ccmedoc Posted February 13, 2008 Share Posted February 13, 2008 ...but often I just think... Pain lets you know you are still alive.... and we cant be doping up every pt with some kind of pain we encounter 8/10 or 5/10 from someone with chronic pain....treat the pain! :angry1: Link to comment Share on other sites More sharing options...
triemal04 Posted February 13, 2008 Share Posted February 13, 2008 8/10 or 5/10 from someone with chronic pain....treat the pain! :angry1: This wouldn't be one of the people I've had that told me very calmly and quietly while in no discernable distress that this was 10:10 pain and "worse than I've ever felt it," would it? Link to comment Share on other sites More sharing options...
ERDoc Posted February 14, 2008 Share Posted February 14, 2008 Keep in mind that not all pain requires narcotics. There are plenty of nonnarcotic pain relievers out there (though I realize that on the ambulance you are limited). There is no real way to test for fibromyalgia. It is basically a diagnosis of exclusion. These pts are fully worked up and have no real cause for the pain. They must have 12 pain points (I believe). This means that they have to hurt when you push on 12 spots on their body. There is a huge debate over whether fibromyalgia is real. Even the physician who first coined the phrase says that he was wrong and there is no such thing as fibromyalgia. Many people feel that fibromyaglia is just the physical manifestations of an underlying psychiatric illness such as depression. Giving pain meds to treat fibromyalgia is probably not the best method to treat these pts. They need the psychiatric support such as SSRIs, therapy, behavior modification, biofeedback etc. Fibromyalgia has almost become the medical code word for a difficult pt. I think it is applied to way too many pts (assuming it is even real). That being said, in this case pain control is appropriate. She might have a legitimate injury. Does she need narcotics? No, not necessarily, but if it is all you have then you do what you have to do. Just watch out for the ones that say they have end-stage fibromyalgia. NO ONE has ever died from fibromyalgia. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 14, 2008 Share Posted February 14, 2008 On a side note, if the pt didn't have fibro, just the pain, you dont have to give every pt with pain, pain meds. Its cost vs benefit not treat the pt not the monitor in this situation. When a pt really needs pain meds, you will know... but often I just think... Pain lets you know you are still alive.... and we cant be doping up every pt with some kind of pain we encounter WHOA wait a second, now it's cost versus benefit for us ole medics? We do have to watch our pennies but what the heck, withholding pain meds due to a cost benefit analysis. That's just plain Whacked out. I just spent the last 31 hours with migraine. I went to the local doc in the box clinic at 9am today and he said "to look at you I'd say you were a very healthy guy and not sick at all" but he gave me 100mg demerol and 50mg of vistaril for my headache because he believed me, not because it was a cost benefit analysis. So for someone to use that analogy "cost benefit" it shows me they have been to too many financial classes. Link to comment Share on other sites More sharing options...
backinboston Posted February 14, 2008 Share Posted February 14, 2008 sorry, this was poorly worded and not completely explained. I was not implying to look at this from a finanical cost vs benefit. More I was looking at it as, how much morphine is it going to take to make this pt with possible pain (pain is often exaggerated) to get them comfortable down the "bumpy road" the ambulance is going to go down. I was talking about cost vs benefit of giving a med with obvious resp depressant effects, reduced preload/afterload effects etc... When if they can just deal with the pain for just a little longer than they already have can get those "good" pain meds when they reach the ER from an MD that will look at the whole picture that the pt brings into the situation (PMH) and then choose from a wide array of drugs to give the pt relief. ps: I could care less how much something costs if I really feel it will help the pt I would use the most expensive anything and I just had someone do my taxes because "I have people" (aka i know nothing) Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 14, 2008 Share Posted February 14, 2008 that was a good explanation on explaining what you meant. I understand your thoughts now. one funny story that happened to me we had a MI patient who had Eminase ordered for them. This cost 3200 per dose. I mixed it up and at the last moment the receiving doc in the heart center said HOLD the eminase and get him to the cath lab first. Well I just put the vial of eminase in the sharps box. I found out that the vial cost 3200 and I would have to pay for it. ha ha ha joke was on me. The hospital ate the 3200 dollars. Link to comment Share on other sites More sharing options...
ccmedoc Posted February 14, 2008 Share Posted February 14, 2008 This wouldn't be one of the people I've had that told me very calmly and quietly while in no discernable distress that this was 10:10 pain and "worse than I've ever felt it," would it? I didn't necessarily mean narcs. We use Tylenol, Toradol, fentanyl, morphine, dilaudid, versed, and valium...Nice to have these options and I understand most don't...I understand your comment, but this patient and those like her would most probably need the pain addressed..with which one..?? Link to comment Share on other sites More sharing options...
backinboston Posted February 14, 2008 Share Posted February 14, 2008 Honestly, when it comes to pain like I stated earlier if they need pain meds from me, its going to be obvious. Often the natural "pain" meds will kick in or id rather talk them through it. I am usually against unnecessary med application unless its truly appropriate. Another part of this ideal is the receiving MD/RN is unable to truly see the pt for who they are when you bring them in and any other injuries that may have occurred are undetectable once they have those meds onboard. If they break their elbow and its the obvious pain for the pt, whos to say that once they are able to control/deal with the pain that they may begin to realize they have pain in that quad of the abd because the elbow actually slammed into the rib and may have caused internal injury. Pain is for a reason Link to comment Share on other sites More sharing options...
triemal04 Posted February 14, 2008 Share Posted February 14, 2008 I didn't necessarily mean narcs. We use Tylenol, Toradol, fentanyl, morphine, dilaudid, versed, and valium...Nice to have these options and I understand most don't...I understand your comment, but this patient and those like her would most probably need the pain addressed..with which one..?? Krispy krap you lucky dog. Best I can offer is fentanyl, nitrous and versed. Much better than just morphine but damn... To be clear, from what got posted in this case the lady more than likely should have gotten a shot of something to help her cope. From your list I'd have gone straight to Fentanyl, backed up with valium/versed to help her relax if needed. And in your situation you may face the problem of having a DSI less than others (or more given the variety of what you carry). My point is really that, as I said, pain is very subjective and hard to judge when it's not you feeling it. If all you carry to fix pain is a narcotic...you're going to get played by some patients and end up helping to get them their fix when they have no medical need for any narcotic pain killers. Not to say that you should withhold meds from someone who needs them, but there are traits that people tend to display as DSI's, and a lot that I've had whip out the fibromyalgia card awful fast. I'm guessing that having the ability to give Toradol (long as it's not contraindicated) tends to help deal with drug seekers. Link to comment Share on other sites More sharing options...
ccmedoc Posted February 14, 2008 Share Posted February 14, 2008 This woman was probably not seeking..I do agree that the Toradol does have an impact on the seekers around here, as does the tylenol..The drug seekers know we carry more, but don't give it that easy. Depending on the situation, NSAIDs are the bomb when sorting them out... edit: sorry for the double post...browser stuck :oops: Link to comment Share on other sites More sharing options...
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