57 yo female, s/p EGD/Colonoscopy.

Hx Migraines, Crohn’s, RA, Morbid Obesity, COPD, DM
Meds: Sumatriptan, Prednisone, Dilaudid ("rare" for HA), Ventolin, metformin

Patient undergoes a 36 min procedure w/o issue receiving 50 mcg Fentanyl, 1.5 mg versed, 15 mg Ketamine, and 180 mg Propofol and is taken to RR. Patient is sedate but appears to be comfortable and stable.

You write standard RR and D/C orders for this procedure (for pain specifically up to 200 mcg Fent. IVP) and leave to do another case.

In 30 min, PACU pages to inform you that your pt is not comfortable. HR 105, BP 163/100, RR 24 Stats 94%.....complaining of severe cramping in the LLQ.... She has received 200 mcg Fent w/o effect....

Next step - students first please....