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Pain relief and EMS


BushyFromOz

ALS and Pain Relief  

35 members have voted

  1. 1.

    • Are you in an ALS procider that carries no pain relief
      0
    • Do you know an ALS provider that carries no pain relief
      2
    • Are you a BLS provider with pain relief
      9
    • Are you a BLS provider with no pain relief
      14
    • Are you an ILS provider that carries no pain relief
      1
    • Are you an ILS provider who carries pain relief
      9


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Yeah turnip, i wont post much about the penthrane here as i have done this before and the reception from several people was less than enthusiastic. Its actually banned by the FDA as a result of nephrotoxicity from when it was used as an anaesthetic for surgery. Despite providing several articles that showed toxicty was dose/time of exposure related, and that the approved use parameters here mean falling well short of toxic exposure times people were not really interested in anything i had to say, Bit like LMA's really. :?

Apparently on many things in here its the US way or no way at all :roll:

We dont have diprova or propofol. One service here have morph/midaz infusions for pain relief. At a stretch we can make our agitated patient guideline work for us in the setting of severe pain, but it requires the patient to be agitated from pain to the point of being unmanigable and a danger to themselves (through worsening their injuries / condition) and theyll get some midazolam for their troubles. One service that i know of has ketamine in the field. We are running a randomised trial of ketamine v morphine a the moment, and have had the priveledge of seeing some amazing results when morph is proving totally ineffective, especially on multiple long bone fractures, sensational! :wink:

In fact, the only time of seen propofol was when i saw a Doc RSI someone a few months back.

As for splinting etc as a method of "pain relief", while i'll admit that it does reduce pain, actually performing the procedure as a method of obtaining relief without giving meds for the purpose of splinting is just barbaric. Are there any people here who feel it is exceptable to splint / apply traction without meds (if they are available)

I must admit, i like hearing stories from the old hands about how awesome trilene was :D

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My current service last service have gone "all Fentanyl" when it comes to pain management, no more Morphine. My last gig did carry Nitronox. Throw that on and add some Fentanyl and you have one happy pt. Diazepam for muscle spasms, midazolam for severe anxiety.

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Are there any people here who feel it is exceptable to splint / apply traction without meds (if they are available)

If it can't be splinted in place without too much manipulation, I much prefer to give pain meds prior to moving/splinting/tractioning. There are situations when time doesn't allow for it. But pain management before manipulation (or as soon after as is practical) is better.

-be safe

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I'm considered a BLS provider here, but we don't have ILS and I can do a lot more than Basics can.

Unfortunately none of that includes pain relief. The only drugs we carry are ASA, NTG, salbutamol, glucagon, epi.

Now PCP/ACP crews are becoming more common (where ALS is available) and they carry fentanyl and/or morphine.

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I'm considered a BLS provider here, but we don't have ILS and I can do a lot more than Basics can.

Unfortunately none of that includes pain relief. The only drugs we carry are ASA, NTG, salbutamol, glucagon, epi.

Now PCP/ACP crews are becoming more common (where ALS is available) and they carry fentanyl and/or morphine.

i must say im really surprised just how few times entonox is mentioned. If ever an analgesic was a BLS med this would be it :shock:

Heck, our volunteer first aid organisations have entonox!

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Below is a list of pain, anxiety, or drugs that relax many for my primary service. Not really much to choose from.

Acetaminophen (Tylenol®)-

Aspirin (ASA)-

Fentanyl-

Lidocaine (Xylocaine®)

Lorazepam (Ativan)-

Midazolam (Versed)-

Morphine Sulfate

Promethazine (Phenergan®)-

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I guess you can say I had been more of an advocate for pain management in the field. While working my way up through the ranks I noticed that giving MS or another analgesic was few and far between. On the few occasions MS was given was for MI's, not for trauma. Of course I just had to ask questions. I asked one Medic why MS was not used on a hip fx. He sort of stammered a little and said that he hadn't thought of using MS for that. For some reason several Medics before me were in a frame of mind that they just didn't think of pain management in the field. But in there defense, they rarely had more than a 3 min. ETA.

But when I and several others from my Paramedic class hit the streets as Medics the use of MS and other analgesics increased quite noticeably. According to many, like the ER staff, it was a welcomed change. But in doing so you had to be more careful of who you do give pain meds to. Too many "kidney stones", migraines, bar fight injuries, etc. that only wanted you to treat them but refuse transport. Other than a possible MI, we usually held back when it came from an illness and not a trauma.

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As a PCP, we use Entonox for pain relief. As Mike mentioned it is disappointing how few PCPs use Entonox for pain control; I use it and find it very effective.

There is talk of giving PCPs in BC a morphine protocol for long distance transfers because trying to administer Entonox for 4+ hours is unrealistic.

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