Post Op:
Friday I get a page from the ER.
Our Patient is having a reaction to the Percocet I Rx'd.
I call the patient's house....
Sister answered.
They had tried to page me (I give out the pager post op just in case)...and they dialed the number and talked into the phone (my pager is numeric....when you dial it, it says to "enter your numeric page and press pound").
Patient is in some pain, but is having itching on the hands and (from the description) small hives on the hands.
I tell them Not to take the Percs.
Ask if the patient has any hives on the upper arms or body...No.
Any trouble breathing, feeling like the lips/tongue/throat is swelling...No.
Ok.
I suggest some Benadryl now...
Patient can't take Benadryl...last time she took it she wouldn't wake up. After 12 hours the family brought her to the ER and she was admitted for a day....Funny thing, this is NOT in any of the history the patient gave BEFORE the surgery. The only allergy she reported (or medication reaction..we ask both ways) is to IV dye and Iodine (and Shellfish).
Ok, so we forget the Benadryl.
Since it is still a minor reaction, I forgo trying another anti-histamine (figure if it gets bad, I'll dump her on the ER and let them mess with it).
So, I need to call in another pain reliever....
I ask if the patient has any stomach problems (still not in the chart, but I ask anyway)...Oh, yeah, she has ulcers now (OK, so she doesn't get Toradol).
What about Darvocet...?
Oh, I don't think she should get Darvocet...She's addictied to them. (As recently as a couple of weeks ago she was begging her PCP for more pain meds, and asked for Darvocet by name...a bit unusual to get addicted to Propoxyphene, but she's strange anyway).
So, I call in Ultracet.
(All this is on the phone).
Yesterday I get a page from the sister (finally figured the pager out).
The dressing "just came off on it's own".
((When I put the post op dressing on...gauze and roll gauze for foot surgery...and I always take a couple of wraps above the ankle for just that reason....I've seen patients come in draggin 3' of roll gauze behind them...but it is still around their ankle)).
Tell them how to re-bandage.
See you in the office Monday.