1EMT-P

Pain Management

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So let’s say you have a priority one trauma patient with open fractures to the radius & ulna plus tibia & fibula plus free fluid in the abdomen. The patient’s  vital signs are BP 100/60, HR 120 ST, RR 24, Spo2 95% on 2 LPM. The patients pain is 10 on a scale of 1-10. The ED that is transferring the patient has hung a unit of blood and gave orders for 0.1 mg/kg of Ketamine for pain. Plus 4 mg of Zofran IV x1 dose. This made the patient comfortable, but 1 hour into a 3 hour transport the pain returned. The medical command physician is contacted, but refused to treat the patients pain. What do you do?

Edited by 1EMT-P
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Well here is the problem. The ED wrote orders for a one time dose of Ketamine & Zofran with orders to contact Medical Command for additional orders. The problem is the transport was 3 hours long. The Medical Command Dr was young & not a fan of Ketamine. There are no standing orders for pain management for inter facility transports.

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Sounds like pretty poor planning / insight from the ED to not have a plan for additional analgeisa but is also something you should have considered and addressed prior to the transfer. 

Anyways, if I was in your situation I would have considered calling back the doc, putting them on speaker phone so they can explain to the pt their rationale for withholding additional analgesia and allowing the pt to remain in significant pain

Edited by paramatt_
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No standing orders for pain control on interfacility transport?  I'm going to channel Dust a bit here: Your agency sucks.

What kind of advocacy did you attempt for your patient?  How many times did you call to ask?  If you weren't pestering them for orders every five minutes why weren't you?  What was the reasoning of the doc in question to deny  your request and to provide such short term pain management before the onset of transport?  What does it matter if the doc in question is not a fan of ketamine?

So many questions.

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