shortage

at the risk of sounding like a paranoid schizophrenic, the world is ending, people.  and this is how we're all going to go.

every day i go to work is a day that i find out that we're short another drug.  first they took our IV zofran away.  this is after most of the other anti-emetics were already in shortage (goodbye droperidol, i miss you compazine). hey, do you know who gets all barfy?  surgical patients.  trauma patients.  ALL MY PATIENTS.  but that's ok, stick this tablet under your tongue and try not to actually vomit until it dissolves.

then they took my IV metoprolol.  hello unsafe swallow dementia patient who is 81 years old and has the A-fib.  allow me to chop this pill up and swirl it in applesauce, then say a prayer to the hospital gods that you don't 1. aspirate in front of my face 2. spit it back at me or 3. refuse to swallow the yummy mixture until i have to go in after it with the yankaur.

IV benadryl?  don't need that.  when the anaphylaxis sets in and my patient is unable to swallow a pill due to her rapidly expanding tongue, i'm sure that pharmacy will be able to sent me a vial from the medicine vault before she codes.  

and who really thought that IV ativan could be adequately substituted with PO?  i would like them to come try to hold down the CIWA patient who's in full DTs while i try to shove a pill down his throat.  

but the worst of all came last week, the shortage that has truly made me think that the apocalypse is upon us.  

OUR PCA SYRINGES ARE IN SHORTAGE.  cue widespread panic and looting and pillaging and angry mob-bage.  

summer is coming, and my unit becomes land of the PCA.  so you got shot 8 times while "just sitting" in the car outside your house eating yourself some chicken?  please have a PCA!!  oh, you got stupid drunk and then hopped (helmet-less, of course) onto your motorcycle and ran yourself into a wall?  enjoy delivering your own medication, via PCA, for your comfort.  

all sarcasm aside, the shortages really are starting to scare me.  sometimes a PCA is the only way to get pain under control on the floor.  with 4-5 patients, i don't have the time to sit in one patient's room pushing small doses of narcs every 10 minutes, nor to i have the monitoring capabilities to give high-dose narcotics.  therefore, summer will go one of two ways.

1. you will get your 2-4 mg of IV morphine or 0.2-0.4 mg of IV dilaudid q 1 hour PRN and like it.  i will make you ice packs and heating pads and prop up your broken limbs and fluff pillows and emotionally support you until you are vilified.  and everyone will be pain-free and happy. (likelihood: haha, yeah right)

2. first the MDs will try to make the nurses human PCAs and write for PCA dosing to be giving IV push.  after that gets shot down, they will begin to write for larger doses of meds and i'll be back to the days of keeping an extra vial of narcan handy.  then narcan will go into shortage and the world as we know it will really be over.

makes me want to go all doomsday preppers and start hoarding dog antibiotics to prepare for end-times, i tell ya.