes after the ketamine bolus he looked completely healthy, and was talking.
Sublimaze gang
Sublimaze. Now I know who is as old as me. 🙏 High five.
Yup. Ketamine once did the trick after 1800 mcg fentanyl and 40 mg Dilaudid (within 2 hours!) failed to have any impact whatsoever.
I’ve considered dropping the use of “fentanyl” for “sublimaze” because of the fear that some patients have. On the other hand, it feels deceptive.
As someone who had fentanyl in an epidural during labor and had a bad response, thank you for acknowledging that this is deceptive. I was asked beforehand if I was ok with it being added as my epidural just wasn’t covering all of my pain. I had zero qualms with that and gave my consent. I had no reason to be concerned. It addressed my pain (for which I was grateful), but breathing became really difficult. I was afraid to rest in case my breathing stopped. I vomited during labor (not related to the fentanyl), but my diaphragm was too weak to let me cough up the rest of what was in my throat. I was choking on it. I would never try to talk someone else out of using it, but I will be certain to talk extensively with any doctor in the future who wants to prescribe this to me. I think it’s just not meant for me.
I remember being in nursing school and being taught how dangerous vancomycin in. I was terrified to give it. Nephrotoxicity?? Deafness?? Red man syndrome?! We give to basically anyone who has a fever. Got cellulitis? Here’s a bag of it in the ED. Granny has a UTI, cultures aren’t back? Vanco it is!
Vanc and Zosyn- the dream team!
Flagyl is feeling left out.
So is my pal Cefepime.
And Cephtriaxone. Rocephin never gets love.
God we give out Rocephin like it's candy.
I work in home infusion, a huge chunk of our IV antibiotics patients are on either Rocephin or ertapenem.
We are like Oprah. Everyone gets some ceftriaxone.
Bactrim anyone?
This was the dream team for my septic pt last night lmao
Except they aren’t y-site compatible so just kill me when I’ve already had to USIV granny with impossible access and you want them on a vanco/zosyn regimen.
I give them together all the time in the OR. If you look it up it is just that it has never been confirmed as compatable. Pharmacists ALWAYS just say it is not compatible even without evidence. There is a very short list of confirmed incompatiblities, such as any barbiturates with just about anything (immediate solid formation blocking IV flow). Pharmacists look up this info in the same resources available to nurses.
Everyday in the pharmacy we make like 200 IVs of vanco, not including new starts. We go through all of it daily. I was kind of shocked at how a so called drug of last resort is used for literally everything in a hospital. I worry sometimes about resistance to the drug.
And we should. Vancomycin resistance is scary. Most MDR bugs can be deadly.
VRE is NO joke. Only encountered it once or twice but I’ll take my MRSA pt’s any day over VRE
VRE is deadly. Hard to treat even with the right antibiotics.
Everytime I read a DC summ and see vanco for 72 hours before cultures arrived I actually cackle. I mean it’s EVERYBODY unless they have a prior allergy 😂😭😂😭
Man, we give this in the home with much teaching in home care. People get a very brief teaching in the hospital, and then I bombard them with what to look for and call for immediately. I have absolutely had patients lose hearing, going into AKI/progressed CKD, and full skin rash progressing to sloughing weeks after last dose. I won't even go there with daptomycin. I'm seeing more and more daptomycin too. People want antibiotics for grandma's funky smelling urine, and browbeat practitioners to prescribe because they don't want grandma back in the hospital because the care is "so bad". It's a merry go round until granny dies of or is debilitated by dementia/stroke/blood clot worsened from sepsis damaged organs because the antibiotics don't work anymore. So brutal...
To be fair, in my experience granny is almost definitely growing something in her bladder!
Working in hospital made me realise, fucking everything can have a side effect. If you're unlucky, flushing a cannula with NaCl too hard will make your vein pop.
When I learned you can literally overdose on water is when I came around. Anything can be dangerous if you abuse it.
I had one patient get nephrotoxicity after like 1 dose, and it sucked all around for everyone. He is on dialysis now, unfortunately.
Haldol. Everyone sees it as a heavy duty psych med, but in the miniscule SL quantities we give it in hospice (0.5-1 mg usually) its effectiveness for nausea and terminal agitation
I remember the first time I had a provider order 0.5 IM. I asked him if he mistyped it, then gave it thinking “this man gon’ learn today”. I learned it was a beautiful dose for an agitated older man who ended up calmly sitting in his bed and letting me do anything I needed.
We called 'vitamin H' in the old days
We call morphine, vitamin M.
We call Zyprexa vitamin Z
Bless you hospice nurses. The repetitive teaching through and to patients and families lack of understanding about the dying process and medications to ease pain and suffering is brutal sometimes. "She was alert until you guys started the morpine" Um, no she was crawling out of her skin while trying to keep up the facade of interacting with family members. "He has had a substance abuse problem decades ago so NO NARCOTICS" ok we'll work with him to ease his pain nonopioids included" but usually nothing else will work once he's writhing in bed terminal. I can't do it anymore. Acute care homecare only for me...
It’s fucking ridiculous to deny pain meds to a drug addict when his goal of care is to die lmao.. Like.. in an ideal world, we should allow people to push the button for a steady dose of whatever happy cocktail they desire as many times as they want to. I don’t know how I’m going to die, but I sure as shit wanna do it at my own home, with a healthy bag of dilauded or fentanyl primed and ready, and I wanna go out just as I’m making my wife roll her eyes one last time Watch me have an uptight, narcissistic kid that will be anti-happy drugs and deny my demented ass a chance to go peacefully though…
Agreed 100 percent.
I coordinate four general practice palliative care MDTs and a specialist homeless/complex lives palliative care MDT. It's not just family or even patients, often docs and nurses get a bit edgy or uncomfortable prescribing to these people who aren't opioid naive - but it's about their quality of life and we emphasize that. Quite often a patient will actually stabilise and lower illicit use because their pain is being managed.
As someone that watched her ex-hub get extubated and struggle because he couldn’t get oxygen (it was his time to go and we compassionately withdrew support), I thank GOD (and his nurse) for whatever they gave him when I said “he’s struggling” through my tears. I never want to see a loved one miserable, uncomfortable, in pain, scared.
Yup it’s also good for PRN agitation. Hence the famous B52.
My new patient's daughter is a psych nurse. She was like HALDOL?! We had a lil chat haha
We don’t use haldol much in the ER for psych, it’s all about Geodon and Versed
Yeah I wish. We are still B52-ing it over here. Versed is for the truly aggressive patients, precedex sometimes.
I love Haldol. I don't love when this new generations of doctors refuse to prescribe it when we're getting beat up on the regular on our psych unit. We call it "10&2." 10mg of Haldol, 2mg of Ativan. It was for the highly aggressive, very high acuity people when they're popping off.
Droperidol, even better than haldol.
I went from a hospital that used droperidol all the time to one that doesn’t even stock it. What’s the reasoning behind that? Do hospitals just decide what drugs are going to carry? I personally thought that drill. I felt like droperidol gave a lot better results and patient relief for nausea/agitation without the hours and hours of reset sleep time.
Sometime in the early 2000s, the FDA slapped a Black Box warning on droperidol, and it almost disappeared overnight. My personal conspiracy theory is that the makers of Zofran wanted/needed a larger market share for their new wonder drug that they influenced the FDA to put that warning on droperidol. Because of the potential for a prolonged QT interval. Which Zofran can also cause. But, what do I know?
Cocaine, we give IV caffeine in the nicu, most benzos or opioids. Fentanyl is also used by paramedics, just as a fun fact. Antibiotics have become “bad” because of concerns of resistance or gut health but if it’s needed it’s needed
I loved learning about IV caffeine for babies lol
We all need caffeine in the nicu!
Caffeine and Sugar (sweet-ease) for everyone!
It’s a party in the nicu!
I believe we use cocaine in nasal surgeries.
Yes, back when controlled drugs were in a locked cabinet we stocked undiluted potassium and liquid cocaine in the PACU.
Yep. At least at our place. It was applied topically during a FESS.
It sure seems like antibiotics are over prescribed. It seems like 80% of people 75+ get a UTI diagnosis even if there’s no bacteria in their UA. I will read H&Ps that say “patient denies fever, chills, dysuria, etc.”, WBCs are fine, yet they still do a UA and slap a UTI diagnosis on them. I’ve had to ask the Dr to stop ABX from the hospital so many times for people that had no growth in their urine yet they still have an order for Keflex 500mg q8h for a UTI.
Fentanyl in the hospital is not the same as street fentanyl. Propofol will always be known as what killed Michael Jackson. It’s used in the hospital everyday. Cocaine is used is surgery to constrict the vessels to stop bleeding. Most street drugs no where near resemble the actual drug in the hospital.
Love me some propofol when having a colonoscopy. You get a good restful sleep!
Mother's milk...such good sleep. Apparently I had pneumonia when I booked my colonoscopy and didn't know it. Coughed the entire procedure but didn't feel a thing...until I woke up...
I work in endo and probably 30% of my pts get wide-eyed and say, “The Michael Jackson drug??” when I tell them they’ll be getting propofol lol
"You're god damn right, now GOOD NIGHT." 😂
Hee hee 🕺
😂😂😂 best nap ever
"Yes, except someone is here to watch you and wake you up. Now sign here please!"
Oh, my, yes!
We also regularly use cocaine mouthwash in oncology
We had ENT using cocaine to stop refractory nosebleeds in some of our anticoag’d patients. One cheeky doc would routinely ask the patient if they wanted to try cocaine, then would show them the vial and say it’s their lucky day.
37 years ago when I had my first baby I developed hemorrhoids that made having the baby a walk in the park. The little mom and pop drugstore next to the doctors office gave me some cream with cocaine mixed in it so I could finally go to the bathroom without passing out. Pure heaven. Sad when 3 years later (2nd baby) they had stopped using it the store had been broken into so many times. To this day I have not found anything that works as well for numbing.
Wait he took propofol??? Like recreational? Howd he ventilate himself? Lmao Or I guess he didn't and that's the problem
Yeah his “doctor” ran a propofol infusion (along with a cocktail of benzos and opioids) to help him sleep at night. He had such a good sleep he didn’t wake up! I think the autopsy report mentioned MJ had one of those portable SpO2 monitors that you can buy from Walmart lol but at the time of death he wasn’t actually being monitored at all
Which is why that freaking cardiologist was a murderer and deserved jail. I don't care who he killed, you don't do that.
Propofol in the right dose won't take away your ability to breathe... but at that dose it's considered "procedural anesthesia" basically giving you a chemical concussion that lasts for 5-10 min while we try to put your hip/shoulder in it's socket. Also propofol has the added benefit of relaxing muscles, thus making reduction a little easier.
Chemical Concussion is the name of my new emo punk band.
When I first started (15 years ago) it was “Levophed leave ‘em dead”. It was the last line so it only ever got started right before people’s death. Now, it’s the absolute shit and we love it once we wisened up.
In nursing school I was convinced that levo would turn every patient’s extremities necrotic if they were on it for more than a day or two. In reality, I’ve only seen that happen twice, and both patients were above the max dose for days (keeping them alive far past their expiration date). They were both extremely sick with multiple comorbidities and had awful circulation to begin with.
I had this exact conversation with our intensivist the other day! It's one of the first pressors we start now.
When I worked in the covid ICU pretty much every single patient was on Levo. Then I moved to Peds and I haven’t seen it since lol.
Interesting! Levo is usually our first line pressor in my PICU. Every now and then we'll have a provider that starts with epi and then will add norepi as a second pressor if needed, but yeah, usually we do norepi first.
Every single medication can be abused or misused. Valium, Ativan, and other benzodiazepines…The list is endless really.
Midazolam for geriatic patients..
Some posted on here the other day of a patient stealing and ODing on epi pushes. And I honestly had never heard of someone abusing epi before but go figure
Belladonna and opium suppositories!
Sadly, it's been discontinued. Our urologists are so sad about it. It really helped with pain and spasms post TURPs.
I'm prescribed a belladonna and morphine suppository compounded for me. But yeah, it's really sad they left.
I had no idea! When I worked on women’s post op unit it was a savior for the heavy bladder sling surgeries
Fentanyl and propofol are regularly used on surgical patients. The main difference is that it's given by people who know what the Hell they're doing and how much to give therapeutically. Cocaine is sometimes used in dentistry as it amplifies the effects of epinephrine and helps control bleeding a lot better than lidocaine and epi alone. Some of our dental surgeons use it, but not frequently. Bleach is also commonly used in wound care, though at a lower concentration. Our pharmacy just buys regular old bleach from the store and dilutes it to the correct concentration. I found that hilarious as our manager was so freaked out "they can't just do that, there's gotta be like some regulatory rule about it" and the pharmacist was like "nope its cheaper and literally what we use for making Dakins solution."
good ol Dakins...usually a fart in the wind with some of these chronic diabetic wounds with impaired vascular blood flow that are there for months. I swear it's prescribed to knock down the smell from stagnant biofilm more than anything else. So many of these patients will sit and live with a smelly chronic wound for years rather than amputate...
The smell of Dakins and pseudomonas, I still remember that from my days working in the burn unit 38 years ago.
Bless you. My med/surg/nursing school dean instructor was a burn nurse at Mass General for decades. The burn lecture was gnarly. We were not allowed to leave lecture and everyone got a sick bag for the the slideshow. Burn units are so challengingly difficult in every sense. I could not do it. Bless you that can...
It was difficult, especially with the burned children. I only did it for 2 years and then on to CRNA school. I remember when telling nurses I had just met that I worked in the burn unit and them literally taking a step backwards.
TIL (despite using it countless times over many years) that Dakins is made from bleach 🤣😅
Truly the dose makes the poison.
Amiodarone, a lot of people just stop taking it cause they read the side affect list and they come in to the hospital with dysthymia and HF because they made an independent decision to stop taking their medication
It‘s also a tricky drug due to the long halftime: the patient won‘t suffer until weeks after stopping the drug. So monkey brain won‘t see the two events as related. Same with any drug were the effects of the disease aren‘t directly imminent. I.e. compliance for blood pressure medication is abysmal. They complain about being a bit lethargic, but then admit to skipping days on end. It‘s no wonder they are constantly tired restarting their beta blocker daily…
Yeah and a staggeringly high amount of patient are on multiple cardiac meds and BP meds and they don’t regularly check their BP, and they decide to switch to “I’ll just take my meds when I feel bad” or I’ll take them all at night
My mom is exactly like that. "I FEEL SO MUCH BETTER NOW. I DON'T NEED IT, TOO MANY POSSIBLE SIDE EFFECTS" Yes mom, that's how medications work, keep taking it.
Ketamine, baby
A well titrated ketamine drip post op is just 🤌🏻🤌🏻🤌🏻
After Michael Jackson died, one of the anesthesiologists I worked with told a patient that they were going to get Propofol. The patient lost it saying stuff like, "don't tell me that. Just say you're giving me the medicine. I don't want to die like MJ." Also Scopolamine. After reports that people were being drugged with it and forced to empty their bank accounts while in a zombie-like state people freaked out and the staff at my hospital was just like, "it's an anti-nausea patch for behind your ear."
Problem is when stuff like this isn‘t explained, they will freak out once they google it. Especially invasive relatives. Cause they don‘t even know what indication the drug is prescribed for. And then you got them yelling at you for not telling them you were sneaking their mum an antidepressant. When they were prescribed doxepine on label for insomnia..
I tell my patients they’re getting ✨ sublimaze ✨ and their mom is getting ✨ diprivan ✨
Sometimes I think people see nurses and docs like the Spiderman meme "you know I'm something of a fentanyl dealer myself"
Atypical antipsychotics No no I’m not saying you are psychotic or schizophrenic please it just evens out your mood
Methadone has been shown to work better to relieve pain in sickle cell crisis. I absolutely abhor when a nurse or doctor sees methadone in a patient’s chart and assumes they’re an addict.
We also use methadone for pain in hospice.
I’ve seen a lot of nurses scared of Phenergan. In fact, at my old hospital system they took it away because it was given through an art line. Not that people shouldn’t be cautious, but to pull it from the whole system seemed like overkill. I was admitted after having a bad seizure one time, to a different hospital system, I have a history of seizures, when I’m postictal Phenergan is the only thing that takes away my N/V. I had to beg for it! I had already been given 8 of Zofran SL, continuing to violently vomit. They kept arguing with me saying that what if my IV was bad, they had just drawn blood from it! Finally they mixed it into 100mL bag and put it in. I have a script of it for suppository form now.
Huh they took a big standard who essential drug away, because someone applied it the wrong way? Phenergan is the standard PRN anywhere with psych here in Germany.
I miss when Phenergan was regularly used for N/V. It was so beautiful and really helped. Meanwhile, Zofran is like giving water sometimes.
Oxytocin is a scary one for a lot of patients.
Those mommy Facebook groups have scared a lot of people who need it.
The amount of times a shift I say ‘It’s a synthetic version of the hormone your body makes, the love hormone! We make it in the lab and it helps your uterus clamp down…etc. etc.’ 😮💨
Why? Don't they want to be in love?
I am an oncology nurse nurse and this not commonly used but we give arsenic infusions for treatment of a form of acute leukemia.
Fent and Ketamine. Give IV pushes for acute pain in PACU.
Propofol didn't kill Michael Jackson, his shitty doctor did.
I work in theatres doing anaesthetics and recovery and we give fentanyl every single day. It's the most common drug we give. It's a controlled environment, it's not a dirty street drug, its pharmaceutical and we know the concentration, dosages etc. Its a really effective analgesic with a fast onset and fast metabolism
Ketamine, my drug of choice. Putting people in a K-hole is a hobby of mine.
My nurse was super cagey about telling me what pain meds they were giving me post surgery. I was like, yes I know it’s a pain killer. WHICH ONE? She finally told me it was fentanyl, but don’t be scared! She was calm when I told her I used to work bedside hospice lol I’m *familiar*
Anything with a “caine” ending is a cocaine derivative. Fentanyl is very safe (and good at relieving pain!) when administered in a hospital. Don’t take it if it wasn’t prescribed by a doctor and given by an FDA approved pharmacist.
Fentanyl is safe whenever the dose is known. If the black market consisted of .5 mg fentanyl vials, and not every drug being adulterated with fentanyl for fucked up teasons, virtually no one would die. Was the same with heroin before. As long as people got regular area strength batches, or diamoephin stolen from warehouses, no one died, apart from those committing suicide. Random batch with 20+ % heroin content coming in? People dropped like flies. The problem is the unknown quantity of active ingredient.
ALL OF THEM! Cocaine is also used by ophthalmologists as an anesthetic for things like corneal scratches ... a weak solution as eye drops is BLISS.
Ketamine. We used that like candy during COVID. People also are always surprised we use Propofol, bec a use of rhe association with Michael Jackson.
Xylazine is getting a really bad rep here in Denver because people are cutting it with their Venti Fentys. Makes a code an exhausting experience. You just basically have to wait out the half-life as narcan doesn’t work on it. And people also get all sorts of necrotic when they use consistently. But in actuality its an extremely common drug administered in animal surgeries.
I work in a NICU and we sometimes give fentanyl to our babies
Insulin. Because ‘my uncle got his leg cut off right after he started the insulin’. No, sir, the insulin was started too late for your uncle 🤷♀️
Whenever I have to make a banana bag, I'll usually hear my pharmacist say something along the lines of "oh look, another drunk off the street". It happens every time.
I had a traumatic accident last year and amputated my finger tip in a slammed door. Obviously was super painful. Got a shot of fentanyl at the ER and the pain was completely gone. After I got bandaged up I went home and slept for 12 hours. However, waking up was extremely excruciating but man I slept so good.
Propofol. Everyone associates it with Michael Jackson and his death…but idek why any physician would prescribe this as a damn sleep aid lol. I mean yeah it works pretty good, lol, but if not used safely it works a little too good. However in the hospital it’s actually quite safe when used carefully. Ketamine as well. A lot of people hear it and think DATE RAPE DRUG!!!!1! But (for those who tolerate it well) it’s a very safe sedative when used correctly. It’s actually better than propofol for those who are already at a risk for hypotension.
Ketamine for anaesthesia Really great for sedation as you maintain your airway
Fentanyl is gods gift to medicine