1EMT-P

I do not feel comfortable giving narcotics to patients with abdominal pain. Especially if the patient has acute pancreatitis or renal failure.

I was always taught that you should not give any narcotics to patients with abdominal pain because it could alter their exam and it could also prevent them from consenting to procedures. I have had ED Docs give me orders for Toradol for renal colic/pain.

I really would like to see additional education in the area of pain management for both hospital & pre-hospital providers.

In addition to pain medications, I also like to use breathing exercises, cold packs, position of comfort & splinting.

I think we could do a better job at managing pain in the field. I like to use combinations of medications like Benadryl + Morphine, Phenergan + Morphine & Phenergan+ Toradol for pain.

Anytime you have a patient with a history of HTN complaining of a severe headache 10/10 and/or the worst headache of their life it is best to assume that the patient is having a CVA and/or SAH until proven otherwise.

I had a case similar to this case about six years ago. The lady was 52 y.o. with a history of Asthma, Anxiety, Depression, GERD, High Cholesterol, HTN x 20 yrs. and a Pacer for Tachy-Brady Syndrome. The lady was on Albuterol PRN, Ativan, Lasix, Lipitor, Paxil, Pepcid PRN and Verapamil SR. She went outside and walked down some steps at her house and developed what she called the worst headache of her life. She rated her pain as 10/10. Her vs were as follows BP 210/120, P 120, RR 20, SPO2 95% on Room Air. The patient was given supportive care and transported to the ED. At the ED she was assessed, a Stat CT was ordered and labs were ordered. Prior to going to the CT the patient complained of nausea and was given IV Compazine. She was transported to the CT where a diagnosis of SAH was made. The patient was given IV Ativan and was flown to a larger teaching hospital with a Stroke Team. Upon arrival in the ED she was given SL Procardia and an Art Line was placed and she was transferred to the SICU under the care of Neurosurgery. Over the course of the next 9 days the patient was given Nimtop and monitored until she was discharged on both Lopressor and Nimtop.

When I took my first ACLS class we were responsible for not only reading the book, but we were also responsible for knowing all of the ACLS medications, Ekgs and modalities and the rationale behind the various modalities & treatments. There was no such thing as a group code or open book test. You either knew the material or you didn't.

Was she taking any medications like Effexor, Lexapro Paxil, Prozac or Wellbutrin by any chance?

I would have encouraged this patient to go to the hospital for an evaluation, given her chief complaint, signs and symptoms. The list of possible causes are endless.

How many of you have taken the CCEMTP course or the CCP course? How many of you do Critical Care Transports?

Fentanyl has a better hemodynamic profile & a better side-effect profile than Morphine. It causes less histamine release, less hypotension, less nausea & vomiting, less respiratory depression & it's shorter acting than Morphine.

Fentanyl:

Onset Action: Immediate IV

Peak Effects: 3-5 Minutes

Duration: 30-60 Minutes

Usual Dose: 25-100mcg

Is Fentanyl the perfect analgesic for EMS? It has a very rapid onset when given IV. It can be easily titrated. It causes less hypotension, respiratory depression & sedation than both Meperidine & Morphine & It does not cause histamine release. Plus it doesn't seem to cause nausea.

Oh Say It Isn't So = Oxygen Saturation, Suction Equipment, IV Line, Intubation Equipment & Sedation & Possible Pain Medication.

I think we have to address the patient's A-fib, CHF and COPD if we are going to have a successful outcome. Instead of cardioverting the patient, I would rather control his rate, decrease his anxiety, decrease his hypoxia, decrease his symptoms and decrease the workload on his heart.

The Relative Contraindications For Beta Blockers Are:

1. Asthma

2. Bradycardia (Less Then 60 BPM )

3. COPD

4. Hypotension

5. 2nd or 3rd Degree Heart Block.

Beta Blockers were once believed to be contraindicated in patients with CHF, but now they are considered first line treatment for patients with mild to moderate CHF. There have been several large studies done that have shown that Beta Blockers actually decrease mortality in patients who are already on heart failure medications like ACE Inhibitors and Diuretics with or without Digoxin.

I would assess the ABC's, Start the patient on O2, Start an IV of NS@KVO & Place the patient on the Cardiac/SPO2 Monitor. I would also consider giving the patient an Albuterol+Atrovent Nebulizer treatment for his COPD/SOB and # 4 Chewable ASA if he was having any signs or symptoms of Angina or AMI. I would also consider giving the patient a trial of either Diltiazem 0.25mg/kg IV over 2 minutes up to 20mg or Metoprolol 2.5-5mg IV over 2-5 minutes to a max. of 15mg. If the patient did not respond to a trial of medication then I would sedate him with 2.5-5mg IV Valium and use synchronized cardioversion starting at 100J.

I like to start off with Oxygen first, followed by # 4 Chewable 81mg Baby ASA. If the patient's BP is stable then I will consider giving # 1 dose of SL Nitro without a line.

Most of the pacers that I have seen have been implanted in the left upper chest, but I have seen a few that were implanted in the abdomen & the right upper chest. Most pacer patient's usually have a small scar & sometimes you can feel & see an outline of the pacer.

Just NS.

Do any of you use Reglan + Benadryl for nausea & vomiting?

How many of you still carry D5W & LR?

Are there any private services in your area that would be willing to take over covering transports after your transport crew leaves. Maybe your agency could do 12 hours of coverage and the private could do 12 hours of coverage. Just a thought.

Good Luck!

Rid as I understand it, every health care agency who transmits health information electronically is covered regardless of their size. It is also my understanding that a hospital ED may give a patient's billing information to an ambulance service who transported the patient to the ED, but that the hospital may not disclose any protected health information about the patient's condition or treatment to the ambulance service once the patient/provider relationship has ended without written consent from the patient.

It can be difficult to assess patient's in the field especially if they are not fully alert and oriented. If you did a full head to toe assessment on your patient in the field, followed your protocols and treated the patient to the best of your ability then I don't think you did anything wrong.

It sounds like your colleague needs to review the HIPPA rules, before he goes discussing a patient's diagnosis or treatment in the ED.