Thanks. Heading over now to say goodnight.
Mmmm … squid pretzellllll … <Homer drool>
ETA: he’s about the same as where I posted earlier. First time in a while that he didn’t fall asleep while I was there. I was the one who started yawning first, until he patted me and said, “Sweet dreams, good night!” knowing I was about to take my leave.
ETA II: squid pretzel does sound pretty gross. Homer takes back his drool noise …
If he isn’t getting pain relief, no matter why, ask to get a consult with pain management. If they don’t have a pain management team, ask if they would consider Tramadol. It’s a totally different type of medicine. It’s used for long term pain, but can and is used with the chronicly critically ill.
It has a side effect of euphoria, not necessarily a bad thing in this case.
Damn, now I want some…
Another thought on the chest percussion: are they doing the pounding exclusively on the chest or can they do some on the back instead? Same ribcage, different spots to bruise. No clue if that’s appropriate or not (and of course they may already be doing it).
I concur with everyone else that says the pain needs to be managed, dammit.
Am I gonna sound like I’m drug-seeking on his behalf? He’s already begging for more fentanyl at every turn.
Yep, on his back, and on both sides of his ribcage, in the front, and pretty much all over. He’s not visually bruised, just very very sore. I don’t know if the CPT is causing or exacerbating it or if that’s just a chicken-and-egg question.
Speaking of CPT on the front: do they do that on women too? My boobs hurt just watching it being done to a dude…
This. I dunno the current crop of pain meds, but I do know that different people react differently to medications. (I get totally wired on hydrocodone; it’s miserable.)
If his pain meds aren’t working for him, they need to find something else. Demerol is lovely, too, from what I hear. Just make sure someone’s there to keep him in bed when he gets a dose and decides he’s all better and it’s time to go walkabout. 
I tend to go with the patient’s assessment of what caused a problem, because it is their body, so they generally have a clue. Sometimes they’re wrong, though. Is there a different resp tech that you could ask about this? Doctors aren’t the specialists in that specific area, the techs are.
Gods above, below, in between and non-existent, I hate the DEA. They have made doctors so fucking paranoid about prescribing pain meds that they’ve made millions of people’s lives miserable. No one who’s just come out of ICU and has been / is being mauled like this should have to fucking worry that someone might think they’re a “drug-seeker”. Of course he’s a fucking drug-seeker, he’s in extreme pain! GAHHHHHH!!!
Sorry, can you tell that I’ve had some issues in this area? 
That’s why you ask for a Pain Management consult. They’re the specialists in that sort of thing nowadays. They’re supposed to be better at it.
They’re going to start by trying a lidocaine patch, right over where his chest wall hurts the most. Will post back with results. The drug-seeker thing might just have been me - I’m not saying anyone has outright accused (or even subtly hinted) that this is an issue.
ETA: he’s getting four to six chest x-rays per week, so I’d think cracked ribs would have shown up on those by now, so I don’t think that’s the case.
I’m no expert, but I’m not sure a cracked rib would show up on the type of Xray they do to look at your lungs. And if it wasn’t a clear break, they might not notice it if they weren’t actively looking for it. Have they decided that he’s got cracked ribs?
I did have a rib popped out of place (on my spine) in a car wreck once. That hurt like all hell until we figured out what it was. I can only imagine what cracked/broken ribs must be like, especially with a cough.
It does seem like a lung inflation could strain some muscles in there, though, if they got just a little carried away. Especially if he thinks that’s what caused it because that’s when it started hurting. But that’s totally outta my butt, I’ve never even heard of one and have no idea what it involves.
The lidocaine patch sounds like an excellent plan. If you’re not familiar with it, it’s a local anesthetic. They use it a lot for minor surgery, like getting stitches. If it’s a local injury hurting intensely in one spot, I’d think that should help.
Hang in there, all y’all Shoes.
[rant]Demerol is a poor pain reliever. Studies were done in the '70s & '80s that showed 50mg of Demerol had about the same pain relief as 2 Tylenol. It makes patients sleep, that’s not pain relief. I once had surgery and had Demerol after. I would dream about how badly I hurt, but the nursing staff would tell me I was asleep, so it must be working.[/end rant]
horseshoe, no, you won’t be labeled “drug seeking by proxy” for asking for better pain management. Suggesting they call in an expert in pain control is just advocating for someone you love.
I suggested Tramadol because I’ve used it on peds ICU patients and it works great. I’ve also had experience with it for myself when I was on medical leave for a bad back strain.
Really? Wow, I never knew that. I was basing it on how well it seemed to work for the SpousalUnit in the ICU after surgery.
It did definitely bring on the sleep, though, after the initial “but I feel fine, why can’t I go X?” argument. I just thought it made you very suggestible, so that when I said “Why don’t you rest for a minute first”, that’s what happened.
Thanks for the info!
His pressure is down from 18-20 to 15 on his vent, for the nurse-types following along. He did say that his chest hurt a little bit less today, too, so that’s good.
Another vote for tramadol. I had it for a herniated disc in my lower back and it worked miracles.
Add me to the “fuck Demerol” camp. As picunurse says, it just makes me sleepy and stop complaining, so the nurse can say I’m not in pain.
Dilaudid, I love. For me, it kills the pain and makes me certain I’ve never felt pain in my life. All my chronic anxiety and my situational anxiety is just…gone. Lovely, lovely stuff that I could totally get hooked on if it was more readily available. But I don’t know enough about painkillers to know if that’s appropriate for his situation or not. It’s pretty dang powerful stuff.
Oh, wow. I thought he’d been weaned off the ventilator.
StG
I think we’re still in the “breathing unassisted for an hour or so a day” phase, right?
What are the expected stages? Bump it down to a CPAP, then to room air? Or will there be more stuff in between?
Another vote for Dilaudid as an awesome pain “delete button”/anxiety relief drug. Just made me feel wonderful, rapturous, calm, and happy. I got great sleep, woke up refreshed and sharp. I only got it ONCE though. They kicked me down to Vicodin and Motrin afterwards. I believe it’s got a bad reputation for being habit-forming.
I believe it’s an hour twice a day now of unassisted breathing, up from 1/2 hour twice a day. He said his chest hurts a bit less than earlier today, too. ETA: not sure what the other step-down stages will be, exactly, but I know they’re going to keep on with the respiratory techs, loosening his trach collar, etc.
yawn Damn, it’s almost 11:30 p.m. and I just now got back home. He’s gone from pissed off, frustrated and borderline suicidal to kinda bored and lonely. Still sucks to be him, I guess, but it’s an, um, better kind of sucky? I guess? Anyway, I had a long-ass day at work and was yawning at his bedside but he just really didn’t want me to leave. So I didn’t. There had better be a nap in my Saturday afternoon. Dishes may have to just go and be damned, although I’ll still have to get around to laundry because he wants fresh socks and, having worked at a place that sells SmartWool and other nicer higher-end cushy fancy socks, he simply cannot abide the cheap cotton hospital socks.
Oh, and on an unrelated note, I came home to a note taped on my front door. Apparently one of my neighbors is having a party (pre Halloween weekend) and was nice enough to let me know 1) that I was invited, and 2) two phone numbers “in case of any concerns” i.e. please call us first if the noise is too much instead of just calling the cops. I thought that was a nice gesture, and if I was less tired and less of a complete introvert I mighta wandered over. So, I was charmed. And nah, they’re not being that noisy!
The advantage Tramadol has over Dilaudid is that Tramadol doesn’t suppress respiratory drive, where Dilaudid does, and longer than it relieves pain. So, it’s not a good choice for someone weaning off the vent.
I call that progress - bored seems a very good sign. you aren’t bored when you are completely miserable.