A woman in her 50s was treated in a burn center and brought to our facility for continued medical treatment of her delayed healing leg. It looked like she got her lower leg stuck underneath a lawn mower, when it was actually due to a heating pad. Surgery was done to clean out the wound and remove dead tissue. External fixation was placed to ensure proper placement. After 3 months of hospitalization, the patient decided to get it amputated due to the severe pain. She was also aware that even if the leg healed, it would take extensive rehab to ever walk again.
This scenario justifies the importance of pain management and education. Pain is now seen as the 4th vital sign. We ask everyone if they are in pain and will medicate the said pain if present. Many patients immediately expect narcotics and opioids to be the only relief for their pain. Educating on nonopioid or no nonpharmacological pain management is crucial to effectively treat pain. These modalities include NSAIDS, ice/heat therapy, massage, imagery, and movement among others.
This patient had several moderate dose narcotics available as well as IV ketoralac/ Toradol. The only medication that was actually effectively for a long duration was the Toradol.
Toradol is classified as an NSAID and can only be given up to 5 days to prevent GI bleeding and kidney issues. However, with it being an anti inflammatory, this medication was greatly effective for a recently amputated leg. The patient was aware of that and only requested the Toradol for her pain. Education is key.
Aside from the pain management of this woman, her positive outlook on her situation is also what leads to positive healing. She repeatedly stated how God will bring her through any situation she faces. She was confident that this was in her plan and was determined to do anything it took to heal her body.
We actually developed a good rapport after realizing we both favor a particular pastor and both plan on attending his church after the pandemic.
It is important to not simply treat the patient, but to try and communicate with them as human beings. You never know who is in that bed.
When I was going off shift, she reminded me that if my leg was ever hurting, not to wish to cut it off.. I plan to take that advice to heart.
Until next shift,
Shania