Another snake bite. This one wasn't provoked. Poor guy was cleaning his shed and the damned snake latched on. Somehow he killed the thing and brought it in. It was a copperhead, which is never good news.
The bite was to his right hand. He was swelling quick and it was moving up his arm. He needed CroFab right away.
So I ordered the standard loading dose and asked the pharmacy to make sure they had enough vials ready...this guy was sick.
The pharmacy kept farting around, and we had to keep calling to rush them. Then the charge nurse came up to me and said, "ER Doc, the pharmacy wants to make sure you know how expensive the CroFab is. They said it is $2,000 dollars a vial." My reply was simple, "Get the pharmacy on the phone now please."
Me to pharmacy boss: "This is ER Doc. I heard you have concerns over the price of the crofab for my rapidly declining patient. You know I am not giving him CroFab for fun. Do you want to call the manufacturer and ask for a discount? Was there a new magic medicine made for this I don't know about? Or how bout I have Ortho come down and chop off his arm because that might be cheaper? Or....maybe I should just let him get worse and die? What do you think of all that? Do you have any suggestions since you are so concerned?
Pharmacy Boss: "Uhhhhhh"
Me: "Then just give me the damn meds."
The CroFab arrived shortly after.
-ER Doc
16 comments:
Jesus H. Christ, I'm embarrased to be a pharmacist right now...
There is a time and a place for utilization review. This was neither the time nor the place. Good for you, ER Doc.
Yeah, last time I had to give Crofab our pharmacy sure did tube me the vials with the powder so I could mix it myself. Fail, return to sender.
good lord, how many signatures are required for an epi-pen?
Although I never shrug off anyone from asking questions, when life and death are hindering, just do as I say. Please!!!
Well done. And I'm hoping your quick thinking made a difference, bud.
Jim
@SuFu: In my home state, Epi-Pens run around $600 for a 2-pack. (My parents found that out when my younger sister was briefly dropped from their health insurance.) Might differ for other states.
As for snakebites, that copperhead picture is creeping me out. If that damn thing latched onto me, I'd probably die from a fright-related tachycardia before the poison could kill me...
This makes me glad I live in an area that is devoid of snakes. You made a good call on this one.
Webster, where do you live that has no snakes? Ireland? We have copperheads (as well as cotton-mouths and the occasional rattlesnake) here in Eastern Missouri and I always wondered what would happen if one bit me. Now I know! Guess I better skip the Urgent Care and head to the Level 1 trauma center for venomous snake bite?
There are no snakes in Alaska! We all got a hoot when the new Walmart opened and had snake bite kits on huge display!
We have a love hate relationship w/ our pharmacy. They don't feel L/D meds are important enough to send in a timely fashion. The procedure is that we have to call them and let them know we need meds. Often the med we need is the cart which is out to delivery...but not to our unit first. Now I realize antibiotics aren't a life and death drug for most units...but to prevent a GBS positive mom from having a GBS sepsis baby it is a stat med. The moms I work w/ often come in active labor w/ ruptured membranes and may delivery 30min -1hr after they hit the bed. STAT meds please!!!
At L/D person:
if she is delivering in 30 -60 minutes, it doesn't really matter if you give the antibiotics- they need to be treated for 4 hours (or more) to be considered treated, so the kid will need antibiotics anyway.
And, I"m sorry, I'm going to delivery the intubation and narcotic (sedation) medications first and the ones that are due sooner first. YOU AREN'T THE ONLY UNIT I'M TAKING CARE OF.
There are only garter snakes in central and northern Minnesota.
Good job man, good job.
He probably assumed the guy was just bitten by a garter snake because of course we don't know our snakes.
I love it when competent docs go on extended rants on the phone. I'd have gotten a little moist for sure.
PharmGirl.. I'm embarrassed for you. Do you really think that the pharmacists weren't doing their best to supply the antivenin? Way to stick up for your colleagues.
Wouldn't you think something might have gotten lost in translation between the nurse and the ER doc or that they are somehow jumping to conclusions?
Any good hospital pharmacist knows that it takes a long time for antivenin to dissolve into solution after reconstitution, and that's what's probably causing the delay.
Uh no the delay was them worrying about the price. When I got on the phone with them the first thing they said was "do you know its 2000 dollars a vial." Give me a freaking break. There are shitty doctors and good doctors and their are shitty pharmacists and good pharmacists. Its like that in any profession.
ER doc
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