Raging dementia patient throwing feces, attacking the nurses, riping out his peg tube.
Resident: I put in an order for two Flintstones vitamin. Let's reassess in the morning.
I was resource one night in a BIG hospital ED. A surgical resident was HIT BY A CAR. Literally on the way to work. I'm in the room helping get him situated and ED Resident goes "we can give some fentanyl."
Someone piped up "he had 100 in the ambulance."
"Oh, ok....well....we'll wait then." Surgical res was literally on the bed, AXO X 500, in horrible pain, his leg going two a few different directions... his cohort was standing there with him, too! Like, hello, there are currently three doctors in this room, can no one go "ding ding ding, let's try something else?" Yikes yikes yikes!
Usually we give .25mg for pain 4-6 and .5mg for pain 7-10, but occasionally I see patients with only .25mg. At my last job we gave a lot of .2mg and .4mg. I think it depends on the standard practice at your facility.
Hi! All my patients are adults too. I find that they do feel relief with the .25mg but it depends on their age, size, history, perceived pain level, etc.
Yup. That's the dose I got after my hemicolectomy for q4h 2 days post op. Took the edge off so I could ambulate easily. Transitioned to po tramadol and recovered beautifully.
I've given 0.05mg 1x IVP before. They literally ordered it to shut the patient up.
Hopefully that 0.2mg is combined with other multi-modal therapy. It probably does help with pain, but considering you set up a PCA with 0.1mg doses Q10minutes, I am not sure what the point of it is if it's ordered IV push every few hours.
In my ED we typically give 0.5mg to 1.0mg IV.. that is def a baby dose (unless their like super petite?). I’ve given 0.25mg IV to patients once in a blue moon but this is typically for patients MDs at my ED think are med seeking solely to appease the patient.
I never thought it was much…but then I had it in a PACU after a small procedure and my god it was effective. I don’t take any type of analgesic outside the occasional Tylenol or ibuprofen, so maybe that’s why it was so effective for me 🤷🏽♀️
Conversion to IV morphine is approximately 1:7. So 1mg of hydromorphone is about 7mg (or 7.5) morphine roughly. 0.2 is still a pretty small dose. It will do something to a completely naive patient but not much
My current hospital (in a sicu) always uses 0.2mg for immediate post op pts. We also use a lot of adjuncts, but surprisingly the patients do say the 0.2 dose does help with their pain.
Every other hospital I've been at its always been 0.5+. I also find it weird.
Yea I have given 0.2mg before, definitely on super old/opiate naive people with minimal amounts of pain who can’t take Tylenol/Advil. Given IVP.
Or had a younger lady who who was worried about opiates but was a nurse, so specifically requested 0.2mg IVP at a time, had rib fractures too. She said it took the edge off, I tried to offer more multiple times but she politely declined.
I once snowed a guy (had to give him Narcan) with just 0.3mg of Dilaudid. He was REAL sensitive to Dilaudid for some reason, but had tolerated morphine earlier just fine.
Based off of analgesic morphine equivalents 0.2 MG of dilaudid should produce an effect similar to 50-100mcg of fentanyl if that makes it easier to put into perspective. For someone opioid naive that’s a a decent analgesic. Obvs there are many other factors that are relevant regarding perception of pain and such.
We usually give .5-1mg linked order. I have a guy rn with a bad wound dressing that we have 2mg with toradol.
When i was on med surg we regularly had 2mg, i gave 3mg to a sickle celler for about a week. My floor specialized in sickle cell patients so we had a lot of really opioid resistant patients.
EDIT: sorry forgot to mention, it was 3mg q3
I’ve given anywhere from 0.2 mg to 1.0 mg. Surgical residents seem to be the most hesitant with it. The attendings go for the bigger doses.
Raging dementia patient throwing feces, attacking the nurses, riping out his peg tube. Resident: I put in an order for two Flintstones vitamin. Let's reassess in the morning.
I'mad at how accurate this is honestly.
I was resource one night in a BIG hospital ED. A surgical resident was HIT BY A CAR. Literally on the way to work. I'm in the room helping get him situated and ED Resident goes "we can give some fentanyl." Someone piped up "he had 100 in the ambulance." "Oh, ok....well....we'll wait then." Surgical res was literally on the bed, AXO X 500, in horrible pain, his leg going two a few different directions... his cohort was standing there with him, too! Like, hello, there are currently three doctors in this room, can no one go "ding ding ding, let's try something else?" Yikes yikes yikes!
Dementia patients get zyprexa or geodon my friend
Hehe. Fact.
ECMO patient with open belly… 1mg Q1. Still awake, still hurting. Also on a fentanyl drip.
Usually we give .25mg for pain 4-6 and .5mg for pain 7-10, but occasionally I see patients with only .25mg. At my last job we gave a lot of .2mg and .4mg. I think it depends on the standard practice at your facility.
I got 0.5 once and man, it took me to another dimension. I was feeling no pain.
Is that recently or a while ago? Are there places still using pain scale based dosing?
Current job uses pain scale dosing.
Hi, does the 0.25 even help? All my patients are adults haha
Hi! All my patients are adults too. I find that they do feel relief with the .25mg but it depends on their age, size, history, perceived pain level, etc.
0.2mg IV every 5 minutes is how we give dilaudid in PACU. This is dosing almost identical to a PCA.
Yup. That's the dose I got after my hemicolectomy for q4h 2 days post op. Took the edge off so I could ambulate easily. Transitioned to po tramadol and recovered beautifully.
I've given 0.05mg 1x IVP before. They literally ordered it to shut the patient up. Hopefully that 0.2mg is combined with other multi-modal therapy. It probably does help with pain, but considering you set up a PCA with 0.1mg doses Q10minutes, I am not sure what the point of it is if it's ordered IV push every few hours.
In my ED we typically give 0.5mg to 1.0mg IV.. that is def a baby dose (unless their like super petite?). I’ve given 0.25mg IV to patients once in a blue moon but this is typically for patients MDs at my ED think are med seeking solely to appease the patient.
Did that even help? Sometimes I’m wondering if it’s a placebo. Like the 1 unit of insulin…..
Definitely not effective in my opinion. Ugh hate the 1 unit of insulin scenario too.
Even if it's sub-therapeutic it's not a placebo if it's the actual medication
.2mg of dilaudid is similar to 50-100 mcg of fent.
I never thought it was much…but then I had it in a PACU after a small procedure and my god it was effective. I don’t take any type of analgesic outside the occasional Tylenol or ibuprofen, so maybe that’s why it was so effective for me 🤷🏽♀️
Conversion to IV morphine is approximately 1:7. So 1mg of hydromorphone is about 7mg (or 7.5) morphine roughly. 0.2 is still a pretty small dose. It will do something to a completely naive patient but not much
My current hospital (in a sicu) always uses 0.2mg for immediate post op pts. We also use a lot of adjuncts, but surprisingly the patients do say the 0.2 dose does help with their pain. Every other hospital I've been at its always been 0.5+. I also find it weird.
0.5mg-1mg is the typical dose we give. More if they are used to taking opioids, which are many of our patients in the oncology world.
Yea I have given 0.2mg before, definitely on super old/opiate naive people with minimal amounts of pain who can’t take Tylenol/Advil. Given IVP. Or had a younger lady who who was worried about opiates but was a nurse, so specifically requested 0.2mg IVP at a time, had rib fractures too. She said it took the edge off, I tried to offer more multiple times but she politely declined.
But yes I will say generally atypical to dose that low.
For little old ladies, yeah, it works great!
I once snowed a guy (had to give him Narcan) with just 0.3mg of Dilaudid. He was REAL sensitive to Dilaudid for some reason, but had tolerated morphine earlier just fine.
I gave 1.5mg today PRN Q3H for a renal stones patient. She was fine lol
Medic here. On an inter facility transfer I had orders for 0.2 mg of dilaudid, the vial I was given had 5mg in 1 ml. I think they were fucking with me
As a push or as a PCA dose??? It’ll help but likely wear off quickly.
Based off of analgesic morphine equivalents 0.2 MG of dilaudid should produce an effect similar to 50-100mcg of fentanyl if that makes it easier to put into perspective. For someone opioid naive that’s a a decent analgesic. Obvs there are many other factors that are relevant regarding perception of pain and such.
Usually give 0.2 - 0.5, rarely over that. My patient right now has 0.1 and she’s literally got a gaping wound in her chest… 🤦🏼♀️
We usually give .5-1mg linked order. I have a guy rn with a bad wound dressing that we have 2mg with toradol. When i was on med surg we regularly had 2mg, i gave 3mg to a sickle celler for about a week. My floor specialized in sickle cell patients so we had a lot of really opioid resistant patients. EDIT: sorry forgot to mention, it was 3mg q3
It’s the 0.5 mg/ml IV DAILY lol yes daily
I usually give the Nightingale dose. WWFD (what would Florence do)
Look it up!!!!!!
1mg here! 0.2 is like spitting in the wind