Is Pain Management a High Priority in Your Approach to Patient Care

[DwayneEMTP]

my point there analgesia =/= ( does not equal) opiates or 'narcs' there's plenty of non opiate options ,

Agreed. But very few in the prehospital environment. At least very few classes. It was my belief that this discussion was centered on a person's rationale for managing pain, or not, and how aggressively they may choose to do so, why, and at what level.

...this has been part of the way in which I've been encouraging this discussion to go and by and large people have taken this message on board, with the discussion or non injectable routes and with the pretty extensive discussion we've had about Entonox, including positive reports from those who have only 'seen ' it being used.

You must be speaking above me man..I have no idea what any of this means, or the context intended.

...in before Godwin , calm down Dwayne please , grammar fascism has it's place and that's in learned work and in important business work rather than in the reasonably informal setting of a forum.

And I'm calm as a gentle breeze brother, and yet still completely disagree with your statements and your presentation. This is a professional forum. You, as with all of the other 'I just came to hang out, not to be judged' crowd either are already or will become invisible as we have many, many intelligent providers here that don't believe that you have to present yourself like a child in order to be informal.

You like to consider yourself an EMTCity intellectual, and as such you should feel obligated to set an example for those that come after you. Instead you choose to spout a bunch of almost intelligent sounding stuff hoping that the kids here will be amazed and the rest will be too scared or too lazy to intervene. Up to this point I've been too lazy, but I'm wide awake now and ready to play!! So if you continue to champion your 'grammar fascism' bullshit, it's going to be a long day man....

...Personally, based on a decade + of clinical practice as either A Student HCP or as an RN I feel this is an issue which is sometimes over emphasised, especially with appropriate dosing and titration, and in terms of the options we've discussed especially regarding none opiate or 'weak' opiate options is very rarely an issue.

Again, I seem to have lost your context. I'm probably so focused on your grammar that I can't follow the complex logic.

Entonox can cause altered levels of consciousness, but as both myself and other posters have remarked the nature of demand valve administration and the rapid offset tend to make this self limiting.

So you have seen Entonox at therapeutic levels that caused no change in mentation? Really? Has this been anyone else's experience? And if you believe that giving them the option to self medicate and then removing it to check mentation every 5-10 mins and then giving it back is the same as monitoring mentation status, then you have no real idea what I'm talking about.

And I could care less if it's self limiting or not, as that has never had a single thing to do with the questions that I've asked you. Again, you seem to think that if you keep saying the same things over and over that we're going to confuse that with continued, intelligent debate. Not happening for me, and I'm going to guess that others aren't fooled either.

There is also the issues around education and preparation for practice to address such concerns of providers of all levels which ties back in with the issues surrounding preparation for practice in general and ensuring that people have an appreciation of the reason for cautions and contra indications for various options and emphasising the role of the pharmacological options as part of a whole picture of patient care, where other parts of effective patient and pain management are just as important i.e. splintage , psychological care ...

As above..this snippet of lecture was tied in with what point, and in what context??

Dwayne

[Happiness]

zippyRN, on 18 November 2010 - 04:43 AM, said:

Entonox can cause altered levels of consciousness, but as both myself and other posters have remarked the nature of demand valve administration and the rapid offset tend to make this self limiting.

So first of all Im going to say I have use entonox in the field alot and have never had any problems with it as I follow my protocols in its use. Second I have used entonox when I was having my first child so I do know the effects of it.. I would to state that entonox does cause altered levels of consciousness, the word "can" is not the appropriate word. I do have to say that the change is not in my opinion ever going to be one that makes you worry about masking things. The biggest difference I have seen in a persons mental state is emotional, as in starting to laugh or cry.

Dwayne

So you have seen Entonox at therapeutic levels that caused no change in mentation? Really? Has this been anyone else's experience? And if you believe that giving them the option to self medicate and then removing it to check mentation every 5-10 mins and then giving it back is the same as monitoring mentation status, then you have no real idea what I'm talking about.

I have never seen entonox at a therapeutic level cause no change but in my answer above I have discribed what mental states I have wittnessed. I have had to discontitue use in one pt as his 02 levels started to drop but that was the only time. I think with entonox the fact is that they do self medicate and in my experience it is them that have the pain (in which I cant feel) and they dont over medicate themselves. I'm sure there are cases of it but that is why you do your assessment. Now with all of this being said entonox is a drug protocol that can be taught in a day or two. I feel it is really only benifical in moving a pt in pain or for short trips (I am generaly about 5 min from my hospital in my calls). There are times that I wish I had other drugs in my arsinal of drugs but to be honest I dont think that I would use them all that often and there fore may loose my skill in admistering them. With all of the Nac drugs that are available to those of higher skill levels I hope to hell that when they are being taught it isnt in a weekend course and that the training time is appropriate to the drug.

Well have a nice day

Happiness

Edited November 18, 2010 by Happiness

[DwayneEMTP]

Point well taken Happiness, and appreciated!

I think perhaps the context of my reference for Etenox is getting lost. I'm not claiming in any way that it is a bad drug, not that the use of it when ONLY the effects of the drug are considered should be limited to ALS providers. My point was in reference to BLS providers using it and my concern that at that level of care that a change in mentation can be a relatively early and obvious sign of a change in overall pt status, and that masking that sign for many BLS providers may not be Do No Harm medicine. See?

I believe that many ALS providers as well as a bunch of BLS providers may pick up significant changes in patient status outside of serial vitals with a change in color, or coordination of limbs or face, or eyes not really tracking as well as they were a few minutes ago, but many, many won't. And often, in my limited experience, a change in mentation will precede even these signs so I'm wondering at the wisdom of removing a relatively obvious symptom for providers not necessarily educated to the value of the others. If that makes sense. (Posting while also visiting with my boss, so I'll ask you to forgive a lack of continuity.)

It seems that when we discuss these issues we often look at them from the point of view of an isolated injury, though in my experience, that is very often not the case. To remove vital information from a multi-system issue when addl skills for monitoring those systems may be weak seems as though it may not be prudent. And I would certainly consider a change in mentation to inappropriately happy, or inappropriately sad to be and issue. See?

Thanks for your thoughts!

Dwayne