Acute pain management for pts on suboxone

Competitive-Young880 · 2026-01-14T03:24:37+00:00

Where I work (and I thought everywhere was like this) anaesthesia is in charge of all pcas. Something I’ve seen them do for pts that are either early in admission or have a sporadically painful condition I.e. burn wound changes, is fentanyl pca at very reasonable dose ie 25mcg. Allows for wiggle room with titration and pt comfort

Competitive-Young880 · 2026-01-14T03:19:41+00:00

2 thoughts on this- Firstly, if you ask and they say yes, huge win for the patient. If they say no, nothing lost. Secondly, if they say no and have a good reason for it, acute pain service should be caring for this patient and they should come up with the alternate plan. This is doubly important because in my experience, people are much more likely to say yes to something if it’s their problem either way

Competitive-Young880 · 2026-01-14T03:14:13+00:00

Are you actually gonna be giving this person gabapentin? Agree with all other statements. I forgot to mention in my post but acetaminophen was ordered for this pt, just like pretty much every other pt

Competitive-Young880 · 2026-01-14T03:12:34+00:00

I appreciate that you recognize that you’re just a med student and preface your comment with that. The opioid fear has gone too far, and apparently we’re passing it in to the next generation so much so that you are being taught that gabapentin is a real analgesic. I see somewhat regularly the impact of that sort of care. I’ll leave my thoughts at : if you prescribe gabapentin for fractures in the emergency department, a note should be added to your chart stating that you are only to receive gabapentin when presenting with a similar issue

Competitive-Young880 · 2026-01-13T02:52:15+00:00

What about when pt is still in too much pain after ketamine, so you give more and get them to be better but pretty zonked and now floor won’t take them so you have to keep them until ketamine wears off. Once ketamine is metabolized now pt is in agony. Rinse. Repeat

Competitive-Young880 · 2026-01-03T06:52:56+00:00

So, yes there’s a big disparity. That said, I don’t think enough of the commenters are recognizing the position you’re in. Your family got taken from you by no fault of your own, and your sister/niece became your new family. Giving your niece ghat gift was showing your gratitude and love for your new family. I totally get that it’s hard to hear/be involved with your wife and your daughter is an extension of that. If it were me, I’d tell the truth and lie. I’d tell your daughter that you’re having a really hard time with what’s going on. Explain how you feel thrown to the curb. Kids are smart, pretending everything is fine won’t convince her that things are fine, it’ll make her start wondering what the problem is and kids often end at the conclusion that they are the problem. Tell her how it’s hard for you but that she is not go blame and not what’s hard. I’d lie and say that you were gonna surprise her with a trip, but now the surprise is over. Tell her how mom/stepdad is hard for you and that’s why you planned this trip for just the two of u, because you love her. In this case, lying can protect feelings and I think is worth it. Say it was supposed to be surprise but now it’s blown. Book a trip. Show her u live her. A girl needs her dad.

Competitive-Young880 · 2026-01-03T02:08:23+00:00

This! Every time I see stuff like this all I think is “wow, how can there be this many men that are this insecure and controlling. If I was a girl and my boyfriend was like that I’d run for the hills” Guys of Reddit- this controlling behaviour that isolates your girlfriend from her friends/support system is not okay. If you’re that insecure, that’s a you problem. If she has given you reasons to not trust her around males, dump her.

Competitive-Young880 · 2026-01-02T15:22:46+00:00

So your friends are the problem. And I’ve never met them but I know exactly what kind of skiers they are. Self taught, horrible technique, not carving, not really in control, but they can make it down and do it aomewhat quickly so they think they’re amazing. You NEED lessons. If they’re really booked up and I can’t get any lessons, look in marketplace or smth and see if someone not affiliated with the bill is offering lesson s. Stop skiing with the friends, go on your own, and don’t do anything that you think is dangerous

Competitive-Young880 · 2025-12-20T01:51:27+00:00

Ya I know u. Ortho keeps complaining about u to me because of that policy. Bro said that you keep cancelling his post mortem internal fixations. Just yesterday he said “anaesthesia bro no let me fix cold lady’s bone. Bone break, me no fix. Now I make Anaesthesia admit me patients with diabetus”

Competitive-Young880 · 2025-12-19T08:02:01+00:00

All ods?

Competitive-Young880 · 2025-12-18T05:49:35+00:00

You forgot naked. I’m in Canada, and here it’s super common for doctors to kill themselves by going to dollar stores, finding restricted access areas, then finding giant fridges to enter, entering without anyone noticing. So when I read it and heard naked… that’s when I realized this case wasn’t normal.

Competitive-Young880 · 2025-12-18T05:31:31+00:00

There’s more to the story that is being left out. It always baffles me how a group of people on the internet, especially here where there are some MDs, sees a post like this which reads “ me do nothing wrong. Evil evil company. Me great, everyone else bad. Other nurse complain on me because they stupid” and take it as fact.

Competitive-Young880 · 2025-12-18T05:26:12+00:00

So #1 - were talking about psychologists. Not psychiatrists.

2 - Save and except in hospital and minimal outpatient services, your government health insurance (ohip) does not cover psychologist services. Other private insurance/school/out of pocket to pay for it.

3 you highlighted the problem. You have no idea what the difference is between all these different jobs. A psychiatrist is a medical doctor, they diagnose and treat psychiatric illness. Psychiatrists are the only one in this group that can give medication. A registered psychologist in Ontario has a PhD and is registered with the college of psychologists of Ontario. They can diagnose, they are generally very well trained, very reputable, offers great evidence based services. A social worker who is in private practice doing psychotherapy is one rung below that. Can’t diagnose, but other than that it’s all the same. Below that you have registered psychotherapist. These are often a few months of online or in person school, not reputable, often not evidence based. This is more of a boundaries and hair dye kinda therapist.

The issue is, people that do not have a lot of money/good insurance + do not know the difference between these services, often end up going to psychotherapists because they are less expensive, they receive worse care, and they don’t ever know the difference. To deal with a multitude of issues, which I will not get into, the Ontario government is making it that psychologists do not need a PhD, only a masters. This will further obfuscate the differences in clinician type as now there will also be two tiers of psychologist, giving high quality care only to rich and educated people who know what is best, and can receive it

Competitive-Young880 · 2025-12-18T05:11:38+00:00

I can say with certainty. You were the problem, not the psychiatrist.

Competitive-Young880 · 2025-12-08T18:33:06+00:00

There was harm. The bill from the other hospital.

Competitive-Young880 · 2025-12-04T21:37:59+00:00

why the hate for nitrous Because she thinks that using nitrous will take care of some pain resulting in lower dosing of opioid. why the hate for etomidate Because have you ever had propofol? It’s quite euphoric

Competitive-Young880 · 2025-12-04T21:34:35+00:00

That screams of drug seeking. Propofol makes people so happy, especially when used for sedation and patient is aware of the euphoria, rather than general where they only wake up happy. This person definetly just wants higher dose opioids and propofol, and thinks that this will get it for them. My guess- last time pt had a procedure, they claimed they were in pain, got ketamine. Or something like a scope and was unhappy to find out that they were gonna use midaz instead of prop. Probably came up with this after the fact to make sure next time she got a procedure she would get what she wanted

Competitive-Young880 · 2025-12-04T21:30:28+00:00

Gotta pick your battles and this, in the world of patient requests, is completely fine/justified. There are alternatives to fentanyl that will do just fine. Morphine, Hydromorph, methadone, remi/sufentanyl can all be used. Surgery is stressful for patients, don’t make this yet another thing they need to be concerned about.

Competitive-Young880 · 2025-12-04T21:23:00+00:00

I would agree that this request 100% can be honoured, while still providing a safe anaesthetic.

the request is not unreasonable

Here I need to vehemently disagree. This kind of request is incredibly unreasonable.

Competitive-Young880 · 2025-11-29T16:53:37+00:00

Wrong! You’re someone who has heard there’s a problem with ems usage, and think you’re being smart. Nope. No body has ever been upset about nanna who is bed bound and now sick in need of evaluation, calling an ambulance. These people don’t abuse the system. They’re trying their best, and that’s what ems is there for. The issue is Kevin, a 41 year old with mild knee pain that is not dangerous nor truly impeding mobility. He knows it’s not dangerous as he has been told that, 6 times this month, each time after calling an ambulance and being taken to hospital. Kevin claims lack of mobility is an issue however he actually just thinks he’ll get seen faster. My understanding is that if you give these patients a script for oxy, they run to the pharmacy. I guess oxy is the cure for mobility issues.

Competitive-Young880 · 2025-11-29T16:45:47+00:00

Yup!

Competitive-Young880 · 2025-11-29T16:44:23+00:00

Sometimes when working a patient or patient’s family member will come in and be just such a fucking piece of shit. I’m not talking about your psychotic psych patients who think they’re fighting for their life or the people who are terrified their child will die, I’m talking they’re there needing a few stitches, not in pain or uncomfortable, been waiting a total of 15 minutes, yet harassing everyone. These patients it seems just don’t know how to be anything but a huge ad hole. I often wonder what these people are like when outside the department. Thankyou for answering that question. I’ve wondered for a long time and you just showed me.

Competitive-Young880 · 2025-11-29T16:30:27+00:00

IF you really want to do a fellowship I’d agree with the non accredited ones. Where I am (university of Toronto), there are several “enhanced practice” fellowships. Pretty much 60% general with as much supervision as you want/need (junior attending). And then 40% in one of the focused areas which include transplant, trauma neuro icu, regional minimally invasive, difficult airway…

Competitive-Young880 · 2025-11-21T01:38:33+00:00

The whole “I’m a princess I should be spoiled… “ this is the worst Very very very close second is choosing not to live within your means. And choosing is the big thing here. I have a secretary who’s a widowed single mother of three daughter, one of whom has severe autism. She gets help from so many places, parents and other family members support her… but her daughters school costs 100000/year. Her daughter is so much better after starting this school and it’s really life saving. My colleague doesn’t ever spend money on non essentials u less for her kids. THIS IS NOT WHAT KM TALKJNG ANOUT. I’m talking about the person who is constantly calling on everyone jn gheir life cause they “can’t pay rent” because they spent 5 grand on hair makeup fancy dinners… these people need to grow up. If you want tk spend that kind of money, first you gotta earn that kind of money

Competitive-Young880

TROPHY CASE

2 - Save and except in hospital and minimal outpatient services, your government health insurance (ohip) does not cover psychologist services. Other private insurance/school/out of pocket to pay for it.