Cascade Hospital Entrance
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Last updated October 10, 1998
The Cascade Hospital is a resource website designed specifically to help FANFIC and other FICTION WRITERS who want to make their stories more medically authentic. It is NOT for people seeking answers to personal medical questions -- that is a job for your private physician.
Pharmacy
~ medications ~
Please read the Sentinel and Medical Disclaimers.
Pain meds
Anxiety and sedation meds (benzodiazepines)
Sleep meds
Constipation meds
Vomiting meds (antiemetics)
Diarrhea meds
Seizure meds (anticonvulsants)
Muscle relaxants
Paralytic agents
Acutely psychotic and combative
patient
Antibiotics
Pneumonia
Otitis media
Cellulitis/infected wound
Surgical prophylaxis
Meningitis
Lyme disease/Rocky Mountain Spotted Fever
Amebic dysentery
Giardia
Malaria
MRSA (super-bad Staph aureus infection)
Pain medicines -- listed from least potent (OTC -- over the counter) to most potent (narcotics)
Tylenol (acetaminophen) -- OTC, a commonly prescribed pain medicine, effective for mild to moderate pain, very few side effects and does not produce stomach upset (aspirin and ibuprofen) and problems with bleeding (aspirin). Does not cause sedation. Good for headaches following head trauma and safe for people with stomach problems or ulcers. Can take every 4 hours.
Ibuprofen (Advil, Motrin, Nuprin, etc.) -- for mild to moderate pain, also commonly prescribed, most people say it gives you stronger pain relief than Tylenol. Produces stomach upset in some people, so doctors often say to take it with food to lessen the stomach upset. Very good for musculoskeletal aches and pains (joint pain, back pain) because of its anti-inflammatory properties. OTC ibuprofen is 200 mg per pill. You can get 400 and 800 mg pills by prescription, which you can take every 6 hours.
Naprosyn (Aleve) -- another NSAID similar to ibuprofen (anti-inflammatory), except that it lasts longer so you only take a pill every 12 hours (twice a day).
Tylenol #3 (Tylenol with codeine) -- a prescription drug given for moderate to severe pain not relieved with OTC meds. Since it contains some codeine (a narcotic), it can cause narcotic side-effects like constipation and drowsiness. You take 1-2 tablets every 4 hours. There's also such a thing as Tylenol #2 and Tylenol #4 with less or more codeine, respectively, but those are less commonly prescribed.
Common narcotic analgesics
Some common narcotic pain meds you can take orally (by mouth): Tylenol #3, Darvocet, Darvon, Demerol, Vicodin, Percocet, Morphine. They all have pretty similar side effects -- constipation, sedation, nausea, dizziness, tiredness, hypotension, and respiratory depression (if you take too much). In someone who's just had surgery, especially abdominal surgery, you have to be careful about making them too constipated (they're already going to have problems because of the post-surgical "ileus" which makes them constipated) and nauseated. You usually give a patient pills for pain medicine after they can eat and after they aren't hurting really badly (since pills take longer to take effect than IV or shots). Most of these you can take 1-2 pills every 4 to 6 hours.
Some common narcotic pain meds you can take by shots (intramuscular injection): Dilaudid, Demerol, Morphine. Same side effects as above. Shots take effect faster. An example of a pain medicine order for someone right after surgery would be Demerol and Vistaril shots every 4 to 6 hours as needed. Vistaril is an antihistamine which is very sedating and helps the person sleep better.
Some common narcotic pain meds you can give IV (intravenously) -- Dilaudid, Demerol, Morphine, Fentanyl. Often delivered via a PCA pump, or Patient-controlled Analgesia. That's where you have some pain medicine put into a small pump and connected to the patient's IV. The patient is given a button to press every time they feel they need some pain medicine. There is a pre-set limit to how often and how much at a time the machine will deliver, so the patient doesn't get over a certain amount. Studies have shown that the PCA pump gives a patient more effective pain control and they use less pain medicine than if they have to ask for injections. Fentanyl is extremely potent -- the most potent narcotic there is. Fentanyl can also be administered as a patch for long-term analgesia.
Anxiety and sedation medications (benzodiazepines)
Xanax, Ativan, Valium, Versed, etc. I thought I'd list these because they're so common. Although they work well, these drugs can be very addicting if taken on a chronic basis. Xanax is commonly prescribed for people with anxiety disorders (i.e. panic disorder), is given in pill form up to three times a day. Ativan is long-lasting and more sedating; sometimes prescribed in a hospital for a patient who is delirious and agitated to calm them down; it can be given as a shot in the arm (helpful when the patient is thrashing around), or as a pill or IV. Valium can be prescribed for anxiety and also can be used as a muscle relaxant -- pill form 3-4 times a day. Versed is very sedating and often used during unpleasant procedures (endoscopy, fixing a dislocated joint) where you don't want the person to go to sleep completely but you don't want them to be anxious or remember (causes amnesia for the period it's acting) -- you can give it as a shot or IV.
In the hospital patients often have a hard time sleeping. The most important thing is to find out why they can't sleep and try to fix the problem -- if they're in too much pain, then they should get more pain medicine, for example. If everything else seems to be okay and they've got insomnia from being in a new place or whatever, Benadryl is commonly prescribed as a pill or shot or IV -- an antihistamine, the same stuff you take for allergies, and it makes you very sleepy. Atarax or Vistaril is similar to Benadryl. If the person seems depressed and the insomnia is more of a chronic problem, the antidepressant Trazodone (pill at night) works very well to help people sleep.
Another common problem in the hospital. Constipation can occur after abdominal surgery or when the person's diet doesn't contain enough fiber, or when the patient is taking narcotic pain medications, and can be very uncomfortable. If the person's very constipated and very uncomfortable, a Fleets enema usually does the trick (though not too much fun for the patient). If things aren't that urgent, Dulcolax pills or suppositories or Colace pills also work well, given as needed. Prune juice contains a similar compound to Colace which is why it also works for constipation. Ex-lax is no longer on the market because there are now less irritating and dangerous compounds than its active ingredient, phenolpthalein.
For long-term treatment, adding more fiber to the diet in the form of fresh fruits and vegetables and whole grain breads, and/or taking a fiber supplement like Metamucil or Citrucel also works well.
Vomiting medications (antiemetics)
Gotta find out why the patient is vomiting, first. If you think it's because of gastroenteritis (stomach flu) or something that doesn't need surgery, and they can't keep anything down, the first thing you have to make sure is that they aren't too dehydrated, because that is the most dangerous thing about continued vomiting. If they are dehydrated, you might have to give them some IV fluids (saline) to rehydrate them. Then you can give them a suppository (patients usually can't keep pills down at this point) of Phenergan or a shot or IV Compazine. After they can keep pills down, you can give them the pill form of either medicine, okay to take 3 or 4 times a day. The person should be encouraged to sip small amounts of liquid (water or Gatorade) throughout the day and probably lay off eating for a few hours. After that, if they have an appetite, they can start slowly with bland foods like rice cereal or chicken soup. Stay away from too much fresh fruits and vegetables and heavy protein and fat like french fries and hamburgers.
One thing you have to watch for is a complication called torticollis which happens to some people when they get Phenergan or Compazine or a related drug. Basically all of a sudden the patient will get this spasm in their neck and start contorting their face and head sideways. It's very frightening to them because they usually don't know what's happening to them and they can't do anything to stop it. If this happens, you give them a shot of Benadryl which reverses the torticollis.
Again, you've got to determine why the patient has diarrhea. If it looks like stomach flu or food poisoning, the best thing is usually to encourage the patient to drink a lot of fluids so they won't get dehydrated. If possible it's usually better to let the diarrhea run its course instead of trying to stop it. Particularly if the diarrhea is bloody (dysentery caused by the Shigella bacteria or amebic dysentery, or a Salmonella infection), it's best not to take any anti-diarrheal medications. However, if it's more likely a viral infection (simple stomach flu) and the patient can't stand it, then you can given them Kaopectate, Imodium, or Pepto-Bismol. Those all work fairly well. In fact, they may be stopped up for several days...
Seizure medications (anticonvulsants)
If someone has an acute seizure, there usually isn't time or need to give a medication to stop it (it's usually over before you can get the medicine out and give it). The important thing is to try to make sure the patient doesn't hurt themselves on nearby furniture or other objects (move those things out of the way if you can). You shouldn't try to stick something in their mouth because they might bite you unintentionally. If the seizure persists for a long time, you could give them a shot of Ativan, but this isn't usually needed.
Treatment of seizures is based on preventing the seizures with regular dosing of medications, and the type of medicine depends on what kind of seizure or epilepsy is diagnosed. Common medications for this purpose include phenytoin (Dilantin), phenobarbital, Valium, Tegretol, and Depakote. These medications also have a lot of side effects, so it's important that the patient is being followed closely by a neurologist.
Used for muscle spasm, back strain of muscles, etc. Also used by people with cerebral palsy and multiple sclerosis. Common medicines include baclofen (pill three times a day) and Flexeril (pill three times a day).
The main use of these drugs is to totally relax the patient before intubating them (makes it a lot easier) and during surgery to relax the body, keep the patient from moving or jerking. Since it is very frightening to most people to feel totally paralyzed, you should give a sedating agent like Versed just beforehand so they don't have to experience this unpleasant feeling or remember it. You also have to provide mechanical ventilation (intubate them) because the paralytic agent will paralyze the diaphragm so the person won't be able to breathe on their own.
There are two main kinds of paralytic agents -- succinylcholine (only one kind) and those in the curare family (yep, the same thing you put on a poisoned arrow). Examples of the curare agents are pancuronium, rocuronium, etc. They all sound similar! The curare drugs last 20 to 60 minutes.
Acutely Psychotic and Combative Patient
We're talking the person that comes into the ER totally out of control physically and a danger to themselves and others, and can't be reasoned with because they're psychotic. To protect the other people in the ER and stop the patient from hurting themselves, one quick solution is to get a bunch of personnel together and have them get a mattress and back the person into a corner and hold them there, while one other person comes with two syringes -- one with Ativan and one with Haldol -- and inject the person with both, anywhere you can get at. This is a very effective tranquilizer combination and usually calms the person down in a matter of minutes (usually they collapse/go to sleep) and then you can proceed to take care of their problem.
This section is super-abbreviated. For more information on these infections, see the Division of Infectious Disease. One must also keep in mind that ideally the doctor will be able to culture the bug from the site of the infection, identify it, and find out exactly which drugs it is sensitive to so the right one can be prescribed. This isn't always practical, so often the initial treatment is "empiric", meaning you take your best guess at what's causing the problem and give an antibiotic to cover the most common causes. This usually works, but if it doesn't, then it becomes more important to identify the bug so proper medicine can be given.
Pneumonia -- for community-acquired pneumonia (as opposed to pneumonia developed in a hospital), erythromycin or Septra/Bactrim. Given for 10 to 14 days. Erythromycin is 4 times a day and Septra or Bactrim is twice a day.
Otitis media (middle ear infection) -- first-line drug is amoxicillin three times a day. If that doesn't work (happens more often in children with recurrent ear infections), there are many drugs available -- for example, Augmentin or Biaxin.
Cellulitis / infected wound (a skin infection, commonly an infected wound, that goes deeper into the subcutaneous tissues -- wound looks red and angry, hot, swollen, pus may be present, painful). Keflex usually works well, four times a day.
Surgical prophylaxis (antibiotic sometimes given right before surgery to try to prevent infection) -- Ancef. May give to a trauma patient in the ER right before going to surgery.
Meningitis -- Rocephin IV, A.S.A.P.! see Infectious Disease section
Lyme disease or Rocky Mountain Spotted Fever -- caused by different organisms, but both diseases result in a rash and are transmitted by a tick bite -- very interesting diseases. Both treated with tetracycline or doxycycline.
Amebic dysentery -- one kind of really bad, bloody traveler's diarrhea -- Flagyl IV if really sick or pill three times a day.
Giardia -- watery diarrhea often developed when camping and drinking out of mountain streams or lakes -- Flagyl pills three times a day for 5 days.
Malaria -- chloroquine or Larium if resistant -- see Infectious Disease section for dosage and length of treatment.
MRSA (Methicillin-resistant Staph aureus; super-bad infection) -- really, really frightening and bad if a patient gets this, usually detected in a blood culture, patient can die. A lot of MRSA is now killed only by one drug -- Vancomycin IV. There is a big fear that eventually the MRSA bacteria will become resistant to Vancomycin and nothing will kill it. Hospitals have strict isolation protocol for someone infected with MRSA -- you have to wear gowns, gloves, and masks when going in to see the patient.