[Verse 1]
Eighty-two years old, hip snapped like a dry twig,
Post-op, confused, eyes wide, brain doing a jig,
Can't self-report the pain, delirium's got the wheel,
So we pull out PAINAD, let the behavioral cues reveal —
Facial grimace, rigid posture, vocalization sounds,
Five domains, scored zero-to-two, that's how we make the rounds,
CPOT for the ventilated, nonverbal is the art,
Reading bodies like a language when the patient can't impart
Now pivot — six years old, sickle cell's a storm inside the bone,
Vaso-occlusive crisis hits, he's crying, scared, alone,
Too young for numeric scales, abstractions fall apart,
So we hand him the Wong-Baker Faces, let him point to what his heart
Communicates — six little faces, zero through ten,
Or FLACC if he won't talk — Face, Legs, Activity, Cry, Consolability then,
Different tools for different minds, one-size fits none at all,
Know your patient, match your measure, that's the clinical protocol
[Chorus]
PAINAD for the elder lost in fog,
FLACC for the child, Wong-Baker for the dialogue,
Structured risk before the opioids flow,
UDS positive? Metabolites — you gotta know
ASSESS before you prescribe, interpret what you see,
ORT, DIRE, PDMP — that's the pharmacology
[Verse 2]
Now here's a puzzle wrapped in chemistry and doubt —
Patient's on hydromorphone, but the urine screen comes out
Positive for morphine — hold up, is this a violation?
Pump the brakes, pull the pharmacokinetics, do the calculation,
Hydromorphone metabolizes — norhydromorphone, that's expected,
But morphine ain't a downstream product, that connection's disconnected,
So morphine in the urine means one thing, crystal clear —
An outside source, undisclosed use — the conversation's here
But don't jump to termination, that's a lazy clinician's move,
Document the finding, have the structured talk, stay in the groove,
Codeine converts to morphine — did they take grandma's pill?
Poppy seeds are folklore, but the enzyme CYP's real,
Two-D-six polymorphism? Ultra-rapid metabolizer?
Rule out the variables first, be the evidence advisor,
Confirmation by GC-MS, don't act on immunoassay alone,
False positive versus true diversion — earn the data before you throw the stone
[Chorus]
PAINAD for the elder lost in fog,
FLACC for the child, Wong-Baker for the dialogue,
Structured risk before the opioids flow,
UDS positive? Metabolites — you gotta know
ASSESS before you prescribe, interpret what you see,
ORT, DIRE, PDMP — that's the pharmacology