giving Narcotics like candy

[Ace844]

We went over this in medic class as well. No chest pain complaint (medical) should continue to have pain while in the care of EMS, 12 lead or not.

Also, most diabetics do not have feel chest pain during an MI. I have seen this first hand on many occations while working in a dialysis center ( good thing they have continuous monitoring while on the dialyzer)

Still good information Ace. thanks for posting it.

You're Welcome, anytime...

[Richard B the EMT]

Also, most diabetics do not have feel chest pain during an MI.

As my dad was a diabetic, that explains a lot.

[Ace844]

As my dad was a diabetic, that explains a lot.

"Richard,"

To keep it short. Diabetics are among the "highest at risk group" to suffer/experience "Silent or atypical presentation" MI's. It has to do with the neuropathy the suffer as a result of their disease, as well as the "vague" somatic dermatome/proprioception of the thoracic area... If there is alot of interest in "silent MI" here. I'll start another topic so as not to "hijack" this one..

Hope this helps,

Ace844

[kevkei]

Anyone familiar with the term "anginal equivelants?"

[canuckEMT]

Not really Kev, but enlighten me. I was hoping to learn something today........

[Dustdevil]

"Anginal equivalents" is basically a set of signs or symptoms which lead you to suspect AMI even in the absence of chest pain. They include all the normal s/sx we look for, including dizziness, SOB, n/v, and diaphoresis. Also included are atypical pain presentations, such as pain in the jaw or neck, shoulder(s) or arm(s), back or abdomen. Obviously, the more s/sx present, the more confident you can be in your assessment. Significant 12 lead changes solidify your diagnosis.

There is a current trend towards treating anginal equivalents as aggressively as a textbook AMI in the field

[canuckEMT]

Hmmmm I am guessing I am the only one living in a cave and did not hear of this phrase yet?????

Thanks Dust.....Now you know " The rest of the story"

[Dustdevil]

Hmmmm I am guessing I am the only one living in a cave and did not hear of this phrase yet?????

I'm thinking it is a relatively new term. I never heard of it until two weeks ago at review.

[Ace844]

Hi All,

To get us back on topic abit, I thought I'd post a copy of these recent studies.....Any comments...thoughts...???

http://journalsonline.tandf.co.uk/(amhyzzy...lesresults,6,6;COMPARISON OF PERCEIVED PAIN WITH DIFFERENT IMMOBILIZATION TECHNIQUES

PREHOSPITAL PAIN MANAGEMENT

A COMPARISON OF PROVIDERS' PERCEPTIONS AND PRACTICES

Halim Hennes A1, Michael K. Kim A1, Ronald G. Pirrallo A2

A1 Department of Pediatrics, Pediatric, Emergency Medicine Section, Milwaukee, Wisconsin

A2 Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Abstract:

Objective. To assess the knowledge of emergency medical technicians–paramedics (EMT-Ps) and compare their practice perceptions with actual pain management interventions in adults and pediatric patients (adolescents and children) with chest pain (CP), extremity injuries, or burns. Methods. This study included a cross-sectional survey of EMT-Ps and review of the emergency medical services (EMS) system patient care database. EMT-Ps were surveyed for: 1) knowledge of pain treatment protocol; 2) estimated number of CP, extremity injury, or burn encounters and the frequency of morphine administration; and 3) barriers to providing morphine. Data on patients transported with any above conditions and those who received morphine were abstracted from the EMS patient care database. Data were analyzed using descriptive statistics, and 95% confidence intervals (CIs) were calculated. Results. Of 202 EMT-Ps, 155 (77%) completed the survey. Eighty-two percent reported knowledge of pain treatment protocol for both adults and pediatric patients. For adults, EMT-Ps estimated they administered morphine to 37% with CP (95% CI 35, 40), 24% with extremity injuries (95% CI 17, 30), and 89% with burns (95% CI 52, 99). In children and adolescents, inability to assess pain (93%) was the most common reason for withholding morphine. According to the EMS database, 5% of adults with CP (95% CI 4, 5), 12% extremity injuries (95% CI 8, 15), and 14% burns (95% CI 8, 20) received morphine. In children and adolescents, 3% with extremity injuries (95% CI 1, 5) and 9% with burns (95% CI 0, 26) received morphine. Pain score was documented in 67.0% of adult patients, compared with only 4.0% in pediatric patients (? = 63.0%, 95% CI: 60, 65). Conclusions. Significant disparity exists between EMT-Ps' perceptions of acute pain assessment and the frequency of providing analgesia and their actual practice. Children and adolescents had less documentation of pain assessment and received less analgesic interventions compared with adults. Inability to assess pain may be an important barrier to the provision of analgesia.

PREHOSPITAL PAIN MANAGEMENT IN CHILDREN SUFFERING TRAUMATIC INJURY

Robert Swor A1, Christine M. McEachin A1, Debra Seguin A1, Kristi H. Grall A1

A1 Department of Emergency Medicine, William Beaumont Hospital, A Wayne State University Affiliated Program, Royal Oak, Michigan

Abstract:

Prehospital pain management has become an important emergency medical services (EMS) patient care issue. Objectives. To describe the frequency of EMS and emergency department (ED) analgesic administration to injured children; to describe factors associated with the administration of analgesia by EMS; and to assess whether children with lower-extremity fractures receive analgesia as frequently as do adults with similar injuries. Methods. This was a retrospective study of children (age < 21 years) who were transported by EMS between January 2000 and June 2002 and had a final hospital diagnosis of extremity fractures or burns. Secondarily, children with lower-extremity fractures were compared with a cohort of EMS-transported adults with similar injuries and transported during the same study period. Receipt of and time of parenteral analgesia were recorded. Results. Seventy-three children met the inclusion criteria. The mean (range) age of this sample was 12.4 (0.9–21) years, with only four patients aged < 5 years. A majority of the patients were male (49/73, 67.1%) and sustained femur (20/73, 27.4%) or tibia/fibula (26/73, 35.6%) fractures. Few pediatric patients received prehospital analgesia (16/73, 21.9%), while a majority received analgesia in the ED (58/73, 79.4%). Prehospital analgesia was associated with earlier patient treatment than that administered in the ED (22.3 ± 5.9 min vs. 88.3 ± 38.2 min). Comparing children (n = 33) with adults (n = 76) with similar lower-extremity fractures, a small insignificant difference was found in the rate of prehospital analgesia between children and adults (7/33, 21.2%, vs. 20/56, 26.3%). Conclusion. Few pediatric patients receive prehospital analgesia, although most ultimately received ED analgesia. Few factors were identified that could be associated with EMS oligoanalgesia. No difference was found between children and adults in the rates of EMS analgesia.

THE FEASIBILITY OF PAIN ASSESSMENT IN THE PREHOSPITAL SETTING

Samuel A. McLean A1, Robert M. Domeier A1, Heather K. DeVore A1, Elizabeth M. Hill A1, Maio DO, MS A1, Shirley M. Frederiksen A1

A1 Department of Emergency Medicine, University of Michigan Medical Center/St. Joseph Mercy Hospital (SAM, RMD, HKD, EMH, RFM, SMF), Ann Arbor, Michigan.

Abstract:

Objective. To determine the feasibility of prehospital pain measurement among patients 13 years of age or older using a verbal and numeric rating scale and to assess the severity of pain in a prehospital patient population. Methods. Retrospective cross-sectional study of emergency medical services (EMS) run sheets after the adoption of a universal prehospital pain assessment protocol. Data were abstracted from a sequential (1:4) sample of run sheets from the first three months after adoption of the protocol. Verbal rating scale (VRS) and numeric rating scale (NRS) pain assessment information was obtained, along with demographic, location, and call information. Run sheets without pain assessment underwent structured review and classification according to predefined protocol. Descriptive statistics and 95% confidence intervals were calculated. Results. A total of 1,227 run sheets were reviewed, 582 (47%) of patients were male, and 452 (36%) were 65 years of age or older. A total of 907 (75%) were nontrauma transports and 27 (2%) were unconscious. Among conscious patients, pain was assessed using the protocol in 1,002 of 1,200 (84% [range, 81%-86%]). Among patients reporting pain, 104 of 518 (20% [range, 17%-24%] completed a VRS but not an NRS. The greatest risk factor for no pain assessment was altered mental status (39% of patients not assessed). Forty-eight percent (23 of 48) of patients with altered mental status reporting pain completed a VRS only. Thirty-one percent (range, 28%-34%) of all patients in the sample reported moderate or severe pain. Conclusion. Prehospital pain assessment using a VRS and NRS was feasible in this patient population. Further studies are needed to confirm this finding in other settings. Moderate or severe pain was present in approximately 31% of patients.

Hope this helps,

Ace844

[Ace844]

Would this be a reference to a so-called "Silent Heart Attack," where the patient has an MI, but does not experience any pain or discomfort while having it?

My dad had one, found out about when the Cardiologist doing an annual routine EKG asked him, "Mr. B, when did you have the heart attack?" and my dad responded, "What heart attack?"

More info on this topic can be found here::: Painless MI

Hope this helps,

Ace844